Adult Posttest

Attachment_3_-_Data_collection_instrument_-_Adult_questionnaire_Posttest_MDF[1].pdf

Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations

Adult Posttest

OMB: 0925-0685

Document [pdf]
Download: pdf | pdf
Attachment 3
Data collection instrument: Adult Questionnaire – Posttest MDF

OMB Control Number: 0925-XXXX

Expiration Date: 09/13/2014

Public reporting burden for this collection of information is estimated to average 45 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-XXXX). Do
not return the completed form to this address.

Introduction to the questionnaire

Thank you for agreeing to complete this questionnaire. Instead of using your name on this questionnaire, you will use a secret
number. Because you are using a number instead of your name, your answers will be kept private to the extent permitted by
law.

If you have more than one child, please answer the questions with respect to the child who is participating in this research
study with you.

Be sure to answer ALL of the questions honestly and carefully. If you are unsure of an answer, please give your best guess.
However, if you do not want to answer a particular question, you may skip it. The questionnaire is not a test—there are no
right or wrong answers.

If at any time during this questionnaire you would like to quit, then please click on the link in the corner of your screen that
says "Exit This Questionnaire" in order to exit the questionnaire.

Please ask a project staff member if you have questions while completing this questionnaire.

Thanks again for your assistance!

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Screen 1 of 46

First, please enter your secret number here. The same number is used for you and your child who is
participating in this study.

To be sure that the number was entered correctly, please enter the secret number again here:

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In the first set of questions for today, we are going to ask you about some behaviors.

1. During the past 30 days, how often did you do the following things?

During the past 30 days,
how often did you…

0
days

1-2

3-5

6-9

days days days

10-

20-

All

19

29

30

days
Drink alcohol (more than
just a sip)?
Smoke cigarettes?

days days

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

Use smokeless tobacco?
(This includes products like
chewing tobacco, snuff, or
dip.)

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2. [If yes to cigarettes] How much do you usually smoke per day?

Less than 1 cigarette per day

О

1-5 cigarettes per day

О

About ½ a pack per day

О

1 pack per day

О

More than 1 pack per day

О

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3. [If yes to smokeless tobacco] How much do you usually use smokeless tobacco per day?

1-2 times a day

О

3-4 times a day

О

5-6 times a day

О

7-8 times a day

О

9-10 times a day

О

More than 10 times a day

О

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4. In the last month have you had [males=5, females=4] or more drinks in a row?

О

Yes, and I do not intend to stop drinking 5/4 or
more drinks in a row

О

Yes, but I intend to stop drinking 5/4 or more
drinks in a row in the next 6 months

О

Yes, but I intend to stop drinking 5/4 or more
drinks in a row during the next 30 days

О

No, but I have had 5/4 or more drinks in a row
in the past 6 months

О

No, and I have not had 5/4 or more drinks in a
row in the past 6 months

О

No, I have never had 5/4 or more drinks in a
row.

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5. Are you currently a smoker?

Yes, I currently smoke

О

No, I quit within the last 6 months

О

No, I quit more than 6 months ago

О

No, I have never smoked

О

6. [For current smokers only] In the last year, how many times have you quit smoking for at least 24 hours?
# of times in past year
you quit for at least
24 hours

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7. [For current smokers only] Are you seriously thinking of quitting smoking?

Yes, within the next 30 days

О

Yes, within the next 6 months

О

No, not thinking of quitting

О

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Now we have some questions about advertisements.

8. Please look at the advertisement on the next screen and answer questions about it that follow. The questions
are open-ended, which means you will type in your responses.

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Screen 9 of 46

Ad #1

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Screen 10 of 46

A. Tell me about Ad #1 (the more detail the better).

B. What are some possible messages that the advertisers want the viewer to think after looking at Ad #1?

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C. How can you tell?

D. What type of person might be interested in Ad #1?

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You have finished questions about Ad #1.
9. Now, please look at a different advertisement on the next screen and answer questions about it that follow.
Again, the questions are open-ended, which means you will type in your responses.

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Screen 13 of 46

Ad #2

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A. Tell me about Ad #2 (the more detail the better).

B. What are some possible messages that the advertisers want the viewer to think after looking at Ad #2?

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C. How can you tell?

D. What type of person might be interested in Ad #2?

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You have finished questions about Ad #2.
The next few questions are about media and advertising in general.

10. There are many types of media. Which of the following best shows an example of a medium?

Letter to the Editor of a newspaper

О

Letter to your grandparents

О

11. Why might it be important for children to learn about who pays for TV shows and why?

To increase media concern

О

To increase media skepticism

О

To increase media awareness

О

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Screen 17 of 46

12. Fill in the blank to define "target audience":
The target audience is the people the advertisement is meant to____________.

…show using the product.

О

… write favorable online reviews of
the product.
…convince to purchase the product.

О

О

13. What do you think best describes “hidden messages” in advertising?

Ways that advertisers try to made
ads desirable to target audiences
Clues that help solve the mystery of
advertising
Hints that ads are not realistic

О

О

О

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Screen 18 of 46

14. Which of the following steps are involved in the production of a counter-ad for alcohol and tobacco?

(A) Identifying the missing information in a
preexisting alcohol or tobacco ad
(B) Finding a clever way of inserting the
missing information into the counter-ad
(C) Learning about the health
consequences of alcohol and tobacco

О

О

О

(D) A and B only

О

(E) A, B, and C

О

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Screen 19 of 46

15. Below you will find a number of questions about television advertising. We would like to ask you how you
deal with advertising directed at your child who is participating in this study. Can you indicate how often you
act in each of the following ways?
How often do you tell your child…

Almost

Sometimes

Often

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

never
That advertising depicts products as
better than they really are?
That advertising does not always tell
the truth?
That the purpose of advertising is to
sell products?
That not all advertised products are
of good quality?
That some advertised products are
not good for children?

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How often do you tell your child…

Almost

Sometimes

Often

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

never
To turn off the television when s/he
is watching commercials?
That s/he should not watch
commercial networks because they
broadcast too many commercials?
To switch to a channel that
broadcasts fewer commercials?
That s/he should not watch
television advertising at all?
To watch specific networks that
broadcast relatively few
commercials?

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16. How often do you use an alternative means of watching TV (e.g., DVDs, DVRs, or services like Netflix or Hulu)
to limit this child’s exposure to commercials?
Never

Rarely

Sometimes

Often

Extremely
much

О

О

О

О

О

17. Do you put any controls on the TELEVISIONS in your home to ensure that this child is not watching any
inappropriate content? Please mark ONE.

О

No
Yes; I use a device that blocks programs

О

based on ratings
Yes; I only allow my child to watch television

О

when I am present

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18. Do you put any controls on the COMPUTER OR INTERNET BROWSER to ensure that this child is not viewing
any inappropriate content? Please mark ONE.

О

No
Yes; I use a device that blocks websites based

О

on ratings
Yes; I only allow my child to use the computer

О

when I am present

19. Do you put any controls on the VIDEO GAME CONSOLES in your home to ensure that this child is not
watching any inappropriate content?

О

No
Yes; I use a device that blocks games based

О

on ratings
Yes; I only allow my child to play video games

О

that I approve

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20. Do you monitor the MOVIES that this child watches to ensure he or she is not watching any inappropriate
content?

О

No
Yes; I use a device that blocks movies on my

О

TV/DVD/DVR based on ratings
Yes; I only allow my child to watch movies

О

when I am present

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The next set of questions ask about alcohol and tobacco.

21. How often is alcohol present in your home?

Never

О

Occasionally

О

Fairly often

О

Very often

О

Always

О

22. Do you keep track of the alcohol supply in your home?

Yes

О

No

О

23. Do you keep alcohol locked up?

Yes

О

No

О

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24. How difficult would it be for your child who is participating in this study to obtain alcohol from your home?
Very

Difficult

Neutral

Easy

Very easy

difficult

There is no
alcohol in
my home

О

О

О

О

О

О

25. In general, how often have you talked with this child about alcohol use?
Never

Rarely

Sometimes

Often

Extremely
often

О

О

О

Go back

О

Next

Screen 26 of 46

О

26. How often would you say you have done the following specific things? As before, “your child” refers to the
child who is participating in this study with you.
Never

Have lectured or given your child a
speech about drinking alcohol
Have warned your child about the
dangers of drinking alcohol
Have talked to your child about how to
handle offers of alcoholic drinks
Have given your child rules to obey
about drinking alcohol

Once

A few

A lot of

times

times

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

Have made a comment to your child
about how drinking alcohol is bad if a
character on TV is drinking or drunk
Tell your child stories of people who
drank alcohol or have been drunk

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How often would you say you…

Never

Once

A few

A lot of

times

times

Tell your child that you would be
disappointed if he or she drank

О

О

О

О

О

О

О

О

О

О

О

О

alcohol
Show your child information on the
web, TV, or in the news about the
dangers of drinking alcohol
Ask for your child’s thoughts and
opinions about drinking alcohol.

27. In general, how often have you talked with this child about tobacco use (cigarettes, chewing tobacco, or other
forms of tobacco)?
Never

Rarely

Sometimes

Often

Extremely
often

О

О

О

Go back

О

Next

Screen 28 of 46

О

28. How often would you say you have done the following specific things? As before, “your child” refers to the
child who is participating in this study with you.
Never

Have lectured or given your child a
speech about tobacco use
Have warned your child about the
dangers of tobacco use
Have talked to your child about how to
handle offers of tobacco products
Have given your child rules to obey
about tobacco use

Once

A few

A lot of

times

times

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

Have made a comment to your child
about how tobacco use is bad if a
character on TV is smoking or using
other forms of tobacco
Tell your child stories of people who
smoke or use other forms of tobacco

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Screen 29 of 46

How often would you say you…

Never

Once

A few

A lot of

times

times

Tell your child that you would be
disappointed if he or she smoked
cigarettes or used other forms of

О

О

О

О

О

О

О

О

О

О

О

О

tobacco
Show your child information on the
web, TV, or in the news about the
dangers of using tobacco products
Ask for your child’s thoughts and
opinions about smoking or using other
forms of tobacco

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Screen 30 of 46

Now, we would like to ask a few questions about your use of the computer program you were given.

29. Did you bring your completed Program Usage Log (the paper where you wrote down the dates, times, and
participants when you used the computer program) with you today?

Yes

О

No

О

[If YES to completed Program Usage Log with the respondent today] Please take out the log now. You will use
it to answer a few questions.

30. [If YES to completed Program Usage Log with the respondent today] First, please count up the number times
you used the computer program in the past month. Enter that number here:

Number of times used
computer program in
past month

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Screen 31 of 46

31. [If YES to completed Program Usage Log with the respondent today] Please fill in the following information
from your log: [the number of rows that appear will correspond to the answer given in #30, above]
Date of Program

How long

Who used the program?

Use

did you use

(select all the people who used the program this

the

time)

program
this time
(minutes)
1.

О

Me
The child who is participating in
the study with me

О

This child’s other parent

О

My boyfriend or girlfriend

О

This child’s grandparent(s)

О

This child’s aunt(s) or uncle(s)

О

This child’s sibling(s)

О

This child’s friend(s)

О

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Screen 32 of 46

Date of Program

How long

Who used the program?

Use

did you use

(select all the people who used the program this

the

time)

program
this time
(minutes)
2.

О

Me
The child who is participating in
the study with me

О

This child’s other parent

О

My boyfriend or girlfriend

О

This child’s grandparent(s)

О

This child’s aunt(s) or uncle(s)

О

This child’s sibling(s)

О

This child’s friend(s)

О

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Screen 33 of 46

Date of Program

How long

Who used the program?

Use

did you use

(select all the people who used the program this

the

time)

program
this time
(minutes)
3.

О

Me
The child who is participating in
the study with me

О

This child’s other parent

О

My boyfriend or girlfriend

О

This child’s grandparent(s)

О

This child’s aunt(s) or uncle(s)

О

This child’s sibling(s)

О

This child’s friend(s)

О

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Screen 34 of 46

Date of Program

How long

Who used the program?

Use

did you use

(select all the people who used the program this

the

time)

program
this time
(minutes)
4.

О

Me
The child who is participating in
the study with me

О

This child’s other parent

О

My boyfriend or girlfriend

О

This child’s grandparent(s)

О

This child’s aunt(s) or uncle(s)

О

This child’s sibling(s)

О

This child’s friend(s)

О

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Screen 35 of 46

32. [If NO to completed Program Usage Log with the respondent today] You last completed a questionnaire one
month ago. In the past month, do you remember how often you used [the assigned computer program]?

Never. We didn’t use the program during the

О

past month.
We used the computer program, and I am able

О

to remember the number of times we used it.
We used the computer program, and I can

О

estimate the number of times we used it by
selecting from a range of choices.

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33. [If NO to completed Program Usage Log with the respondent today, but ability to REMEMBER number of
times indicated in #32] How many times did you use the computer program in the past month? Enter that
number here:

Number of times used
computer program in
past month

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34. [If NO to completed Program Usage Log with the respondent today, but ability to ESTIMATE RANGE of times
indicated in #32] How many times did you use the computer program in the past month?

Never. We didn’t use the program during the

О

past month.
Once

О

2-3 times

О

4-7 times

О

8-10 times

О

More than 10 times

О

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Screen 38 of 46

35. [If NO to completed Program Usage Log with the respondent today, but some computer program use
indicated] In the past month, how much time did you typically spend on the assigned computer program
when you used it?

Less than 15 minutes

О

Between 15 and 30 minutes

О

Between 30 and 45 minutes

О

Between 45 minutes and 1 hour

О

More than 1 hour

О

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36. [If NO to completed Program Usage Log with the respondent today, but some computer program use
indicated] In the past month, who has used the assigned computer program? Mark all the people who have
used the assigned computer program together at least once.

О

Me
The child who is participating in the study with

О

me
This child’s other parent (mom, dad, stepmom,

О

stepdad)

О

My boyfriend or girlfriend
This child’s grandparent (grandmother or

О

grandfather)
This child’s aunt or uncle

О

This child’s siblings (brothers/sisters or

О

stepbrothers/stepsisters)
This child’s friends

О

Someone else: _________________

О

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Now, we would like to get your opinions on different aspects of the Media Detective Family program.

37. As compared to before the Media Detective Family program, how would you describe your READINESS in
each area? As before, “your child” refers to the child who is participating in this study with you.
Much

Less

less
Talking with this child about media messages

About

More

the same

Much
more

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

Identifying ways that advertisements target
specific age groups, people with particular
interests, etc.
Assessing the realism of advertising
Being aware of the health risk information left out
of ads for tobacco and alcohol
Monitoring this child’s media exposure
Monitoring media exposure for other children in
the household

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Screen 41 of 46

As compared to before the MDF program, how would you describe your READINESS in each area?
Much

Less

less
Talking with this child about substance use
Talking with this child about your expectations for
his/her behavior regarding substance use
Helping this child understand the purpose of
advertising
Selecting age-appropriate TV shows, movies,
video games, Internet content, etc. for this child

About

More

the same

Much
more

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

О

Changing how you yourself use substances (e.g.,
changing the frequency of use or changing use in
situations where children are present)
Changing the availability of substances to children
in your household (e.g., locking cabinets where
alcohol is stored, keeping count of your cigarettes)

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Screen 42 of 46

38. How would you evaluate the Media Detective Family program in the following areas?
Poor

Fair

Good

Very

Excellent

good
Ease of use

О

О

О

О

О

Convenience

О

О

О

О

О

Thoroughness

О

О

О

О

О

Amount of content

О

О

О

О

О

Topic appropriateness

О

О

О

О

О

Quality of media

О

О

О

О

О

Appeal

О

О

О

О

О

Motivational/inspiring to parents

О

О

О

О

О

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Screen 43 of 46

39. Please tell us one or two specific aspects of the Media Detective Family program that you think we could
improve. We are particularly interested in how you think we can make the program more useful for families
who live in rural areas.

40. How would you evaluate the extension activities in the following areas?
Poor

Fair

Good

Very

Excellent

good
Ease of use

О

О

О

О

О

Convenience

О

О

О

О

О

Topic appropriateness

О

О

О

О

О

Appeal

О

О

О

О

О

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Screen 44 of 46

41. Which was the primary format for the extension activities that you used?

Paper and pen or pencil

О

Tablet computer

О

Smartphone

О

Did not complete any extension activities

О

42. How would you rate the overall experience with this program?
Not at all

Somewhat

satisfied

unsatisfied

О

О

Satisfied

Very
satisfied

О

Go back

О

Next

Screen 45 of 46

43. How did this program benefit you? Choose all that apply.

Time saving

О

No travel needed to access or use the materials

О

Convenience

О

Start and stop when needed

О

Engaged the child who is participating in this study

О

Engaged other members of the family

О

Answered my questions

О

Answered this child’s questions

О

Provided information I didn’t know I needed

О

Gave our family time to reflect

О

Gave me confidence in talking about substance use with this child

О

Extension activities helped to guide conversations

О

Was a fun activity to do as a family

О

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Screen 46 of 46

44. Please check any of the following that you would say are TRUE for you. Choose as many as apply.

О

I prefer in-person family training to online
I would like additional online trainings about

О

media literacy and health

О

I would like additional extension activities
I plan to do the extension activities again with

О

other children in the household

THANK YOU FOR COMPLETING THIS QUESTIONNAIRE.
CLICK ‘NEXT’ TO SUBMIT YOUR RESPONSES AND EXIT.
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File Typeapplication/pdf
File TitleParent Follow-Up Questionnaire
AuthorJennifer Erausquin
File Modified2013-11-06
File Created2013-11-05

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