Form 0920-0621 Youth Cogntive Testing Screener

Screener

Cognitive Testing Participant Screener

Understanding Use of Electronic Cigarettes among Youth

Parent Introduction

Hello Mr. /Ms. __________________________________, my name is __________________ from [INSERT MARKET RESEARCH FACILITY NAME]. Previously, you provided us with your name and telephone number for our directory and asked us to contact you about any market research opportunities. I would like to talk to you about that we are conducting for the Centers for Disease Control and Prevention (the CDC). We are recruiting middle schoolers for this project that seeks to better understand how youth think about and discuss tobacco-related issues. Youth will receive an incentive of $40 to participate in the interview that will last 60 minutes.

This project will help ensure that we are asking survey questions about tobacco use in a manner that teens can understand. The findings from the interviews will be used to improve a future survey about tobacco that is given to youth. The interview will be observed by project staff and will be audiotaped.

Can we speak to _______________ [youth name] in private to see if he/she is able to participate in the project? If he/she is able to participate, we will need you to review a permission form and give your consent prior to his/her participation in the interview.

Youth Introduction

Hello __________________________________, my name is __________________.

I’m with [INSERT MARKET RESEARCH FACILITY NAME] and we’re interested in talking to middle schoolers about tobacco products and electronic cigarettes or e-cigarettes such as JUUL, SMOK, Sourin, Vuse, or blu. You also may know them as vapes, mods, e-cigs, e-hookahs, or vape-pens. If you’re eligible and selected, you will receive $40 to participate in the interview with us that will last 60 minutes.

This information is being collected for the Centers for Disease Control and Prevention (the CDC). If you participate in the interview, we will ask you different questions related to your thoughts and opinions about tobacco-related topics. Nothing that you share in the interview will be shared with anyone outside of the interview, including your parents. Would you be willing to answer a few questions to see if you are able to participate in the project?

[If YES]: Are you in a location where you are alone and will not be overheard by others?

[If NO], thank and terminate.

[If YES], continue.

[If NO]: I just want to let you know that I’m going to ask some questions about your use of e-cigarettes. Is it ok for me to proceed?

[If YES], continue.

[If NO], terminate.

Screening Questions

Eligibility Questions

Q1. Are you home schooled?

[NO] Continue

[YES] TERMINATE

Q2. What grade are you in?

[A] 6th grade

[B] 7th grade

[C] 8th grade (or just graduated 8^th grade, if interview scheduled during the summer)

[D] Other

[A-C] Continue

[D] TERMINATE

The next question are about electronic cigarettes or e-cigarettes, such as JUUL, SMOK, Suorin, Vuse, or blu. You also may know them as vapes, mods, e-cigs, e-hookahs, or vape-pens. E-cigarettes are battery powered devices that usually contain a nicotine-based liquid that is vaporized and inhaled.

Q3. Have you ever used an e-cigarette, even once or twice?

[A] Yes

[B] No

[A] Continue to Q4

[B] Continue to Q5 (until X non-users have been recruited. If already recruited X, TERMINATE)

Q4. During the past 30 days, that is, since [insert date], on how many days did you use an e-cigarette?

[A] 0 days

[B] 1-2 days

[C] 3-5 days

[D] 6-9 days

[E] 10-19 days

[F] 20-29 days

[G] All 30 days

[A] TERMINATE

[B-G] Continue to Q5

Demographic Questions

Q5. What is your sex?

[A] Male

[B] Female

[C] Other

[D] Prefer not to answer

Q6. Are you Hispanic, Latino, Latina, or of Spanish origin?

[A] Yes

[B] No

Q7. What is your race? I am going to read several categories of race. You may choose one or more categories as they apply. Are you…

[A] White

[B] Black or African American

[C] Asian

[D] Native Hawaiian or other Pacific Islander

[E] American Indian or Alaska Native

[F] Other [WRITE IN] ________________________

Invitation Questions

From what you told me it looks like you are eligible to participate in the project and we invite you to participate in an interview to discuss tobacco issues and products, including e-cigarettes. The interview will last about 60 minutes, will be audio recorded for notetaking purposes, and observed by the project staff. Your participation is voluntary and nothing you share in the interview will be shared with anyone outside of the interview, including your parent or guardian. You will receive $40 to cover ti.me and transportation costs

Are you interested in being interviewed?

[YES] Continue

[NO] TERMINATE [Read termination script.]

I’m glad that you will be able to join us! The interview will take place on [Day], [Date], at [] at [site location]. If you normally wear contacts, or glasses to read please remember to bring them with you.

Because you are under age 18 years, we will need a parent or guardian’s permission for you to be in the project. Can I speak to your parent or a guardian to ask for permission now?

[YES] Continue

[NO] You will need to have your parent review the permission form when you come to the interview. If they don’t review the form, you won’t be able to participate.

[Read the parental consent form to the parent. Record verbal consent at the bottom of the page].

Termination Script:

I’m sorry but you are not eligible to participate in the project. There are many reasons why individuals are not eligible to participate. The participation criteria were set prior to our call today. However, CDC would like to remind you that there is no safe tobacco product, including the products I asked you about today.

Participant permission recorded by _____________________________ on ___/ ____/ 20__