Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/xxxx
Adult Biometric Measures Recruitment Screener (Phone/Paper)
Public
reporting burden of this collection of information is estimated to
average 8 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 NE,
MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx)
SCRIPT FOR TELEPHONE INTERVIEW, WILL ALSO BE MODIFIED AND INCLUDED IN THE PAPER QUESTIONAIRE.
[IF D_06=1 (R IS PREGNANT) AND SAMPE TYPE=1 (MAIN SAMPLE) SKIP TO INCENTIVE]
[D_06=1 (R IS PREGNANT) AND SAMPE TYPE=2 (SCHOOL CATCHMENT SAMPLE); GO TO INEL_PREG_SC.]
INEL_PREG_SC.
Before you go, we would like to give you your incentive for participation.
However, earlier in the interview, you mentioned that you are currently pregnant. Unfortunately, we are unable to include pregnant women in the part of the study that involves an in-home visit.
(We are excluding pregnant women from the second part of our study because some of the measurements we take are temporarily affected by pregnancy.)
PRESS NEXT TO COLLECT INFORMATION FOR TELEPHONE INCENTIVE.
[GO TO INCENTIVE]
[IF ALL YABS STUDIES ALREADY COMPLETE FOR THIS HOUSEHOLD, SKIP TO INCENTIVE]
[IF SAMPLETYPE=2 (SCHOOL CATCHMENT), THEN CONTINUE;
IF SAMPLE TYPE=1 (TARGETED SURVEILLANCE) AND AWARDEE<=4 (COMMUNITY IN ONE OF THE YABS STUDY AREAS), THEN CONTINUE;
ELSE (IF IN TARGETED SURVEILLANCE SAMPLE BUT NOT IN ONE OF THE YABS STUDY AREAS) SKIP TO INCENTIVE]
[IF SAMPLE TYPE=1 (TARGETED SURVEILLANCE) AND KIDS=2 (NO CHILDREN 3-17 LIVING IN THE HOUSEHOLD) AND
(THE NUMBER OF ADULT-ONLY BIOMETRICS COMPLETES FOR THIS COMMUNITY<1000
OR THE TOTAL NUMBER OF APPOINTMENTS TO COMPLETE BIOMETRICS INTERVIEWS WITH ADULTS IN HOUSEHOLDS WITH NO ELIGIBLE CHILDREN IN THIS COMMUNITY< 143,
THEN CONTINUE; ELSE SKIP TO INCENTIVE.]
[IF ADULT RESPONDENT (AR) LIVES IN A HOUSEHOLD WITH NO ELIGIBLE CHILDREN (KIDS=2 (NO CHILDREN)), PRESENT INTRO_ABS;
ELSE IF KIDS=1 (ELIGIBLE CHILDREN LIVE IN THE HOUSEHOLD), SKIP TO INTRO_YABS]
[IF AR = ABS (ADULT RESPONDENT (AR) LIVES IN A HOUSEHOLD WITH NO ELIGIBLE CHILDREN (KIDS=2 (NO)) THEN ASK INTRO_ABS]
INTRO_ABS
This study for the Centers for Disease Control and Prevention has a second part to it.
Adults who agree to participate will be asked questions about their personal health and will have physical measurements taken, such as height, weight, waist circumference, blood pressure, pulse and a sample of saliva.
For this second part of the study, one of our interviewers will come to your house to talk to you directly and take your physical measurements.
It would take less than 1 hour of your time. Adults who complete this part of the study will receive $40 in cash.
(The $40 cash for the in-home visit will be in addition to the $20 check or gift card sent as a token of our appreciation for completion of this telephone interview.)
IF NEEDED, SAY: A staff member will give the $40 to you in cash, immediately after you complete your participation in the in-home examination.
- CONTINUE
[GO TO INTRO_ABS_ACC]
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[IF AR = ABS AND THE SITE-SPECIFIC QUOTA FOR NUMBER OF ACCELEROMETERS ASSIGNED HAS NOT YET BEEN MET, ASK INTRO_ABS_ACC. ELSE GO TO ABS1 ]
INTRO_ABS_ACC.
You may also be asked to wear a belt around the waist to measure physical activity and sedentary behavior for 7 days. Participants who wear this belt will be asked to keep a diary of daily activities such as when they exercise, when they get up in the morning and when they go to bed. If you choose to participate by wearing a monitoring belt, you will be given a $20 gift card once you mail back the belt device and it is found to contain sufficient data. (That $20 gift card would be additional. It’s separate from the $20 given for completing this telephone interview and the $40 in cash given at the end of the in-home visit.)
We’ll tell you more about the possibility of wearing an activity monitoring belt when we visit your home. You can decide whether you’d like to wear the belt at that time.
CODE VOLUNTEERED COMMENTS FROM R, IF ANY
1. NO COMMENTS2. NOT INTERESTED IN ACTIVITY MONITORING
3. INTERESTED IN ACTIVITY MONITORING
[GO TO ABS1]
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[IF AR = YABS (ADULT RESPONDENT (AR) HAS ONE OR MORE ELIGIBLE CHILDREN LIVING IN THE HOUSEHOLD (KIDS=1 (YES) ), ASK INTRO_YABS]
INTRO_YABS
Thank you for your participation in this survey. Before we go, I have some additional information for you.
This study for the Centers for Disease Control and Prevention has a second part to it. We will be collecting information from one adult and one child who live within the same household.
Adults will be asked questions about their personal health and will have their physical measurements taken, such as height, weight, waist circumference, blood pressure, pulse and a sample of saliva.
Children will have their physical measurements taken as well. Children between the ages of 12 and 17 will be asked questions about their physical activity and health. Caregivers of children between the ages of 3 and 11 will be asked questions about their children.
For this part of the study, our interviewers visit participants’ homes and talk with them in person.
One adult and one child, aged 3-17 years old, may be eligible to participate in this second part of the study. It would take less than 2 hours of your time. Adults who complete this part of the study will receive $40 in cash and children who complete this part of the study will receive $10 in cash.
IF NEEDED, SAY: (The $40 and $10 for the in-home visit will be in addition to the $20 check or gift card sent as a token of our appreciation for completion of this telephone interview.)
IF NEEDED, SAY: (A staff member will give the $40 to you and the $10 to the participating child immediately after you both complete your participation in the in-home examination.)
1 – CONTINUE
[GO TO INTRO_YABS_ACC]
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[IF AR =YABS AND THE SITE-SPECIFIC QUOTA FOR NUMBER OF ACCELEROMETERS ASSIGNED HAS NOT YET BEEN MET, ASK INTRO_YABS_ACC. ELSE GO TO YABS_A1.]
INTRO_YABS_ACC
You and a child in your household may also be asked to wear and a belt around the waist to measure physical activity and sedentary behavior for 7 days. Participants who wear this belt will be asked to keep a diary of daily activities such as when they exercise, when they get up in the morning and when they go to bed.
If you chose to participate by wearing a monitoring belt, you will be given a $20 gift card once you mail back the belt device and it is found to contain sufficient data. (That $20 gift card would be additional. It’s separate from the $20 given for completing this telephone interview and the $40 in cash given at the end of the in-home visit.)
Parents will be given a $10 gift card after a child participates. (The $10 gift card would be additional. It’s separate from the $10 in cash given at the end of a guardian’s or child’s participation in the in-home visit.)
We’ll tell you more about the possibility of wearing an activity monitoring belt when we visit your home. You can decide whether you’d like to wear the belt at that time.
CODE VOLUNTEERED COMMENTS FROM R, IF ANY
1. NO COMMENTS
2. NOT INTERESTED IN ACTIVITY MONITORING
3. INTERESTED IN ACTIVITY MONITORING
1-CONTINUE
[GO TO YABS_A1]
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[IF AR = ABS, ASK ABS1]
ABS1.
Your participation is critical to understanding health issues that may affect you or other members of your community. Are you willing to participate in this part of the study?
IF R HESITATES, USE FAQs TO ADDRESS QUESTIONS AND CONCERNS
IF NO, JUST ENTER ANSWER AND THEN FOLLOW REFUSAL CONVERSION GUIDANCE ON NEXT SCREEN
PRESS F1 FOR MORE INFORMATION ABOUT IN-HOME EXAMINATIONS
[HELP SCREEN TEXT]
OFFER INFORMATION AND ASSURANCES OR REPEAT THE FOLLOWING, IF NEEDED:
Adults will be asked questions about their personal health and will have their physical measurements taken, such as height, weight, waist circumference, blood pressure, pulse and a sample of saliva.
A staff member will give $40 to you in cash immediately after you complete your participation in the in-home examination.
If you chose to participate by wearing a monitoring belt, you will be given a separate $20 gift card once you mail back the monitoring belt and it is found to contain sufficient data.
1 YES
2 NO
[IF ABS1 = 1 (YES), GO TO SCHD1. IF ABS1 = 2 (NO), GO TO RFCNV1]
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[IF AR = YABS, ASK YABS_A1]
YABS_A1
Would you be interested in participating in the in-home examination along with an eligible child household resident?
IF R HESITATES, USE FAQs TO ADDRESS QUESTIONS AND CONCERNS
IF NO, JUST ENTER ANSWER AND THEN FOLLOW REFUSAL CONVERSION GUIDANCE ON NEXT SCREEN
PRESS F1 FOR MORE INFORMATION ABOUT IN-HOME EXAMINATIONS
[HELP SCREEN TEXT]
OFFER INFORMATION AND ASSURANCES OR REPEAT THE FOLLOWING, IF NEEDED:
IF NEEDED, SAY: Adults will be asked questions about their personal health and will have their physical measurements taken, such as height, weight, waist circumference, blood pressure, pulse and a sample of saliva.
IF NEEDED, SAY: Children will be asked questions about their physical activity, health and will have their physical measurements taken as well. For this part of the study, one of our interviewers will come to your house to talk to you directly.
IF NEEDED, SAY: A staff member will give $40 to you in cash, and a $10 bill to the child that participates, immediately after you both complete your participation in the in-home examination.
IF NEEDED, SAY: If you participate in the activity monitoring study and mail back the monitoring belt after 7 days of wear, we will also send you a $20 gift card. Parents will be given a $10 gift card after a child participates.
1 – YES
2 – NO
3 – (NOT WILLING OR ABLE TO AGREE TO CHILD PARTICIPATION)
[IF YABS_A1 = 1 (YES), GO TO ChildNum.
IF YABS_A1 = 2 (NO) OR 3 (NOT WILLING/ABLE), GO TO RFCNV1]
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[IF (ABS1 = 2 (NO)) OR (YABS_A1 = 2 (NO) OR 3 (NOT WILLING/ABLE)), ASK RFCNV1]
RFCNV1
REFUSAL CONVERSION
May I ask what your concerns are or why you do not wish to participate in this study?
INTERVIEWER: LISTEN TO R CONCERNS AND USE FAQs TO ADDRESS QUESTIONS AND CONCERNS.
Continue 1. NOW AGREES TO PARTICIPATE
Refusal 2 UNABLE TO CONVERT REFUSAL
[IF AR = ABS AND RFCNV1 = 1, GO TO SCHD1.
IF AR =YABS AND RFCNV1 = 1, GO TO ChildNum.
IF (AR = ABS OR YABS) AND RFCNV1 = 2, GO TO INCENTIVE]
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SCHD1
Thank you for agreeing to participate. One of our field staff will get in contact with you to schedule an appointment for this part of the study. What would be the best day or days of the week and times for that person to call you about scheduling an appointment?
INTERVIEWER: RECORD AS MANY DAYS AND TIMES AS PROVIDED BY RESPONDENT. USE COMMENTS FIELD IF NECESSARY.
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Thursday |
Friday |
Saturday |
Sunday |
Morning |
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{Allow multiple selections}
COMMENTS [ ] max 1000 characters
[IF AR = ABS, GO TO ContactNums.
IF AR =YABS AND CONFRM=1, GO TO END2;
ELSE GO TO ContactNums]
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ChildNum
We would like to randomly select one child age 3 to 17 who lives in your household and invite his or her participation. Please do not include anyone who is just visiting temporarily or renting a room. How many children who are 3 to 17 years old live in your household?
IF NEEDED, SAY: I know you already told me that there were {FILL NUMBER OF CHILDREN FROM THE CORE ATSS INTERVIEW} children living in your household. Now we want to know specifically how many are 3-17 years old.
____ [RANGE: 0-17]
-1 DON’T KNOW
-2 REFUSED
[IF ChildNum (NUMBER OF CHILDREN) =1, GO TO CHILDR_NAME. IF ChildNum (NUMBER OF CHILDREN) =2 OR MORE, GO TO MSNum. IF ChildNum (NUMBER OF CHILDREN) = 0 OR DK OR RF, GO TO INCENTIVE]
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MSNum
Of the children that live in your household, how many are (or will be) enrolled in grades 7 or 8 (middle school) during the 2012-2013 school year
___ [RANGE 1-Y1Total]
-1 DON’T KNOW
-2 REFUSED
[THE NUMBER OF CHILDREN REPORTED HERE WILL BE USED TO FILL ^MSChildNum AS NEEDED THROUGHOUT THE INTERVIEW.]
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[IF MSNum >=2, THEN ^Fill (NOTE THE ADDITIONAL FILL -- ^MSChildNum -- IN THE FILL TEXT) SHOULD SAY: “Of the ^MSChildNum 7th through 8th graders living in your household, please tell me the first name of the child whose birthday is coming up next.”
IF MSNum =1, THEN ^Fill SHOULD SAY: “Please tell me the first name of the one 7th or 8th grader living in your household.”
IF MSNum = 0 OR DK OR RF AND ChildNum =2 OR MORE, THEN ^Fill SHOULD SAY: “Of the children aged 3-17 living in your household, please tell me the first name of the child whose birthday is coming up next.”
IF MSNum = 0 OR DK OR RF AND ChildNum =1, THEN ^Fill SHOULD SAY: “Please tell me the first name of the child.”]
CHILDR_NAME
^Fill
ONLY IF NEEDED: (His)/(her) initials will be fine.
IF TWO WITH SAME BIRTHDAY, SAY: If two children share the birthday that’s coming up next, please just give us the first name or initials for whichever child you’d prefer to invite to participate.
______________ [ACCEPT UP TO 25 CHARACTERS]
-1 DON’T KNOW
-2 REFUSED
[THE NAME OR INITIALS FROM CHILDR_NAME WILL BE USED THROUGHOUT THE INTERVIEW TO FILL ^ChildName.
IF CHILDR_NAME = DK OR RF, THEN GO TO CHLDR_NMCNV ; ELSE GO TO YABS_A2]
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[If ChildNum = 1, THEN ^ChildNumfill SHOULD SAY: this child. If ChildNum = 2 or more, THEN ^ChildNumfill SHOULD SAY: one of these children]
CHILDR_NMCNV
REFUSAL CONVERSION
May I ask what your concerns are or why you do not want ^ChildNumfill to participate in this study?
INTERVIEWER: LISTEN TO R CONCERNS AND USE FAQs TO ADDRESS QUESTIONS AND CONCERNS.
Continue 1. NOW AGREES TO PARTICIPATE
Refusal 2 UNABLE TO CONVERT REFUSAL
[IF CHILDR_NMCNV = 1, GO BACK TO CHILDR_NAME TO COLLECT NAME. IF CHILDR_NMCNV = 2, THEN CODE AS A YABS REFUSAL AND GO TO INCENTIVE]
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[DISABLE DK/RF]
YABS_A2.
Are you the parent or guardian of ^ChildName ?
1 – YES
2 – NO
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[IF YABS_A2 = 2, ^lcfill SHOULD SAY “Even though you are not the parent or guardian of ^ChildName, your opinion is important to us.” ELSE DO NOT FILL.]
YABS_A3.
^lcfill
Would you be interested in having ^ChildName participate in this in-home examination?
1 – Yes
2 – No
[IF YABS_A3 = 1 (YES), GO TO YABS_A3_BD.
IF YABS_A3 = 2 (NO) AND RESELECT = BLANK AND ChildNum >1, GO TO RESELECT.
ELSE GO TO YABS_A3a]
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YABS_A3a.
REFUSAL CONVERSION
May I ask what your concerns are or why you do not want ^ChildName to participate in this study?
INTERVIEWER: LISTEN TO R CONCERNS AND USE FAQs TO ADDRESS QUESTIONS AND CONCERNS.
Continue 1. NOW AGREES TO PARTICIPATE
Refusal 2 UNABLE TO CONVERT REFUSAL
[IF YABS_A3a = 1 (CONTINUE), GO TO YABS_A3_BD;
IF YABS_A3a = 2 (REFUSAL) GO TO END_2;
ELSE GO TO INCENTIVE]
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YABS_A3_BD.
When our field interviewer arrives for the interview, he or she will ask if ^ChildName would be willing to participate in the study.
Knowing the age of participating children helps us prepare materials for visits.
Would you please provide ^ChildName’s birth date?
1___ MONTH [range 1 – 12]
2___ DAY [range 1 – 31]
3___ YEAR [range 1995-2009]
4 DON’T KNOW /NOT SURE
5 REFUSED
{HARD CHECK : UNLESS DK OR RF, MONTH CANNOT BE LESS THAN 1 OR GREATER THAN 12.}
{HARD CHECK : UNLESS DK OR RF, DAY CANNOT BE LESS THAN 1 OR GREATER THAN 31.}
{HARD CHECK TEXT: MONTH OR DAY OUT OF RANGE, PLEASE CLARIFY WITH R}
[IF YEAR<1995 OR YEAR>2009, GO TO YABS_A3_BD_CONF;
IF DK/RF GO TO YABS_A3_AGE;
ELSE LOOP BACK TO SCHD1 TO COLLECT DAYS AND TIMES TO BE CONTACTED]
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YABS_A3_AGE.
Instead of providing ^ChildName’s birth date, can you tell us instead how old is he/she? How old is ^ChildName?
IF NEEDED, SAY: Knowing the age of participating children helps us prepare materials for visits.
1 -____ AGE [range 3 – 17]
-1 - DON’T KNOW
-2 - REFUSED
[IF (YABS_A3_AGE = -1 (DK) OR -2 (RF)) AND YABS_A2 = 1 (AR IS THE PARENT OR GUARDIAN) GO TO GrdNm.
IF (YABS_A3_AGE = -1 (DK) OR -2 (RF)) AND YABS_A2 = 2 (AR IS NOT THE PARENT OR GUARDIAN) GO TO YABS_B1.
ELSE CONTINUE.]
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[IF YABS_A3_BD WAS ANSWERED WITH A BIRTHDATE, THEN ^Fill SHOULD SAY: “was born on {fill month, day and year from YABS_A3 _BD}.” IF YABS_A3_AGE WAS ANSWERED WITH AN AGE, THEN ^Fill SHOULD SAY: “is {fill age from YABS_A3_AGE.”]
YABS_A3_BD_CONF.
You said that ^ChildName ^Fill
Is that correct?
1 YES
2 NO
-1 DON’T KNOW / NOT SURE
-2 REFUSED
[CALCULATE CHILD’S AGE FROM YABS_A3_BD; USE AGE PROVIDED IN YABS_A3_AGE IF AVAILABLE. IF YABS_A3_BD_CONF = 1 (YES) AND AGE LT 3 YEARS OR GT 17 YEARS, GO TO YABS_AgeOut.
if YABS_A3_BD_CONF = 1(yes) AND YABS_A2 = 1 (AR IS THE PARENT OR GUARDIAN) GO TO GrdNm.
IF YABS_A3_BD_CONF = 1(YES) AND YABS_A2 = 2 (AR IS NOT THE PARENT OR GUARDIAN) GO TO YABS_B1.
IF YABS_A3_BD_CONF = 2 (no) OR -1 (DK) or -2 (RF) AND YABS_A3_BD WAS ANSWERED WITH A BIRTHDATE, GO BACK TO YABS_A3_BD AND COLLECT THE CORRECTED BIRTHDATE.
IF YABS_A3_BD_CONF = 2 (no) OR -1 (DK) or -2 (RF) AND YABS_A3_AGE WAS ANSWERED WITH AN AGE, GO BACK TO YABS_A3_AGE AND COLLECT THE CORRECTED AGE.]
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[CALCULATE CHILD’S AGE FROM YABS_A3_BD; USE AGE PROVIDED IN YABS_A3_AGE IF AVAILABLE. FILL ^CHILDAGE WITH THE AGE OF CHILD. IF YABS_A3_AGE WAS ANSWERED WITH AN AGE, THEN ^Fill SHOULD SAY: “age”. IF YABS_A3_BD WAS ANSWERED WITH A BIRTHDATE, THEN ^Fill SHOULD SAY: “birth date”.
IF CHILD’S AGE LT 3 YEARS OR GT 17 YEARS, ASK YABS_AgeOut. ]
YABS_AgeOut.
According to the ^Fill you provided, ^ChildName is ^CHILDAGE years old now. We’re only including children aged 3-17 in this part of our study.
Is ^ChildName ^CHILDAGE years old now?
1 YES
2 NO
-1 DON’T KNOW / NOT SURE
-2 REFUSED
[IF (YABS_AgeOut = 2(NO) OR -1 (DK) OR -2 (RF)) AND (YABS_A3_AGE WAS ANSWERED WITH AN AGE), GO BACK TO YABS_A3_AGE AND COLLECT CORRECT AGE.
IF (YABS_AgeOut = 2(NO) OR -1 (DK) OR -2 (RF)) AND (YABS_A3_BD WAS ANSWERED WITH A BIRTHDATE, GO BACK TO YABS_A3_BD AND COLLECT CORRECT AGE.
IF YABS_AgeOut = 1 AND (RESELECT=1 OR CHILDNUM = 1), GO TO END2;
IF YABS_AgeOut = 1 AND RESELECT NE 1 AND CHILDNUM >1, GO TO RESELECT]
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[ASK YABS_B SERIES ONLY IF ELIGIBLE CHILDREN IN THE HOUSEHOLD AND AR IS NOT PARENT OR GUARDIAN OF THE SELECTED CHILD. IN OTHER WORDS, IF YABS_A2 = 2 (NOT PARENT/GUARDIAN OF SELECTED CHILD), ASK YABS_B1.]
YABS_B1.
So that our field staff can speak to the correct person when they arrive at your home for this part of the study, can you confirm your first name?
IF NEEDED, JUST CONFIRM NAME GIVEN IN THE SCREENER: {FILL FROM I5A}
_______ [ADULT RESPONDENT NAME]
-2 REFUSED
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PG_CB.
Thank you for agreeing to participate. However, for this part of the study, we will need to gain consent to participate from both you and the child’s parent/guardian for the in-home visit. One of our field staff will get in contact with you and them to schedule an appointment for this part of the study. What would be the best day or days of the week and times for that person to call about scheduling an appointment?
INTERVIEWER: RECORD AS MANY DAYS AND TIMES AS PROVIDED BY RESPONDENT. USE COMMENTS FIELD IF NECESSARY.
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{Allow multiple selections}
COMMENTS [ ] max 1000 characters
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PG_CBa.
Before we collect your contact information, can you tell me the name of the parent/guardian that our field staff should ask to speak to when they call?
_______ [Parent/Guardian Name]
[THE NAME COLLECTED HERE WILL BE USED TO FILL ^ParGrdName AS NEEDED THROUGH THE INTERVIEW. GO TO PG_CBrelate]
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PG_CBrelate.
How is ^ParGrdName related to ^ChildName?
1 – MOTHER
2 – FATHER
3 – GRANDMOTHER
4 – GRANDFATHER
5 – AUNT
6 – UNCLE
7 – BROTHER
8 – SISTER
9 – COUSIN
10 – OTHER [SPECIFY]
[IF BOTH PG_CBa AND PG_CBrelate HAVE ANSWERS WITH DK OR REFUSE
[GO TO ContactNums]
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[IF END_AR = 1 (YES, PARENT/GUARDIAN AVAILABLE), ASK YABS_B4.DISABLE DK/RF.]
YABS_B4.
[READ WHEN PARENT/GUARDIAN COMES TO THE PHONE]:
Hello, I am calling for RTI International. My name is (name). We are gathering information about the health beliefs and health behaviors of residents in your community as part of a study for the Centers for Disease Control and Prevention. We will be collecting information from one adult and one child who live within the same household. Adults will be asked questions about their personal health and will have their physical measurements taken, such as height, weight, abdominal circumference, blood pressure, pulse and a sample of saliva. We’re also asking parents/guardians if it’s okay for one of their children to participate in this study. Children will have their physical measurements taken as well. Children between the ages of 12 and 17 will be asked questions about their physical activity, health. Caregivers of children between the ages of 3 and 11 will be asked questions about their children. For this part of the study, one of our interviewers will come to your house to talk to you directly. Adults who participate will receive a $40 gift card. Children who participate will receive a $10 gift card. The person I was just speaking with said [he/she] would be interested in participating as the adult representative of your household. [He/She] also mentioned that you are the parent/guardian of a child named ^ChildName (who’s initials are [INITIALS]). Is this correct?
IF R IS NOT THE PARENT/GUARDIAN, READ: “Thank you for your time. We will not contact you again.”
1 YES
2 NO
[IF YABS_B4 = 1 (YES), GO TO YABS_B5.
IF YABS_B4 = 2 (NO), GO TO END_AR.]
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YABS_B5.
Would you be interested in having ^ChildName participate in this in-home examination?
1 – Yes
2 – No
[IF YABS_B5 = 1 (YES), GO TO YABS_B5_BD.
IF YABS_B5 = 2 (NO) AND RESELECT=1, GO TO END2.
IF YABS_B5 = 2(NO) AND RESELECT NE 1 AND ChildNum >1, GO TO RESELECT.
ELSE GO TO YABS_B5a.]
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YABS_B5a
REFUSAL CONVERSION
May I ask what your concerns are or why you do not want your child to participate in this study?
INTERVIEWER: LISTEN TO R CONCERNS AND USE FAQs TO ADDRESS QUESTIONS AND CONCERNS.
Continue 1. NOW AGREES TO PARTICIPATE
Refusal 2 UNABLE TO CONVERT REFUSAL
[IF YABS_B5a=1, GO TO YABS_B5_BD;
IF YABS_B5a=2, THEN CODE AS A YABS REFUSAL AND GO TO END2]
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YABS_B5_BD.
When our field interviewer arrives for the interview he or she will ask if ^ChildName would be willing to participate in the study.
Knowing the age of participating children helps us prepare materials for visits.
Would you please provide ^ChildName’s birth date?
1___ MONTH [range 1 – 12]
2___ DAY [range 1 – 31]
3___ YEAR [range 1995-2009]
4 DON’T KNOW /NOT SURE
5 REFUSED
{HARD CHECK : UNLESS DK OR RF, MONTH CANNOT BE LESS THAN 1 OR GREATER THAN 12.}
{HARD CHECK : UNLESS DK OR RF, DAY CANNOT BE LESS THAN 1 OR GREATER THAN 31.}
{HARD CHECK TEXT: MONTH OR DAY OUT OF RANGE, PLEASE CLARIFY WITH R}
[IF YEAR<1995 OR YEAR>2009, GO TO YABS_B5BD_CONF;
IF DK/RF GO TO YABS_B5_AGE]
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YABS_B5_AGE.
Instead of providing ^ChildName’s birth date can you tell us instead how old is he/she? How old is ^ChildName?
IF NEEDED, SAY: Knowing the age of participating children helps us prepare materials for visits.
1 -____ AGE [range 3 – 17]
-1 - DON’T KNOW
-2 - REFUSED
[IF YABS_B5_AGE = -1 (DK) OR -2 (RF), GO TO GrdNm. ELSE CONTINUE]
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[IF YABS_B5_BD WAS ANSWERED WITH A BIRTHDATE, THEN ^Fill SHOULD SAY: “was born on {fill month, day and year from YABS_B5 _BD}.” IF YABS_B5_AGE WAS ANSWERED WITH AN AGE, THEN ^Fill SHOULD SAY: “is {fill age from YABS_B5_AGE.”]
YABS_B5_BD_CONF.
You said that ^ChildName ^Fill. Is that correct?
1 YES
2 NO
-1
DON’T KNOW / NOT SURE
-2 REFUSED
[[CALCULATE CHILD’S AGE FROM YABS_B5_BD; USE AGE PROVIDED IN YABS_B5_AGE IF AVAILABLE. IF YABS_B5_BD_CONF = 1 (YES) AND AGE LT 3 YEARS OR GT 17 YEARS, GO TO YABS_AgeOut5.
if YABS_B5_BD_CONF = 1 (yes), GO TO GrdNm.
IF (YABS_B5_BD_CONF = 2 (no) OR -1 (DK) or -2 (RF)) AND YABS_B5_BD WAS ANSWERED WITH A BIRTHDATE, GO BACK TO YABS_B5_bd AND COLLECT CORRECTED BIRTHDATE.
IF (YABS_B5_BD_CONF = 2 (no) OR -1 (DK) or -2 (RF)) AND YABS_B5_AGE WAS ANSWERED WITH AN AGE, GO BACK TO YABS_B5_AGE AND COLLECT CORRECTED AGE.]
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[CALCULATE CHILD’S AGE FROM YABS_B5_BD; USE AGE PROVIDED IN YABS_B5_AGE IF AVAILABLE. FILL ^CHILDAGE WITH THE AGE OF CHILD. IF YABS_B5_AGE WAS ANSWERED WITH AN AGE, THEN ^Fill SHOULD SAY: “age”. IF YABS_B5_BD WAS ANSWERED WITH A BIRTHDATE, THEN ^Fill SHOULD SAY: “birth date”.
IF CHILD’S AGE LT 3 YEARS OR GT 17 YEARS, ASK YABS_AgeOut. ]
YABS_AgeOut5.
According to the ^Fill you provided, ^ChildName is ^CHILDAGE years old now. We’re only including children aged 3-17 in this part of our study.
Is ^ChildName ^CHILDAGE years old now?
1 YES
2 NO
-1 DON’T KNOW / NOT SURE
-2 REFUSED
[IF (YABS_AgeOut5 = 2(NO) OR -1 (DK) OR -2 (RF)) AND (YABS_B5_AGE WAS ANSWERED WITH AN AGE), GO BACK TO YABS_B5_AGE AND COLLECT CORRECT AGE.
IF (YABS_AgeOut5 = 2(NO) OR -1 (DK) OR -2 (RF)) AND (YABS_B5_BD WAS ANSWERED WITH A BIRTHDATE, GO BACK TO YABS_B5_BD AND COLLECT CORRECT AGE.
IF YABS_AgeOut5 = 1 AND (RESELECT=1 OR CHILDNUM = 1), GO TO END2;
IF YABS_AgeOut5 = 1 AND RESELECT NE 1 AND CHILDNUM >1, GO TO RESELECT]
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GrdNm.
So that I can speak to the correct person when I arrive at your home for this part of the study, can you tell me your first name? If you prefer, you can give me your initials or a made-up name.
_______ [Parent/Guardian Name]
[IF NAME PROVIDED IN GrdNm NE ^ParGrdName, FILL ^ParGrdName WITH NAME PROVIDED IN GrdNm.
Go To YABS_ B5relate]
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YABS_B5relate.
How are you related to ^ChildName?
1 – MOTHER
2 – FATHER
3 – GRANDMOTHER
4 – GRANDFATHER
5 – AUNT
6 – UNCLE
7 – BROTHER
8 – SISTER
9 – COUSIN
10 – OTHER [SPECIFY]
[Go To YABS_B6]
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[IF THE AGE OF THE SELECTED CHILD IS LT OR EQ 11, ^Fill SHOULD SAY: “Thank you for agreeing to participate.”
IF THE AGE OF THE SELECTED CHILD IS GT 11, ^Fill SHOULD SAY: “Thank you for agreeing to speak with one of our field staff to allow ^ChildName to participate.”]
YABS_B6
^Fill
One of our field staff will get in contact with you to schedule an appointment for this part of the study. What would be the best day or days of the week and times for that person to call you about scheduling an appointment?
INTERVIEWER: RECORD AS MANY DAYS AND TIMES AS PROVIDED BY RESPONDENT. USE COMMENTS FIELD IF NECESSARY.
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Sunday |
Morning |
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Afternoon |
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Evening |
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{Allow multiple selections}
COMMENTS [ ] max 1000 characters
[GO TO ContactNums (COLLECT ALL CONTACT INFORMATION) AND THEN LOOP BACK TO YABS_B7]
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YABS_B7.
Those were all the questions I had for you today. Thank you for your help.
[TERMINATE; CODE AS COMPLETE WITH YABS APPOINTMENT]
[If multiple children but only one in MS, then ask about that MS child.
OTHERWISE, ASK ABOUT THE OTHER CHILDREN.
IF ChildNum = 2 OR MORE, THEN ^Fill SHOULD SAY: “us to randomly select another child to participate.”
{IF ChildNum =2, THEN ^Fill SHOULD SAY: “the other child 3-17 years old living in your household to participate.”]
RESELECT.
Because the child we randomly selected is unable to participate in the study we would like to know if you would allow ^Fill
1 – Yes
2 – No
[IF RESELECT=1 (YES) GO TO RESELECT_1.
IF RESELECT=2 (NO), -1 (DK), OR -2 (RF), CODE AS YABS REFUSAL AND IF INCENTIVE= BLANK AND R IS ELIGIBLE FOR INCENTIVE, GO TO INCENTIVE.
ELSE GO TO END2]
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[IF MSNum = 2 OR MORE, THEN ^Fill SHOULD SAY: “who are 7th through 8th graders”. ELSE DO NOT FILL]
RESELECT_1
Thinking of the other children ^Fill living in your household, please tell me the first name of the child with the next upcoming birthday who you would consent to have interviewed.
ONLY IF NEEDED: (His)/(her) initials will be fine.
______________ [ACCEPT UP TO 25 CHARACTERS]
-1 DON’T KNOW
-2 REFUSED
[THE NAME COLLECTED HERE WILL BE USED TO FILL ^ChildName.
IF RESELECT_1 = -2 (RF) OR -1 (DK), GO TO END2.
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[DISABLE DK/RF]
RESELECT_2.
Are you the parent or guardian of ^ChildNameR?
1 – YES
2 – NO
[IF RESELECT_2 = 1 (YES), GO BACK TO YABS_A3.
IF RESELECT_2 = 2 (NO), GO TO END_AR (THIS WILL LEAD TO GETTING THE PARENT/GUARDIAN ON THE PHONE).]
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ContactNums.
What would be the best way to contact you to set up an appointment for an in-home visit—your home phone, cell phone, or work phone?
Our staff can try more than one number, if that would be helpful.
SAMPLE NUMBER: {FILL SAMPLE NUMBER FROM CATI}
NUMBER CALLED TODAY: {TELEPHONE NUMBER FROM CURRENT ROSTER LINE}
{ALLOW ENTRY IN ALL FIELDS
Home: ___-___-____
Cell: ___-___-____
Work: ___-___-____
[HARD CHECK: REQUIRE ENTRY IN AT LEAST ONE; REQUIRE 10 DIGITS FOR ANY TELEPHONE FIELD THAT ISN’T ENTIRELY EMPTY]
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CONFRM.
Thank you for your time. If you would like to contact our field staff directly to schedule an appointment, please call this toll-free number [TOLL-FREE NUMBER to FIELD FS, MIGHT BE SPECIFIC TO SITE].
1 CONTINUE
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[IF CallIns_PhaseB B5=1,2, GO TO END2;
ELSE IF YABS_A2=2, ^FILL “Before we continue,”]
INCENTIVE.
^FILL We would like to send $20 as a token of our appreciation for your participation in this telephone interview. Would you like to receive that $20 in the form of a check or a Wal-Mart gift card?
1 CHECK
2 GIFT CARD
3. DECLINED INCENTIVE
[IF CHECK SELECTED (INCENTIVE=1), GO TO LOCAT1_C;
IF GIFT CARD SELECTED (INCENTIVE =2), GO TO LOCAT1_G;
IF INCENTIVE DECLINED, GO TO END_AR; IF MISSING GO TO END_AR]
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LOCAT1_c.
In order to send you a check, we’ll need to confirm your mailing address and enter your full name.
This information will be kept in secure and protected data files, and will be separate from the responses already provided in the interview.
CONTINUE
DECLINED PROVIDING CONTACT INFORMATION FOR $20 CHECK
[IF LOCAT1_c = 1 (CONTINUE), ASK LOCAT2a THROUGH LOCAT3g .
IF LOCAT1_c = 2 (DECLINED) AND YABS_A2=2, GO TO END_AR. ELSE GO TO END2]
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LOCAT1_g.
In order to send you a gift card, we’ll need to confirm your mailing address. We also ask for your full name because including your name along with your address helps to ensure successful delivery of your gift card.
This information will be kept in secure and protected data files, and will be separate from the responses already provided in the interview.
CONTINUE
DECLINED PROVIDING CONTACT INFORMATION FOR $20 GIFT CARD
[IF LOCAT1_g = 1 (CONTINUE), ASK LOCATE2a THROUGH LOCAT3g.
IF LOCAT1_g = 2 (DECLINED) AND YABS_A2 = 2, GO TO END_AR. ELSE GO TO END2]
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LOCAT2a.
(What is your first name?)
SAY, IF NEEDED for GIFT CARD RECIPTIENTS: Including your full name along with your address will help to ensure successful delivery.
SAY, IF NEEDED for CHECK RECIPTIENTS: We need your full name in order to print a check that you can cash.
YOU MAY CONFIRM NAME GIVEN AT THE BEGINNING OF THE INTERVIEW: {FILL FROM I5a}
_______ {allow 60}
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LOCAT2b.
(What is your last name?)
SAY, IF NEEDED for GIFT CARD RECIPTIENTS: Including your full name along with your address will help to ensure successful delivery.
SAY, IF NEEDED for CHECK RECIPTIENTS: We need your full name in order to print a check that you can cash.
_______
{allow 60 }
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LOCAT3a.
(To what street address or PO Box should your {check/ gift card} be sent?)
[FILL SAMPLED ADDRESS, BUT ALLOW EDITS]
_______{allow 60 }
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LOCAT3aa.
Do you have an apartment number?
_______ {allow 60}
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LOCAT3b.
(To what city should your {check/ gift card} be sent?)
[FILL SAMPLED CITY, BUT ALLOW EDITS]
_______ {allow 30}
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LOCAT3c.
(To what state should your {check/ gift card} be sent?).
[FILL SAMPLED STATE, BUT ALLOW EDITS]
{provide state list}
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LOCAT3d.
(To what zip code should the check/ gift card be sent?)
[FILL SAMPLED ZIP CODE, BUT ALLOW EDITS]
{provide state list}
_______ {allow 5}
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LOCAT3e.
I just want to confirm that the phone number we called you on is {xxx-xxx-xxxx}?”
_______ {allow 10}
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LOCAT3g.
Is the address you just provided your primary residence?
1 YES
2 NO
-1 DON’T’ KNOW
-2 REFUSED
[PRESENT LOCAT3_alt IF POB=1 (SAMPLE FILE INDICATES THE SAMPLED ADDRESS WAS A PO BOX)
LOCAT3_alt. [THE FOLLOWING IS A TEXT NOTE THE FOR INTERVIEWER:] ASK ONLY IF THE
(We’ll send your check / gift card to the PO Box you provided, but we’d also like to know your street address.)
SAY IF, NEEDED: Knowing the neighborhood in which people live can be helpful when interpreting our results.
STREET _________________________{allow 500}
CITY _________________________{allow 500}
ZIP CODE_____{range 10001-99999}
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[IF YABS_A2 = 2(NO, R IS NOT THE PARENT/GUARDIAN) OR YABS_B4 = 2, ASK END_AR. ELSE GO TO END2.]
END_AR.
{FILL IF INCENTIVE = 1 OR 2 AND YABS_A2 = 2(NO, THE R IS AN ATSS R (AND IS NOT A PARENT/GUARDIAN):
IF INCENTIVE ACCEPTED, INCENTIVE=(1 or 2): Your $20 {check/gift card} will arrive sometime in the next 4-6 weeks, in an envelope with a blue RTI logo. }
I would now like to speak with ^ParGrdName. Is he/she available to come to the phone?
IF R ANSWERS YES, SAY: Thank you for your help. Those were all the questions I had for you today. Would you put ^ParGrdName on the phone?
1 YES
2 NO
-1 DON’T KNOW
-2 REFUSED
[IF END_AR= 1 (YES), GO BACK TO YABS_B4.
IF END_AR = 2(NO) OR -1 (DK) OR -2 (RF), GO TO END2]
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END2
Thank you, those were all the questions I had for you today.
[IF RFCNV1 = 2 OR ChildNum = 2 OR CHILDR_NMCNV = 2 OR YABS_A3a = 2 OR YABS_B5a = 2, GO TO WHY_REF. ELSE TERMINATE.]
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[IF REFUSAL TO THE YABS SCREENER, PLEASE PRESENT THE FOLLOWING TO INTERVIEWERS—MAY BE APPENDED TO STANDARD REFUSAL REASONS LIST, IF THAT’S MOST PRACTICAL]
WHY_REF.
PLEASE SELECT THE REASON(S) GIVEN FOR REFUSING PARTICIPATION IN THE IN-HOME VISIT:
[ALLOW MULTIPLE SELECTIONS]
DON'T WANT SOMEONE COMING TO HOUSE.
INCENTIVE IS NOT ENOUGH FOR INCONVENIENCE
TYPE OF INCENTIVE IS NOT FAVORED
A SPECIFIC BIOMETRIC MEASUREMENT FEELS TOO INTRUSIVE
LENGTH OF VISIT
DON'T WANT CHILD TO BE MEASURED
OTHER
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-END-
VARIABLES TO PASS FROM CATI TO FIELD
Adult Respondent Name: I5a or updated by YABS_B1.
Child Name: ^ChildName
Guardian Name (If applicable): Captured at GrdNm OR PG_CBa.
Relation of Adult Respondent or Guardian to Child: Captured at YABS_A2, PG_CBrelate, OR YABS_B5relate.
Phone Number: Captured at CATI and the ones updated by ContactNums
Best Times to Contact: Captured at SCHD1, PG_CB, and YABS_B6
Date of ATSS Interview: Captured by CATI -CMS– not in survey
Appointment Comments: Captured at SCHD1, PG_CB, and YABS_B6
VARIABLES TO PASS FROM FIELD TO CATI
The total number of appointments to complete biometrics interviews with adults in households with no eligible children in this community< 143.
| File Type | application/msword |
| Author | Information Technology Services |
| Last Modified By | larena |
| File Modified | 2012-06-19 |
| File Created | 2012-06-08 |