Rapid Message Testing with Consumer Panel - Public Service Announcements About Safe Disposal of Opioids

FDA RAPID – MESSAGE #8

Opioid PSAs

Recruiting Screener

Introduction

The U.S. Food and Drug Administration, or FDA, hired Westat to help them get opinions about health information. Research Now is helping Westat and FDA find people who may be interested in being interviewed about health information. To make sure you are a good fit for the interview, please take about 3 minutes to answer the questions below.

1. What is your gender?

1. Female

2. Male  INELIGIBLE

2. What is your age?

1. Under 35  INELIGIBLE

2. 35 to 39

3. 40 to 49

4. 50 to 59

5. 60 to 64

6. 65 or older  INELIGIBLE

3. Which of the following describe your role? Select all that apply.

1. A mother or stepmother of a child or children living in your household

2. A grandmother who lives with or watches a grandchild or grandchildren regularly in your own home

3. A person who provides unpaid care for the medical needs of a family member aged 65 or older

4. A person who provides unpaid care for the medical needs of a friend aged 65 or older

5. None of the above  INELIGIBLE

 IF C OR D NOT SELECTED, SKIP TO Q6

4. [Ask if Q3=C OR D] Do you live in the same home as the person aged 65 or older for whom you provide unpaid care?

1. Yes

2. No

5. [Ask if Q3=C OR D] Has the person for whom you provide unpaid care been prescribed any of the following pain relievers in the last 3 years? Select all that apply.¹

1. Prescription strength ibuprofren If not C-H, INELIGIBLE

2. Diclofenac, also known as Cataflam, Cambia,
   Voltaren or Zorvolex If not C-H, INELIGIBLE

3. Hydrocodone acetaminophen, also known
   as Vicodin, Lortab, Lorcet, Norco, or Zydone

4. Oxycodone acetaminophen, also known
   as Percocet, Endocet, or Primlev

5. Oxycodone, also known as Oxycontin,
   Oxy IR, or Oxyfast

6. Tramadol, also known as Ultram

7. Codeine acetaminophen, also known
   as Tylenol #3, Tylenol #4, or Vopac

8. Morphine, also known as MS Contin,
   Morphine Sulfate ER, Morphine Sulfate IR, or Kadian

9. None of the above INELIGIBLE

10. Don’t know INELIGIBLE

6. What is the highest grade or level of education you have completed?

1. Less than High School

2. High School Diploma or GED

3. Some College, including Associate’s Degree

4. Bachelor’s Degree (for example: BA, BS)

5. Graduate or Professional Degree  INELIGIBLE

7. Do you currently work for pay?

YES

NO  GO TO Q9

8. What kind of work do you do?

OPEN-ENDED TEXT BOX

9. Are you of Hispanic, Latino, or Spanish origin?

YES

NO

10. What is your race? Please select one or more.

White

Black or African-American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

11. What language do you speak most often at home?

English GO TO Q13

Spanish GO TO Q12

Other  INELIGIBLE

12. [Ask if Q11=Spanish] How well do you speak Spanish?

Very well

Well

Not well  INELIGIBLE

Not at all  INELIGIBLE

13. What state do you live in? [DROP DOWN LIST OF US STATES, INCLUDING “OUTSIDE OF THE US”] [“OUTSIDE OF THE US”  INELIGIBLE]

Request for Contact Information

C1. Thank you for answering the questions. Based on your answers, you may be chosen for an interview. If you are chosen for the interview and you finish it, you will get $35 E-Rewards Currency. At the start of the interview, the interviewer will ask if it’s okay to audio record it. This helps Westat to make sure they hear everything you say correctly. If you are chosen for an interview, you will get a package in the mail. Make sure to have the package with you during the interview. Is it okay with you for Research Now to share your contact information with Westat?

YES

NO  INELIGIBLE

Thank and Terminate

Thank you for taking our survey.

Contact Information

C2. In the space below, please give us the best information to contact you by phone, email, and regular mail. Please know that Research Now and Westat will not share your information with anyone else.

Contact Information

Name ______________________________________________________________________

Address 1 ___________________________________________________________________

Address 2 ___________________________________________________________________

City, State, ZIP _______________________________________________________________

Phone Number _______________________________________________________________

Email Address________________________________________________________________

Available Times

C3. Someone from Westat will call or email in the next 1-2 days to schedule an interview with you. Please mark the times you can be reached by phone in the next 1-2 days.

9 a.m. to Noon

Noon to 2 p.m.

2 p.m. to 5 p.m.

5 p.m. to 7 p.m.

7 p.m. to 9 p.m.

Technology Preferences

C4. The Westat interviewer would like to be able to show you information on her computer screen during the interview. Westat will send directions for how to view the interviewer’s screen. Which app do you prefer for screen sharing? [SINGLE SELECT]

1. Skype

2. Google Hangouts

3. WebEx

4. I am not able to use any of these, please just call me

Closing

Thank you for your answers to these questions. If you are chosen for an interview, someone from Westat will contact you with the next 1-2 days.

1 Loosely based on 2016 NSDUH. See pages 201 and 224. https://www.samhsa.gov/data/sites/default/files/NSDUHmrbCAIquex2016v2.pdf