Screeners

NSDUH Main Study Pretest_PDF 1_Attachments A B C.pdf

National Survey on Drug Use and Health: Methodological Field Tests

Screeners

OMB: 0930-0290

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0930-0290 can be found here:

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NSDUH Main Study Pretest
Attachment A – Recruitment Flyers

Attachment 1 – Recruitment Advertisements
Possible Adult Criteria:
•
•
•
•
•
•
•
•
•

Recent history of vaping or e-cigarette use
Recent history of marijuana use, including medical marijuana use
Recent history of opioid use including pain relievers, heroin, or fentanyl
Recent pain issues
Recent sleep issues
Have been in drug or alcohol treatment in the past year
Have been in mental health treatment in the past year
Have received detox or medication assisted treatment for alcohol or drug use in the past year
Have ever been incarcerated

Possible Adolescent/Parent Criteria:
• Recent history of vaping or e-cigarette use
• Recent history of marijuana use, including medical marijuana use
• Recent history of opioid use including pain relievers, heroin, or fentanyl
• Recent sleep issues
• Have been in drug or alcohol treatment in the past year
• Have been in mental health treatment in the past year
• Have received detox or medication assisted treatment for alcohol or drug use in the past year

Adult online ad [English only]
*Research Opportunity for Qualified Participants*
RTI International, a not-for-profit research organization, is looking for individuals to provide input on
questions for a national study on alcohol use, drug use, and other health-related issues. We are
interested in interviewing adults (18 and older) who fit ANY of the following criteria:
• [ADULT CRITERIA 1]
• [ADULT CRITERIA 2]
• …
• [ADULT CRITERIA N]
All responses will be kept confidential under federal law. No medical tests or examinations are involved.
Requires about 60-75 minutes. The private interview will be conducted at [LOCATION]. Eligible
participants who complete the interview will receive $40.
To see if you are eligible for the study, please complete a short questionnaire at
www.XXXXXXXX.XXX
Adolescent online ad for vaping [English only]
*Research Opportunity for Youth Age 12 to 17*
RTI International, a not-for-profit research organization, is looking for 12- to 17-year-olds to provide
input on questions for a national study on alcohol use, drug use, and other health-related issues. We are
interested in interviewing 12- to 17-year-olds with a recent history of vaping nicotine, e-juice, or other
substances, using e-cigarettes or other vaping devices.
All responses will be kept confidential under federal law. No medical tests or examinations are involved.
Requires about 60-75 minutes. The private interview will be conducted at [LOCATION]. Eligible
participants who complete the interview will receive $40. A parent must accompany the youth to the
interview.
To see if you are eligible for the study, please complete a short questionnaire at
www.XXXXXXXX.XXX

Parent online ad [English only]
*Attention Parents! Youth Aged 12 to 17 Needed for Study*
RTI International, a not-for-profit research organization, is looking for youth age 12 to 17 to provide
input on survey questions for a national study on alcohol use, drug use, and other health-related issues.
We are interested in interviewing youth age 12 to 17 who fit ANY of the following criteria:
• [PARENT CRITERIA 1]
• [PARENT CRITERIA 2]
• …
• [PARENT CRITERIA N]
First, we need to speak briefly with parents and youth respondents over the phone to determine if the
child is eligible for this study. If your child is eligible, the private interview will be conducted at our
offices in [LOCATION]. A parent must accompany the youth to the interview. Eligible participants who
complete the interview will receive $40. All responses will be kept confidential under federal law. No
medical tests or examinations are involved. Requires about 60-75 minutes.
To see if your child is eligible for the study, call [NAME] at:
[NUMBER]

[ADULT PRINT AD TO BE POSTED/DISTRIBUTED AT TREATMENT FACILITIES, SUPPORT GROUPS, LOCAL
COMMUNITY ORGANIATIONS, CANNBIS DISPENSARIES, PROBATION OFFICERS, AND HALFWAY HOUSES.

*Research Opportunity for Qualified Participants*
RTI International, a not-for-profit research organization, is looking for
individuals to provide input on questions for a national study on alcohol
use, drug use, and other health-related issues. We are interested in
interviewing adults (18 and older) who fit ANY of the following criteria:
• [ADULT CRITERIA 1]
• [ADULT CRITERIA 2]
• …
• [ADULT CRITERIA N]
All responses will be kept confidential under federal law. No medical
tests or examinations are involved. Requires about 60-75 minutes. The
private interview will be conducted at [LOCATION]. Eligible participants
who complete the interview will receive $40.
To see if you are eligible for the study, please complete a short
questionnaire at
www.XXXXXXXX.XXX

[VAPING ONLY PRINT AD TO BE POSTED/DISTRIBUTED TO VAPE SHOPS or COMMUNITY
ORGANIZATIONS]

*Research Opportunity for Qualified Participants
RTI International, a not-for-profit research organization, is looking for
individuals 12 or older to provide input on questions for a national
study on alcohol use, drug use, and other health-related issues. We are
interested in interviewing people who have a recent history of vaping
nicotine, e-juice, or other substances, using e-cigarettes or other
vaping devices.
All responses will be kept confidential under federal law. No medical
tests or examinations are involved. Requires about 60-75 minutes. The
private interview will be conducted at [LOCATION]. Eligible participants
who complete the interview will receive $40.
For participants under 18, parental permission is required, and a parent
must accompany youth to the interview.
To see if you are eligible for the study, please complete a short
questionnaire at
www.XXXXXXXX.XXX

[ADOLESCENT PRINT AD TO BE DISTRIBUTED AT TREATMENT FACILITIES AND SUPPORT GROUPS]

*Research Opportunity for Youth Aged 12 to 17*
RTI International, a not-for-profit research organization, is looking for
youth aged 12 to 17 to provide input on questions for a national study
on alcohol use, drug use, and other health-related issues. We are
interested in interviewing youth who fit ANY of the following criteria:
• [ADOLESCENT CRITERIA 1]
• [ADOLESCENT CRITERIA 2]
• …
• [ADOLESCENT CRITERIA N]
No medical tests or examinations are involved. Requires about 60-75
minutes. The private interview will be conducted at [LOCATION].
Eligible participants who complete the interview will receive $40.
Parental permission is required, and a parent must accompany youth to
the interview. All responses will be kept private under federal law.
To see if you are eligible, call [NAME]:
[NUMBER]
or
1-800-334-8571 ext. [EXTENSION]

[PARENT PRINT AD TO BE POSTED/DISTRIBUTED AT TREATMENT FACILITIES, SUPPORT GROUPS, LOCAL
COMMUNITY ORGANIATIONS, AND CANNBIS DISPENSARIES]

*Attention Parents! Youth Aged 12 to 17 Needed for Study*
RTI International, a not-for-profit research organization, is looking for
youth age 12 to 17 to provide input on questions for a national study on
alcohol use, drug use, and other health-related issues. We are
interested in interviewing youth age 12 to 17 who fit ANY of the
following criteria:
• [PARENT CRITERIA 1]
• [PARENT CRITERIA 2]
• [PARENT CRITERIA 3]
First, we need to speak briefly with parents and youth respondents
over the phone to determine if the child is eligible for this study. If your
child is eligible, the private interview will be conducted at our offices in
[LOCATION]. A parent must accompany the youth to the interview.
Eligible participants who complete the interview will receive $40. All
responses will be kept confidential under federal law. No medical tests
or examinations are involved. Requires about 60-75 minutes.
To see if your child is eligible, call [NAME]:
[NUMBER]
or
1-800-334-8571 ext. [EXTENSION]

NSDUH Main Study Pretest
Attachment B – Web Recruitment Screeners

Web Screener (Adult - all criteria)
INTRO1

We are doing research to improve questions about substance use, including
alcohol and tobacco, issues with pain, issues with sleep, and past alcohol, drug,
and mental health treatment. These questions are used in a large national survey,
called the National Survey on Drug Use and Health, which is given to about
70,000 people every year. The purpose of the study is to get feedback on how
easy or difficult some survey questions are to answer. These questions will be
presented on a laptop computer.
The study is conducted by RTI International and is funded by the Substance
Abuse and Mental Health Services Administration or SAMHSA. The interview
will take about 60 minutes and be conducted at [LOCATION] between [DATE]
and [DATE]. If you qualify and take part in the in-person interview, you will
receive $40 cash.
If you have any questions about the study, you can call Ms. Emily Geisen at 1800-334-8571 ext. 26566. If you have any questions about your rights as a study
participant, you can call RTI's Office of Research Protection at 1-866-214-2043 (a
toll-free number).

[CONTINUE]
NOTICE: Public reporting burden for this collection of information is estimated to average 60 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. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (0930-0290),
Center for Behavioral Health Statistics and Quality; Room 15E57B; 5600 Fishers Lane, Rockville, MD
20857. 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. The OMB control number for this
project is 0930-0290, expiration date 5/31/20.
Instrument Version: 22.XX

INTRO2

information you give us with anyone other than necessary project staff.
If you are eligible for the study, a staff person will call or email you to schedule a
time for the interview.
Do we have your permission to ask you a few questions to determine whether you
are eligible for this study?
1
2

Yes
No [GO TO REFUSAL]

[CONTINUE]
REFUSAL

Thank you for taking the time to answer our questions today.

SOURCE

How did you hear about this study?
1
2
3
4
5
6

AGE*

What is your age?
1
2
3
4
5

GEO*

Treatment Center
Support Group
Craigslist or online ad
Printed flyer in my community
A friend or relative told me about it
Some other way [SPECIFY]

11 or younger [GO TO TERM]
12-17
18-34
35-54
55 or older

In what geographic area do you currently live?
1
2
3
4
5
6
7
8

Raleigh, Durham, Chapel Hill area
Washington, DC metro area
Baltimore, MD metro area
Portland, OR metro area
Chicago, IL metro area
Lincoln, Nebraska
[Houston, TX/Miami/FL or TBD LOCATION FOR SPANISH
INTERVIEWS]
Other [GO TO TERM1]

CIGS

This question is about smoking cigarettes. How long as it been since you last
smoked a cigarette?
1
2
3
4
5

VAPE

This question is about vaping or using an e-cigarette for either nicotine or other
substances. How long as it been since you last vaped or used an e-cigarette?
1
2
3
4
5

VAPEOTH

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
I have never smoked a

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
I have never vaped or used an e-cigarette

[IF VAPE = 2 OR 3] In the past 12 months, when you vaped or used an ecigarette, was it for nicotine only, some other substance (such as e-cig juice, eliquid, or marijuana), or both?
1
2
3

Nicotine only
Other substance only
Both nicotine and another substance

[IF AGE = 2, SKIP TO SLEEP; ELSE CONTINUE]
MARIJU

This question is about marijuana or cannabis products, such as pot, weed, hashish
and concentrates. How long has it been since you last used marijuana or cannabis
products?
1
2
3
4
5

MAJMM

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
I have never used marijuana or cannabis products

[MARIJU = 2-5] Was any of your marijuana use in the past 12 months
recommended by a doctor or other health professional?
1
2

Yes
No

MJTYPE

In the past 12 months, which of the following types of marijuana have you used?
Yes
No
Buds, leaves or stems
Liquid THC, hash oil or concentrates such
as hash, wax, resin, shatter or budder
Edibles or tinctures
Lotions

CBDUSE

In the past 12 months, have you used CBDs, also called cannabidiol?
1
2
3

FENT

Yes
No
Not sure

In the past 12 months, have you used prescription fentanyl?
1 Yes
2 No

RXDRUGS

These questions are about using prescription drugs in any way a doctor did not
direct you to use them.
When you answer this question, please think only about your use of the drug in
any way a doctor did not direct you to use it, including:




Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it

Have you ever, even once, used a prescription pain killer in any way a doctor
did not direct you to use it?
1
2
LAST_RX

Yes
No

[IF RXDRUGS=1] How long has it been since you last used a prescription pain
killer in any way a doctor did not direct you to use it?
1
2
3
4

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago

RXTYPE

[IF LAST_RX = 1 OR 2] In the past 12 months, what prescription pain killers
did you use?
_____________ [ALLOW 500 CHARACTERS]

RXSTIM

Have you ever, even once, used a prescription stimulant in any way a doctor
did not direct you to use it?
1
2

LAST_ST

[IF RXSTIM=1] How long has it been since you last used a prescription
stimulant in any way a doctor did not direct you to use it?
1
2
3
4

HEROIN

Yes
No

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago

In the past 12 months, have you used heroin or fentanyl (without a prescription)?
1 Yes
2 No

ALTX

The next questions are about treatment you may have received. In the past 12
months, have you received treatment for your alcohol use?
1
2

DRTX

In the past 12 months, have you received treatment for your drug use?
1
2

MHTX

Yes
No

In the past 12 months, have you received treatment for your mental health?
1
2

JAIL

Yes
No

In the past 12 months, have you been in jail, prison or a juvenile detention
center?
1

Yes

2
PAIN

This question is about experiencing physical pain. In the past 3 months, how
often did you have pain?
1
2
3
4

SLEEP

Never
Some days
Most days
Every day

This question is about your sleep. During the past 30 days, on how many nights
did you have problems falling asleep or waking up before you wanted to?
________ Nights

SEX

Are you male or female?
1
2

EDUC

What is highest grade or year of school you have completed?
1
2
3
4
5
6

HISP

Yes
No

Which of these groups describes you? Select all that apply.
1
2
3
4
5
6

RACE2

High school or less
High school diploma or GED
Some college, but no degree
Associate’s Degree (for example, A.A., A.S)
Bachelor’s Degree (B.A., B.S.)
Graduate Degree (for example, MA, MS, PhD, JD, MD, DDS)

Are you of Hispanic, Latino, or Spanish origin?
1
2

RACE

Male
Female

White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other

[IF RACE=6] Please describe your other race.

_____________________________________
LANG

What is your primary language?
1
2
3

LANG2

English
Spanish
Other

[IF LANG=3] What is your primary language?
______________________________________

BLIND

Are you blind or do you have serious difficulty seeing?
1
2

Yes
No

DEAF

Are you deaf or do you have serious difficulty hearing?
1
Yes
2
No

TERM

[IF AGE=1 OR GEO=7] Thank you, but you are not eligible to participate in this
study.

THANK

[IF AGE = 3-5] Thank you! We will review your responses to see if you are
eligible for this study. If you are eligible to participate in the study and we are still
recruiting participants, we will contact you within 2 weeks to schedule an
interview. The interview will last about 60-75 minutes and you will receive $40 in
cash.
Please provide your contact information on the following screens. When we
contact you, we will only say that we are contacting you about a health study for
RTI International.

THANK2

[IF AGE = 2] Thank you! We will review your responses to see if you are eligible
for this study. If you are eligible to participate in the study and we are still
recruiting participants, we will contact you within 2 weeks to schedule an
interview. The interview will last about 60 minutes and you will receive $40 in
cash.
Before we can schedule an interview, we must speak with a parent or guardian to
describe the purpose of the study. A parent will also need to accompany you to

the interview.
Your answers to these questions will be kept private and will not be shared with
your parent. We will only tell them:
•
•
•
•

That their child responded to an advertisement we placed for research
participants between the ages of 12 and 17.
The purpose of the study is to get feedback on how easy or difficult
different questions about tobacco and nicotine are to answer. Respondents
do not need to have used tobacco or nicotine to participate.
We are doing this research to improve the questions about tobacco and
nicotine used in a large national survey, called the National Survey on
Drug Use and Health, which is given to about 70,000 people every year.
The survey is conducted by RTI International and is funded by the
Substance Abuse and Mental Health Services Administration or
SAMHSA.

On the next screens, we will ask for your contact information.
NAME

Please provide your first name or a nickname.
NAME: _______________________________

PARENT

[IF AGE = 2] Please provide your parent(s) first name.
NAME: _______________________________

[IF AGE = 3-5] Please provide an email address where we can contact you about
this study.
__________________________

PHONE

[IF AGE = 3-5] Please provide a phone number where we can contact you about
this study.
PHONE 1: _ _ _ - _ _ _ - _ _ _ _
PHONE 2: _ _ _ - _ _ _ - _ _ _ _

PHONEP

[IF AGE = 2] Please provide a phone number where we can contact your parent to
describe the study and gain permission for you to participate.
PHONE 1: _ _ _ - _ _ _ - _ _ _ _
PHONE 2: _ _ _ - _ _ _ - _ _ _ _

WHEN

[IF AGE = 3-5] What is the best time to contact you?

____________________________________________________________
WHEN2

[IF AGE = 2] What is the best time to contact your parent?
____________________________________________________________
Eligibility Determination

Cigarette users: IF CIGS = 1 OR 2
Vape or e-cig users: IF VAPE = 1 OR 2
Vape or e-cig users for other substances: IF VAPEOTH = 2 OR 3
Marijuana users: IF MARIJU = 1 OR 2
CBD users: IF CBDUSE = 1
Rx opioid users: IF (FENT = 1) OR (LAST_RX = 1 OR 2)
Illicit opioid users: IF (HEROIN = 1 OR 2)
Alcohol treatment: IF ALTX = 1
Drug treatment: IF DRTX = 1
Mental health treatment: IF MHTX = 1
Pain issues: IF PAIN = 2 OR 3 OR 4
Sleep issues: IF SLEEP = >0
Incarceration: IF JAIL = 1
IF BLIND=1 OR DEAF=1, CONTACT RESPONDENT TO CONFIRM WHETHER THIS
WILL BE A PROBLEM

Web Screener (Adolescent - vaping/sleep)
INTRO1

We are doing research to improve questions about substance use, including
alcohol and tobacco, issues with sleep, and past alcohol or drug, treatment. These
questions are used in a large national survey, called the National Survey on Drug
Use and Health, which is given to about 70,000 people every year. The purpose of
the study is to get feedback on how easy or difficult some survey questions are to
answer. These questions will be presented on a laptop computer.
The study is conducted by RTI International and is funded by the Substance
Abuse and Mental Health Services Administration or SAMHSA. The interview
will take about 60 minutes and be conducted at [LOCATION] between [DATE]
and [DATE]. If you qualify and take part in the in-person interview, you will
receive $40 cash.
If you have any questions about the study, you can call Ms. Emily Geisen at 1800-334-8571 ext. 26566. If you have any questions about your rights as a study
participant, you can call RTI's Office of Research Protection at 1-866-214-2043 (a
toll-free number).

INTRO2

Yes
No [GO TO REFUSAL]

[CONTINUE]

REFUSAL

Thank you for taking the time to answer our questions today.

SOURCE

How did you hear about this study?
1
2
3
4
5
6

AGE*

What is your age?
1
2
3
4
5

GEO*

Treatment Center
Support Group
Craigslist or online ad
Printed flyer in my community
A friend or relative told me
Other [SPECIFY]

11 or younger [GO TO TERM]
12-17
18-34 [ROUTE TO ADULT WEB SCREENER]
35-54 [ROUTE TO ADULT WEB SCREENER]
55 or older [ROUTE TO ADULT WEB SCREENER]

In what geographic area do you currently live?
1
2
3
4
5
6
7
8

CIGS

This question is about smoking cigarettes. How long as it been since you last
smoked a cigarette?
1
2
3
4
5

VAPE

This question is about vaping or using an e-cigarette for either nicotine or other
substances. How long as it been since you last vaped or used an e-cigarette?
1
2
3
4
5

VAPEOTH

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
I have never vaped or used an e-cigarette

[IF VAPE = 2 OR 3] In the past 12 months, when you vaped or used an ecigarette, was it for nicotine only, some other substance (such as e-cig juice, eliquid, or marijuana), or both?
1
2
3

SLEEP

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
I have never smoked a

Nicotine only
Other substance only
Both nicotine and another substance

This question is about your sleep. During the past 30 days, on how many nights
did you have problems falling asleep or waking up before you wanted to?
________ Nights

SEX

Are you male or female?
1
2

HISP

Are you of Hispanic, Latino, or Spanish origin?
1
2

RACE

Male
Female

Yes
No

Which of these groups describes you? Select all that apply.
1
2

White
Black or African American

3
4
5
6

RACE2

American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other

[IF RACE=6] Please describe your other race.
______________________________________

LANG

What is your primary language?
1
2
3

LANG2

English
Spanish
Other

[IF LANG=3] What is your primary language?
______________________________________

BLIND

Are you blind or do you have serious difficulty seeing?
1
2

Yes
No

DEAF

Are you deaf or do you have serious difficulty hearing?
1
Yes
2
No

TERM

[IF AGE=1 OR GEO=7] Thank you, but you are not eligible to participate in this
study.

THANK2

[IF AGE = 2] Thank you! We will review your responses to see if you are eligible
for this study. If you are eligible to participate in the study and we are still
recruiting participants, we will contact you within 2 weeks to schedule an
interview. The interview will last about 60 minutes and you will receive $40 in
cash.
Before we can schedule an interview, we must speak with a parent to describe the
purpose of the study. A parent will also need to accompany you to the interview.

Your answers to these questions will be kept private and will not be shared with
your parent. We will only tell them:
•
•
•
•

On the next screens, we will ask for your contact information.
NAME

Please provide your first name or a nickname.
NAME: _______________________________

PARENT

[IF AGE = 2] Please provide your parent(s) first name.
NAME: _______________________________

[IF AGE = 3-5] Please provide an email address where we can contact you about
this study.
__________________________

PHONE

[IF AGE = 3-5] Please provide a phone number where we can contact you about
this study.
PHONE 1: _ _ _ - _ _ _ - _ _ _ _
PHONE 2: _ _ _ - _ _ _ - _ _ _ _

PHONEP

WHEN

[IF AGE = 3-5] What is the best time to contact you?
____________________________________________________________

WHEN2

[IF AGE = 2] What is the best time to contact your parent?
____________________________________________________________
Eligibility Determination

Cigarette users: IF CIGS = 1 OR 2
Vape or e-cig users: IF VAPE = 1 OR 2
Sleep issues: IF SLEEP = >0
IF BLIND=1 OR DEAF=1, CONTACT RESPONDENT TO CONFIRM WHETHER THIS
WILL BE A PROBLEM

NSDUH Main Study Pretest
Attachment C – Telephone Recruitment
Screener

Telephone Recruitment Screener
INTRO1

SOURCE

My name is _______ from RTI International. I understand that you're calling
about participation in an upcoming study. Is that correct?
1

FOR ADULTS CALLING FOR ADULT INTERVIEWS, THE RECRUITER
SHOULD DIRECT CALLERS TO THE WEB SCREENER OR LOG ONTO
THE WEB SCREENER AND ADMINISTER THE QUESTIONS TO THE
RESPONDENT. THIS WILL ALLOW THE SCREENING INFORMATION
FOR ALL ADULTS TO BE STORED IN THE SAME PLACE.

FOR ADULTS CALLING FOR CHILD, GO TO AVAIL2 ON PAGE 2

FOR ADOLESCENT CALLING FOR SELF, CONTINUE WITH
QUESTIONS BELOW.

OTHER/UNKNOWN, CONTINUE WITH QUESTIONS BELOW

May I ask, how did you hear about this study?
1
2
3
4
5
6

TREATMENT CENTER
SUPPORT GROUP
CRAIGSLIST OR ONLINE AD
PRINTED FLYERS IN COMMUNITY
WORD OF MOUTH
OTHER [SPECIFY]

Let me ask you a few questions about you to see if you are eligible.
AGE

What is your age?
1
2
3
4
5

PARENT

11 OR YOUNGER [GO TO TERM1]
12-17
18-34 [ADMINISTER WEB SCREENER]
35-54 [ADMINISTER WEB SCREENER]
55 OR OLDER [ADMINISTERWEB SCREENER]

Since you are under 18, I will need to talk with a parent and ask them if it is okay
for you to participate. I will describe the study to your parent including the types
of questions that we will ask and what you will need to do to participate. Your
parent will need to tell us if it is okay for you to participate in the study. Your
answers to the questions will remain private and not be shared with your parent or
guardian.
May I speak with your parent now to ask if it is okay for you to participate?

[NOTE: IF A PARENT IS UNAVAILABLE TO PROVIDE CONSENT FOR A
YOUTH INTERVIEW BUT RESIDES IN THE HOUSEHOLD, MARK
PARENT IS UNAVAILABLE (2). IF A PARENT DOES NOT RESIDE IN THE
HOUSEHOLD WITH THE YOUTH (FOR EXAMPLE: A YOUTH AGE 16 OR
YOUNGER LIVING WITH ANOTHER ADULT RELATIVE), ASK TO
SPEAK WITH THE YOUTH’S GUARDIAN (4).
NEVER ATTEMPT TO OBTAIN PERMISSION TO INTERVIEW A YOUTH
FROM ANYONE OTHER THAN A PARENT OR PERSON WHO VERBALLY
CONFIRMS THEIR STATUS AS THE LEGAL GUARDIAN. THIS
INCLUDES ADULT SIBLINGS AND OTHER RELATIVES AGED 18 AND
OVER WHO ARE NOT LEGAL GUARDIANS.]
1
2
3
4

YES – GO TO AVAIL
NO, PARENT IS NOT AVAILABLE – GO TO NOAVAIL
NO, REFUSE – CONCLUDE THE CALL
NO PARENT, ONLY LEGAL GUARDIAN – GO TO GUARDIAN

GUARDIAN May I speak with your legal guardian now to ask if it is okay for you to
participate?
1
2
3
NOAVAIL

YES – GO TO AVAIL
NO, PARENT IS NOT AVAILABLE – GO TO NOAVAIL
NO, REFUSE – CONCLUDE THE CALL

When would be a good time for me to call back to talk with them? And what
phone number should I call?
______________________________________________________________
Thank you. If I can't get in touch with your (parent/guardian), I may need to leave
a message for them to call me back. If that happens, I will only say that I'm
calling about a health study and will not tell anything more about the study until I
have them on the phone. Likewise, when I call you back, if I can't get in touch
with you, I may need to leave a message, but I'll only say that I'm calling about a
health study. We won't ask you anything further for the study until I have a
chance to talk with a (parent/guardian). CONCLUDE CALL.

IF PARENT/GUARDIAN IS AVAILABLE
AVAIL

Your child responded to an advertisement we placed for research participants
between the ages of 12 and 17.

GUARD2

[IF PARENT=4] First, I need to confirm that you are [CHLID]’s legal guardian
and have the authority to make decisions for [CHILD.]

1
2
AVAIL2

YES – GO TO AVAIL2
NO – CONCLUDE CALL

This study will help us see how well young people understand survey questions
about substance use and health. We would like to talk with you further about your
child’s participation in this study. [IF SPEAKER IS NOT PARENT, VERIFY
THEY ARE THE LEGAL GUARDIAN.]
The purpose of the study is to get feedback on how easy or difficult different
questions about substance use, including alcohol and tobacco, issues with sleep,
and past alcohol, drug, and mental health treatment are to answer. These questions
will be presented on a laptop computer. I will also ask follow-up questions about
some of the survey questions. For example, I might ask, “How did you come up
with your answer to that question?” There are no right or wrong answers to the
questions I ask. Our main goal is to make sure that the questions make sense and
that people can answer them easily.
We are doing this research to improve the questions about past substance use and
health in a large national survey, called the National Survey on Drug Use and
Health, which is given to about 70,000 people every year.
The survey is conducted by RTI International and is funded by the
Substance Abuse and Mental Health Services Administration or
SAMHSA.
The interview will take about 60-75 minutes and be conducted between
[DATE] and [DATE] at [LOCATION]. If your child qualifies and takes
part in the interview, [he/she] will receive $40 cash for completing the
interview. Since your child is under 18, he or she must be accompanied to
the interview by a parent or guardian who can provide permission for the
child to complete the interview in person.
Are you and your child interested in participating?
1
2

YES [CONTINUE]
NO [Since you or your child are unable to participate, we cannot
interview your child for this study either. Thank you for your time
and interest. CONCLUDE THE CALL.]

OK, great! I just need to ask your child a few additional questions to
determine if your child is eligible to participate.

ASK REMAINING QUESTIONS OF CHILD
INTRO1

[CONTINUE]

INTRO2

To determine if you are eligible for the in-person interview, we must ask you a
few questions about your substance use, issues with pain and sleep, and past
treatment experiences as well as your background.
There are no known risks to participating. However, it is possible some of the
survey questions may make you feel uncomfortable or upset. Taking part in this
eligibility survey is completely voluntary. You can skip any questions you do not
wish to answer.
All responses to the survey will remain confidential. We will not share
information you give us with anyone other than necessary project staff.
If you are eligible for the study, a staff person will call or email you to schedule a
time for the interview.
Do we have your permission to ask you a few questions to determine whether you
are eligible for this study?
1
2

YES
NO [GO TO REFUSAL]

REFUSAL

Thank you for taking the time to answer our questions today.

GEO

In what city do you live?
1
2
3
4
5
6
7
5

CIGS

This question is about smoking cigarettes. How long as it been since you last
smoked a cigarette? Was it…
1
2
3
4
5

VAPE

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
Or have you never vaped or used an e-cigarette?

[IF VAPE = 1 OR 2] In the past 12 months, when you vaped or used an ecigarette, was it for nicotine only, some other substance such as e-cig juice, eliquid, or marijuana, or both?
1
2
3

MARIJU

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
Or have you never smoked a cigarette?

This question is about vaping or using an e-cigarette for either nicotine or other
substances. How long as it been since you last vaped or used an e-cigarette? Was
it …
1
2
3
4
5

VAPEOTH

RALEIGH, DURHAM, CHAPEL HILL AREA
WASHINGTON, DC METRO AREA
BALTIMORE, MD METRO AREA
PORTLAND, OR METRO AREA
CHICAGO, IL METRO AREA
LINCOLN, NEBRASKA
[TBD LOCATOIN FOR SPANISH INTERVIEWS]
OTHER [GO TO TERM1]

NICOTINE ONLY
OTHER SUBSTANCE ONLY
BOTH NICOTINE AND ANOTHER SUBSTANCE

[MARIJU = 2-5] This question is about marijuana or cannabis products, such as
pot, weed, hashish and concentrates. How long has it been since you last used
marijuana or cannabis products? Was it …
5

1
2
3
4
5

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago
Or have you never used marijuana or cannabis products?

MJTYPE

In the past 12 months, which of the following types of marijuana have you used?
YES
NO
Buds, leaves or stems
Liquid THC, hash oil or concentrates such
as hash, wax, resin, shatter or budder
Edibles or tinctures
Lotions

CBDUSE

In the past 12 months, have you used CBDs, also called cannabidiol?
1
2
3

FENT

In the past 12 months, have you used prescription fentanyl?
1
2

RXDRUGS

YES
NO
NOT SURE

YES
NO

Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it

Have you ever, even once, used a prescription pain killer in any way a doctor
did not direct you to use it?
1
2
LAST_RX

YES
NO

[IF RXDRUGS=1] How long has it been since you last used any prescription
pain killer in any way a doctor did not direct you to use it? Has it been…

1
2
3
4
RXTYPE

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago

[IF LAST_RX = 1 OR 2] In the past 12 months, what prescription pain killers
did you use?
_____________ [ALLOW 500 CHARACTERS]

RXSTIM

Have you ever, even once, used a prescription stimulant in any way a doctor
did not direct you to use it?
1
2

LAST_ST

[IF RXSTIM=1] How long has it been since you last used a prescription
stimulant in any way a doctor did not direct you to use it? Has it been…
1
2
3
4

HEROIN

YES
NO

In the past 12 months, have you received treatment for your drug use?
1
2

MHTX

YES
NO

The next questions are about treatment you may have received. In the past 12
months, have you received treatment for your alcohol use?
1
2

DRTX

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago but with the past 5 years
More than 5 years ago

In the past 12 months, have you used heroin or fentanyl (without a prescription)?
1
2

ALTX

YES
NO

Yes
No

In the past 12 months, have you received treatment for your mental health?
1
2

YES
NO
7

SLEEP

This question is about your sleep. During the past 30 days, on how many nights
have you had problems falling asleep or waking up before you wanted to?
_____ NIGHTS

HISP

Are you of Hispanic, Latino, or Spanish origin?
1
2

RACE

Which of these groups describes you? You may select all that apply.
1
2
3
4
5
6

RACE2

YES
NO

White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other

[IF RACE=6] Please describe your other race.
______________________________________

Gender

[CONFIRM VERBALLY IF NEEDED]
1
2

LANG

Is your primary language English, Spanish, or another language?
1
2
3

LANG2

MALE
FEMALE

ENGLISH
SPANISH
OTHER

[IF LANG=3] What is your primary language?
______________________________________

BLIND

Are you blind or do you have serious difficulty seeing?
1
2

YES
NO

TERM1

[IF AGE=1 OR (ALC_AMT=0 AND MJ_AMT=0 AND LASTDRUG>2) OR
BLIND=1] Thank you, but you are not eligible to participate in this study.
CONCLUDE THE CALL.

THANK

[IF ELIGIBLE AND RECRUITING] Thank you! You are eligible to participate
in the study. The interview will last about 60-75 minutes in total. You will be
asked to answer questions about alcohol and drug use. The interviewer will ask
how well you understand the questions in the interview. If you take part in the
interview, you will receive $40 cash. The interviews will be held at
[LOCATION]. Since you are under 18, you must be accompanied to the interview
by a parent or guardian who can provide permission for you to complete the
interview in person. If your parent or guardian does not come with you, you will
not be able to participate and you will not receive the $40.
Are you interested in participating? Do you have any questions for me?
ANSWER QUESTIONS, COLLECT CONTACT INFORMATION, AND
SCHEDULE A TIME FOR INTERVIEW.

WAITLIST [IF ELIGIBLE BUT NOT RECRUITING] ASK IF THEY ARE WILLING TO
BE ON WAIT LIST. COLLECT CONTACT INFO.

____________________________________________________________
Eligibility Determination
Cigarette users: IF CIGS = 1 OR 2
Vape or e-cig users: IF VAPE = 1 OR 2
Vape or e-cig users for other substances: IF VAPEOTH = 2 OR 3
Marijuana users: IF MARIJU = 1 OR 2
CBD users: IF CBDUSE = 1
Rx opioid users: IF (FENT = 1) OR (LAST_RX = 1 OR 2 OR LAST_STIM = 1 OR 2)
Illicit opioid users: IF (HEROIN = 1 OR 2)
Alcohol treatment: IF ALTX = 1
Drug treatment: IF DRTX = 1

Mental health treatment: IF MHTX = 1
Sleep issues: IF SLEEP = > 0

Scheduling Script for Adolescent Vaping interviews
INTRO1

My name is _______ from RTI International. May I speak with [PARENT]?
1
2
3

AVAIL

YES, WILLING – GO TO AVAIL
NO ANSWER – CALL BACK LATER
UNWILLING – CONCLUDE THE CALL [DO NOT CALL BACK]

Your child responded to an advertisement we placed for research participants
between the ages of 12 and 17.
We would like to talk with you further about your child’s participation in this
study. [IF SPEAKER IS NOT PARENT, VERIFY THEY ARE THE LEGAL
GUARDIAN.]
The purpose of the study is to get feedback on how easy or difficult different
questions about tobacco and nicotine are to answer. Respondents do not need to
have used tobacco or nicotine to participate. These questions will be presented on
a laptop computer. I will also ask follow-up questions about some of the survey
questions. For example, I might ask, “How did you come up with your answer to
that question?” There are no right or wrong answers to the questions I ask. Our
main goal is to make sure that the questions make sense and that people can
answer them easily. This study will help us see how well young people
understand survey questions about substance use and health.
We are doing this research to improve the questions about tobacco and nicotine
used in a large national survey, called the National Survey on Drug Use and
Health, which is given to about 70,000 people every year.
The survey is conducted by RTI International and is funded by the
Substance Abuse and Mental Health Services Administration or
SAMHSA.
The interview will take no more than 60 minutes and be conducted
between [DATE] and [DATE] at [LOCATION]. If your child qualifies
and takes part in the interview, [he/she] will receive $40 cash for
completing the interview. Since your child is under 18, he or she must be
accompanied to the interview by a parent or guardian who can provide
permission for the child to complete the interview in person.
Are you and your child interested in participating?
1
2

YES [SCHEDULE INTERVIEW OR ADD TO WAITLIST]
NO [Since you or your child are unable to participate, we cannot
interview your child for this study either. Thank you for your time
and interest. CONCLUDE THE CALL.]
11

File Type	application/pdf
Author	gmchenry
File Modified	2018-10-08
File Created	2018-10-08