Cognitive Interview Screener

Experimental Studies on Consumer Responses to Nutrient Content Claims on Fortified Foods

Appendix A Fortification Study Cognitive Interview Screener

Cognitive Interview Screener

OMB: 0910-0763

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Experimental Studies on Consumer Responses

to Nutrient Content Claims on Fortified Foods

As of June 2013

Cognitive Interview Screener




Hello, my name is [ ] and I work for RTI, a local research firm. We’re doing research for the Food and Drug Administration about food and nutrition. If you are eligible and you agree to participate, we will give you $40 to complete an in-person interview that should last about an hour. In order to find out if you are eligible to be interviewed, I’d like to get some background information.


1. Before I proceed, may I ask to which of the following age groups you belong?


17 years or younger _____ [THANK AND END]

18 to 35 years old _____

36 to 50 years old _____

51 to 65 years old_____

66 years or older _____


2. Do you work either full- or part-time in market research company, a food company, or a nutrition company?

YES_____[THANK AND END]

NO _____


3. In an average week, about how many hours would you say you use the Internet?

NONE _____ [THANK AND END]

1 HOUR OR MORE _____

DON’T KNOW_____ [THANK AND END]


4. How much of your household’s food shopping do you do?


All of the food shopping_____

Most of it_____

About half of it _____

Only a little of it _____ [THANK AND END]

None of it _____ [THANK AND END]

Don’t know_____ [THANK AND END]


5. On average, how often do you eat/drink the following food products?

5a. Cookies_____

5b. Oatmeal_____

5c. Whole milk, Unflavored_____


Daily_____

A few times a week_____

Once or twice a month_____

About once or twice every six months_____

Less than every six months_____[FOR COOKIES ONLY, THANK AND END]

Don’t know_____[FOR COOKIES ONLY, THANK AND END]


6. [RECORD GENDER. IF NOT OBVIOUS, ASK; RECRUIT 4-5 OF EACH]

Are you male or female?

FEMALE _____

MALE_____


7. What is the highest level of education that you have completed? [CODE INTO ONE OF THE FOLLOWING CATEGORIES]

LESS THAN A HIGH SCHOOL DIPLOMA _____

HIGH SCHOOL GRADUATE OR GED _____

SOME COLLEGE, ASSOCIATES DEGREE _____

COLLEGE GRADUATE _____

ADVANCED DEGREE _____

[RECRUIT 2 WITH HIGH SCHOOL DIPLOMA OR LESS]


8. Are you of Hispanic or Latino origin?

YES _____

NO _____


9. What is your race? You may choose one or more categories as they apply.

WHITE _____

BLACK OR AFRICAN AMERICAN _____

ASIAN _____

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER _____

AMERICAN INDIAN OR ALASKA NATIVE

SOME OTHER RACE (specify)_______________________________________

[RECRUIT 3-4 WHO ARE NOT WHITE]


10. What is your occupation?

______________________________________________________________________



INVITATION


[IF ELIGIBLE AND QUOTA REMAINS UNFILLED]


Thank you for answering all my questions. I’d like to invite you to participate in an in-person interview that will take about an hour to complete. We’ll pay you $40. for your time with us. Let me give you some available times and you tell me what would be best for you.


INTERVIEW DATE AND TIME:

The interview will be held at (location). I would like to send you directions. Where can I send them? Also, may I please have your phone number in case we need to get hold of you for any reason?


COLLECT RESPONDENT NAME, ADDRESS (AND EMAIL ADDRESS, IF APPLICABLE) AND PHONE

Name: _____________________________________________________________

Address: _____________________________________________________________

City: _________________________________ State: ______ Zip Code: __________

Phone: ________________________________________

E-mail: ________________________________________


In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx.


File Typeapplication/msword
File TitleAppendix C
Authorserena.lo
Last Modified ByVerrill, Linda
File Modified2013-06-18
File Created2013-06-18

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