Tracking Study Above the Influence Screener

Tracking Study Above the Influence Screener 20 Aug 2013.docx

National Youth Anti-Drug Media Campaign (NYADMC) - Parent and Youth Tracking Studies

Tracking Study Above the Influence Screener

OMB: 3201-0010

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Above the Influence

Multi-Platform Communications

Campaign Tracking and Assessment

Baseline #37452


SCREENER


AGE

What is your age? [ALLOW 13-17] QUOTA FOR 13, 14-16, AND 17


GENDER

What is your gender?


Male

Female


EN01CTY

In what country do you live?

USA [CONTINUE]


ZIP

What is your 5-digit zip code? [NUMERIC OPEN END]

ERROR MESSAGE IF LESS THAN FIVE DIGITS: “Please type your five digit zip code.”

ONLY INCLUDE VALID ZIP CODES


US01PST

Please tell us which of the following types of online surveys you have completed in the past 3 months.

Please select all that apply.


Automotive

Beauty/Cosmetics

Beverages – Alcoholic [TERMINATE]

Beverages - Non Alcoholic

Education

Electronics/Computer/Software

Fashion/Clothing

Financial Services/Insurance

Food/Snacks

Healthcare/Pharmaceuticals

Home Entertainment (DVD, VHS)

Home Improvement/Real Estate/Construction

Movies

Music

Personal Care/Toiletries

Pets

Politics

Publishing (Newspaper, Magazines, Books) Restaurants

Sports

Telecommunications (phone, cell phone, cable)

Television (Network/Cable/Satellite)

Toys

Transportation/Shipping

Travel

Video Games

Websites/Internet/E-Commerce

Other online survey

None of the above [EXCLUSIVE]



US01RAC

Which of the following best describes you?


Hispanic or Latino?


US01ETH

Which of the following best describes you?


White or Caucasian

Black or African-American

Asian/Pacific Islander

Native American, Alaska Native, Aleutian

Prefer not to answer


ATIGrade

What grade are you currently in?


7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

None of the above [TERMINATE]


SENSATIONSEEKING

Next, we would like to know how much you agree or disagree with each of the following statements. Please be honest.


[SCALE ACROSS THE TOP]

Disagree a lot

Disagree a little

Neither agree nor disagree

Agree a little

Agree a lot



[DOWN THE SIDE - RANDOMIZE]

I like to do scary things

I like new and exciting experiences, even if I have to break the rules

I would like to explore strange places

I prefer friends who are exciting and unpredictable





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