Form NHTSA Form 1272 NHTSA Form 1272 Survey for Child Passenger Safety

OMB Control No 2127-0682

Expiration Date 04/30/2018

Survey for Child Passenger Safety Public Service Advertising Campaign

[INTRODUCTION] Thank you for agreeing to participate in this online study. The survey will take about 10-15 minutes to complete. All responses are anonymous and will only be viewed in aggregate.

This study is being conducted on behalf of the National Highway Traffic Safety Administration (NHTSA). Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. The OMB control number for this study is 2127-0682. This survey is voluntary. We will not collect any personal information that would allow anyone to identify you. Any information you do provide will be kept private to the fullest extent of the law.

1. We are looking for people who work in certain occupations and industries. Do you or does anyone in your household work in any of the following occupations or industries? (Please select all that apply).

1. Market Research

2. Advertising Agency / Public Relations

3. Marketing

4. Automobile manufacturing or sales

5. Manufacturer, Distributor or Seller of household paper products

6. A company that supplies or sells telephone, cellular or Internet services

7. Insurance

8. Banking

9. None of these

IF “MARKET RESEARCH” OR “ADVERTISING AGENCY / PUBLIC RELATIONS” OR “MARKETING” OR “Automobile manufacturing or sales” THEN TERMINATE, OTHERWISE CONTINUE

2. Are you the parent or guardian of any children under the age of 18 who are living in your household?

1. Yes [GO TO Q2a.]

2. No [SKIP TO Q3]

2a. How old are your children? (Select all that apply)
MULTIPLE RESPONSE

1. 0-12 months [CONTINUE TO Q4]

2. 1-3 years [CONTINUE TO Q4]

3. 4-7 years [CONTINUE TO Q4]

4. 8-12 years [CONTINUE TO Q4]

5. 13 years or older [TERMINATE IF ONLY SELECTION CHECKED]

IF CHILD AGE “0-12 MONTHS”, “1-3 YEARS”, “4-7 YEARS”, OR “8-12 YEARS” CHECKED, THEN CONTINUE; IF “13 YEARS OR OLDER” IS THE ONLY SELECTION CHECKED, TERMINATE.

3. Do you look after children for family or friends for three or more days per week regularly?

1. Yes [CONTINUE TO Q3a]

2. No [TERMINATE]

3a. How old are the children you care for? (Select all that apply)
MULTIPLE RESPONSE

1. 0-12 months

2. 1-3 years

3. 4-7 years

4. 8-12 years

5. 13 years or older [TERMINATE IF ONLY SELECTION CHECKED]

IF CHILD AGE “0-12 MONTHS”, “1-3 YEARS”, “4-7 YEARS”, OR “8-12 YEARS” CHECKED, THEN CONTINUE; IF “13 YEARS OR OLDER” IS THE ONLY SELECTION CHECKED, TERMINATE.

4. What is your gender?

1. Male

2. Female

RECRUIT 55% FEMALE, 45% MALE

5. What is your age? _________ PROGRAMMER NOTE: MUST BE 18+

1. 18-24 years

2. 25-34 years

3. 35-44 years

4. 45-54 years

5. 55+ years

6. Refused [TERMINATE]

6. Are you of Hispanic or Latino descent?

1. Yes

2. No

7. Select one or more of the following that best describes your race?

(ACCEPT MULTIPLE RESPONSES)

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

PLEASE ADD THE FOLLOWING DUMMY VARIABLE (ETHNICITY):

• CAUCASIAN = SELECTED WHITE AT Q7:

• AFRICAN AMERICAN = SELECTED BLACK OR AFRICAN-AMERICAN AT Q7

• ASIAN/OTHER = SELECTED ONE OF THE FOLLOWING AT Q7

  • ASIAN

  • NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

  • AMERICAN INDIAN OR ALASKA NATIVE

  • OTHER

• HISPANIC = SELECTED YES AT Q6

CHECK ETHNICITY QUOTAS. IF OPEN, CONTINUE. OTHERWISE TERMINATE

8. What is the highest level of education that you have completed? ACCEPT ONE

1. 8^th grade or below

2. 9th grade to 11th grade

3. High school graduate

4. Some college

5. Associate's degree

6. Bachelor's degree

7. Some postgraduate study

8. Graduate school degree

9. Trade school

10. None of the above/ Prefer not to state

9. Which classification best describes your total pre-tax household income? [*Add popup option: “Why do we ask this question?”] ACCEPT ONE

1. Under $10,000

2. $10,000-$19,999

3. $20,000-$29,999

4. $30,000-$39,999

5. $40,000-$49,999

6. $50,000-$74,999

7. $75,000-$99,999

8. $100,000-$124,999

9. $125,000-$149,999

10. $150,000-$174,999

11. $175,000-$199,999

12. More than $200,000

13. Prefer not to state

10. Do you live in the city, suburbs, or some other area?

1. City

2. Suburbs

3. Small town

4. Rural community

5. Some other area

CHECK URBANICITY QUOTAS. IF OPEN, CONTINUE. OTHERWISE TERMINATE

PROGRAMMER NOTE: INSTRUCTION 1

[If “Yes” in S2 and ONLY ONE AGE SELECTED in S3:]

“Please answer the rest of this survey with your child age [X] in mind.”

[“X” is the age RANGE of child 0-12 indicated in S3]

[If “Yes” in S2 and MULTIPLE AGES SELECTED in S3:]

“Please answer the rest of this survey with your child age [X] in mind.”

[“X” is the age RANGE of one child 0-12 indicated in S3, randomly selected from all AGES 0-12 indicated in S3]

11. How often do you drive with [your child(ren)/the child(ren) you care for], age [INSERT AGE OF CHILD] in the car?

1. Three days a week or more

2. Less than three days a week [TERMINATE]

3. I do not drive [TERMINATE]

IF “LESS THAN THREE DAYS A WEEK” OR “DO NOT DRIVE” THEN TERMINATE, OTHERWISE CONTINUE

11. How often does your child age [X] currently use each of the following types of passenger safety restraints when he/she is in the car with you? (An example of what each might look like has been provided.) MATRIX – RANDOMIZE

	Always	Sometimes	Never	Not sure
Rear-facing car seat
Forward-facing car seat
Booster Seat
Adult Seat Belt

11. Have you recently seen, heard, or read messages about using child passenger safety restraints in advertising, publicity, the media, the Web or other places? ACCEPT ONE

Yes

No

Not sure

ASK IF YES AT Q13

13a. Where was that…? MATRIX – RANDOMIZE. MUST SELECT EITHER YES OR NO FOR EACH ROW.

	YES	NO
TV program	Yes	No
TV ad	Yes	No
Radio program	Yes	No
Radio commercial	Yes	No
Magazine article	Yes	No
Magazine ad	Yes	No
Newspaper article	Yes	No
Newspaper ad	Yes	No
Website content	Yes	No
Web ad	Yes	No
Outdoor billboards or outdoor posters	Yes	No
From friends or family	Yes	No
Car seat or vehicle owner’s manual	Yes	No
Hospital or physician’s office	Yes	No
Car seat fitting station	Yes	No
Automobile dealer	Yes	No
Some other place	Yes	No

IF SELECTS YES FOR “SOME OTHER PLACE” IN Q12a, ASK FOLLOW UP Q13b:

13b. You mentioned you have recently seen, heard, or read messages about using child passenger safety restraints in some other place. Where was that? OPEN END. NO CODING.

11. In the past year, have you sought information about which car safety restraint to use for your child? ACCEPT ONE

Yes

No

Not sure

ASK IF YES AT Q14

11. Where did you seek information about which car safety restraint to use for your child?

Please list all sources of information below. OPEN END. NO CODING.

11. Have you ever heard of a website called SaferCar.gov/TheRightSeat? ACCEPT ONE

Yes

No

Not sure

PROGRAMMER NOTE: RANDOMIZE ORDER OF AD RECOGNITION QUESTIONS (Q17-24): KEEP TV (Q17-19) AND RADIO (Q20-21) AND BANNER (Q23-Q23a) ADS TOGETHER IN BLOCKS & RANDOMIZE ADS WITHIN BLOCKS

• IF TV AD:  HIDE THE CONTINUE BUTTON FOR 45 SECONDS.  INCLUDE THE FOLLOWING TEXT UNDER THE AUDIO FILE:  Please note that the ‘Continue’ button will appear at the bottom of the screen, once the ad is almost completed. 

• IF radio AD: HIDE THE CONTINUE BUTTON FOR 30 SECONDS. INCLUDE THE FOLLOWING TEXT UNDER THE AUDIO FILE: Please note that the ‘Continue’ button will appear at the bottom of the screen, once the ad is almost completed.

• if PRINT, bAnner, or ooh ad: insert the following text below the image: You may click on the image above to see a larger version of the ads.

Below is a video of a public service ad you might see on TV or some other place. After you view the ad, please indicate if you have seen it before.

[INSERT VIDEO_REAL KNOW IT ALLS :30]

11. Have you seen this ad? ACCEPT ONE

1. Yes

2. No

3. Not sure

[INSERT VIDEO_CHAIRS :30]

11. Have you seen this ad? ACCEPT ONE

Yes

No

Not sure

[INSERT VIDEO_FLASHBACK:30]

11. Have you seen this ad? ACCEPT ONE

Yes

No

Not sure

Below is an audio file of a public service ad you might hear on the radio. After you listen to the ad, please indicate if you have heard it before.

[INSERT AUDIO FILE_BASEBALL :60]

11. Have you heard this ad? ACCEPT ONE

Yes

No

Not sure

[INSERT AUDIO FILE_PARTY :30]

11. Have you heard this ad? ACCEPT ONE

Yes

No

Not sure

11. Have you seen any of these ads in a newspaper or magazine? ACCEPT ONE

[INSERT PRINT AD MONTAGE]

Yes

No

Not sure

11. Have you seen any of these ads online? ACCEPT ONE

[INSERT “OLD” BOTTLE/POPSICLE BANNER AD MONTAGE]

Yes

No

Not sure

23a. Have you seen any of these ads online? ACCEPT ONE

[INSERT “NEW” PENCIL/TOY BANNER AD MONTAGE]

Yes

No

Not sure

11. Have you seen any of these ads someplace, such as on a poster, billboard, or phone kiosk? ACCEPT ONE

[INSERT OUTDOOR AD MONTAGE]

Yes

No

Not sure

The following background questions will help us divide the interviews into groups.

11. What is your marital status? ACCEPT ONE

1. Single (never married)

2. Living together but not married

3. Married

4. Separated

5. Divorced

6. Widowed

7. Prefer not to state

11. What state do you live in?

[DROP-DOWN BOX]

CODE FOR REGION

DROP DOWN LIST - PLEASE ADD TRACKING VARIABLE - LABEL AS “REGION”:

Northeast: Selected Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York Or Pennsylvania

Midwest: Selected Indiana, Illinois, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota Or South Dakota

South: Selected Delaware, Dc, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma Or Texas

West: Selected Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, Wyoming, Alaska, California, Hawaii, Oregon Or Washington

OUTSIDE SAMPLE TERM AND THANK YOU PAGE

Thank you for taking our survey! Those are all of the questions we have for you today. Please click “Continue” to submit your survey.

SAMPLE:

n=1000

GENERAL SPECS

• Adults ages 18+ (balanced across gender)

• Parents/guardians of children ages 0-12 (balanced across age and gender)

• Must own or have access to a car and drive with child at least once per week

• Match U.S. Census on: HH income, Census region, and Ethnicity

QUOTAS:

		QUOTAS
		Boys	Girls
Total		500	500
Age Of Child (Q2, Q3)	Ages 0-12 months old	125	125
	Ages 1-3 years old	125	125
	Ages 4-7 years old	125	125
	Ages 8-12 years old	125	125
Parent Gender (Q4)	Male	445
	Female	555
HH Income (Q9)	< $49,999	445
	$50,000 +	500
	Prefer not to answer	75
Urbanicity (Q10)	City	285
	Suburbs	555
	Other	160
Region (Q26) Ethnicity (Q6,7)	Northeast	Total n=180
		Caucasian	128
		African American	18
		Hispanic	23
		Asian/Other	11
	Midwest	Total n=225
		Caucasian	177
		African American	23
		Hispanic	15
		Asian/Other	10
	South	Total n=370
		Caucasian	236
		African American	64
		Hispanic	54
		Asian/Other	16
	West	Total n=225
		Caucasian	135
		African American	12
		Hispanic	52
		Asian/Other	26

NHTSA Form 1272 Page 22