B-1 Adult Interview Intro.

O MB Control Number: 0925-0663
Expiration Date: 11/30/2015

PATH Adult Cognitive Interview Protocol

Introduction

Hello, my name is ______________ and I work for Westat, a survey research company in Rockville, Maryland. Thank you for taking the time to participate in this research study.

Westat is working to develop some survey questions for the Population Assessment of Tobacco and Health study, which is sponsored by the National Institutes of Health and the Food and Drug Administration. Before surveys are conducted, it’s important to try out questions with the help of people such as yourself. The questions that we are working on today are about tobacco products.

It is important that the questions make sense, are easy to answer, and that everyone understands the questions the same way. If you agree to take part in this study, we will ask you to read and answer questions from the survey. We will then ask you to explain what you were thinking and how you came up with your answers. There are no right or wrong answers. Our purpose is not to collect information about you. Instead, your interview along with those of several others will show us how to improve these questions for a later survey.

Informed Consent

The interview will take about an hour and you will receive $40 for your time. Your participation is voluntary. You may choose to not answer any question and you can stop this interview any time. There are no known risks to taking part; all of the information we collect will be kept private and we will never use your name in our reports. There are also no direct benefits to taking part, but your answers will help us improve the survey.

With your permission, I will record the interview. The recording and all materials will be destroyed after the completion of the study.

[IF OBSERVERS ARE PRESENT] Some of the researchers developing the questions are here today observing our interview to learn if there are things that might need to be changed.

HAVE RESPONDENT SIGN INFORMED CONSENT. GIVE SECOND COPY TO RESPONDENT TO KEEP.

[IF RESPONDENT AGREES TO RECORDING] I’m going to start the recorder. Today is ___________________. Now that the recorder is running, let me ask again: is it okay with you if I record this interview?

Public reporting burden for this collection of information is estimated to average 56 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0663). Do not return the completed form to this address.