Study 1 - Screener

Disease Awareness and Prescription Drug Promotion on Television

Project Screeners

Study 1 - Screener

OMB: 0910-0874

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FDA Disease Awareness Project Screeners


[INTRO TEXT]

Thank you for your interest in participating in this study. Please make sure to answer all of the following questions during this initial screening process to determine if you are eligible to participate in this study.


//NEW SCREEN//


Question Type: Open End Numerical

S1. How old are you?

Variable Label: S1. How old are you?




years old


Value

Value Label

-99

Refused


[IF AGE < 18 | AGE = -99, TERMINATE]


Question Type: Multiple Punch

S2. Have you ever been diagnosed by a health professional with any of the following conditions? (Check all that apply)


Variable

Variable Text

Variable Label


S2_A

High cholesterol

S2_A: High cholesterol

Continue

S2_B

Seasonal allergies

S2_B: Seasonal allergies

Continue

S2_C

Asthma

S2_C: Asthma

If selected (= 01), Skip to S4

S2_D

Acid reflux

S2_D: Acid reflux

Continue

S2_E

High blood pressure

S2_E: High blood pressure

Continue

S2_F

COPD

S2_F: COPD

Continue

S2_G

None of the above

S2_G: None of the above

Continue


Value

Value Label

01

Selected

00

Not selected

-99

Refused



Question Type: Single Punch

S3. During the past 30 days, did you have any of these symptoms: cough, wheezing, shortness of breath, chest tightness, or phlegm production that was not due to a cold/respiratory infection, COPD, or seasonal allergies?

Variable Label: S3. During the past 30 days, did you have any of these symptoms: cough, wheezing, shortness of breath, chest tightness, or phlegm production that was not due to a cold/ respiratory infection, COPD, or seasonal allergies?


Value

Value Label

01

Yes

00

No

-99

Refused


No Terminate

Yes indicate and continue to S3A; continue if 3/5 marked; otherwise, terminate


Question Type: Multiple Punch

S3A. Which symptoms did you experience?


Variable

Variable Text

Variable Label

S3A_A

Cough

S3A_A: Cough

S3A_B

Wheezing

S3A_B: Wheezing

S3A_C

Shortness of breath

S3A_C: Shortness of breath

S3A_D

Chest tightness

S3A_D: Chest tightness

S3A_E

Phlegm production

S3A_E : Phlegm production


Value

Value Label

01

Selected

00

Not selected

-99

Refused

-100

Valid skip


[TERMINATE IF S2_C=00 AND < 3 symptoms selected for S3A]


Question Type: Single Punch

S4. Are you trained or employed as a health care professional?
Variable Label: S4. Are you trained or employed as a health care professional?


Value

Value Label


01

Yes

[TERMINATE]

00

No

[CONTINUE]

-99

Refused

[TERMINATE]


Question Type: Single Punch

S5. Do you work for a pharmaceutical company, an advertising agency, a market research company, or the Department of Health and Human Services (HHS)?

Variable Label: S5. Do you work for a pharmaceutical company, an advertising agency, a market research company, or the Department of Health and Human Services (HHS)?


Value

Value Label


01

Yes

[TERMINATE]

00

No

[CONTINUE]

-99

Refused

[TERMINATE]


Question Type: Single Punch

S6. Have you taken part in survey research within the last three months?

Variable Label: S6. Have you taken part in survey research within the last three months?

Value

Value Label


01

Yes

[Continue to S7]

00

No

[Skip to S8]

-99

Refused

[TERMINATE]


Question Type: Multiple Punch

S7. Please indicate the survey topic(s). Select all that apply.


Variable

Variable text

Variable label

S7_A

Food advertising

S7_A: Food advertising

S7_B

Prescription drug advertising

S7_B: Prescription drug advertising

S7_C

Beauty products

S7_C: Beauty products

S7_D

Automotive

S7_D: Automotive

S7_E

Other: please indicate________________

S7_E: Other:


Value

Value Label

01

Selected

00

Not selected

-99

Refused

-100

Valid skip


[TERMINATE IF S7_B = 01]

Question Type: Single Punch

S8. Are you:

Variable Label: S8: Are you (Male/Female)?


Value

Value Label

01

Male

02

Female

-99

Refused


Question Type: Single Punch

S9. What is the highest level of school you have completed or the highest degree you have received?

Variable Label: S9. What is the highest level of school you have completed or the highest degree you have received?

Value

Value Label

01

Some high school or less

02

High school graduate—high school diploma or equivalent (for example, GED)

03

Some college but no degree

04

Associate degree in college

05

Bachelor’s degree in college (for example, BA, AB, BS)

06

Advanced or post-graduate degree (for example, Master’s degree, Ph.D., M.D., J.D.)

Question Type: Single Punch

S10. Are you Hispanic or Latino?

Variable Label: S10: Are you Hispanic or Latino?


Value

Value Label

01

Hispanic or Latino

00

Not Hispanic or Latino

-99

Refused


Question Type: Multiple Punch

S11. What is your race? You may select one or more races.

Variable Label: S11. What is your race? You may select one or more races.


Variable

Variable text

Value Label

S11_1

American Indian or Alaska Native

S11_1: American Indian or Alaska Native

S11_2

Asian

S11_2: Asian

S11_3

Black or African American

S11_3: Black or African American

S11_4

Native Hawaiian or other Pacific Islander

S11_4: Native Hawaiian or other Pacific Islander

S11_5

White

S11_5: White

S11_6

Prefer not to answer

S11_6: Prefer not to answer


Value

Value Label

01

Selected

00

Not selected

-99

Refused

[DETERMINE ELIGIBILITY]


[IF S1 <18, THEN INELIGIBLE. THANK AND TERMINATE.]

[IF S4 = 01 (“Yes”), THEN INELIGIBLE. THANK AND TERMINATE.]

[IF S5 = 01 (“Yes”), THEN INELIGIBLE. THANK AND TERMINATE.]

[IF S7B = 01, THEN INELIGIBLE. THANK AND TERMINATE.]


[TERMINATION LANGUAGE FOR INELIGIBLE PARTICIPANTS]

I’m sorry, but you are not eligible for this study. There are many possible reasons why people are not eligible. These reasons were decided earlier by the researchers. However, thank you for your interest in this study and for taking the time to answer our questions today.



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AuthorBetts, Kevin
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File Created2021-01-15

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