Community Violence Survey and Consent

[OS] CDC/ATSDR Formative Research and Tool Development

Att 6. CV Survey and Consent

[NCIPC] Formative Research for Firearm Violence and Community Violence Messaging

OMB: 0920-1154

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Attachment 6: CV 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 community violence. 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 community violence prevention.


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 community violence and their ability to support community 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:



Defining Community Violence


  1. When you hear about violence in your community or other communities, what comes to mind (such as specific words, places, people, events, etc.)? [open text box]


  1. When you think about violence happening in your community, what locations come to mind? Select all that apply

    1. home

    2. school

    3. workplace

    4. neighborhood

    5. streets

    6. public places (e.g., park, grocery store, shopping mall)

    7. public events (e.g., concert, parade)

    8. other, specify: [open-ended]


  1. This is how CDC defines “community violence”:

Community violence happens in public places (e.g., streets, schools, parks) between people who may or may not know each other. Youth and young adults, aged 10-34, are most likely to experience community violence. Examples include assaults, fights among groups, homicides, and fatal and nonfatal shootings.

  1. On a scale of 1-10, how easy is this definition of community violence to understand? [Likert scale 1-7]

    1. What could make this easier to understand? [open-ended]


Reactions to Draft CV Message Sets

[Display message from message bank (Att 9. CV Messages for Testing)]


[Participants will be presented with three message sets. The following set of questions will be asked for each message set displayed]


  1. How easy is it to understand this message? [Likert scale 1-7]

    1. What could make it easier to understand? [open-ended]

    2. Would data or a statistic make this message easier to understand? [yes/no]

  1. How believable is this message? [Likert scale 1-7]

    1. What could make it more believable? [open-ended]

    2. Would data or a statistic make this message more believable? [yes/no]

  2. How appealing is this message to you? [Likert scale 1-7]

    1. What could make it more appealing? [open-ended]

  3. How well do you think you would remember this message? [Likert scale 1-7]

    1. What could make it easier to remember? [open-ended]

  4. How important is the information in this message? [Likert scale 1-7]

    1. Can you share why you gave that rating? [open-ended]


A/B Testing of Draft CV 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 9. CV Messages for Testing)]


[The following set of questions will be asked for each of the three message pairs displayed]


  1. Please select the message that you understand best. [one option]

      1. Message A

      2. Message B

      3. Neither message

    1. [If message A or B] Why was this message more clear? [open text box]

    2. [If neither] What could be explained more clearly in these messages? [open text box]


  1. Please select the message that you find most believable. [one option]

      1. Message A

      2. Message B

      3. Neither message

    1. [If message A or B] Why did you find this message believable? [open text box]

    2. [If neither] What could make these messages more believable? [open text box]


  1. Please select the message that you find most appealing. [one option]

      1. Message A

      2. Message B

      3. Neither message

    1. [If message A or B] Why was this message more appealing? [open text box]

    2. [If neither] What could make these messages more appealing? [open text box]


  1. Please select the message that you will remember best. [one option]

      1. Message A

      2. Message B

      3. Neither message

    1. [If Message A or B] What was easy to remember about this message? [open text box]

    2. [If neither] What could make these messages easier to remember? [open text box]


  1. Please select the message that you find most important. [one option]

      1. Message A

      2. Message B

      3. Neither message

    1. [If Message A or B] Why was this message most important? [open text box]

    2. [If neither] What could make these messages more important? [open text box]


  1. Would knowing this message came from CDC make it more or less believable?

    1. Why or why not? [open text box]


Reactions to Stock Images

  1. Which of these images most represent “community” to you? Select your top 3.

[show visual depictions of community (Att 10. CV Images for Testing)]

Empathy


When it comes to information or messages put out by CDC or other federal organizations:

  1. How important is it for CDC or other federal organizations to understand your perspective? [Likert scale 1-7]

    1. Can you share why you gave this rating? [open text box]


  1. How important is it for CDC or other federal organizations to understand your concerns or feelings? [Likert scale 1-7]

    1. Can you share why you gave this rating? [open text box]



Trusted Messengers Regarding CV

  1. If violence occurs in your community or you hear about violence occurring somewhere, what types of information do you look for? [open-ended]


  1. Where is the first place you go for this information?

    1. Internet search engine (e.g., Google, Bing, Yahoo, DuckDuckGo, etc.)

    2. Online news sources (local/national)

    3. TV news sources (local/national)

    4. Social media (e.g., Facebook, Instagram, Twitter, Nextdoor, etc.)

    5. YouTube

    6. Online forums (e.g., Reddit, Quora, etc.)

    7. Friends/family

    8. Doctor or other health professional

    9. Neighbors

    10. Other, specify: [open-ended]

  2. If community safety information was available at/on [insert options below] would you read or view it? (yes/no)

      1. Social media

      2. School

      3. Church

      4. The community center or another community setting

      5. A website


Additional Information

  1. Is there any additional information that you would like to share? [open-ended]

Demographics

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.


  1. Age:

    1. How old are you?

      1. under 18 years of age

      2. 18-24 years of age

      3. 25-34 years of age

      4. 35-44 years of age

      5. 45-54 years of age

      6. 55-64 years of age

      7. 65-74 years of age

      8. 75 years of age or older


  1. Location: What is your ZIP code?


  1. Language

    1. What is your preferred language for reading and writing?

      1. English

      2. Spanish

      3. Other


  1. Race/Ethnicity

    1. What is your ethnicity?

      1. Hispanic or Latino

      2. Not Hispanic or Latino


    1. What is your race? Select all that apply.

      1. American Indian or Alaska Native

      2. Asian

      3. Black or African American

      4. Native Hawaiian or Other Pacific Islander

      5. White


  1. Gender Identity

    1. Are you: Mark all that apply.

      1. Female

      2. Male

      3. Transgender, non-binary, or another gender


  1. Education attainment

    1. What is the highest grade or year of school you completed?

      1. Never attended school

      2. Attended kindergarten only

      3. Grades 1 through 8 (Elementary)

      4. Grades 9 through 11 (Some high school)

      5. Grade 12 or GED (High school graduate)

      6. College 1 year to 3 years (Some college or technical school)

      7. College 4 years or more (College graduate)

      8. Graduate school

      9. I don’t know


  1. Firearm ownership

    1. Do you own any firearms/guns? [Yes/No]

    2. [If previous answer is Yes] What are your reasons for owning firearms/guns? Select all that apply.

      1. Personal protection

      2. Recreational shooting

      3. Competitive shooting

      4. Hunting

      5. Other

    3. [If previous answer is No] What are your reasons for not owning a firearm? Select all that apply.

      1. Firearms are dangerous

      2. Don’t have a need (for personal protection, hunting, recreational/competitive shooting)

      3. Would like to own one, but don’t currently have one

      4. Other

    4. Do you live in a household with one or more firearms/guns? [Yes/No]

    5. Did you grow up in a household with one or more firearms/guns? [Yes/No]


  1. Household Income

    1. Last year, that is in [2022], what was your total household income from all sources, before taxes?

      1. Less than $15,000

      2. $15,000 to $24,999

      3. $25,000 to $34,999

      4. $35,000 to $49,999

      5. $50,000 to $74,999

      6. $75,000 to $99,999

      7. $100,000 to $149,999

      8. $150,000+

      9. I prefer not to answer

      10. I don’t know


  1. Household Size

    1. How many children (under age 18) live in your household?

      1. None

      2. 1-2 children

      3. 3-4 children

      4. 5 or more children

    2. 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. 1

      2. 2

      3. 3

      4. 4 or more

  2. Political Leaning

    1. Generally speaking, do you think of yourself as a Democrat, a Republican, an independent, or something else? Select one.

      1. Democrat

      2. Republican

      3. Independent

      4. Something else

      5. Prefer not to answer

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDills, Jennifer (CDC/NCIPC/DVP)
File Modified0000-00-00
File Created2025-05-19
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