Form 1472 Screener Guide

OMB Control No. 2105-0573

Expiration Date 01/31/2020

Recruitment Screener for Focus Groups

OMB Control No: 2105-0573: Focus Groups for Development of a National Public Service Awareness Campaign to Reduce Drug-Impaired Driving

Hello, this is __________________, from (Elliott Benson Market Research OR Shugoll Research OR Lucas Market Research), calling on behalf of the U.S. Department of Transportation. We are conducting a study of Americans’ opinions about driving attitudes and behaviors. I would like to ask you a few questions to determine if you are eligible for the study which will be in the form of a focus group. (NOTE TO RECRUITER: If necessary, read:)

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 2105-0573. Public reporting for this collection of information is estimated to be approximately ten 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

All your answers will be confidential. Could we begin now?

1. (NOTE TO RECRUITER: Based on person’s name and voice, determine and record gender; in this case, no need to ask. However, if uncertain, ask):

Are you…

( ) Female (TERMINATE)

( ) Male

( ) Refused (TERMINATE)

2. Into which of the following ranges does your age fall? (READ)

( ) Under 18 (TERMINATE)

( ) 18 - 25

( ) 26 - 34

( ) 35-44 (TERMINATE)

( ) Above 45 (TERMINATE)

Recruit one group ages 18-25 & one group ages 26-34 per market.

3. Have you ever participated in any type of marketing research such as a focus group, panel discussion or individual interview conducted by a market research company?

( ) Yes (ASK Q.3a.)

( ) No (CONTINUE TO Q.4)

3a. How long ago was that? _______ (TERMINATE IF LESS THAN 3 MONTHS AGO; OTHERWISE CONTINUE TO Q.3B.)

3b. What was the topic of that discussion or interview? __________________ (TERMINATE IF TOPIC WAS RELATED TO ALCOHOL, MARIJUANA, PHARMACEUTICALS OR OTHER DRUGS OR IF RELATED TO DRIVING/TRANSPORTATION)

4. Do you, or does anyone living in your household, work in any of the following industries or professions? (TERMINATE if “yes” to any)

( ) Marketing, advertising, public relations or marketing research

( ) News media, including newspaper, television, radio or publishing

( ) Law enforcement

( ) Legal

( ) Local, state or federal government

( ) Manufacturing, distribution or sales of alcohol or marijuana (NOTE TO RECRUITER: Marijuana only relevant in Sacramento)

( ) Manufacturing, distribution or sales of pharmaceutical medications

5. Are you of Hispanic or Latino descent?

( ) Yes (NOTE TO RECRUITER: Quota: at least 1, but no more than 3 per group)

( ) No

6. Which one or more of these best describes your race? (NOTE TO RECRUITER: Read list. OK to accept multiple responses.)

( ) American Indian or Alaska Native

( ) Asian

( ) Black or African American (NOTE TO RECRUITER: Quota: at least 1, but no more than 3 per group)

( ) Native Hawaiian or Other Pacific Islander

( ) White

(RECRUIT A MIX)

7. Which of the following best describes the area where you live?

( ) Urban/City Center

( ) Suburban

( ) Small city or town

( ) Rural

(RECRUIT A MIX OF URBAN/SUBURBAN; ALL CATEGORIES QUALIFY)

8. Are you a licensed driver?

( ) Yes

( ) No (TERMINATE)

9. Do you drive a personal vehicle 10 miles or more per week, on average?

( ) Yes

( ) No (TERMINATE)

10. Which of the following statements describes your driving habits in a typical week? (Read list.)

( ) I drive daily to get most places.

( ) I don’t drive daily, but I drive to most social occasions.

( ) I only drive to commute to/from work or school. (TERMINATE)

( ) I drive very little on a weekly basis. (TERMINATE)

( ) Refused (TERMINATE)

(NOTE: At this stage, disclose the following information, then ask question 11)

Again, I remind you that all your answers are confidential. Likewise, the focus group discussion and people’s participation will also be confidential. This research is not for law enforcement efforts, nor will law enforcement be involved in the research. Rather, the research is solely to gather opinions. So, let me ask…

11. Which of the following have you done at least once in the past three months?

( ) Consumed an alcoholic beverage

( ) Drank an energy drink

( ) Smoked or consumed marijuana recreationally (MUST SAY YES TO CONTINUE; OTHERWISE TERMINATE)

12. How often do you typically smoke or consume marijuana recreationally?

(Do not read list.)

( ) 5 times per week or more

( ) 3-4 times per week

( ) 1-2 times per week

( ) 2-3 times per month

( ) Once per month

( ) Once every 2-5 months

( ) Once every 6 months or less (TERMINATE)

( ) Refused or not sure (TERMINATE)

(RECRUIT A MIX OF FREQUENCY ACROSS GROUPS.)

13. Of the following types of occasions, when do you typically smoke or consume marijuana recreationally? Select all that apply. (READ LIST)

( ) Alone at home (1)

( ) While socializing with others at home (2)

( ) While socializing with others outside of the home (3)

(RECRUIT PRIMARILY THOSE WHO SELECT OPTION 3 – OUTSIDE OF THE HOME)

14. Thinking about recreational marijuana use, how much do you agree or disagree with each of the following statements: (NOTE TO RECRUITER: READ & RECORD A RESPONSE FOR EACH STATEMENT.)

Smoking or consuming marijuana….

Enhances my mood (1)

Gives me a buzz (2)

Helps me to socialize at parties (3)

Makes me feel more confident (4)

Helps me to focus (5)

Has an impact on my ability to drive safely (6)

Do you…?

( ) Strongly agree

( ) Somewhat agree

( ) Somewhat disagree

( ) Strongly disagree

( ) Not sure

(RECRUIT A MIX OF RESPONSES FOR STATEMENT 6 – HAS AN IMPACT ON MY ABILITY TO DRIVE SAFELY.)

15. Have you ever driven somewhere while under the influence of marijuana? As a reminder, your response is confidential and will never be shared with law enforcement. It is for informational purposes only.

( ) Yes

( ) No

(ACROSS GROUPS, AIM TO RECRUIT AT LEAST A FEW RESPONDENTS WHO ANSWER YES.)

(NOTE TO RECRUITER: Question 16 is an articulation question. What the respondent says is not important; rather, judge her/his ability and willingness to comment with a specific point-of-view and ideally with more than just a few words.)

16. In your opinion, what would be the best way to minimize traffic congestion on highways in the (name of city) area?

( ) Articulate

( ) Not articulate (TERMINATE)

Based on your responses, we would like to invite you to participate in a focus group research study about advertising ideas. The group discussion will be about two hours in length. We also request that you arrive approximately fifteen minutes before the group discussion begins. For your participation, you will receive $75 cash. As many as five others will participate. The meeting will be on (SCHEDULED DATE) at (SCHEDULED START TIME) p.m. It will be at our focus group research facility at (FOCUS GROUP FACILITY ADDRESS/LOCATIONAL INFORMATION).

(Exchange additional appropriate details if respondent is willing to participate)

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NHTSA Form 1472