Form Screening Protocol Screening Protocol Screening Protocol and Questionnaire

TAB B

Screening Protocol and Questionnaires

Opioid Public Education Program – Screening Protocol

Six focus groups will be conducted in total. Two focus groups will be conducted in each of the following geographic locations: Bedford, NH; Charlestown, WV; and Phoenix, AZ. The screening questionnaire is the same for each location; however, the focus group composition differs between the three locations. All focus groups will be stratified by gender and age with a mix of race/ethnicity, as well as other demographic factors (if possible).

Nine people will be recruited for each focus group in anticipation that 6-8 people will have the availability and/or show up to participate in the focus group. In total, 54 people will need to be recruited (18 from each of the three geographic locations), with anticipation that 12-16 people will show up to participate in the focus groups at each geographic location.

Inclusion Criteria

• Individuals who are between the ages of 18 and 44 years old

• Individuals who have taken and/or been prescribed medication from their doctor in the past three years

• Individuals who strongly/somewhat agree with the following statement, “All medications prescribed by a doctor are safe to use.”

• Individuals who strongly/somewhat agree with the following statement, “If I do not use all of the medication prescribed to me by my doctor, I will keep it in case I need it later.”

Each group will be stratified by age and gender, but those stratifications will differ depending on where the focus group is being conducted (see table 1 for more details).

Additionally, each group needs an overall mix of the following factors (see Table 1):

• Mix of ages within specified age range

• Mix of races/ethnicities

• Mix of education levels

• Mix of individuals with or without children living at home with them

• Mix of individuals who are and are not caretakers for aging family members

• Mix of income levels

Exclusion Criteria

• Individuals who are age 17 and younger

• Individuals who are age 45 and older

• Individuals who do not provide their race/ethnicity

• Individuals with occupations in the following industries: media, marketing, advertising, healthcare, psychology, psychiatry, pharmaceutical, and rehabilitation

• Individuals who have not taken and/or been prescribed medication from their doctor in the past three years

• Individuals who strongly/somewhat disagree with or are unsure about the following statement, “All medications prescribed by a doctor are safe to use.”

• Individuals who strongly/somewhat disagree with or are unsure about the following statement, “If I do not use all of the medication prescribed to me by my doctor, I will keep it in case I need it later.”

• Individuals who are unsure if they have ever shared a prescription medication with a family member or friend

• Individuals who are unsure if anyone has ever shared a prescription medication with them

• Individuals who have participated in a focus group discussion in the last 12 months

• Individuals who are or have an immediate family member involved in the media or market research

Recruitment Objectives

Bedford, NH: Recruit 9 females between the ages of 18 and 24 and 9 males between the ages of 25 and 34 who are willing and available to participate in a focus group of 120 minutes, preferably in the evening hours. Select a mix of participants based on race/ethnicity, presence of children in the home, education level, caretaker status, and income level.

Charlestown, WV: Recruit 9 females between the ages of 35 and 44 and 9 males between the ages of 18 and 24 who are willing and available to participate in a focus group of 120 minutes, preferably in the evening hours. Select a mix of participants based on race/ethnicity, presence of children in the home, education level, caretaker status, and income level.

Phoenix, AZ: Recruit 9 females between the ages of 25 and 34 and 9 males between the ages of 35 and 44. Select a mix of participants based on race/ethnicity, presence of children in the home, education level, caretaker status, and income level.

All participants must have been prescribed a medication by a doctor in the past three years and must strongly/somewhat agree with the following statements:

1. All medications prescribed by a doctor are safe to use.

2. If I do not use all of the medication prescribed to me by my doctor, I will keep it in case I need it later.

Table 1. Focus Group Stratification

	FG1	FG2	FG3	FG4	FG5	FG6
Characteristics							TOTAL
Geographic Location
Bedford, NH	9	9	-	-	-	-	18
Charlestown, WV	-	-	9	9	-	-	18
Phoenix, AZ	-	-	-	-	9	9	18
Gender
Female	9	-	9	-	9	-	27
Male	-	9	-	9	-	9	27
Age
18-20	5	-	-	5	-	-	10
21-24	4	-	-	4	-	-	8
25-29	-	5	-	-	5	-	10
30-34	-	4	-	-	4	-	8
35-39	-	-	5	-	-	5	10
40-44	-	-	4	-	-	4	8
Race/Ethnicity
American Indian/Native American	Hispanic/Latino		Attempt a mix per group
Asian/Pacific Islander
Black/African American
White
Presence of children in the home
Yes	Attempt a mix per group
No
Education Level
Some high school or less	Attempt a mix per group
High school or equivalent
Some college but no degree
Associate’s degree/ Trade school degree
Bachelor’s degree
Graduate degree
Doctorate degree
Marital Status
Married	Attempt a mix per group
Living with partner/significant other
Single, never married
Separated or divorced
Widowed
Employment Status
Employed full-time	Attempt a mix per group
Employed part-time
Self-employed
Student
Retired
Not employed/ Homemaker
Caretaker Status
Yes	Attempt a mix per group
No
Income Level
Below $25,000	Attempt a mix per group
Between $25,000-50,000
Between $50,000-75,000
Between $75,000-100,000
More than $100,000

Opioid Public Education Program

Recruitment Screener

Bedford, NH

Hello.  My name is _________ and I work with Lake Research. We are working with a federal health agency to gather information that will be used to help create a national program. We are conducting focus groups in the local Bedford, NH area during the week of March XX-XX, 2018.

1. Would you be interested in participating in this focus group?

• Yes

• No [TERMINATE: Thank you very much for your time. Have a good day/evening, goodbye.]

2. Are you available to participate in a 120-minute session in Bedford, NH during the week of March XX-XX, 2018?

• Yes

• No [TERMINATE: Based on your availability, we cannot include you this time. Thank you for your interest. Have a good day/evening, goodbye.]

I am going to ask you some questions to determine whether you are eligible to participate in the focus group.

*TERMINATION SCRIPT: “We appreciate your willingness to answer each of the questions. Unfortunately, one of your answers does not meet our requirements for participation in the group session. Thank you for your time.”

3. [DO NOT ASK -- BUT RECORD GENDER]

• Male [GROUP 2]

• Female [GROUP 1]

4. What is your age? [Do not read age range options. Wait for response and circle the appropriate age range below.]

• 17 years old or younger [TERMINATE]

• 18-20 years [GROUP 1]

• 21-24 years [GROUP 1]

• 25-29 years [GROUP 2]

• 30-34 years [GROUP 2]

• 35-39 years [TERMINATE]

• 40-44 years [TERMINATE]

• Over 45 years [TERMINATE]

5. In the past three years, have you traveled outside or been in contact with someone who has traveled outside of the United States?

• Yes

• No

6. In the past three years, have you been involved with or the victim of gun violence?

• Yes

• No

7. In the past three years, have you been affected by severe weather or a natural disaster?

• Yes

• No

8. In the past three years, have you taken and/or been prescribed medication from your doctor?

• Yes

• No [TERMINATE]

9. In the past three years, have you driven a car on an interstate highway?

• Yes

• No

10. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: All medications prescribed by a doctor are safe to use.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

11. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: If I do not use all of the medication prescribed to me by my doctor I will keep it in case I need it later.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

12. And just to make sure we have a representative sample, can I ask you a couple of questions about your race and ethnicity?

• Yes

• No

• Refuse to answer

12a. Are you of Hispanic or Latino origin?

• Yes

• No

12b. What is your race(s)?

• American Indian/Alaska Native

• Asian/Pacific Islander

• Black/African American

• White

13. Do you have any children living at home with you? [Wait for response and circle option below.]

[RECRUIT A MIX]

• Yes

• No

*[IF = YES, HAVE KIDS] How old are your children? [RECORD VERBATIM]

14. Do you have any aging family members who you act as a caretaker for? [Wait for response and circle answer below.]

[RECRUIT A MIX]

• Yes

• No

15. What is the highest level of education you've completed? [Wait for response and circle appropriate option below. Read options and clarify as necessary.]

[RECRUIT A MIX]

• Some high school or less

• High school or equivalent

• Some college, but no degree

• Associate's degree / Trade school degree

• Bachelor's degree

• Graduate degree 

• Doctorate degree 

16. Which of the following best describes your current employment status? [Select one.]

[RECRUIT A MIX]

• Employed full-time

• Employed part-time

• Self-employed

• Student

• Retired

• Not employed

17. What is your occupation? [TERMINATE: members of the media, marketing, advertising, healthcare professionals (like doctors, nurses, hospital administration), psychiatrists, pharmacists, pharmaceutical reps, rehab workers]

18. Which of the following best describes your marital status? [Select one.]

[RECRUIT A MIX]

• Married

• Living with partner/significant other

• Single, never married

• Separated or divorced

• Widowed

19. Have you ever shared your prescription medication with a family member or friend? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

20. Has anyone ever shared their prescription medication with you? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

21. In your opinion, which of the following do you believe is the primary reason wealthy Americans have achieved financial success?

 Statement 1: They were born into wealthy families or had more opportunities than others.

 Statement 2: They worked harder than most others to be successful.

22. If [Statement 1 OR 2], do you feel that way strongly or not so strongly?

• Strongly

• Not so strongly

23. Would you strongly favor, somewhat favor, somewhat oppose, or strongly oppose creating a process to attain citizenship for immigrants who are in the United States without documentation?

• Strongly favor

• Somewhat favor

• Somewhat oppose

• Strongly oppose

24. In which of the following ranges does your total annual household income fall before taxes? [Select one.]

[RECRUIT A MIX]

• Below $25,000

• Between $25,000 and $50,000

• Between $50,000 and $75,000

• Between $75,000 and $100,000

• More than $100,000

• Don’t know/refused [SEE NOTE]

NOTE: If refused, ask “Could you tell me if your annual household income is below or above 50 thousand dollars?”

25. Have you participated in a focus group discussion in the last 12 months?

• Yes [TERMINATE]

• No

26. Are you or is any immediate family member involved in the media or market research?

• Yes [TERMINATE]

• No

Opioid Public Education Program

Recruitment Screener

Charlestown, WV

Hello.  My name is _________ and I work with Lake Research. We are working with a federal health agency to gather information that will be used to help create a national program. We are conducting focus groups in the local Charlestown, WV area during the week of March XX-XX, 2018.

1. Would you be interested in participating in this focus group?

• Yes

• No [TERMINATE: Thank you very much for your time. Have a good day/evening, goodbye.]

2. Are you available to participate in a 120-minute session in Charlestown, WV during the week of March XX-XX, 2018?

• Yes

• No [TERMINATE: Based on your availability, we cannot include you this time. Thank you for your interest. Have a good day/evening, goodbye.]

I am going to ask you some questions to determine whether you are eligible to participate in the focus groups.

*TERMINATION SCRIPT: “We appreciate your willingness to answer each of the questions. Unfortunately, one of your answers does not meet our requirements for participation in the group session. Thank you for your time.”

3. [DO NOT ASK -- BUT RECORD GENDER]

• Male [GROUP 4]

• Female [GROUP 3]

4. What is your age? [Do not read age range options. Wait for response and circle the appropriate age range below.]

• 17 years old or younger [TERMINATE]

• 18-20 years [GROUP 4]

• 21-24 years [GROUP 4]

• 25-29 years [TERMINATE]

• 30-34 years [TERMINATE]

• 35-39 years [GROUP 3]

• 40-44 years [GROUP 3]

• Over 45 years [TERMINATE]

5. In the past three years, have you traveled outside or been in contact with someone who has traveled outside of the United States?

• Yes

• No

6. In the past three years, have you been involved with or the victim of gun violence?

• Yes

• No

7. In the past three years, have you been affected by severe weather or a natural disaster?

• Yes

• No

8. In the past three years, have you taken and/or been prescribed medication from your doctor?

• Yes

• No [TERMINATE]

9. In the past three years, have you driven a car on an interstate highway?

• Yes

• No

10. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: All medications prescribed by a doctor are safe to use.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

11. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: If I do not use all of the medication prescribed to me by my doctor I will keep it in case I need it later.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

12. And just to make sure we have a representative sample, can I ask you a couple of questions about your race and ethnicity?

• Yes

• No

• Refuse to answer

12a. Are you of Hispanic or Latino origin?

• Yes

• No

12b. What is your race(s)?

• American Indian/Alaska Native

• Asian/Pacific Islander

• Black/African American

• White

13. Do you have any children living at home with you? [Wait for response and circle option below.]

[RECRUIT A MIX]

• Yes

• No

*[IF = YES, HAVE KIDS] How old are your children? [RECORD VERBATIM]

14. Do you have any aging family members who you act as a caretaker for? [Wait for response and circle answer below.]

[RECRUIT A MIX]

• Yes

• No

15. What is the highest level of education you've completed? [Wait for response and circle appropriate option below. Read options and clarify as necessary.]

[RECRUIT A MIX]

• Some high school or less

• High school or equivalent

• Some college, but no degree

• Associate's degree / Trade school degree

• Bachelor's degree

• Graduate degree 

• Doctorate degree 

16. Which of the following best describes your current employment status? [Select one.]

[RECRUIT A MIX]

• Employed full-time

• Employed part-time

• Self-employed

• Student

• Retired

• Not employed

17. What is your occupation? [TERMINATE: members of the media, marketing, advertising, healthcare professionals (like doctors, nurses, hospital administration), psychiatrists, pharmacists, pharmaceutical reps, rehab workers]

18. Which of the following best describes your marital status? [Select one.]

[RECRUIT A MIX]

• Married

• Living with partner/significant other

• Single, never married

• Separated or divorced

• Widowed

19. Have you ever shared your prescription medication with a family member or friend? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

20. Has anyone ever shared their prescription medication with you? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

21. In your opinion, which of the following do you believe is the primary reason wealthy Americans have achieved financial success?

 Statement 1: They were born into wealthy families or had more opportunities than others.

 Statement 2: They worked harder than most others to be successful.

22. If [Statement 1 OR 2], do you feel that way strongly or not so strongly?

• Strongly

• Not so strongly

23. Would you strongly favor, somewhat favor, somewhat oppose, or strongly oppose creating a process to attain citizenship for immigrants who are in the United States without documentation?

• Strongly favor

• Somewhat favor

• Somewhat oppose

• Strongly oppose

24. In which of the following ranges does your total annual household income fall before taxes? [Select one.]

[RECRUIT A MIX]

• Below $25,000

• Between $25,000 and $50,000

• Between $50,000 and $75,000

• Between $75,000 and $100,000

• More than $100,000

• Don’t know/refused [SEE NOTE]

NOTE: If refused, ask “Could you tell me if your annual household income is below or above 50 thousand dollars?”

25. Have you participated in a focus group discussion in the last 12 months?

• Yes [TERMINATE]

• No

26. Are you or is any immediate family member involved in the media or market research?

• Yes [TERMINATE]

• No

Opioid Public Education Program

Recruitment Screener

Phoenix, AZ

Hello.  My name is _________ and I work with Lake Research. We are working with a federal health agency to gather information that will be used to help create a national program. We are conducting focus groups in the local Phoenix, AZ area during the week of March XX-XX, 2018.

1. Would you be interested in participating in this focus group?

• Yes

• No [TERMINATE: Thank you very much for your time. Have a good day/evening, goodbye.]

2. Are you available to participate in a 120-minute session in Phoenix, AZ during the week of March XX-XX, 2018?

• Yes

• No [TERMINATE: Based on your availability, we cannot include you this time. Thank you for your interest. Have a good day/evening, goodbye.]

I am going to ask you some questions to determine whether you are eligible to participate in the focus group.

*TERMINATION SCRIPT: “We appreciate your willingness to answer each of the questions. Unfortunately, one of your answers does not meet our requirements for participation in the group session. Thank you for your time.”

3. [DO NOT ASK -- BUT RECORD GENDER]

• Male [GROUP 2]

• Female [GROUP 1]

4. What is your age? [Do not read age range options. Wait for response and circle the appropriate age range below.]

• 17 years old or younger [TERMINATE]

• 18-20 years [TERMINATE]

• 21-24 years [TERMINATE]

• 25-29 years [GROUP 5]

• 30-34 years [GROUP 5]

• 35-39 years [GROUP 6]

• 40-44 years [GROUP 6]

• Over 45 years [TERMINATE]

5. In the past three years, have you traveled outside or been in contact with someone who has traveled outside of the United States?

• Yes

• No

6. In the past three years, have you been involved with or the victim of gun violence?

• Yes

• No

7. In the past three years, have you been affected by severe weather or a natural disaster?

• Yes

• No

8. In the past three years, have you taken and/or been prescribed medication from your doctor?

• Yes

• No [TERMINATE]

9. In the past three years, have you driven a car on an interstate highway?

• Yes

• No

10. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: All medications prescribed by a doctor are safe to use.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

11. Now I’m going to read you a statement and I’d like you to tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it: If I do not use all of the medication prescribed to me by my doctor I will keep it in case I need it later.

• Strongly agree

• Somewhat agree

• Somewhat disagree [TERMINATE]

• Strongly disagree [TERMINATE]

• Not sure [TERMINATE]

12. And just to make sure we have a representative sample, can I ask you a couple of questions about your race and ethnicity?

• Yes

• No

• Refuse to answer

12a. Are you of Hispanic or Latino origin?

• Yes

• No

12b. What is your race(s)?

• American Indian/Alaska Native

• Asian/Pacific Islander

• Black/African American

• White

13. Do you have any children living at home with you? [Wait for response and circle option below.]

[RECRUIT A MIX]

• Yes

• No

*[IF = YES, HAVE KIDS] How old are your children? [RECORD VERBATIM]

14. Do you have any aging family members who you act as a caretaker for? [Wait for response and circle answer below.]

[RECRUIT A MIX]

• Yes

• No

15. What is the highest level of education you've completed? [Wait for response and circle appropriate option below. Read options and clarify as necessary.]

[RECRUIT A MIX]

• Some high school or less

• High school or equivalent

• Some college, but no degree

• Associate's degree / Trade school degree

• Bachelor's degree

• Graduate degree 

• Doctorate degree 

16. Which of the following best describes your current employment status? [Select one.]

[RECRUIT A MIX]

• Employed full-time

• Employed part-time

• Self-employed

• Student

• Retired

• Not employed

17. What is your occupation? [TERMINATE: members of the media, marketing, advertising, healthcare professionals (like doctors, nurses, hospital administration), psychiatrists, pharmacists, pharmaceutical reps, rehab workers]

18. Which of the following best describes your marital status? [Select one.]

[RECRUIT A MIX]

• Married

• Living with partner/significant other

• Single, never married

• Separated or divorced

• Widowed

19. Have you ever shared your prescription medication with a family member or friend? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

20. Has anyone ever shared their prescription medication with you? [Select one.]

• Yes

• No

• Not sure [TERMINATE]

21. In your opinion, which of the following do you believe is the primary reason wealthy Americans have achieved financial success?

 Statement 1: They were born into wealthy families or had more opportunities than others.

 Statement 2: They worked harder than most others to be successful.

22. If [Statement 1 OR 2], do you feel that way strongly or not so strongly?

• Strongly

• Not so strongly

23. Would you strongly favor, somewhat favor, somewhat oppose, or strongly oppose creating a process to attain citizenship for immigrants who are in the United States without documentation?

• Strongly favor

• Somewhat favor

• Somewhat oppose

• Strongly oppose

24. In which of the following ranges does your total annual household income fall before taxes? [Select one.]

[RECRUIT A MIX]

• Below $25,000

• Between $25,000 and $50,000

• Between $50,000 and $75,000

• Between $75,000 and $100,000

• More than $100,000

• Don’t know/refused [SEE NOTE]

NOTE: If refused, ask “Could you tell me if your annual household income is below or above 50 thousand dollars?”

25. Have you participated in a focus group discussion in the last 12 months?

• Yes [TERMINATE]

• No

26. Are you or is any immediate family member involved in the media or market research?

• Yes [TERMINATE]

• No

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