Screener

Attachment 3a – PRAMS Respondent Screening Script (English version)

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0222).

OMB #0920-0222; Expiration Date: 06/30/2015

Sample screening script for respondent contact by QDRL Recruiter/QDRL Staff for

PRAMS cognitive interviewing study recruited through newspaper advertisement/flyer

Dial respondent’s telephone number [hereafter referred to as R] as indicated on audiotape recording.

 Note: Speak only to R. If the number is answered by an answering machine, call back at another time.

Laboratory Manager: Good morning/afternoon, may I speak to (name)?

 If R is not available or not at home, say, “Thank you” and try again at another time.

If the person who answered the phone (NOT R) asks, “Who is calling?” or “What’s this about?” say, “I am returning their call to me. I’ll try to reach them at another time.

 If R has been successfully contacted, continue...

...Hello, my name is [Laboratory Manager’s name]. I am calling from the National Center for Health Statistics. You may remember that you responded to the advertisement we placed in the [name of newspaper] on [date] or flyer looking for mothers with babies 2-12 months old to help us test survey questions which may be used on a national survey.

 Wait for acknowledgment, such as, “Oh, yes, I remember.”

...In order to determine if you are eligible for our study, I’ll need a few minutes of your time to ask some background questions. Answering these questions is completely voluntary. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any information that may identify you without your consent. Is this a good time to ask the questions or should I call back later?

 If not a good time to talk, schedule a time to call back.

 If good time to talk, continue...

1. Where did you see our advertisement?

___________________________________________________

2. How old are you? [If under age 18, go to exit script 1]

________________

3. Do you have a baby between the ages of 2 and 12 months?

 Yes

How old is your baby? ______________

 No (Go to exit script #2)

3. Did you work outside the home for pay at the time you were pregnant?

 Yes

 No

3. Do you or did you breastfeed your baby?

 Yes

 No

3. Do you or did you use a breast pump?

 Yes

 No

3. Have you ever used or are very familiar with e-cigarettes?

 Yes

Ask:  Used

 Familiar with

 No (Go to Q8)

3. Do you know any relatives or friends who have used e-cigarettes?

 Yes

 No

3. Have you ever used or are very familiar with hookah?

 Yes

Ask:  Used

 Familiar with

 No (Go to Q8)

3. Do you know any relatives or friends who have used hookah?

 Yes

 No

3. Are you a current smoker, are you a former smoker, or have you never smoked cigarettes?

 current smoker

How long have you smoked regularly? _____

 former smoker

 never smoked cigarettes

3. How many years of education do you have?

9 or less 10 11 12 13 14 15 16 17 18 19

3. Are you Spanish, Hispanic or Latino?

 Yes

 No

3. What race or races do you consider yourself to be? You may indicate more than one race.

 White

 Black or African American

 Asian

 American Indian or Alaska Native

 Native Hawaiian or Other Pacific Islander

[If the recruitment needs for certain demographic groups have been achieved, go to exit script 3].

Entry Script:

...Based on your answers to the questions so far, we would like you to take part in our study. For this study we’d like you to come here to the National Center for Health Statistics in Hyattsville, MD/agreed mutual location. An interviewer will ask you questions about your health behavior and experiences before and during your pregnancy and early infancy of your child including prenatal care, breastfeeding, health care coverage, employment, tobacco use, non-cigarette tobacco use, health conditions, family history of health conditions, emergency preparedness, and other things that affect your health and the health of your baby. Then the interviewer will ask you to explain what you were thinking as you answered the questions. The interviewer will also ask you about your opinions of the questions. Your answers will help us find out if the survey questions will be easy for other people to answer. Everything you say will be kept private. With your permission, we would like to record your interview. The recording is a record of what we asked and what you said about the questions. Do you give permission to have your interview video recorded? Yes/No. [If no, ask if for permission to audio record]. Do you give permission to have your interview audio recorded? Yes/No. [If no, go to exit script 4. At a minimum audio recording is essential for this project].

Do you have any questions at this point? Pause to answer questions. If (not/you have no other questions), then let’s get you on the schedule, ok? We will be interviewing (Day, Month/Date) through (Day, Month/Date) from 8 a.m. to 6 p.m. Looking at your schedule, when would you be available to participate? Schedule. [If date/times not available go to exit script 5.]

A reminder call will be made to you a few days in advance. Should you have any questions or need to change your appointment, please feel free to contact me [name] at [phone number]. Thank you for responding to our ad, and I look forward to seeing you here at (DATE/TIME) Get respondent to cite date & time if possible.

---------------------------------------------------------

Exit script 1: I’m sorry, you have to be over the 18 years of age or older to take part in this study and therefore we won’t be able to use you at this time. However, I would like to put your name and telephone number you gave me into our database so that I can contact you about other studies coming up in the future. Is that OK? If yes, record name & telephone number. If no: OK, thank you for your time. Your name and telephone number will not be added to our database.

Exit script2: I’m sorry, you have not met one of the eligibility requirements for this particular study. However, I would like to put your name and the information you gave me into our database so that I can contact you about other studies coming up in the future. Is that ok? If yes, record name & number. If no: OK, thank you for your time.

Exit script 3: Based upon your answers, it seems that we may already have a number of volunteers with very similar answers to yours. At this point we need to talk with people with some different characteristics. However, if we have cancellations or other slots open up, I may wish to call you back. Would it be okay if I kept your name, telephone number, and the information you provided in response to the eligibility questions until the end of this study? If yes, make notation. If no, Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 4: I’m sorry, willingness to be audio recorded is required in order to take part in this study and therefore we won’t be able to use you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 5: I see...ok, we were hoping to complete this particular study between (Month/Date) and (Month/Date), so it looks like we won’t be able to schedule you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Attachment 3b – PRAMS Respondent Screening Script (Spanish version)

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0222).

OMB #0920-0222; Expiration Date: 06/30/2015

Sample screening script for respondent contact by QDRL Recuiter/QDRL Staff/QDRL Contractor for

PRAMS cognitive interivewing study recruited through newspaper advertisement/flyer

Dial respondent’s telephone number [hereafter referred to as R] as indicated on audiotape recording.

 Note: Speak only to R. If the number is answered by an answering machine, call back at another time.

QDRL Contractor: Buenos días/Buenas tardes, ¿puedo hablar con (NAME)?

 If P is not available or not at home, say, “Muchas gracias” and try again at another time.

 If P has been successfully contacted, continue...

...Buenos días/Buenas tardes/Buenas noches, hablar [NAME]. Estoy llamando del Centro Nacional para Estadísticas de Salud. Como usted tal vez recuerde, usted respondió a un anuncio que pusimos en [name of newspaper] el día [date] o un volante en el que decía que buscamos mamás (de 18 años o más) con bebés entre 2 y 12 meses de edad para ayudarnos a probar unas preguntas de un cuestionario que tal vez se usen en una encuesta nacional.

 Wait for acknowledgment, such as, “Ah, sí, ya recuerdo.”

...Para determinar si usted es elegible para nuestro estudio, voy a necesitar unos minutos de su tiempo para hacerle algunas preguntas sobre usted. Contestar estas preguntas es completamente voluntario. La ley requiere que usemos su información solo para hacer investigaciones estadísticas, y estamos obligados a mantenerla (su información) de forma confidencial.¿Ahora es un buen momento para hacerle las preguntas o necesita que llame más tarde?

 If not a good time to talk, schedule a time to call back.

 If good time to talk, continue...

1. ¿Dónde vio nuestro anuncio?

___________________________________________________

2. ¿Cuántos años tiene? [If under age 18, go to exit script 1]

________________

3. ¿Tiene un bebé entre las edades de 2 a 12 meses?

 Yes

¿Qué edad tiene su bebé? ______________

 No (Go to exit script #2)

3. ¿Trabajó afuera de su hogar por un sueldo en el tiempo que estaba embarazada?

 Yes

 No

3. ¿Usted amamanta o amamantó a su bebé?

 Yes

 No

3. ¿Utiliza o ha utilizado un sacaleches?

 Yes

 No

3. ¿Alguna vez ha utilizado o tiene buen conocimiento de los cigarrillos electrónicos?

 Yes

Ask:  Used

 Familiar with

 No (Go to Q8)

3. ¿Conoce familiares o amigos que han utilizado cigarrillos electrónicos?

 Yes

 No

3. ¿Alguna vez ha utilizado o tiene buen conocimiento del narguile (hookah)?

 Yes

Ask:  Used

 Familiar with

 No (Go to Q8)

3. ¿Conoce familiares o amigos que han utilizado el narguile (hookah)?

 Yes

 No

11. ¿Fuma usted actualmente, es ex–fumadora, o nunca ha fumado cigarrillos?

 fuma actualmente

¿Cuánto hace que fuma de manera regular? _____

 ex–fumadora

 nunca ha fumado cigarrillos

12. ¿Cuántos años de estudios tiene?

9 o menos 10 11 12 13 14 15 16 17 18 19

13. ¿Es usted de origen español, hispano(a) o latino(a)?
 Sí

 No

14. ¿De qué raza o de qué razas considera que es? Puede indicar más de una raza

 Blanco(a)

 Negro(a) o africano(a)-americano(a)

 Asiático(a)

 Indio(a) de EEUU o nativo(a) de Alaska

 Nativo(a) de Hawai o de otras islas del Pacífico

[If the recruitment needs for certain demographic groups have been achieved, go to exit script 3].

Entry Script:

De acuerdo a las respuestas dadas a las preguntas hasta el momento, nos gustaría que participara en nuestro estudio. Para este estudio nos gustaría que viniera a [fill location]. Una entrevistadora le hará preguntas sobre su comportamiento y sus experiencias en relación a su salud antes y durante el embarazo y los primeros meses de vida de su hijo(a), incluyendo el cuidado prenatal, la lactancia, la cobertura de atención médica, el empleo, el uso de tabaco, el uso de tabaco de otra forma que no sea de cigarrillos, las condiciones de salud, la historia familiar de las condiciones de salud, historia familiar, preparación para emergencias, y otras cosas que afectan su salud y la salud de su bebé.

Luego la entrevistadora le pedirá que usted explique lo que estaba pensando cuando contestó las preguntas. La entrevistadora también le pedirá sus opiniones sobre las preguntas. Sus respuestas nos ayudarán a saber si las preguntas de la encuesta serán fáciles de contestar para otras personas. Todo lo que usted diga se mantendrá en privado. Con su permiso, quisiéramos hacer una grabación de su entrevista. La grabación es un registro de las preguntas que le vamos a hacer y de lo que usted conteste sobre las preguntas. ¿Nos da permiso para grabar su entrevista? Sí/No. [If no, go to exit script 4].

¿Tiene alguna pregunta por el momento? Pause to answer questions. Si (no/no tiene más preguntas), hagamos la cita para la entrevista, ¿ok? Estaremos haciendo entrevistas del (Day, Month/Date) al (Day, Month/Date) de 8 a.m. a 6 p.m. Por favor fíjese en su calendario y dígame cuándo estaría disponible para participar. Schedule. [If date/times not available go to exit script 5.]

Unos días antes le llamaremos para recordarle la cita. Si tiene alguna pregunta o necesita cambiar la cita, por favor no dude en llamarme; mi nombre es [name] y mi número de teléfono es [phone number]. Gracias por contestar a nuestro anuncio, y espero verle aquí el (DATE/TIME) Get respondent to cite date & time if possible.

---------------------------------------------------------

Exit script 1: Lo lamento, pero tienes que ser mayor de 18 años y tener un bebé entre los 2 y los 12 meses de edad para participar en este estudio y por lo tanto no podemos entrevistarte en este momento.] De todos modos, me gustaría guardar tu nombre y el teléfono que me diste en nuestra base de datos para ponernos en contacto contigo sobre otros estudios que tengamos en el futuro. ¿Está bien? If yes, record name & telephone number. If no: Bueno, gracias por su tiempo. No agregaremos a nuestra base de datos ni tu nombre ni tu número de teléfono.

Exit script2: Lo siento, no ha cumplido con uno de los requisitos de elegibilidad para este estudio en particular. De todos modos, me gustaría guardar su nombre y el teléfono que me dio en nuestra base de datos para ponernos en contacto con usted sobre otros estudios que tengamos en el futuro. ¿Está bien? If yes, record name & telephone number. If no: Bueno, gracias por su tiempo. No agregaremos a nuestra base de datos ni su nombre ni su número de teléfono.

Exit script 3: De acuerdo a sus respuestas, parece que ya tenemos suficientes voluntarios con respuestas muy semejantes a las de usted. En este momento necesitamos hablar con gente con algunas características diferentes. Sin embargo, si tenemos alguna cancelación o algún horario libre, me gustaría volver a llamarle. ¿Está bien si guardo hasta el final de este estudio su nombre, número de teléfono y la información que nos dio al responder a las preguntas para ver si era elegible? If yes, make notation. If no, ¿Está bien si agrego su nombre, número de teléfono, edad, nivel de educación y raza a nuestra base de datos para ponerme en contacto con usted para otros estudios que tengamos en el futuro? If yes, add to database. If no: Bueno, gracias por su tiempo. No agregaremos a la base de datos ni su nombre ni nada más de la información que me dio.

Exit script 4: Lo siento, es necesario acepte ser grabado por audio para participar en este estudio y por lo tanto no vamos a ser capaces de utilizarle en este momento. ¿Está bien si agrego su nombre, número de teléfono, edad, nivel de educación y raza a nuestra base de datos para ponerme en contacto con usted para otros estudios que tengamos en el futuro? If yes, add to database. If no: Bueno, gracias por su tiempo. No agregaremos a la base de datos ni su nombre ni nada más de la información que me dio.

Exit script 5: Ah, bueno. Teníamos pensado completar este estudio en particular entre (Month/Date) y (Month/Date), así es que parece que no podremos hacer una cita para usted en este momento. ¿Está bien si agrego su nombre, número de teléfono, edad, nivel de educación y raza a nuestra base de datos para ponerme en contacto con usted para otros estudios que tengamos en el futuro? If yes, add to database. If no: Bueno, gracias por su tiempo. No agregaremos a la base de datos ni su nombre ni nada más de la información que me dio.

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