OMB CONTROL NO.: 0584-0523
EXPIRATION DATE: 11/30/2022
OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523 and the expiration date is 11/30/2022. The time to complete this information collection is estimated at 10 minutes per initial screening for non-qualifying participants and 15 minutes per initial screening for qualifying participants. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0523). Do not return the completed form to this address.
Attachment C-1 Screener (English)
(B-24 Caregiver Audience)
Audience 1: SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 0 to <6 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Female (Q1), Breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 2: Not SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 6 to <12 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), 26-40 years of age (Q6)
Audience 3: SNAP-eligible (Q9-Q9d), Healthy BMI (Q14-Q15), Child 12-24 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 4: Not SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 0 to <6 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Female (Q1), Breastfeeding (Q13), 26-40 years of age (Q6)
Audience 5: SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 6 to <12 mos. (Q2-Q2a), English-speaking (Q10-Q11), African American (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 6: Not SNAP-eligible (Q9-Q9d), Overweight BMI (Q14-Q15), Child 12-24 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 7: SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 0 to <6 mos. (Q2-Q2a), Spanish-speaking (Q10-Q11), Hispanic (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 8: Not SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 6 to <12 mos. (Q2-Q2a), English-speaking (Q10-Q11), Mixed race/ethnicity (Q4-Q5), Mixed gender (Q1), Mixed breastfeeding (Q12-Q13), mix of ages (Q6)
Audience 9: SNAP-eligible (Q9-Q9d), Mixed BMI (Q14-Q15), Child 6 to <12 mos. (Q2-Q2a), Spanish-speaking (Q10-Q11), Hispanic (Q4-Q5), Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
Audience
10:
SNAP-eligible (Q9-Q9d), Overweight BMI (Q14-Q15), Child 12-24 mos.
(Q2-Q2a), English-speaking (Q10-Q11), African American (Q4-Q5),
Mixed gender (Q1), Not breastfeeding (Q12-Q13), mix of ages (Q6)
All groups recruit 10 to seat six.
Hello, My name is_______________________, and I am calling from Edge Research, a research company in CITY/LOCATION. We are calling on behalf of the United States Department of Agriculture (USDA FNS) Food and Nutrition Service (FNS) Center for Nutrition Policy and Promotion (CNPP) to ask for your participation in a discussion about how USDA can best communicate nutrition information to people like you. Your participation is voluntary and as a token of our appreciation, we will provide a $90 gift card as an incentive for your participation in a 2-hour discussion on this subject (including 30 minutes to log in). There are no penalties if you chose not to participate. This feedback session will be private, which means that nothing that you say will be seen by anyone other than qualified researchers working on this project, except as otherwise required by law. Your responses will be combined with others and you will never be personally identified.
Are you interested in participating?
IF NO: Thank you and have a great day/evening.
IF YES: Great! First, I need to ask you a few questions to find out if your background meets the needs of this study.
Before the questions, I need to inform you about the process.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523 and the expiration date is 11/30/2022. The time to complete this information collection is estimated at 10 minutes per initial screening for non-qualifying participants and 15 minutes per initial screening for qualifying participants. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0523). Do not return the completed form to this address. If you have comments on any aspect of this information collection, there is a mailing address to send comment to USDA. Would you like that address? [IF YES: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0523).]
DO NOT READ: RECORD GENDER
Male
Female [MUST
BE FEMALE FOR AUDIENCE 1, 4]
RECRUIT MIX FOR AUDIENCE 2, 3, 5, 6, 7, 8, 9, 10
Are you the parent/caregiver of a child 24 months or younger who lives with you, even part-time?
Yes [MUST SELECT TO CONTINUE]
No [THANK AND TERMINATE: Based on the requirements of the study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]
2a. How old is the child who lives with you?
0 to less than 6 months [MUST SELECT TO CONTINUE FOR AUDIENCE 1, 4, 7]
6 to less than 12 months [MUST SELECT TO CONTINUE FOR AUDIENCE 2, 5, 8, 9]
12 to 24 months [MUST SELECT TO CONTINUE FOR AUDIENCE 3, 6, 10]
2b. Are you currently pregnant or trying to become pregnant within the next year?
Trying to become pregnant within next year
Currently pregnant [THANK AND TERMINATE]
No, none of these
In
what state do you live?
(DROPDOWN; ONLY ACCEPT WA,
MD, FL, TX)
RECRUIT MIX
ACROSS STATES TO EXTENT POSSIBLE
Are you Hispanic, Latino or of Spanish descent?
Yes, Hispanic or Latino [CONTINUE SCREEN FOR ALL GROUPS; MUST SELECT FOR AUDIENCE 7, 9]
No, not Hispanic or Latino
Prefer not to answer
Which of the following best describes your race? Select all that apply. [ACCEPT MULTIPLE RESPONSES; RECRUIT A MIX FOR AUDIENCES 1, 2, 3, 4, 6, 8 INCLUDING HISPANIC AND NATIVE AMERICAN]
American Indian or Alaska Native
Asian
Black or African American [MUST SELECT TO CONTINUE FOR AUDIENCE 5, 10]
Native Hawaiian or Other Pacific Islander
White [MAX 4 PER GROUP THAT SELECT WHITE ONLY]
Prefer not to answer [EXCLUSIVE; THANK AND TERMINATE]
Please stop me when I come to the category that includes your age.
Under 18 [THANK AND TERMINATE: Based on the requirements of the study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]
18 – 25
26 – 29
30 – 40
41 – 59
60 – 74
75 or older [THANK AND TERMINATE]
GROUPS 2 AND 4 MUST BE 26-40 YEARS OF AGE (Q6 = 2,3,4)
RECRUIT MIX FOR GROUPS 1, 3, 5, 6, 7, 8, 9, 10
Please select the category that best represents your living situation:
Live in parent/guardian’s home
Live in dorm/group home
Live with spouse/significant other
Live with children/other family members [CHECK AGAINST PARENT Q2]
In your household, who is responsible for making choices regarding the food you and your household eats?
I am primary responsible for making choices regarding the food I/my household eats
I share responsibility for making choices regarding the food I/my household eats
Someone else is primarily responsible for making choices regarding the food I/my household eats [THANK AND TERMINATE]
How many people live with you regularly and make up your “household” including yourself? Please exclude any roommates/boarders/etc. __ __ [NUMERIC 1-99; REQUIRED]
9a. [ASK ONLY TEXAS] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.
SNAP Eligibility:
Household size |
Annual Income |
1 |
$16,248.00 |
2 |
$21,984.00 |
3 |
$27,732.00 |
4 |
$33,480.00 |
5 |
$39,228.00 |
6 |
$44,976.00 |
7 |
$50,724.00 |
8 |
$56,460.00 |
IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 3, 5, 7, 9, 10
IF NOT SNAP ELIGIBLE, RECRUIT A MIX OF INCOME FOR 2, 4, 6, 8
9b. [ASK ONLY MARYLAND] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.
SNAP Eligibility:
Household size |
Annual Income |
1 |
$16,248 |
2 |
$21,984 |
3 |
$27,732 |
4 |
$33,480 |
5 |
$39,228 |
6 |
$44,976 |
7 |
$50,724 |
8 |
$56,460 |
IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 3, 5, 7, 9, 10
IF NOT SNAP ELIGIBLE, RECRUIT A MIX OF INCOME FOR 2, 4, 6, 8
9c. [ASK ONLY FLORIDA] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.
SNAP Eligibility:
Household size |
Annual Income |
1 |
$25,520 |
2 |
$34,480 |
3 |
$43,440 |
4 |
$52,400 |
5 |
$61,360 |
6 |
$70,320 |
7 |
$79,280 |
8 |
$88,240 |
IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 3, 5, 7, 9, 10
IF NOT SNAP ELIGIBLE, RECRUIT A MIX OF INCOME FOR 2, 4, 6, 8
9d. [ASK ONLY WASHINGTON] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.
SNAP Eligibility:
Household size |
Annual Income |
1 |
$25,520 |
2 |
$34,480 |
3 |
$43,440 |
4 |
$52,400 |
5 |
$61,360 |
6 |
$70,320 |
7 |
$79,280 |
8 |
$88,240 |
IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 3, 5, 7, 9, 10
IF NOT SNAP ELIGIBLE, RECRUIT A MIX OF INCOME FOR 2, 4, 6, 8
[ADDITIONAL SCREEN FOR HISPANIC PARTICIPANTS]
What language do you usually speak at home?
Only Spanish
Mostly Spanish
Spanish and English equally
Mostly English
Only English [SKIP TO RESUME ALL QUESTION]
Thinking of your media habits, including television, the internet, social media, radio, and print newspapers and magazines, would you say you use …
Only Spanish language media
Mostly Spanish language media
Spanish and English language media equally
Mostly English language media
Only English language media
MUST BE MOSTLY SPANISH IN MEDIA OR AT HOME (Q10 or Q11 = 1,2) TO QUALIFY FOR SPANISH-SPEAKING AUDIENCES 7, 9. IF EQUAL OR MOSTLY ENGLISH ON BOTH (Q10 and Q11=3-5), MAY QUALIFY FOR ENGLISH-SPEAKNG AUDIENCES.
RESUME ASKING ALL
How do you currently feed your child who is 24 months of age or younger? Select all that apply.
Breastfeeding (including pumping)
Formula/Breast-milk substitutes
Pureed food
Solid food
Other, please describe: ______________ [HOLD FOR EDGE REVIEW]
[ASK IF Q12 DOES NOT EQUAL 1]
Have you ever breastfed your child who is 24 months of age or younger?
Yes
No
IF Q2A=1 (CHILD 0-6 MONTHS), MUST SELECT Q12=1 TO QUALIFY FOR BREASTFEEDING GROUPS 1, 4
ALL:
IF Q2A=2 OR 3 (CHILD OLDER THAN 6 MONTHS), MUST SELECT Q12=1 OR 13=1
TO QUALIFY FOR BREASTFEEDING GROUPS 1, 4
ALL: IF Q2A=2 OR 3
(CHILD OLDER THAN 6 MONTHS), MUST SELECT Q13=2 AND
NOT
SELECT Q12=1 FOR NON-BREASTFEEDING GROUPS 2, 3, 5, 6, 7, 9, 10
RECRUIT
MIX OF BREASTFEEDING AND NON-BREASTFEEDING FOR GROUP 8
Can
you tell me how tall you are in feet and inches? IF RESPONDENT
DOESN’T KNOW, ASK FOR BEST GUESS. IF THEY CAN’T GUESS,
TERMINATE.
____ Feet
_____ Inches
Can
you tell me how much you weigh (pre-pregnancy, if applicable), in
pounds? IF RESPONDENT DOESN’T KNOW, ASK THEM TO GIVE YOU THEIR
BEST GUESS. IF THEY CAN’T GUESS, TERMINATE.
____
Pounds
USE
NIH LINK (BELOW) AND ENTER HEIGHT AND WEIGHT TO CALCULATE
BMI.
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
IF
BMI <18.5, TERMINATE
IF 18.5 <= BMI <= 24.9, CODE AS
HEALTHY WEIGHT; MUST SELECT FOR GROUP 3
IF 25 <= BMI <=
29.9, CODE AS OVERWEIGHT; MUST SELECT FOR GROUPS 6, 10
IF 30 <=
BMI <= 40, CODE AS OBESE; MUST SELECT FOR GROUPS 6, 10
IF
BMI > 40, TERMINATE FOR ALL GROUPS
RECRUIT
A MIX OF HEALTHY/OVERWEIGHT/OBESE FOR GROUPS 1, 2, 4, 5, 7, 8, AND
9
RECRUIT A MIX OF OVERWEIGHT/OBESE FOR GROUPS 6, 10
For each statement, please tell me whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with that statement.
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Don’t know/Not sure
[RANDOMIZE]
I am confident in my ability to make nutritious eating choices
The people closest to me have nutritious eating habits
I know where to find/purchase nutritious foods near me
Eating food you know is not good for you is fine as long as you have a balanced diet
Nutritious food is expensive
I eat whatever I want, whenever I want
I eat whatever I know my kids/family will eat
RECRUIT FOR A MIX OF ATTITUDES/LIFESTYLE
How familiar are you with each of the following programs from USDA?
Very familiar
Somewhat familiar
Not too familiar
Never heard of/don’t know
[ROTATE]
“SNAP” or the Supplemental Nutritional Assistance Program. It is sometimes referred to and formerly known as “Food Stamps”
“WIC” or the Special Supplemental Nutrition Program for Women, Infants, and Children
“MyPlate”
MAX 2 PER GROUP “NEVER HEARD OF” SNAP (Q17 A=4) FOR GROUPS 1, 3, 5, 7, 9, 10
MIN 2 PER GROUP “VERY FAMILIAR” WITH SNAP (Q17 A=1) FOR GROUPS 1, 3, 5, 7, 9, 10
What is your zip code? __ __ __ __ __ __ __ [NUMERIC, RECORD]
In what type of community do you live? [CONFIRM AGAINST ZIP CODE. RECRUIT A MIX REFLECTIVE OF THE CITY/LOCATION]
Urban, which is inside a city
Suburban, which is just outside of a city
Rural, which is farther outside of a city, like in the country [MIN. 4 PER GROUP IN “RURAL” CITY/LOCATIONS]
IF HIGHER INCOME: The discussion we are recruiting for is virtual, meaning that you can participate from the comfort of your own home, but you would need to be in front of a computer with internet access, as well as on a telephone and in a quiet place. Please make sure and confirm that you can be in a quiet place and can commit to the full 2 hours (including 30 minutes to log on) without many interruptions. It is okay to breastfeed or pump, if needed, during this time. To better simulate a discussion, you would also need to be visible to the interviewer via a web camera. Someone will call you before the group to help you get set up the webcam and make sure all the technology needed for the discussion is working properly.
IF SNAP ELIGIBLE: The discussion we are recruiting for is virtual, meaning that you can participate from the comfort of your own home, but you would need to be in front of a device with internet access, in a quiet place. Please make sure and confirm that you can be in a quiet place and can commit to the full 2 hours (including 30 minutes to log on) without many interruptions. It is okay to breastfeed or pump, if needed, during this time. To better simulate a discussion, you would also need to be visible to the interviewer via a web camera.
ALL: This is for research purposes only, and all of your feedback during the group would be anonymous and private, and the remote connection is safe and secure. To thank you for participating in this study, we will give you a $90 gift card at the end of the group.
Is this something you are interested in and comfortable with?
Yes
No THANK AND TERMINATE
Now, just a couple of questions about your technology usage.
How would you describe your comfort level with using the internet?
Very comfortable
Somewhat comfortable
Neutral
Not that comfortable THANK AND TERMINATE
Not comfortable at all THANK AND TERMINATE
Not sure THANK AND TERMINATE
Do you have a high-speed internet connection that you can use while participating in this research?
Yes CONTINUE
No THANK AND TERMINATE
ASK Q23 AND Q24 IF SNAP-ELIGIBLE
What type of device will you be using to participate?
Computer/laptop
Tablet
Phone
Do you have a webcam on your computer, laptop, tablet, or smartphone that you can use for the discussion?
Yes CONTINUE
No PLEASE HOLD FOR EDGE REVIEW, IDEALLY ALL RESPONDENTS HAVE WEBCAMS. PRIORITIZE RESPONDENTS WITH WEBCAMS OVER RESPONDENTS WITHOUT WEBCAMS.
Thank you for completing the screening questions. As I mentioned previously, you have been invited to participate in a small discussion group regarding how USDA can best communicate about nutrition information to people like you. Your participation means that you would participate in the 2-hour discussion (including 30 minutes to log on) that will be held virtually on DATE/TIME. As a token of our appreciation, you will receive a $90 gift card upon completion of the group.
Would you still like to participate?
[If Respondent seems uncomfortable, explain, “This information will be used only to send you a confirmation and details for the group.”]
Respondent’s name _____________________________________
Address ______________________________________________
Email Address__________________________________________
Telephone Number: ________________
Alternate Number: ___________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Liana Gainsboro |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |