Form NHTSA Form 1384 NHTSA Form 1384 Impaired Driving Survey

Online Survey Questionnaire

Impaired Driving Public Service Advertising Campaign

OMB Control No. 2127-0682

Expiration Date 8/31/2021

[INTRODUCTION] Thank you for taking this survey. Your opinions are important to us! Please be honest when answering the survey. Your collected answers will be anonymous and confidential, and none of your information will be shared with any third parties.

[INCLUDE UPFRONT] This collection of information is voluntary and will be used for formative purposes only so that we may develop communications programs designed to reduce the number of traffic-related injuries and deaths. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0682. Public reporting for this collection of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

1. (Q1) Today, we are looking for people who work in certain industries or fields. Are you, or is any member of your immediate family or close friends, employed in any of the following sectors?

1 TV/Radio/Press/Newspaper/ Magazine

2 Travel agency

3 Ad agency/Public Relations

4 Banking

5 Market Research/Marketing Consulting

6 Agriculture

7 Production or Distributor of Alcoholic Beverages

8 Drug and Health Related Products Distributor

9 Insurance

10 Medical Field

11 None of the above

PROGRAMMING NOTE: If 1, 3, 5, or 7 checked Terminate

2. What is your gender?

1 Male

2 Female

3. What is your exact age? _________

(PROGRAMMER NOTE: MUST BE 21 OR OLDER; else Terminate)

4. Are you of Hispanic or Latino origin?

1 Yes

2 No

5. What is your race? Please select one or more. [^*Add popup option: “Why do we ask this question?”]

1 White

2 Black or African-American

3 Asian

4 Native Hawaiian or other Pacific Islander

5 American Indian or Alaska Native

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

1 8^th grade or below

2 9th grade to 11th grade

3 12th grade No Diploma

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

7. (AC20) Which classification best describes your total pre-tax household income? [^*Add popup option: “Why do we ask this question?”]

Under $10,000 [0]

$10,000-$19,999 [1]

$20,000-$29,999 [2]

$30,000-$39,999 [3]

$40,000-$49,999 [4]

$50,000-$74,999 [5]

$75,000-$99,999 [6]

$100,000-$124,999 [7]

$125,000-$149,999 [8]

$150,000-$174,999 [9]

$175,000-$199,999 [10]

More than $200,000 [11]

Prefer not to state [12]

8. (Q33) Are you the parent or guardian of any children under the age of 18 living in your household?

1 Yes

2 No

9. (Q35) What is your marital status?

1 Never married (Single)

2 Living together but not married

3 Married

4 Separated

5 Divorced

6 Widowed

7 Prefer not to state

10. (Q37) Do you live in the city, suburbs, or some other area?

1 City

2 Suburbs

3 Some other area

11. (Q38) What state do you live in?

[DROP DOWN BOX WHICH INCLUDES ALL 50 STATES AND DISTRICT OF COLUMBIA]

In which state do you currently reside?

1. AK West	14. ID West	27. MT West	40. RI Northeast
2. AL South	15. IL Midwest	28. NE Midwest	41. TN South
3. AR South	16. IN Midwest	29. NV West	42. TX South
4. AZ West	17. KS Midwest	30. NH Northeast	43. UT West
5. CA West	18. KY South	31. NJ Northeast	44. VA South
6. CO West	19. LA South	32. NM West	45. VT Northeast
7. CT Northeast	20. ME Northeast	33. ND Midwest	46. SD Midwest
8. DC South	21. MD South	34. NC South	47. SC South
9. DE South	22. MA Northeast	35. NY Northeast	48. WA West
10. FL South	23. MI Midwest	36. OH Midwest	49. WI Midwest
11. GA South	24. MN Midwest	37. OK South	50. WV South
12. IA Midwest	25. MO Midwest	38. OR West	51. WY West
13. HI West	26. MS South	39. PA Northeast

12. What is your current employment status?

1 Employed full-time

2 Employed part-time

3 Temporarily unemployed

4 Unemployed – not looking for work

5 Full-time student

6 Part-time student

7 Retired

8 Stay-at-home parent

[PROGRAMMER NOTE: ASK Q13 IF 1 OR 2 IS CHECKED IN Q12]

13. What is your occupation? (Read list and record one answer below.)

1 Professional (such as a doctor, lawyer, accountant, consultant)

2 Executive/Manager

3 Technical (such as a computer programmer, medical technician)

4 Services

5 Clerical

6 Sales/Advertising/Marketing

7 A trade, such as plumber or electrician

8 Laborer

9 Other

10 Prefer not to answer

[PROGRAMMER NOTE: ASK Q14 IF 1 OR 2 IS CHECKED IN Q12

14. Is the type of work you do compensated on:

1 A salary

2 An hourly basis

15. Which of the following activities do you do frequently, meaning at least three or four times a week?

Working out	Yes	No
Driving an automobile	Yes	No
Reading a book	Yes	No
Watching the news on TV	Yes	No

[PROGRAMMER NOTE: Must select “yes” for ‘driving an automobile’ to continue]

16. Which of the following types of foods and beverages do you consume at least occasionally, meaning at least once a month?

Juice	Yes	No
Soy Milk	Yes	No
Alcoholic beverage	Yes	No
Soda	Yes	No
Coffee	Yes	No

[PROGRAMMER NOTE: Must select “yes” for ‘Alcoholic beverage’ to continue]

[INTRO SCREEN PRIOR TO Q17] As a reminder, your answers in this survey are confidential, and no individual responses will be reported. We want to hear your opinions, so please be honest when answering.

17. People make different decisions about the amount of alcohol that they will drink if they know they will be driving afterwards. If you are at a social occasion lasting a few hours, about how many drinks do you typically allow yourself if you are planning to drive home afterwards?

1 1 drink

2 2 drinks

3 3 drinks

4 4 drinks

5 5 drinks

6 6 drinks

7 7 drinks

8 8 drinks

9 9 drinks

10 10+ drinks

11 I never drink any alcohol if I need to drive afterwards

18. When people are out socializing and having a few drinks, there may be times when they feel “buzzed” or somewhat impaired, even though they do not feel drunk or out of control. If you have driven somewhere to socialize and you are feeling “buzzed” or somewhat impaired, how likely is it that you will drive yourself home?

1 Extremely likely

2 Very likely

3 Somewhat likely

4 Not too likely

5 Not at all likely

6 Not applicable – I never drink any alcohol if I need to drive afterwards

19. If you are out socializing and feeling “buzzed” or somewhat impaired, which statement best describes you?

1 I’ll drive without worrying too much about it

2 I’ll drive even though I worry about it

3 I’ll always get a ride from a friend, get a taxi or use public transportation

4 Not applicable – I never drink any alcohol if I need to drive afterwards

20. Among the friends you socialize with, which statement generally best describes what they would do if they were feeling “buzzed” or somewhat impaired?

1 My friends will generally drive without worrying too much about it

2 My friends will generally drive even though they would worry about it

3 My friends will generally get a ride from a friend, get a taxi or use public transportation

4 Not applicable – My friends generally never drink any alcohol if they need to drive afterwards

21. As an issue in your community, how personally concerned are you about drunk driving prevention?

1 Extremely concerned

2 Very concerned

3 Somewhat concerned

4 Not too concerned

5 Not at all concerned

22. How much do you agree or disagree with the following statements?

[RANDOMIZE STATEMENTS]	1 Disagree strongly	2 Disagree somewhat	3 Agree somewhat	4 Agree strongly	5 Not sure
A. There was a time recently when I probably had too much to drink before getting behind the wheel
B. I’m confident in my ability to tell when I am too impaired to drive
C. I don’t drink too much and drive, but many of my friends do

23. Have you recently done the following?

A. Discussed the risks of drinking and driving with a friend or family member

Yes

No

24. In the past, have you ever been in a situation where you decided to

NOT drive after drinking, even though you had originally planned to drive?

1 Yes

2 No

[PROGRAMMER NOTE: IF YES to Q24 THEN ASK Q25]

25. When was the last time this happened?

1 About a week ago

2 A few weeks ago

3 A month ago

4 A few months ago

5 A year ago

6 A few years ago

7 Not sure

26. In the past 12 months, have you been in a situation where you felt you were probably okay to safely drive after drinking alcohol but not completely sure? Think only about instances when you were planning to drive.

1 Yes

2 No

3 Not sure

[PROGRAMMER NOTE: IF YES to Q26 THEN ASK Q27]

27. In the most recent instance where this happened, did you decide to drive as planned?

1 Yes

2 No

28. Have you seen, heard or read anything about drunk driving prevention anywhere recently including all the different kinds of advertising, publicity and other activities that talk about it?

1 Yes

2 No

3 Not sure

[PROGRAMMER NOTE: IF “Yes” TO Q28 (Old Q18) THEN ASK Q29 (Old Q19)]

29. (Q19) Where was that…? (Accept multiple responses.)

A. TV Program	Yes	No
B. TV Ad	Yes	No
C. Radio Program	Yes	No
D. Radio Ad	Yes	No
E. Magazine Article	Yes	No
F. Magazine Ad	Yes	No
G. Newspaper Article	Yes	No
H. Newspaper Ad	Yes	No
I. Internet or Web	Yes	No
J. Outdoor billboards or outdoor posters	Yes	No
K. From friends or family	Yes	No
L. Some other place (Specify)__________	Yes	No

30. Are you aware of any public service ads with the slogan “Buzzed Driving Is Drunk Driving”?

1 Yes

2 No

3 Not sure

[INTRO TO AD RECOGNITION SECTION]

On the next several screens you will see some TV public service ads. For each, please indicate whether or not you have seen it.

[RANDOMIZE ORDER OF AD RECOGNITION QUESTIONS. KEEP MEDIA TYPE TOGETHER IN BLOCK. RESPONDENT WILL ONLY EVALUATE 11 of 14 PIECES OF CREATIVE TO REDUCE RESPONDENT FATIGUE. Note: Final media files TBD but each respondent will see seven video/audio ads (:30 or less) and 4 still images (jpegs of outdoor, print, or web banners). Split samples will be used to accommodate additional ads.]

[The following question will be asked for each video ad.]

Below is an ad you might see on TV or online.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

PN: Play video file.

Have you seen this public service ad?

1 Yes

2 No

3 Not sure

[The following question will be asked for each audio ad.]

PN: Play audio file.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

Have you heard this public service ad on the radio or streaming online?

1 Yes

2 No

3 Not sure

[The following question will be asked for each OOH/print ad exposure.]

PN: Insert jpeg of outdoor or print montage

Have you seen any of these ads on a billboard, poster, or some other place?

1 Yes

2 No

3 Not sure

[The following question will be asked for each online banner exposure.]

PN: Insert jpeg of banner montage.

31. Have you seen any of these ads online?

1 Yes

2 No

3 Not sure

* These questions about [race/income] are important so that we make sure the voices of people in all different populations are represented. In this way, we can be fair and objective by adjusting our results based on the proportions of the various groups in the larger population.

Collecting data from all respondents on this question is important so that we can better and more reliably report differences and similarities between people of different backgrounds.

We understand that you might be concerned about sharing this information. Please be assured that the responses you provide are kept completely confidential. Any identifying information will be separated from your answers. Results are reported using the average, or pooled answers to the questions, instead of the responses of any one individual.

*

NHTSA Form 1384