Study 1 Screener

Study of Oncology Indications in Direct-to-Consumer Television Advertising

Appendix G - Screener

Study 1 Screener

OMB: 0910-0885

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Screening Questions

[CUSTOM TERMINATION SCREEN For terminated RESPONDENTS]

[Thank you for your answers. Unfortunately, you do not meet the desired demographic criteria that our client is looking for.]

S1 How old are you? ______ [open ended] [If S1 <18, terminate]


GENDER What is your gender?

1 Male

2 Female

Prefer not to answer



ETHNICITY Are you:

1 Hispanic or Latino

2 Not Hispanic or Latino

Prefer not to answer



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

RACE1 American Indian or Alaska Native

RACE2 Asian

RACE3 Black or African American

RACE4 Native Hawaiian or other Pacific Islander

RACE5 White

Prefer not to answer


S2 What is your current occupation?

1 Health care professional (e.g., physician, nurse, counselor, physical therapist) [Terminate and show termination screen. Link to screening responses and keep data.]

2 Pharmaceutical employee (e.g., pharma rep) [Terminate and show termination screen. Link to screening responses and keep data.]

3 Market research employee/advertising employee [Terminate and show termination screen. Link to screening responses and keep data.]

4 Employee of the Department of Health and Human Services [Terminate and show termination screen. Link to screening responses and keep data.]

5 All other occupations


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

1 Less than high school

2 High school graduate—high school diploma or the equivalent (for example: GED)

3 Some college but no degree

4 Associate’s degree in college

5 Bachelor’s degree (for example: BA, AB, BS)

6 Advanced or postgraduate degree (for example: master’s degree, MD, DDS, JD, PhD, EdD)

Prefer not to answer



S3 How confident are you filling out medical forms by yourself? [SOFT QUOTA: Include at least 15% of the sample with a score of 3 or lower]

1 Not at all

2 A little bit

3 Somewhat

4 Quite a bit

5 Extremely



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSullivan, Helen W (CDER)
File Modified0000-00-00
File Created2021-04-06

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