Generic Sub-Study Form

GENERIC SUB-STUDY SUBMISSION – 0925-0589-04

DATE OF REQUEST: May 22, 2012

SUB AGENCY (I/C): NIH/NCI/ Division of Cancer Control and Population Sciences

TITLE OF SUB-STUDY: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating

(FLASHE) Survey

GENERIC CLEARANCE UNDER OMB #0925-0589-04 EXP. DATE: 04/30/2014

TOTAL ANNUAL BURDEN APPROVED: 3600 hours

BURDEN APPROVED TO DATE: 172 hours

BURDEN FOR THIS REQUEST: 63 hours

ABSTRACT:

The National Cancer Institute’s Division of Cancer Control and Population Sciences, Behavioral Research Program is planning to conduct data collection using the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey. This submission is for the cognitive testing that will help refine and finalize the data collection instruments. For this generic sub-study, NCI is proposing formative research to refine the survey instruments. The objective of this cognitive testing is to identify any potential sources of measurement error within the questionnaires and to gather adequate information to make informed modifications to the questionnaires to reduce the potential for response error.

The research will consist of conducting 40 cognitive interviews with people who meet the eligibility criteria for FLASHE (parent-teenager dyads). There will be 20 pairs of a parent and his/her teenage child between the ages of 11 and 18. Each interview will be about an hour and a half long and participants will each receive cash incentive as a thank you for their participation. A $75 incentive will be provided for parent participants and a $50 incentive will be provided for teenage participants.

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED? ___X___YES ____NO_______N/A	IS PERSONALLY IDENTIFIABLE INFORMATION (PII) BEING COLLECTED? ___X___YES _____NO_______N/A
OBLIGATION TO RESPOND: ___X__ VOLUNTARY ______ REQUIRED TO OBTAIN OR RETAIN BENEFITS ______ MANDATORY	TYPE OF COLLECTION/RESEARCH? _____ CUSTOMER SATISFACTION _____ USABILITY TESTING _____FOCUS GROUPS __x__PRETESTING _____FORMATIVE RESEARCH _____QUESTIONNAIRE DEVELOPMENT _____ OTHER: _________________________
HOW WILL THIS SURVEY BE OFFERED? _____ WEB SITE _____ TELEPHONE INTERVIEW _____ MAIL RESPONSE __x__ IN PERSON INTERVIEW _____ OTHER: _________________________
CONTACT INFORMATION: NAME: Linda Nebeling, PhD, MPH, RD, FADA TELEPHONE NUMBER: 301-435-2841 EMAIL ADDRESS: [email protected]