NHTSA Form 1255 NHTSA Tween Seat Belt Recruitment Screener - English

Focus Group Studies Under Generic Clearance - Recruitment Screener

OMB No. 2127-0682
Expiration Date: 02/28/2015

Recruitment Screener

Parent & Caretaker Focus Groups to Develop

New Seat Belt Safety “Tween” Public Service Advertising Campaign

Generic Clearance OMB Control No: 2127-0682: Focus Groups for Traffic and Motor Vehicle Safety Programs and Activities

PHONE SCREENING INTERVIEW GUIDE

The Spanish language interviews will be conducted in Spanish by a fluent Spanish-speaking moderator who specializes in research with the Hispanic audience

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 Americans’ 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., W51-316, Washington, DC, 20590.

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

1. NOTE TO RECRUITER: RECORD SEX. (RECRUIT MIX, OK TO SKEW FEMALE)

( ) Female

( ) Male

2. 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 the past 6 months, have you participated in a group discussion or interview regarding a product or service?

( ) Yes (TERMINATE)

( ) No (CONTINUE)

4. Which of the following groups does your age fall into? (READ LIST)

( ) Under 18 (TERMINATE)

( ) 18 – 24 (TERMINATE)

( ) 25 – 34 (CONTINUE)

( ) 35 – 44 (CONTINUE)

( ) 45 – 54 (CONTINUE)

( ) 55 – 64 (CONTINUE)

( ) 65+ (CONTINUE)

( ) Refused (TERMINATE)

5. Are you the parent or guardian of any children age 14 or younger living in your household?

( ) Yes (CONTINUE)

( ) No (SKIP TO Q7)

6. What are the ages of your children age 14 or younger who currently live with you?

NOTE TO RECRUITER: WRITE IN AGES

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

NOTE TO RECRUITER: VERIFY ONE CHILD IS BETWEEN AGES 8-14. IF YES, SKIP TO Q9. IF NO, CONTINUE TO Q7.

NOTE TO RECRUITER: RECRUIT 40 GEN POP AND 32 HISPANIC PARENTS/CARETAKERS. RECRUIT A MIX OF PARENTS/CARETAKERS OF CHILDREN AGES 8-11 AND 12-14.

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

( ) Yes

( ) No (TERMINATE)

8. How old is this child/children that you look after?

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

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

9. Are you of Hispanic or Latino descent?

( ) Yes

( ) No

9a. Select one or more of the 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: RECRUIT FAIR REPRESENTATION OF RACE/ETHNICITY; FOR SPANISH-SPEAKING GROUPS, RECRUIT HISPANIC ONLY.

NOTE TO RECRUITER: ASK Q10-11C FOR HISPANIC RESPONDENTS ONLY.

9. In what country were you born? (DO NOT READ LIST. RECORD ANSWER.)

( ) Argentina

( ) Bolivia

( ) Chile

( ) Columbia

( ) Costa Rica

( ) Cuba

( ) Ecuador

( ) El Salvador

( ) Guatemala

( ) Honduras

( ) Mexico

( ) Nicaragua

( ) Panama

( ) Paraguay

( ) Peru

( ) Puerto Rico

( ) Dominican Republic

( ) Uruguay

( ) Venezuela

( ) United States (TERMINATE)

( ) Other/Refusal (TERMINATE)

NOTE TO RECRUITER: RECRUIT A MIX OF COUNTRIES TO MATCH THE MARKET

10. How many years have you lived in the United States? (RECORD ANSWER)

( ) Less than 1 year (TERMINATE)

( ) 1 to 4 years CONTINUE

( ) 5 to 10 years CONTINUE

( ) 11 to 15 years CONTINUE

( ) 16 to 20 years CONTINUE

( ) More than 20 years (TERMINATE)

10a. Of the first 18 years of your life, how many years did you live in the United States?

Points

( ) Less than 3 years……………………………………..…….0

( ) 4-6 years ……………………...2

( ) 7-9 years ……………………...4

( ) 10-12 years ……………………...6

( ) 13-15 years ……………………...8

( ) 16-18 years …………………….10

10b. Which language are you most comfortable speaking?

Points

( ) English always 8

( ) English mostly 6

( ) Both English & Spanish equally 4

( ) Spanish mostly 2

( ) Spanish always 0

10c. In what language do you prefer to watch, read, and listen to media?

Points

( ) English always 4

( ) English mostly 3

( ) Both English and Spanish equally 2

( ) Spanish mostly 1

( ) Spanish always 0

10c1. How many hours of TV and radio do you consume in Spanish per week?

( ) 10 or more hours CONTINUE

( ) Less than 10 hours (TERMINATE)

( ) Don’t know/Refused (TERMINATE)

10d. Thinking about your interpersonal relationships including friends and relatives, would you say they are…?

Points

( ) All outside of your culture/ethnicity 4

( ) Mostly outside of your culture/ethnicity 3

( ) Even split 2

( ) Mostly within your culture/ethnicity 1

( ) All within your culture/ethnicity 0

10e. Thinking about your neighborhood, would you describe it as…? (READ LIST)

Points

( ) 0 to 20% Hispanic …………………………………..….4

( ) 21 to 40% Hispanic…………………………………….3

( ) 41 to 60% Hispanic……………………………………..2

( ) 61 to 80% Hispanic……………………………………..1

( ) 81 to 100% Hispanic……………………………………0

Acculturation Model Scoring Key

INTERVIEWER: ADD THE POINTS FROM QUESTIONS 10a THRU 10e AS INDICATED BELOW AND CLASSIFY THE RESPONDENT.

	Q. 10a	Q. 10b	Q. 10c	Q. 10d	Q.10e	Total
TOTAL POINTS

INTERVIEWER: MARK THE RESPONDENT’S ACCULTURATION LEVEL BELOW:

TOTAL POINTS	LEVEL OF ACCULTURATION	MARK HERE
From 0 to 5	Unacculturated	CONTINUE FOR SPANISH-SPEAKING GROUPS
From 6 to 11	Low/Partially Unacculturated	CONTINUE FOR SPANISH-SPEAKING GROUPS
From 12 to 17	Bicultural	CONTINUE FOR GENERAL MARKET GROUPS
From 18-23	Partially Acculturated	CONTINUE FOR GENERAL MARKET GROUPS
From 24-30	Acculturated	CONTINUE FOR GENERAL MARKET GROUPS
Max 30 points

NOTE TO RECRUITER: READ THE FOLLOWING:

We would like to know how well you speak Spanish.

11a. Would you say you speak Spanish...? (READ LIST)

11b. Would you say you speak English...? (READ LIST)

11c. In what language do you prefer to communicate? (READ LIST)

P.11a P.11b P.11c

SPANISH ENGLISH LANGUAGE

Very well ( ) ( ) English ( )

Well ( ) ( ) Spanish ( )

A little ( ) ( )

Either one/ ( )

No preference

Very little ( ) ( )

Not at all ( ) ( )

NOTE TO RECRUITER: FOR SPANISH-SPEAKING HISPANIC GROUPS, RECRUIT RESPONDENTS WHOSE ANSWERS FALL IN BOXES

12. Do you drive a car, truck, SUV, or van on a regular basis?

( ) Yes (CONTINUE)

( ) No (TERMINATE)

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.

12. On average, how often does [your child/the child you care for] AGE 8-14 travel with you when you are driving?

( ) 3 days per week or more (CONTINUE)

( ) Less than 3 days per week (TERMINATE)

12. Thinking about the car that you drive when you are with [your child/the child you care for], how often do you do each of the following? (READ LIST, CHECK ALL THAT APPLY)

	Never	Sometimes	Most of the time	Always
Lock your doors when you leave the car
Wear your seat belt
Ask others riding in the car to buckle their seat belt
Take the car in for tune-ups
Use a safety restraint like a car seat or a seat belt [for your child(ren)/the child(ren) you care for]

NOTE TO RECRUITER: MUST ANSWER “SOMETIMES,” “MOST OF THE TIME” OR “ALWAYS” TO “E” IN Q14 TO CONTINUE. OTHERWISE, TERMINATE.

15. 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 with you when you’re driving.

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.”

15. When riding in the car, where do your children ages 8-14 sit in the car?

NOTE TO RECRUITER: ALLOW MULTIPLE RESPONSE IF MULTIPLE CHILDREN 8-14

( ) Front Passenger Seat

( ) Back Seat

( ) Other (Please describe)

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

15. 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

15. Please tell me which of the following bests describes your annual household income before taxes? NOTE TO RECRUITER: 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

19. What was the last grade of school that you’ve completed? NOTE TO RECRUITER: READ LIST

( ) Lower than Grade 6 (TERMINATE)

( ) Grades 6-8

( ) Grades 9-11

( ) Completed high school

( ) Some college/Trade School/Associate’s Degree

( ) Completed college

( ) Post Graduate

( ) Refused (TERMINATE)

PARTICIPANTS MUST HAVE COMPLETED THE 6TH GRADE TO PARTICIPATE. OTHERWISE THANK AND TERMINATE. RECRUIT FAIR REPRESENTATION AND SKEW TOWARDS AT LEAST SOME HIGH SCHOOL OR HIGHER

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

20. If you could go on an all-expense paid vacation for two weeks anywhere in the world, where would you go and why?

( ) Articulate (CONTINUE)

( ) Not articulate (TERMINATE)

INVITATION

Thank you for helping us with this survey. We have been asked to conduct interviews with people like you to give us ideas related to child safety in the car. We would like to invite you to a research interview to be held on MM/DD/YY at XX:XX. The session will last approximately 90 minutes. We understand the demand on your schedule; therefore, you will receive $75 for your participation. Your participation is strictly voluntary.

May we count on you to join us?

( ) Yes (CONTINUE)

( ) No (TERMINATE)

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: ____________________________

PREFFERED 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 soon.

END OF SCREENER GUIDE

NHTA Form 1255 Page 17