Attachment D
Non-Response Questionnaire
1. HP2020 questions are marked HP
2. Tracking items from 1988, 1993, 1998, 2001, 2006, and 2010 are marked (Tr88, Tr93, Tr98, Tr01, TR06, TR10)
INTRODUCTION:
Hello, I'm ________________ with Ipsos. I am calling on behalf of the United States Food and Drug Administration, the FDA. We’re not selling anything. We’re doing a study about xxxxx. Have I reached you on a landline phone or a cell phone?
[IF LANDLINE]
SCR1. May I speak to the member of your household who is aged 18 or over and has had the most RECENT birthday? Would that be you?
[IF SCR2:1, REINTRODUCE; IF SCR2:2, ASK FOR THE FIRST NAME OF THE ELIGIBLE RESPONDENT FOR CALL-BACK PURPOSE. REINTRODUCE AS NECESSARY.]
SCR2. May I speak with a member of the household who is at least 18 years old and has the most recent birthday?
Yes
No/Not available
(IF NOT AVAILABLE, ASK FOR THE FIRST NAME OF THE ELIGIBLE RESPONDENT FOR CALL-BACK PURPOSE. REINTRODUCE AS NECESSARY.)
[ONLY respondents reached via a cell number]
SCR4. Are you at least 18 years old or under 18?
Yes, 18+ years old
No, under 18
[IF SCR4:1; CONTINUE, OTHERWISE TERMINATE]
FIRST QUESTION SCRIPTED
[ASK SCR0 OF ALL RESPONDENTS]
SCR0. INTERVIEWER DO NOT READ. Is respondent on cell phone or landline?
Landline phone
Cell phone
INTERVIEWER WARNING: YOU HAVE SELECTED [INSERT SCR0 RESPONSE]. IS THIS CORRECT?
YES
NO
[IF NO GO BACK TO SCR0 AND ENTER CORRECT RESPONSE]
SCR3. This call may be monitored for quality control purposes. Your answers to this survey are voluntary and will be kept confidential. The survey will take about 10 minutes.
[ONLY respondents reached via a landline number]
SCR3a. For personal calls, do you only use a landline phone at your household, or do you also have cell phone service on which I could have reached you?
Landline only
Cell phone also
[SCR5 ON ONLY RESPONDENTS REACHED VIA A CELL NUMBER]
SCR5. For personal calls, do you only use a cell phone, or do you also have regular landline phone at your household on which I could have reached you?
Cell phone only
Landline also
This call may be monitored for quality control purposes. Your answers to this survey are voluntary and will be kept secure to the extent provided by law. The survey will take about 15 minutes.
S4B. GENDER
1. Male
2. Female
IR1. I understand that you don’t want to participate in the full study. Would you please just give us 5 minutes to answer a few brief questions; that would really help us.
Yes………………….............-> CONTINUE
No…………………..............-> THANK AND TERMINATE
Don’t Know………...............-> THANK AND TERMINATE
Refused……………..............-> THANK AND TERMINATE
SECTION A: (6 questions)
2 risk perception:
A2. TR98, TR 01, TR06, TR10
How common do you think it is for people in the United States to get food poisoning because of the way food is prepared in their home? (READ LIST)
1. very common,
2. somewhat common, or
3. not very common?
8. DON’T KNOW (DO NOT READ)
9. REFUSED (DO NOT READ)
A3. TR98, TR01, TR06, TR10
How common do you think it is for people in the United States to get food poisoning from restaurant food? Would you say that it is… (READ LIST)
1. more common than from food prepared at home,
2. less common than food prepared at home, or
3. about the same as food prepared at home?
8. DON’T KNOW (DO NOT READ)
9. REFUSED (DO NOT READ)
2-3 food handling
D4. HP
Before you begin preparing food, how often do you wash your hands with soap? (READ LIST)
1. All of the time
2. Most of the time
3. Some of the time, or
4. Rarely
8. DON’T KNOW (DO NOT READ)
9. REFUSED (DO NOT READ)
D9. HP
In your home, are hamburgers usually served rare, medium, or well done?
[CLARIFY: IF DIFFERENT WAYS FOR DIFFERENT PEOPLE: What is the rarest degree of doneness hamburgers are served?]
1. RARE, (GO TO J1)
2. MEDIUM (GO TO D10)
3. WELL DONE(GO TO J1)
4 MEDIUM RARE (GO TO D10) [DO NOT READ]
5. MEDIUM WELL (GO TO D10) [DO NOT READ]
6. HAMBURGERS ARE NEVER SERVED (GO TO D11) [DO NOT READ]
8. DON’T KNOW (GO TO J1)
9. REFUSED (GO TO J1)
D10. HP [ASK IF D9V1 = 2, 4, or 5]
When you say hamburgers are usually served "medium / medium well / medium rare” (HAVE THE ANSWER FROM PREVIOUS QUESTION POP UP) do you mean they are... (READ LIST)
1. brown all the way through, or
2. still have some pink in the middle?
8. DON’T KNOW (DO NOT READ)
9. REFUSED (DO NOT READ)
Raw food consumption
J1. Tr98, TR01, TR06, TR10
In the past 12 months, which of the following raw foods did you eat? (READ
LIST)
a. Raw clams
b. Raw oysters
d. Sushi with raw fish, ceviche (se - VEE - chay), or other raw fish? [DO NOT
INCLUDE PICKELED FISH, SMOKED FISH, OR LOX]
YES
NO
DON’T KNOW
REFUSED
1 personal risk perception
F10A. TR98, TR01, TR06, TR10
I’m going to read a list of some ways that food may be handled. For each, please tell me how likely it is that you would get sick if you ate food that was handled that way. Please use any number between 1 and 5, where 1 is “not at all likely” and 5 is “very likely.” (IF RESPONDENT SAYS THEY DON’T PREPARE THE FOOD, ASK THEM FOR THEIR OPINION.)
(ROTATE F1A- F1C)
F1A.
If you forget to wash your hands before you begin cooking, how likely are
you to get sick? Where 1 is not likely at all and 5 is very likely.
1(not at all likely) 2 3 4 5(very likely) 8 9
F1B.
If vegetables you will eat raw happen to touch raw meat or chicken, how likely
are you to get sick? Where 1 is not likely at all and 5 is very likely.
1 (not at all likely) 2 3 4 5(very likely) 8 9
F1C.
If you eat meat or chicken that is not thoroughly cooked, how likely are you to get
sick? Where 1 is not likely at all and 5 is very likely. 1(not at all likely) 2 3 4
5 (very likely) 8 9
Section V and P: DEMOGRAPHICS [These are all tracking questions]
[PROG.:V2. ONLY respondents reached via a landline number]
V2. Now, I have a few questions for statistical purposes. Are there any telephone numbers in addition to [the telephone number being called] in your home that you receive calls on? Please exclude cell phone numbers or numbers used only for fax or computer.
Yes
No
DK/NS
RF
[IF V2=YES GO TO V2a
IF V2=( (No, DK/NS, OR RF) AND If SCR3a=”cell also,” )GO TO V4a. OTHERWISE, SKIP TO V3]
[PROG. ASK V2a: ASK V2a. to ONLY respondents reached via a landline number]
V2a. Is this/Are these number(s) for …
Home use
Business and home use
Business use only
DK/NS
RF
[PROG. V4a : ASK IF SCR5=’landline also,’ OR IF V2=’no/dk/ns/rf AND ROUTED TO V4A]
V4a. Of all the telephone calls that you or your household receive, are all or almost all calls received on cell phones, some received on cell phones and some on regular phones, or very few or none received on cell phones?
All or almost all calls received on cell phones
Some received on cell phones and some on regular phones
Very few or none on cell phones
DK/NS
RF
V4b. Thinking just about the landline home phone, not your cell phone, if that telephone rang and someone was home, under normal circumstances, how likely would it be answered? Would you say extremely likely the landline would be answered, very likely, somewhat likely, somewhat unlikely or not at all likely the landline would be answer?
Extremely likely that landline would be answered
Very likely that landline would be answered
Somewhat likely that landline would be answered
Somewhat unlikely that landline would be answered
Very unlikely that landline would be answered
Not at all likely that landline would be answered
DK/NS
RF
V3. How many adults, age 18 and older, including yourself live in your household?
NUMBER: ____________ (RANGE: 1-15)
DK/NS
RF
P5. What year were you born? ___________ (RANGE: 1900-1987)
DON’T KNOW
REFUSED
P8. Are you Hispanic or Latino?
1. YES
2. NO
8. DON’T KNOW
9. REFUSED
P9. TR88, TR93, TR98, TR01
What is your race? Please select one or more. Are you...[Read out loud as needed.] (MARK ALL THAT APPLY)
P9A.
White
P9B.
Black or African American,
P9C.
Asian
P9D.
Native Hawaiian or other Pacific Islander,
P9E.
American Indian or Alaska Native?
P9I.
DON’T KNOW
REFUSED
P10. TR88, TR93, TR98, TR01, TR06
What is the last grade or year of school that you have completed? [READ LIST IF NECESSARY]
1. LESS THAN HIGH SCHOOL DEGREE
2. 12 YEARS (HIGH SCHOOL GRADUATE OR GED)
3. 13-15 YEARS (1-3 YEARS COLLEGE (SOME COLLEGE))
4. 16 YEARS (COLLEGE GRADUATE (BACHELOR DEGREE OR
QUIVALENT))
5. (>16 YEARS) POSTGRADUATE, MASTER'S DEGREE, DOCTORATE, LAW DEGREE, OTHER PROFESSIONAL DEGREE [CLARIFY: THIS INCLUDES PEOPLE WORKING ON A GRADUATE DEGREE]
8. DON’T KNOW
9. REFUSED
Thank you, those are all the questions I have for you at this time.
| File Type | application/msword |
| File Title | DRAFT 4-26-05 |
| Author | FDA |
| Last Modified By | Lando, Amy |
| File Modified | 2014-11-25 |
| File Created | 2014-11-25 |