Form 1 Screener

ABCD Study Audience Feedback Teams OMB #0925-0781 | Expiration 03/31/2027

Teen Phone Screener

PAPERWORK REDUCTION ACT STATEMENT

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 minutes per response, including the time to review instructions and respond to questions. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, Attn: OMB-PRA 0925-0781.

Introduction

Hello, my name is _______________ and I’m calling from _________________ about an upcoming project managed by the National Institutes of Health. The National Institutes of Health—or NIH—is a government agency that supports research on health.

We would like to tell you more about the project and, if you are interested, ask you a short series of questions to see if you are eligible to participate. We estimate this to take an average of 5 minutes, and this information collection has been approved by the Office of Management and Budget under PRA 0925-0781.

NIH is looking for teens for a dynamic and diverse teen feedback team to share their thoughts and opinions about research on how brains develop from childhood to adulthood. We’ll discuss the kinds of questions scientists are asking about topics like teens’ health, life experiences, activities, and identities. We want to make sure scientists are asking these questions in the best way possible. We also want to get your opinions on material NIH has created to tell people about the study so that it can be engaging and relevant.

The feedback teams are groups of people who provide their thoughts and opinions through surveys, interviews, or bulletin board discussions. The input from these feedback teams will help the ABCD Study® researchers ask questions about life experiences in the best way possible.

Feedback teams started in 2024 will run for up to three years. Not every feedback team member will participate in every activity; team members will be invited to at least one but no more than three feedback activities per year. All feedback team activities will take place online.

Participation in the feedback team is voluntary and you can stop being part of the team at any time. You can decide which feedback activities you want to join. Your individual responses and personal information will be kept private. Your parent or guardian has given permission for us to ask you some eligibility questions – would you like to continue? [RECORD YES/NO ANSWER, THEN CONFIRM.]

Eligibility Questions for Teens

1. Note for recruiters: Ask your typical articulation question (e.g., If you could have a dinner conversation with anyone, who would it be and why?).

Check if the potential participant speaks English fluently and articulates verbally well enough to participate in a meaningful discussion: _____Yes _____No [THANK AND TERMINATE CALL.]

2. Which of these best describes your race or ethnicity [choose one or more]?

   1. American Indian or Alaska Native

   2. Asian

   3. Black or African American

   4. Hispanic or Latino

   5. Middle Eastern or North African

   6. Native Hawaiian or Other Pacific Islander

   7. White

[RECRUIT A MIX, AS POSSIBLE.] 

3. Do you consider yourself LGBTQ+? [READ ALL CHOICES.]

   1. Yes

   2. No

   3. Not sure

   4. Prefer not to answer

4. We want to make sure we are referring to you appropriately during feedback team activities. Which of the following pronouns do you use most often (choose one or more)?

   1. He/him

   2. She/her

   3. They/them

   4. Something else _______

Suggested Language When Terminating a Call
Thank you very much for your time today. We are required to recruit a wide variety of participants to help with this project. Unfortunately, we have filled the feedback team spaces for your background. However, we thank you for your interest.

Invitation to Feedback Teams

Thank you for answering my questions. We would like to invite you to join our teen feedback team! The feedback teams started in 2024 will run for up to three years. There will be a maximum of three feedback activities per year. You can always choose which activities you join, and you can decide to stop being part of the feedback team at any time.

When a feedback activity is ready, we will reach out to team members with an invitation. For each feedback activity you join, we will send you a monetary token of appreciation for your time.

Would you like to join the teen feedback team?

1. Yes [CONFIRM CONTACT INFORMATION FOR FEEDBACK ACTIVITY INVITATIONS.]

2. No [THANK AND TERMINATE CALL.]

Thanks so much for agreeing to be a part of the feedback team. Let me get the correct spelling of your name, your email, and your phone number(s). I will be contacting you to invite you to feedback team activities later this year.

NAME_______________________________________________________________________

EMAIL________________________________________________________________________

HOME PHONE_________________________________

CELL PHONE___________________________________

TODAY’S DATE________________________________

RECRUITER____________________________________

Invitation to Survey

You have been invited to take a feedback survey. This survey will take no longer than 30 minutes to complete.

Please use this link to access the survey: _____________________

To make sure you get credit for completing the survey, you will be asked to put in a unique ID code.

Your ID code is: ___________

Please do not share this link or your ID code with anyone else, including other feedback team members.

Thank you!

Invitation to Virtual Discussion

You have been invited to participate in a virtual group discussion. The live, virtual discussion will take place on MONTH DAY, 202X, via Zoom. The discussion will be 60 minutes long and you will be joined by up to three members of the feedback team.

Before your scheduled discussion, we will send you a confirmation text or email. We will also contact you the day before as a reminder.

If you decide not to participate, please let us know immediately so we can find someone to take your place. My name is ___________ and you can reach me at _____________.

Thank you!

Invitation to Online Bulletin Board

You are invited to join an online bulletin board discussion, which is set up like other online forums (such as Reddit or Facebook groups). On your own schedule while the board is open, you will join other members of the feedback team to answer some questions and share your thoughts. A moderator will also be in the discussion to ask follow-up questions, and team members can comment on each other’s answers. We expect this to take up to 60 minutes, including answering questions and commenting. We encourage you to check in over the X days to see new questions and reactions in the discussion.

The bulletin board will be open from TIME MONTH DAY, 202X, to TIME MONTH DAY, 202X. We will contact you as a reminder on the first day of the bulletin board.

Please use this link to access the bulletin board: _____________

As a reminder, please do not share this link with anyone else, including other members of the feedback team. This is to protect everyone’s privacy.

Thank you!

0