[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]
1 Male
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 Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Sullivan, Helen W (CDER) |
| File Modified | 0000-00-00 |
| File Created | 2021-04-06 |