Attachment 1: FA Survey and Consent
OMB Control No. 0920-1154
Exp. Date 3/31/2026
The public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-1154).
Introduction and Consent
Thank you for your interest in participating in this survey related to firearm injury and death. The following survey should take no longer than 15 minutes to complete. The results will inform future communications developed by the Centers for Disease Control and Prevention (CDC) related to preventing firearm violence.
Your participation is completely voluntary. All survey questions are optional. You may choose to skip survey questions that you do not wish to answer or discontinue the survey at any point. There are no foreseeable risks associated with participating in this survey. We will not ask you for any personal identifiable information (PII), such as your name or email address, that could link your responses to you. There are no direct benefits to participating in the survey. However, you may benefit from knowing your participation will help improve future communication materials related to firearm violence and their ability to support firearm violence prevention work going forward.
If you have any questions or concerns about this survey, you may contact [PI NAME] by phone at [PHONE NUMBER] or by email at [EMAIL ADDRESS].
If you understand the information above and agree to participate in the survey, please proceed to the first survey question.
____________________________________
Survey Questions:
This survey will ask questions about firearm injury and death (sometimes referred to as firearm violence or gun violence). We are defining firearm injury and death as including homicide or suicide, or nonfatal injury from assault or suicide attempt, or accidental firearm injuries.
How concerned are you about firearm injury and death? [Likert scale 1-7]
Can you share why you gave that rating? [open-ended]
How concerned do you think other people you know (e.g., friends, family, neighbors) are about firearm injury and death? [Likert scale 1-7]
Can you share why you gave that rating? [open-ended]
How possible do you think is it to prevent firearm injury and death? [Likert scale 1-7]
Can you share why you gave that rating? [open-ended]
Whose responsibility is it to prevent or address firearm injury and death? Select all that apply.
Law enforcement (i.e., police)
Criminal justice (i.e., prosecutors, judges, courts)
Medical/Healthcare
Mental Health
Public Health
Communities
Everyone
Other, specify: [open-ended]
In terms of local, state, and federal levels, whose responsibility is it to prevent or address firearm injury and death? Select all that apply.
Local government or agencies (e.g., mayor, county commission, county health department, other city or county agencies)
State government or agencies (e.g., governor, state legislature, state health department, other state agencies)
Federal government or agencies (e.g., White House, Department of Justice, Centers for Disease Control and Prevention, Congress)
None of the above
Did you know, before taking this survey, that CDC does research and other work to prevent firearm injury and death? [Yes/No]
[Display message from message bank (Att 4. FA Messages for Testing)]
[Participants will be presented with three message sets. The following set of questions will be asked for each message set displayed]
How easy is it to understand this message? [Likert scale 1-7]
What could make it easier to understand? [open-ended]
Would data or a statistic make this message easier to understand? [yes/no]
How believable is this message? [Likert scale 1-7]
What could make it more believable? [open-ended]
Would data or a statistic make this message more believable? [yes/no]
How appealing is this message to you? [Likert scale 1-7]
What could make it more appealing? [open-ended]
How well do you think you would remember this message? [Likert scale 1-7]
What could make it easier to remember? [open-ended]
How important is the information in this message? [Likert scale 1-7]
Can you share why you gave that rating? [open-ended]
A/B Testing of Draft Firearm Messages
You will be presented with two messages to read, and then asked some questions to compare the messages.
[Display two messages from message bank for comparison (Att 4. FA Messages for Testing)]
[The following set of questions will be asked for each of the three message pairs displayed]
Please select the message that you understand best. [one option]
Message A
Message B
Neither message
[If message A or B] Why was this message more clear? [open text box]
[If neither] What could be explained more clearly in these messages? [open text box]
Please select the message that you find most believable. [one option]
Message A
Message B
Neither message
[If message A or B] Why did you find this message believable? [open text box]
[If neither] What could make these messages more believable? [open text box]
Please select the message that you find most appealing. [one option]
Message A
Message B
Neither message
[If message A or B] Why was this message more appealing? [open text box]
[If neither] What could make these messages more appealing? [open text box]
Please select the message that you will remember best. [one option]
Message A
Message B
Neither message
[If Message A or B] What was easy to remember about this message? [open text box]
[If neither] What could make these messages easier to remember? [open text box]
Please select the message that you find most important. [one option]
Message A
Message B
Neither message
[If Message A or B] Why was this message most important? [open text box]
[If neither] What could make these messages more important? [open text box]
Would knowing this message came from CDC make it more or less believable?
More believable
Less believable
Why or why not? [open text box]
When it comes to information or messages put out by CDC or other federal organizations:
How important is it for CDC or other federal organizations to understand your perspective? [Likert scale 1-7]
Can you share why you gave this rating? [open text box]
How important is it for CDC or other federal organizations to understand your concerns or feelings? [Likert scale 1-7]
Can you share why you gave this rating? [open text box]
[Images for this section are in Att 5. FA Images for Testing]
To accompany messages about prevention of firearm injury and death, which of these images best accompanies the prevention message? [show photos of guns]
To accompany messages about prevention of firearm injury and death, do you prefer photos or illustrations of guns?
[show photo of gun vs. illustration of gun]
To accompany messages about safe firearm storage, which of these images is more believable? [show photos of guns with locks, guns in safes, guns in lock boxes]
Where is the first place you go for health and safety information?
Internet search engine (e.g., Google, Bing, Yahoo, DuckDuckGo, etc.)
Online news sources (local/national)
TV news sources (local/national)
Social media (e.g., Facebook, Instagram, Twitter, Nextdoor, etc.)
YouTube
Online forums (e.g., Reddit, Quora, etc.)
Friends/family
Neighbors
Other, specify: [open-ended]
If firearm injury or death occurs in your community or you hear about it occurring somewhere, what types of information do you look for? [open-ended]
To what degree do you feel that CDC information about firearm injury and death, and how to prevent it, is credible? [Likert scale 1-7]
Can you share why you gave that rating? [open-ended]
Is there any additional information that you would like to share? [open-ended]
Finally, we ask you to please answer a few demographic questions. After we compile all survey responses, we use the demographic information to identify trends and patterns across the data set. As a reminder, we are not collecting personally identifiable information and these data cannot be linked to you.
Age: How old are you?
under 18 years of age
18-24 years of age
25-34 years of age
35-44 years of age
45-54 years of age
55-64 years of age
65-74 years of age
75 years of age or older
Location: What is your ZIP code? [open text box]
Language: What is your preferred language for reading and writing?
English
Spanish
Other
Race/Ethnicity
What is your ethnicity
Hispanic or Latino
Not Hispanic or Latino
What is your race? Select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Gender Identity
Are you:
Female
Male
Transgender, non-binary, or another gender
Education attainment
What is the highest grade or year of school you completed?
Never attended school
Attended kindergarten only
Grades 1 through 8 (Elementary)
Grades 9 through 11 (Some high school)
Grade 12 or GED (High school graduate)
College 1 year to 3 years (Some college or technical school)
College 4 years or more (College graduate)
Graduate school
I don’t know
Firearm ownership
Do you own any firearms/guns? [Yes/No]
[If previous answer is Yes] What are your reasons for owning firearms/guns? Select all that apply.
Personal protection
Recreational shooting
Competitive shooting
Hunting
Other
[If previous answer is No] What are your reasons for not owning a firearm? Select all that apply.
Firearms are dangerous
Don’t have a need
Would like to own one, but don’t currently have one
Other
Do you live in a household with one or more firearms/guns? [Yes/No]
Did you grow up in a household with one or more firearms/guns? [Yes/No]
Household Income
Last year, that is in [2022], what was your total household income from all sources, before taxes?
Less than $15,000
$15,000 to $24,999
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000+
I prefer not to answer
I don’t know
Household
Do you currently have any children under the age of 18 who live with you at least part time? [Yes/No]
Including yourself, how many members of your household are 18 years of age or older, excluding adults living away from home (such as students away at college)?
1
2
3
4 or more
Political Leaning
Generally speaking, do you think of yourself as a Democrat, a Republican, an independent, or something else? Select one.
Democrat
Republican
Independent
Something else
Prefer not to answer
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Dills, Jennifer (CDC/NCIPC/DVP) |
| File Modified | 0000-00-00 |
| File Created | 2025-05-19 |