Telephone Interview

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/XX

Attachment 5: Community Telephone Interview

CPPW National Prevention Media Initiative

Public reporting burden of this collection of information is estimated to range between 5 and 15 minutes with an average of 10 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

II. INTERVIEW

Thank you for taking the time to answer a few questions today. You qualify to participate in this survey which is being conducted on behalf of CDC. This survey will take about 10 minutes to complete. I would like to ask you some questions about you and your community. This could include people in your town, neighborhood, place of worship, local organization, or yourself and family. Survey results will be used to improve public health programs. Your participation is completely voluntary.

Your responses will be entered into a database and will only be seen by project staff who are collecting information and analyzing results. Your answers will be kept private. We will not ask for your name, and your telephone number will be deleted so that your answers cannot be linked to you. There will be no risk to you. You may stop the interview at any time.

If you have any questions, please email Thomas Lehman at [email protected]. You may ask him about your rights as a project participant.

[Instructions to Interviewers]

For all respondents who initially respond “don’t know” or “not sure” to the questions below, please re-ask the question, and, if necessary reassure them that: “There are no right or wrong answers. We are interested in hearing your thoughts and opinions.”

[Attitudes and Beliefs]

1. I’m going to read you a list of statements. For each one I would like to know if you agree, disagree, or feel neutral about the statement.

[If agree, follow up with:] “Would you say you strongly agree or somewhat agree?”

[If disagree, follow up with:] “Would you say you strongly disagree or somewhat disagree?”

Strongly disagree		Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	3	4	5	8	9
[Rotate a-e]
a.	Adult obesity is a problem in my community.
b.	Childhood obesity is a problem in my community.
c.	Children not getting enough healthy foods and drinks is a problem in my community.
d.	Children not having access to places to be active and do things like walk, bike, and play is a problem in my community.
e.	Children not getting enough physical education and physical activity in schools is a problem in my community.
[Rotate f-j]
f.	My community should do more to make it easier for adults to get healthy foods.
g.	My community should do more to make it easier for adults to be active and do things like walk, bike, and play.
h.	My community should do more to make it easier for children to get healthy foods and drinks.
i.	My community should do more to make it easier for children to be active and do things like walk, bike, and play.
j.	My community should do more to increase physical education and physical activity for children in schools.

2. Which of the following three statements best describes how you think the problem of obesity should be solved in your community? [Read options a-c, and mark the response that BEST describes how the respondent thinks about the problem of obesity.]

[Rotate a-c.]
a.	Obesity is an individual problem that is best solved by people taking personal responsibility for what they eat and how physically active they are.
b.	Obesity is a community problem that is best solved by people working together to make it easier for everyone to eat healthy foods and be physically active.
c.	Obesity is both an individual and community problem that is best solved by people taking personal responsibility for what they eat and how physically active they are, and the community working together to make these behaviors easier to do.
d.	Don’t know [do not read]
e.	Refused [do not read]

[Self-Efficacy]

3. For each of the following, tell me if you agree, disagree, or feel neutral about the statement.

[If agree, follow up with:] “Would you say you strongly agree or somewhat agree?”

[If disagree, follow up with:] “Would you say you strongly disagree or somewhat disagree?”

Strongly disagree		Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	3	4	5	8	9
[Rotate a-c] [Only ask c of parents of children 6-15 (QX).]
a.	I am confident that I can take personal responsibility for what I eat and how physically active I am.
b.	I am confident that I can work with others in my community to make it easier for everyone to eat healthy foods and be physically active.
c.	I am confident that I can have a positive influence on what my children eat and how physically active they are.

[Behaviors]

4. Thinking back over the past year, how would you say your interest in the following topics has changed?

Would you say that your interest in _________________________ has increased, decreased or stayed about the same over the past year?

[If increased, follow up with:] “Would you say your interest in this topic has greatly increased or somewhat increased?”

[If decreased, follow up with:] “Would you say your interest in this topic has greatly decreased or somewhat decreased?”

Greatly decreased		Somewhat decreased	Stayed about the same (Neither increased nor decreased)	Somewhat increased	Greatly increased	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	3	4	5	8	9
[Rotate a-d.]
	Eating healthy foods
	Drinking healthy drinks, like water, milk, and 100% fruit juice.
	Being physically active and doing things like walking, biking and playing
	Getting more physical education and physical activity for children in schools
[Only ask questions d-g if the respondent has children age 6-15 in the household (QX). Rotate e-g.]
	Getting my children to eat healthy foods
	Getting my children to drink healthy drinks like water, milk, and 100% fruit juice
	Getting my children to be physically active and do things like walk, bike and play

5. Which, if any, of the following are you currently doing? [Mark the “yes” responses.]

[Rotate a-d.]
	Taking action to eat healthy foods
	Taking action to drink healthy drinks, like water, milk, and 100% fruit juice.
	Taking action to be physically active and do things like walk, bike and play
	Taking action to get more physical education and physical activity for children in schools
[Only ask questions e-g if the respondent has children age 6-15 in the household (QX). Rotate e-g.]
	Taking action to get my children to eat healthy foods
	Taking action to get my children to drink healthy drinks like water, milk, and 100% fruit juice
	Taking action to get my children to be physically active and do things like walk, bike and play

[Intentions]

6. Please indicate how likely you are to do each of the following in the next six months. For each one I would like to know if you likely, unlikely or neither likely nor unlikely to do each of the following.

How likely are you to…?

[If LIKELY, follow up with:] “Would you say you are VERY likely or SOMEWHAT likely?”

[If UNLIKELY, follow up with:] “Would you say you are VERY unlikely or SOMEWHAT unlikely?”

Very unlikely		Somewhat unlikely	Neither likely nor unlikely	Somewhat Likely	Very likely	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	3	4	5	8	9
[Rotate a-e]
a.	Support efforts in your community that make it easier for adults in your community to get healthy foods and drinks
b.	Support efforts in your community that make it easier for adults in your community to be active and do things like walk, bike, and play
c.	Support efforts in your community that make it easier for children in your community to get healthy foods and drinks
d.	Support efforts in your community that make it easier for children in your community to be active and do things like walk, bike, and play
e.	Support efforts in your community that get more physical education and physical activity for children in schools.

[Unaided Campaign Awareness]

Now changing topics a little...

7. Are you aware of any program or programs in your local community that are encouraging people to eat healthy foods, drink healthy beverages, be more physically active, or work together to make these things easier to do?

( ) 1 YES Continue to Q+1

( ) 2 No Skip to Q+3

( ) 8 Don’t Know/Not Sure (DO NOT READ) Skip to Q+3

( ) 9 Refused (DO NOT READ) Skip to Q+3

8. What is the name of the program or programs in your local community that are encouraging people to eat healthy foods, drink healthy beverages, be more physically active, or work together to make these things easier to do? [Probe: Any others?]

[Record open-ended verbatim response]

88= Don’t Know/Not Sure (DO NOT READ)

99= Refused (DO NOT READ)

9. Who is the sponsor or sponsors of the program or programs in your local community that are encouraging people to eat healthy foods, drink healthy beverages, be more physically active, or work together to make these things easier to do? [Probe: Any others?]

[Record open-ended verbatim response]

88= Don’t Know/Not Sure (DO NOT READ)

99= Refused (DO NOT READ)

10. During the past 30 days, have you read, watched, or listened to any news stories or articles about obesity-related topics in your community…?

Yes		No	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	8	9
[Rotate a-d]
a.	On TV?
b.	On the radio?
c.	In a newspaper, magazine, or other print publication?
d.	Online?

11. During the past 30 days, have you seen or heard any advertising about obesity-related topics in your community on TV, the radio, in a newspaper, magazine, or other print advertising, on billboards, bus or transit posters, or other outdoor or out-of-home advertising, or in any online advertising?

( ) 1 YES

( ) 2 No

( ) 8 Don’t Know/Not Sure

( ) 9 Refused (DO NOT READ)

[Aided Campaign Awareness]

12. In the past 30 days have you seen, heard, or read any TV, radio, newspaper, or online advertising about any of the following?

Yes		No	Don’t know (DO NOT READ)	Refused (DO NOT READ)
1		2	8	9
[Rotate a-g]
a.	Encouraging individuals to eat healthy food
b.	Encouraging individuals to drink healthy drinks, for example water, milk, or 100% fruit juice
c.	Encouraging individuals to get physical activity
d.	Increasing local healthy food and drink options
e.	Increasing local physical activity options
f.	Making it easier in communities to walk, bike, and play
g.	Getting more physical education and physical activity for children in schools

13. In the past 30 days, how often have you seen or heard any messages that encourage individuals to eat healthy foods, drink healthy beverages, and/or be physically active?

( ) 1 Not at all

( ) 2 Once in the past 30 days

( ) 3 A few times in the past 30 days

( ) 4 Many times in the past 30 days

( ) 5 Daily or almost daily in the past 30 days

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

14. In the past 30 days, how often have you seen or heard any messages that support making it easier to get healthy food, healthy drinks, and/or physical activity in your community?

( ) 1 Not at all

( ) 2 Once in the past 30 days

( ) 3 A few times in the past 30 days

( ) 4 Many times in the past 30 days

( ) 5 Daily or almost daily in the past 30 days

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. Are you aware of a local obesity-related program that is encouraging people to eat healthy foods, drink healthy beverages, be more physically active, or work together to make these things easier to do, that is sponsored by _______________ [Based on local community, refer to list]

( ) 1 YES

( ) 2 NO

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. I’m going to read a list of a few names of programs you may or may not have heard about. Have you heard of…? [ROTATE a – c]

1. Let’s Move

( ) 1 YES

( ) 2 NO

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

2. ______________________________ [Based on local community, refer to list]

( ) 1 YES [Continue to QX+1]

( ) 2 NO [After QXa-c, skip to QX+3]

( ) 8 Don’t Know/Not Sure (DO NOT READ) [After QXa-c, skip to QX+3]

( ) 9 Refused (DO NOT READ) [After QXa-c, skip to QX+3]

3. This Stops Now

( ) 1 YES

( ) 2 NO

( ) 8 Don’t Know/Not Sure(DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. During the past 30 days, have you have you read, watched, or listened to any news stories or articles about obesity-related topics in your community that mentioned the program ____________________ , sponsored by _________________________ [Based on local community – Refer to list]?

( ) 1 YES

( ) 2 NO

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. During the past 30 days, have you seen or heard any advertising about obesity-related topics in your community for the program ____________________ , sponsored by _________________________ [Based on local community – Refer to list]?

( ) 1 YES

( ) 2 NO

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

[Demographics]

We’re almost finished. Now, I’d like to ask you a few more questions about you.

15. [Record gender. Do not ask.]

( ) 1 Male

( ) 2 Female

15. Are there any children living in your household under the age of 18?

( ) 1 Yes [continue to QX+1]

( ) 2 No [skip to QX+2]

( ) 9 Refused [skip to QX+2]

15. What are the ages of these children?

1. Child 1: ______

2. Child 2: ______

3. Child 3: ______

4. Child 4: ______

5. Child 5: ______

6. Child 6: ______

7. Child 7: ______

8. Child 8: ______

15. Has a health care professional ever told you that you are overweight or at risk for being overweight?

( ) 1 Yes

( ) 2 No

( ) 8 Don’t know/Not sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. Has anyone else in your household been identified by a health care professional as being overweight or at risk for being overweight?

( ) 1 Yes

( ) 2 No

( ) 3 Don’t know/Not sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. What is your marital status? [If needed, read responses 1-6 and allow respondent to select one]

( ) 1 Married

( ) 2 Unmarried living with a partner

( ) 3 Divorced

( ) 4 Widowed

( ) 5 Separated, or

( ) 6 Single, never married

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. What is the highest level of education you have completed? [If needed, read responses 1-7 and allow respondent to select only one]

( ) 1 Grade school

( ) 2 Less than high school graduate/some high school

( ) 3 High school graduate or completed GED

( ) 4 Some college or technical school

( ) 5 Received four-year college degree

( ) 6 Some post graduate studies

( ) 7 Received advanced degree

( ) 8 Don’t Know/Not Sure (DO NOT READ)

( ) 9 Refused (DO NOT READ)

15. Which of the following categories best describe your total, annual household income? [Read responses 1-5 and allow respondent to select only one]

( ) 1 Under $20,000/year

( ) 2 $20,001 - $50,000/year

( ) 5 $50,001 - $100,000/year

( ) 8 Over $100,000/year

( ) 88 Don’t Know/Not Sure (DO NOT READ)

( ) 99 Refused (DO NOT READ)

Thank you very much for your time. I don’t have any further questions for you today.

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