4 Rep

OMB Number: 0925-XXXX

Expiration Date: __________

attachment 2e

NAQC Representative Data Collection Instrument

Contact Information

Home Organization:	_______________________________________________________
Respondent name:	_______________________________________________________
Phone number:	_______________________________________________________
Email:	_______________________________________________________
Date of interview:	_______________________________________________________
Interviewer:	_______________________________________________________
Interview result:	_______________________________________________________

Public reporting burden for this collection of information is estimated to average 30 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form to this address.

OMB Number: #########

Expires: mm/dd/yyyy

Intro Script

Hello, my name is ______________________. I am a researcher from Westat, a national health research organization.

The National Cancer Institute and the Centers for Disease Control and Prevention have contracted with Westat to conduct an evaluation of the National Network of Tobacco Cessation Quitlines Initiative. As part of this Initiative, the Federal government established a national toll-free tobacco quitline number in November, 2004, 1-800-QUIT-NOW.

I would like to obtain your views on a number of topics related to the Initiative. Some of the questions I ask will be about your thoughts and ideas about the Quitline Network Initiative itself, some questions will be about NAQC, and others will be about state quitlines generally. Our interview should last about 30 minutes. Is this a convenient time for you? [IF NO: When would be a better time for me to call back?]

If you agree, I’d like to record our conversation so that I can pay close attention to what you are telling me without having to stop and write extensive notes. The recording will only be used to review our discussion for a more detailed analysis. Do you agree to have this interview recorded?

[CHECK HERE IF RESPONDENT AGREES TO RECORDING: _______ ]

Your participation in this interview is voluntary and there are no penalties if you decide not to respond to the information collection as a whole or any particular question. You can refuse to answer any question and “I don’t know” is an acceptable response. The information you provide will be kept confidential and will not be disclosed in identifiable form to anyone. Responses to this interview will be reported in summary form only or will be presented in a way that their source cannot be identified. Do you have any questions before we begin?

1.	What is your role at NAQC?

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2.	Please briefly describe the relationship between NAQC and the National Cancer Institute and the Centers for Disease Control, with respect to the planning and initial launch of the Initiative.

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3.	What specific activities did NAQC perform, in relation to the planning and launch of the Initiative?

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4.	What was your personal role, in relation to the planning and launch of the Initiative?

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5.	In general, how did you regard the announcement of the Initiative when you first heard of it?

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6.	In general, how do you regard it now?

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7.	Overall, how do you think the states regarded the announcement of the Initiative when they first heard of it?

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8.	In general, how do you think they regard it now?

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9.	What successes became apparent during the first year following the launch of 1-800-QUIT-NOW in November, 2004?

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10.	What difficulties, anticipated or unanticipated, did the states encounter during the first year following the launch of 1-800-QUIT-NOW in November, 2004?

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11.	In general, how would you describe the effect of the Initiative on NAQC’s activities and objectives?

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12.	In general, how would you describe the effect of the Initiative on the objectives of the state quitlines?

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13.	How would you describe the Initiative’s overall effect on state quitlines generally?

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14.	Think about the specific needs or requirements for state quitlines that began after the Initiative announcement, as compared to already existing quitlines. Are you aware of any significant differences between the two? If so, please describe what was different.

______________________________________________________________________

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15.	To your knowledge, did any state or national promotions involving the 1-800-QUIT-NOW number adversely impact quitline operations? If so, please describe the impact.

______________________________________________________________________

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16.	In your opinion, what would be the most significant difference if the Initiative had not occurred?

______________________________________________________________________

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17.	Finally, is there anything else about the Initiative you would like to discuss?

______________________________________________________________________

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______________________________________________________________________

Thank you very much for your time. Your experience and insights will make an important contribution to our evaluation of the Initiative. If you would like to contact me, my name is ______________________, and can be reached at 301-251-1500 or 800-937-8281.

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