Screener English

OMB No. 0920-0572

Expiration Date: 03/31/2025

Project Title: CDC Screen for Life Message Testing

Attachment Title: Screener_English_paper version

Attachment Number: D

CDC Contact Information:

Ginny Kincaid

Health Communication Specialist

Division of Cancer Prevention and Control (DCPC) 

Centers for Disease Control and Prevention 

Email: [email protected]

Public reporting burden of this collection of information is estimated to average 2.7 minutes per response, including the time for reviewing instructions, 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572).

Attachment D: Screener

CDC/NCCDPHP/DCPC Message Testing of “Screen for Life” Campaign Materials

1b. Do you work for:

1. A market research company [exclude]

2. An advertising agency, public relations firm, or digital media company [exclude]

3. The media (TV/radio/newspapers/magazines) [exclude]

4. A healthcare or public health professional (doctor, nurse, pharmacist, dietician, etc.) [exclude]

5. None of these

2. How old are you?

Years old

[Include if between ages of 45–55]

3. Please select if you have ever had any of the following cancer screenings:

1. Mammogram

2. Magnetic resonance imaging (MRI)

3. Colonoscopy [exclude]

4. Stool Test (fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), or Cologuard) [exclude]

5. Prostate-specific antigen test (PSA)

6. Digital rectal exam (DRE)

7. None of the above 

//Hover box definitions for S3//:

Mammogram: An X-ray of the breast (source).

Magnetic resonance imaging (MRI): An MRI uses magnets and radio waves to take pictures of certain parts of the body to look for cancer (e.g., breast)(source).

Colonoscopy: A doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon (source).

Stool Tests: (source)

• The guaiac-based fecal occult blood test (gFOBT) uses the chemical guaiac to detect blood in the stool. It is done once a year. For this test, you receive a test kit from your health care provider. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the doctor or a lab, where the stool samples are checked for the presence of blood.

• The fecal immunochemical test (FIT) uses antibodies to detect blood in the stool. It is also done once a year in the same way as a gFOBT.

• The FIT-DNA test (also referred to as the stool DNA test) combines the FIT with a test that detects altered DNA in the stool. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood. It is done once every three years.

Prostate-specific antigen test (PSA): A blood test called a prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate (source).

Digital rectal exam (DRE): A digital rectal examination (DRE) is when a health care provider inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for anything abnormal, such as cancer (source).

4. In the course of your lifetime, have you had any of the following cancers?

1. Breast Cancer

2. Thyroid Cancer

3. Colorectal (Colon) Cancer [exclude]

4. None of the above

5A. What is your sex?

1. Male

2. Female

6. What is your race and/or ethnicity? Select all that apply.

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 Pacific Islander

7. White

8. Don’t Know/Not Sure

7. What language do you use when finding or reading health information?

1. English

2. Spanish

3. Another language (not English or Spanish) [exclude]

[If 6 = d and 7 = b, then direct to Spanish-language survey if eligible]

8. At what age is colorectal cancer screening recommended to begin for most people (those at average risk for developing the disease)?

1. 45 years

2. 50 years

3. 55 years

4. 60 years

5. 65 years

6. Not sure

9. Who can develop colorectal cancer?

1. People of any sex

2. Only people born male

3. Only people born female

4. Not sure

10. Please select the number which indicates how much you agree or disagree with each statement. Rate on a scale of 1 to 5, where 1 means “strongly disagree” and 5 means “strongly agree.”

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I feel worried about my risk of colorectal cancer.
Finding colorectal cancer early could save my life.
[46f] I am confident that I can get screened for colorectal cancer.
I intend to talk to my doctor about getting screened for colorectal cancer.
[19f] I intend to get screened for colorectal cancer.

11. The following question will ask about your familiarity with public health campaigns and media content related to colorectal cancer.

Think about if you have recently seen or heard any media content from the CDC Screen for Life National Colorectal Cancer Action Campaign. Campaign advertisements would have referred to the CDC and may have included the statement “Screen for Life.” Some advertisements would have included the images below. In the past 3 months, do you recall seeing or hearing any content from this campaign?

1. Yes

2. No

3. Not sure

IF INELIGIBLE (TERMINATION LANGUAGE):

Thank you for taking the time to answer these questions. Unfortunately, based on the responses you provided you are not eligible for this study. Have a good day.

IF ELIGIBLE:

Thank you for taking the screener. You are eligible for this study. Please click next to complete the message testing questionnaire.

Attachment D: Screener 6