0920-0572 Survey Instrument for Young Women

Form Approved

OMB No. 0920-0572

Exp. Date 03/31/2018

Attachment C1:

Survey Instrument for

Young Women

Public reporting burden of this collection of information is estimated to average 20 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572).

1. Do you listen to podcasts (at least once per month)?

• Yes

• No

2. Is breast cancer a topic on which you seek out information? (72d.)

• Yes

• No

3. Has your doctor talked with you about breast cancer? (70d.)

• Yes

• No

4. [For those who answer Yes to Q5 in screener only] Have you ever discussed your family history of breast or ovarian cancer with your doctor?

• Yes

• No

5. [For those who answer Yes to Q5 in screener only] Discussions with my family members about our family’s medical history of breast or ovarian cancer is: (select all that apply)

   • Normal

   • Hard or difficult

   • Sad

   • Uncomfortable

   • Informative

   • Important

   • Not really relevant

   • Rare

   • Very factual

   • Very emotional

   • Embarrassing

   • Frowned upon by some family members

   • Other: (please describe)

6. [For those who answer Yes to Q5 in screener only] When do you discuss your family’s medical history of breast or ovarian cancer with family members?

• We’ve never discussed it

• We discuss it only when someone was recently diagnosed or going through treatment

• We’ve only discussed it one time

• We discuss it multiple times a year

• We discuss it annually

• Other: (please describe)

7. Please select any of the following actions you do.

• See my doctor each year for a clinical breast exam

• Conduct my own personal self-breast exams regularly

• Undergo mammograms

• Undergo breast MRIs, ultrasounds, tomography, or other breast screening tests

• None

• Other [please describe any other actions you take for your breast health]:

If yes to any of the above:

Please describe your reason(s) for taking the actions above.

• It is a part of my normal routine to maintain my general health

• My doctor recommended I do this

• A family member recommended I do this

  • (If checked) How is this family member related to you (e.g., mother, sister, daughter)?

• I’m worried about my risk of breast cancer

• I take these action(s) because someone in my family had breast cancer

• Other [please describe any other reasons why you take actions for your breast health]

Materials

Responses to Q1 will determine to which set of materials participants are asked to respond. Those who answer ‘yes’ will listen to 1 podcast and be shown 4 social media graphics. Those who answer ‘no’ will be shown 4 short videos and 4 social media graphics. No respondent will be shown all materials

Screener Q1 [Do you listen to podcasts?] – Yes Respondents (No respondents begin on page 12)

Material A

PODCAST [Caroline’s Story]

8. After listening to this podcast, I would (check all that apply)

• Not take any action

• Look up information on the topic

• Share it with someone

• Think about the issue

• Talk with a family member about the information

• Talk with a friend about the information

• Take steps to learn my family history of cancer

• Talk with my doctor about this information

• Other: (please explain)

9. Did you learn something new by listening to this? (E.55.e)

• Yes

• No

10. Does it seem like this message is talking to you, and people like you? (24d.)

• Yes

• No

Why or why not?

11. Were there parts of the podcast that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the podcast.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This podcast said something important to me (69e.)
I’m glad I heard Caroline’s story
The spokeswoman is engaging
I like her voice

16. Did this podcast suggest any action(s) you should take?

• Yes

• No

If yes: What action(s) did it suggest you take?

17. What other comments would you like to make about this podcast? (E.63.e)

Material B

18. Do you remember seeing this graphic before? (123d.)

• Yes

• No

• IF YES

  1. Please indicate any actions you took after seeing this graphic (check all that apply)

• I did not take any action after seeing this graphic

• I ‘liked’ it on social media

• I shared it with others on social media

• I thought about the issue

• I talked with a family member about the information

• I talked with a friend about the information

• I took steps to learn my family history of cancer

• I talked with my doctor about this information

• Other: (please explain)

• IF NO

2. Please indicate any actions you would take after seeing this graphic (check all that apply)

• I would not take any action

• I would ‘liked’ it on social media

• I would share it with others on social media

• I would think about the issue

• I would talk with a family member about the information

• I would talk with a friend about the information

• I would take steps to learn my family history of cancer

• I would talk with my doctor about this information

• Other: (please explain)

19. How much of the graphic would you read? Please choose all that apply. (37d.)

• I would only read the headline

• I would only look at the image/s

• I would only read the headline and look at the image/s

• I would read the whole thing

• I wouldn’t read any of it

20. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me
I learned something new by reading this (E.55.e)
The message was dumb (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

26. What other comments or questions do you have about this graphic? (E.63.e)

Material C

27. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing it

      • I clicked on the link provided

      • I shared it on social media

      • I thought about the issue

      • I talked with a friend or family member about the information

      • I modified my alcohol consumption

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify my alcohol consumption

    • I would talk with my doctor about this information

    • Other: (please explain)

28. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me
I learned something new by reading this (E.55.e)
The message was dumb (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

34. What other comments or questions do you have about this graphic? (E.63.e)

Material D

35. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing this ad

      • I clicked on a link provided

      • I shared the graphic on social media

      • I thought about the issue

      • I talked with a family member about the information

      • I talked with a friend about the information

      • I modified the amount of physical activity I get

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify the amount of physical activity I get

    • I would talk with my doctor about this information

    • Other: (please explain)

36. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me
I learned something new by reading this (E.55.e)
The message was dumb (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

42. What other comments or questions do you have about this graphic? (E.63.e)

Material E

43. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing this ad

      • I clicked on a link provided

      • I shared the graphic on social media

      • I thought about the issue

      • I talked with a friend or family member about the information

      • I modified my behavior related to breastfeeding

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify my behavior related to breastfeeding

    • I would talk with my doctor about this information

    • Other: (please explain)

44. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me
I learned something new by reading this (E.55.e)
The message was dumb (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

50. What other comments or questions do you have about this graphic? (E.63.e)

Q1 – ‘No’ responses (Respondents will be shown a subset of materials F, G, H, and I based on their self-selected racial/ethnic identity. No single respondent will be shown all four videos. Rather, a single respondent will be shown one 15 second video and one 2.5 minute video.)

Material F –Marleah video

17. Do you remember seeing this video before? (123d.)

• Yes

• No

• IF YES

  1. Please indicate any actions you took after seeing this video (check all that apply)

• I did not take any action

• I ‘liked’ it on social media

• I shared it with others on social media

• I thought about the issue

• I talked with a family member about the information

• I talked with a friend about the information

• I took steps to learn my family history of cancer

• I talked with my doctor about this information

• Other: (please explain)

• IF NO

2. Please indicate any actions you would take after seeing this graphic (check all that apply)

• I would not take any action

• I would ‘liked’ it on social media

• I would share it with others on social media

• I would think about the issue

• I would talk with a family member about the information

• I would talk with a friend about the information

• I would take steps to learn my family history of cancer

• I would talk with my doctor about this information

• Other: (please explain)

17. Were there parts of the video that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

17. Does it seem like this video is talking to you, and people like you?

• Yes

• No

Why or why not?

Please select the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This video grabbed my attention (71e.)
This video told me something I didn’t already know (72e.)
I do not like this video (76e.)
I liked the person in this video (27e.)
I am interested in this video’s topic (36e.)
I trust the information in this video (42e.)

17. Did this video suggest any action(s) you should take?

• Yes

• No

If yes: What action(s) did it suggest you take?

17. What other comments or questions do you have about this video? (E.63.e)

Material G –Carletta video

17. Do you remember seeing this video before? (123d.)

• Yes

• No

• IF YES

  1. Please indicate any actions you took after seeing this video (check all that apply)

• I did not take any action

• I ‘liked’ it on social media

• I shared it with others on social media

• I thought about the issue

• I talked with a family member about the information

• I talked with a friend about the information

• I took steps to learn my family history of cancer

• I talked with my doctor about this information

• Other: (please explain)

• IF NO

2. Please indicate any actions you would take after seeing this graphic (check all that apply)

• I would not take any action

• I would ‘liked’ it on social media

• I would share it with others on social media

• I would think about the issue

• I would talk with a family member about the information

• I would talk with a friend about the information

• I would take steps to learn my family history of cancer

• I would talk with my doctor about this information

• Other: (please explain)

17. Were there parts of the video that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

17. Does it seem like this video is talking to you, and people like you?

• Yes

• No

Why or why not?

Please select the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This video grabbed my attention (71e.)
This video told me something I didn’t already know (72e.)
I do not like this video (76e.)
I liked the person in this video (27e.)
I am interested in this video’s topic (36e.)
I trust the information in this video (42e.)

17. Did this video suggest any action(s) you should take?

• Yes

• No

If yes: What action(s) did it suggest you take?

17. What other comments or questions do you have about this video? (E.63.e)

Material H – Charity video

17. After seeing this video, I would (check all that apply)

• Not take any action

• Click on the link provided

• Share it on social media

• Think about the issue

• Talk with a family member about the information

• Talk with a friend about the information

• Take steps to learn my risk of breast cancer

• Look up information on BRCA mutations

• Look up information on breast cancer in young women

• Learn ways to reduce my risk of breast cancer

• Talk with my doctor about this information

• Other: (please explain)

17. Were there parts of the video that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

17. Does it seem like this video is talking to you, and people like you?

• Yes

• No

Why or why not?

17. What do you think about the length of the video?

• Too long

• Too short

• Just right

Please select the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This video grabbed my attention (71e.)	1	2	3	4	5
This video told me something I didn’t already know (72e.)	1	2	3	4	5
I do not like this video (76e.)	1	2	3	4	5
I liked the person in this video (27e.)	1	2	3	4	5
I am interested in this video’s topic (36e.)	1	2	3	4	5
I trust the information in this video (42e.)	1	2	3	4	5

17. Did this video suggest any action(s) you should take?

• Yes

• No

If yes: What action(s) did it suggest you take?

17. What other comments would you like to make about this video?

Material I – Caroline/Emily video

17. After seeing this video, I would (check all that apply)

• Not take any action

• Click on the link provided

• Share it on social media

• Think about the issue

• Talk with a family member about the information

• Talk with a friend about the information

• Take steps to learn my risk of breast cancer

• Look up information on BRCA mutations

• Look up information on breast cancer in young women

• Learn ways to reduce my risk of breast cancer

• Talk with my doctor about this information

• Other: (please explain)

17. Were there parts of the video that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

17. Does it seem like this video is talking to you, and people like you?

• Yes

• No

Why or why not?

17. What do you think about the length of the video?

• Too long

• Too short

• Just right

Please select the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This video grabbed my attention (71e.)	1	2	3	4	5
This video told me something I didn’t already know (72e.)	1	2	3	4	5
I do not like this video (76e.)	1	2	3	4	5
I liked the women in this video (27e.)	1	2	3	4	5
I am interested in this video’s topic (36e.)	1	2	3	4	5
I trust the information in this video (42e.)	1	2	3	4	5

17. Did this video suggest any action(s) you should take?

• Yes

• No

If yes: What action(s) did it suggest you take?

17. What other comments would you like to make about this video?

Material B

51. Do you remember seeing this graphic before? (123d.)

• Yes

• No

• IF YES

  1. Please indicate any actions you took after seeing this graphic (check all that apply)

• I did not take any action after seeing this graphic

• I ‘liked’ it on social media

• I shared it with others on social media

• I thought about the issue

• I talked with a family member about the information

• I talked with a friend about the information

• I took steps to learn my family history of cancer

• I talked with my doctor about this information

• Other: (please explain)

• IF NO

2. Please indicate any actions you would take after seeing this graphic (check all that apply)

• I would not take any action

• I would ‘liked’ it on social media

• I would share it with others on social media

• I would think about the issue

• I would talk with a family member about the information

• I would talk with a friend about the information

• I would take steps to learn my family history of cancer

• I would talk with my doctor about this information

• Other: (please explain)

52. How much of the graphic would you read? Please choose all that apply. (37d.)

• I would only read the headline

• I would only look at the image/s

• I would only read the headline and look at the image/s

• I would read the whole thing

• I wouldn’t read any of it

53. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me.
I learned something new by reading this (E.55.e)
The message was dumb. (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

59. What other comments or questions do you have about this graphic? (E.63.e)

Material C

60. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing it

      • I clicked on the link provided

      • I shared it on social media

      • I thought about the issue

      • I talked with a friend or family member about the information

      • I modified my alcohol consumption

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify my alcohol consumption

    • I would talk with my doctor about this information

    • Other: (please explain)

61. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me
I learned something new by reading this (E.55.e)
The message was dumb (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

67. What other comments or questions do you have about this graphic? (E.63.e)

Material D

68. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing this ad

      • I clicked on a link provided

      • I shared the graphic on social media

      • I thought about the issue

      • I talked with a family member about the information

      • I talked with a friend about the information

      • I modified the amount of physical activity I get

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify the amount of physical activity I get

    • I would talk with my doctor about this information

    • Other: (please explain)

69. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me.
I learned something new by reading this (E.55.e)
The message was dumb. (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

75. What other comments or questions do you have about this graphic? (E.63.e)

Material E

76. Do you remember seeing this graphic before? (123d.)

• Yes

• No

  • IF YES

    • Please indicate any actions you took after seeing this graphic (check all that apply)

      • I did not take any action after seeing this ad

      • I clicked on a link provided

      • I shared the graphic on social media

      • I thought about the issue

      • I talked with a friend or family member about the information

      • I modified my behavior related to breastfeeding

      • I talked with my doctor about this information

      • Other: (please explain)

• IF NO

  • Please indicate any actions you would take after seeing this graphic (check all that apply)

    • I would not take any action after seeing it

    • I would clicked on the link provided

    • I would share it on social media

    • I would think about the issue

    • I would talk with a friend or family member about the information

    • I would modify my behavior related to breastfeeding

    • I would talk with my doctor about this information

    • Other: (please explain)

77. Were there parts of the graphic that were unclear or confusing?

• Yes

• No

If yes, please describe the parts that were confusing or hard to understand:

Please indicate how much you agree or disagree with the following statements about the graphic.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This graphic seems like it’s talking to me and people like me.
I learned something new by reading this (E.55.e)
The message was dumb. (79e.)
I like the way this graphic looks (37e.)
I trust the information in this graphic (42e.)

83. What other comments or questions do you have about this graphic? (E.63.e)

Concluding Questions

1. What types of information would you like to receive regarding breast cancer or breast health, in general?

2. Where do you think the content you have seen in this survey should be posted? Check all that apply.

• Facebook

• Twitter

• Instagram

• Pinterest

• Reddit

• YouTube

• CDC website

• Other

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