NHTSA Form 1210 Tween Screener

Focus Group Studies Under Generic Clearance - Recruitment Screener

OMB Control No. 2127-0682

Expiration Date 02/28/2015

Recruitment Screener

Tween Focus Groups to Develop

Child Passenger Safety Public Service Advertising Campaign

OMB Control No: 2127-0682: Focus Groups for Traffic and Motor Vehicle

Safety Programs and Activities

PHONE SCREENING INTERVIEW GUIDE

NOTE TO RECRUITER: If a child answers the phone say, “May I speak with a parent or adult who lives in the household?”

Hello, this is __________________, from (NAME OF FOCUS GROUP COMPANY), calling on behalf of the U.S. Department of Transportation. We are conducting a study of American’s opinions about motor vehicle safety. I would like to ask you a few questions to determine if you are eligible for the study. (INTERVIEWER NOTE: If necessary, read:)

This collection of information is voluntary and will be used for formative purposes only so that we may develop communications programs designed to reduce the number of traffic-related injuries and deaths. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0682. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

All of your answers will be confidential. Could we begin now? [GO TO Q1]

REFERRED PROSPECT INTRODUCTION:

Hello, this is __________________, from (NAME OF FOCUS GROUP COMPANY), calling on behalf of the U.S. Department of Transportation. We are conducting a study of American’s opinions about motor vehicle safety. I’m calling today because the [son/daughter] of___________ has agreed to participate in a market research interview. The discussion would take place with __________ and four of his/her peers. He/she provided your child’s name as peer who might like to participate. This is not an attempt to sell anything. We are interested in your child’s opinions. If your child qualifies, is this something you might allow them to participate in? [IF YES, CONTINUE; OTHERWISE TERMINATE] (INTERVIEWER NOTE: If necessary, read:)

This collection of information is voluntary and will be used for formative purposes only so that we may develop communications programs designed to reduce the number of traffic-related injuries and deaths. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0682. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

All of your answers will be confidential. Could we begin now?

1. Are you the parent or guardian of any children under age 15 living in your household?

( ) Yes GO TO Q1a

( ) No GO TO Q2

1a. What are the ages of your children under age 15 who currently live with you?

NOTE TO RECRUITER: WRITE IN AGES THEN CONTINUE TO Q3.

	Age
Child 1	_____
Child 2	_____
Child 3	_____
Child 4	_____
Child 5	_____

NOTE TO RECRUITER: AT LEAST ONE CHILD MUST BE BETWEEN AGES 8-14 TO CONTINUE; IF 15 OR OLDER, TERMINATE. IF MULTIPLE CHILDREN AGE 8-14, CHOOSE CHILD BASED ON WHICH AGE/GENDER GROUP YOU NEED TO FILL.

2. Do you look after children for family or friends for three or more days per week regularly?

( ) Yes

( ) No (TERMINATE)

2a. How old is the child/children that you look after?

	Age
Child 1	_____
Child 2	_____
Child 3	_____
Child 4	_____
Child 5	_____

NOTE TO RECRUITER: AT LEAST ONE CHILD MUST BE BETWEEN AGES 8-14 TO CONTINUE; IF 15 OR OLDER, TERMINATE. IF MULTIPLE CHILDREN AGE 8-14, CHOOSE CHILD BASED ON WHICH AGE/GENDER GROUP YOU NEED TO FILL.

3. Do you, or does anyone in your immediate family, work in any of the following industries or professions?

NOTE TO RECRUITER: IF YES TO ANY ANSWER, TERMINATE

( ) Marketing or marketing research (TERMINATE)

( ) Advertising or public relations (TERMINATE)

( ) News media, including newspaper, television, radio or publishing

(TERMINATE)

( ) Any company that manufactures, distributes, or sells automobiles or automobile parts (TERMINATE)

( ) Any company that manufactures, distributes, or sells car seats (TERMINATE)

3. In which city and zip code do you currently reside? (RECORD CITY AND ZIP CODE)

____________________________________________________________

NOTE TO RECRUITER: RECRUIT FAIR REPRESENTATION OF RURAL, SUBURBAN AND URBAN

3. Are you of Hispanic or Latino descent?

( ) Yes

( ) No

5a. Select one or more of following that best describes your race?

(ACCEPT MULTIPLE RESPONSES)

( ) American Indian or Alaska Native

( ) Asian

( ) Black or African American

( ) Native Hawaiian or Other Pacific Islander

( ) White

NOTE TO RECRUITER: READ THE FOLLOWING:

For the rest of the survey, I will use the term car. When I use this term, please also think about vans, trucks, and SUVs.

3. On average, how often does your child AGE 8-14 ride in a car?

( ) 3 days per week or more CONTINUE

( ) Less than 3 days per week (TERMINATE)

3. As I reference the age of each child AGE 8-14, please tell me which of the following type of car safety restraint you use for that child when they ride in the car.

NOTE TO RECRUITER: REFERENCE CHILD’S AGE, READ LIST OF SAFETY RESTRAINTS, CHECK ONE.

	Child 1 Age ___	Child 2 Age ___	Child 3 Age ___	Child 4 Age ___	Child 5 Age ___
Booster seat	( )	( )	( )	( )	( )
Adult seat belt	( )	( )	( )	( )	( )
No car seat or seat belt	( )	( )	( )	( )	( )
Don’t know	( )	( )	( )	( )	( )

NOTE TO RECRUITER: TERMINATE IF RESPOND “DON’T KNOW” OR BOOSTER SEAT FOR ALL CHILDREN. ONLY CONTINUE IF AT LEAST ONE CHECK FOR “ADULT SEAT BELT” OR “NO CAR SEAT OR SEAT BELT.”

3. What is your marital status?

( ) Single (never married)

( ) Living together but not married

( ) Married

( ) Separated

( ) Divorced

( ) Widowed

( ) Prefer not to state

NOTE TO RECRUITER: RECRUIT FAIR REPRESENTATION OF MARITAL STATUS

3. Please tell me which of the following categories best describes your annual household income before taxes? (READ LIST)

( ) Less than $30,000

( ) Between $30,000 and $49,999

( ) Between $50,000 and $74,999

( ) Between $75,000 and $99,999

( ) Between $100,000 and $149,999

( ) More than $150,000

( ) Refused

NOTE TO RECRUITER: RECRUIT A FAIR REPRESENTATION OF HOUSEHOLD INCOME LEVELS

PARENT INTRO TO SPEAK WITH CHILD:

We are planning to hold a discussion with children ages 8-14 year olds to discuss decisions they make and hear their opinions and are interested in hearing from your child.

3. When, if ever, was the last time your child participated in a marketing research study, such as a consumer in person interview or a group discussion, either with us or any other research company?

( ) Within the past 6 months (TERMINATE)

( ) Longer than 6 months CONTINUE

TOPIC DISCLOSURE – ALL PARENTS OF UNDERAGE PARTICIPANTS

This research project is being conducted by the National Highway Traffic Safety Administration (NHTSA). They are trying to understand attitudes and behaviors in regards to seat belt use. The research will not attempt to impact your child’s decisions or opinions, but we want to hear their opinions about what it is like to be a tween and what influences their decision-making. The organization will use the learning from this research to craft public service messaging with intent to encourage all children to buckle up. We will not be telling this to any of the children participating in the research prior to the discussion because we do not want to influence their opinions. However, the organization felt it was important that parents know the topic ahead of time. The discussion would last 90 minutes, would take place on (DATE) and your child would be paid $75 for their time.

Now, I’d like to ask your XX age son/daughter a few questions and see if he/she is interested in participating. Would that be okay? Remember, we’d rather not have your child know the nature or purpose of the discussion until they find out during the discussion.

Could I speak with him/her? (REQUEST THAT CHILD BE ALLOWED TO ANSWER ON HIS/HER OWN. IF PARENT WANTS TO LISTEN, PLEASE MAKE NOTE OF THAT ON THE SCREENER.)

( ) YES CONTINUE

( ) NO (TERMINATE)

TO ALL TWEENS:

Hi my name is __________. I was just speaking with your [mom/dad] about discussions we are putting together with other kids your age so we can hear your opinions. If you might be interested in participating in this kind of discussion, I’d like to ask you a few quick questions about yourself. Can I ask you a few questions? Please know that we will not be sharing your answers with anyone else.

3. GENDER (DO NOT ASK)

( ) Male

( ) Female

3. Please tell me, what is your exact age? ________ (RECORD EXACT AGE & CHECK RANGE BELOW)

( ) UNDER 8 (TERMINATE)

( ) 8-11

( ) 12-14

( ) 15-18 (TERMINATE)

3. When riding in your car, how often do you buckle your seat belt?

( ) Never

( ) Sometimes

( ) Most of the time

( ) Always

NOTE TO RECRUITER: RECRUIT A FAIR REPRESENTATION OF FREQUENCY

3. When riding in your car, where do you usually sit in the car?

( ) Front passenger seat

( ) Back seat

( ) Other (Please describe)

NOTE TO RECRUITER: RECRUIT A FAIR REPRESENTATION OF FRONT AND BACK SEAT

NOTE TO RECRUITER: The next question is an articulation question. What the respondent says is not important; rather, judge his/her ability to speak clearly and willingness to comment with a specific point-of-view.

3. The next question is for fun. There is no right or wrong answer. If you could go on an all-expense paid vacation for two weeks anywhere in the world, where would you go and why?

( ) Articulate

( ) Not articulate (TERMINATE)

INVITATION TO RECRUIT PEERS (FOR INITIAL RESPONDENT IN EACH GROUP)

Thank you for helping us with these questions today. Could I speak with your mom/dad again?

We are interested in holding a discussion to speak with your [son/daughter]and five of [his/her] peers who are the same age [age 8-11 or 12-14]. If you agree to participate, you will provide a list of five of your [son’s/daughter’s] friends, and I would call to ask them to attend. The discussion would be held on MM/DD/YY at XX:XX, and the session will last approximately 90 minutes. You and each participant will receive $75 cash incentive for participating. Your child’s participation is strictly voluntary.

Would you allow your child to participate?

( ) Yes CONTINUE

( ) No (TERMINATE)

REFERRED INVITATION

Thank you for helping with this survey. I would like to invite your child to a research discussion to be held on MM/DD/YY at XX:XX. __________ (referrer) and 4 other participants close to your [son’s/daughter’s] age are also invited to participate. The session will last approximately 90 minutes. Each participant will receive $75 cash incentive. Participation is strictly voluntary.

Would you allow your child to participate?

( ) Yes CONTINUE

( ) No (TERMINATE)

FINAL INSTRUCTION

We will be giving you a reminder call the day before the session. Is this the best number to reach you? Is there a preferred time for us to call you?

ALTERNATIVE PHONE, IF NECESSARY:_________________________

PREFERRED TIME, IF APPLICABLE: ____________________________

If, for any reason, you are unable to attend, please call us at XXX-XXX-XXXX.

Thank you, and we look forward to seeing you and your child soon.

END OF SCREENER GUIDE

NHTSA Form 1210 Page 11