Attach 3B_Interview Script and Consent North Carolina

OMB NO.: 0925-0406

EXPIRATION DATE: 10/31/2011

Attachment 3B:

Interview Script and Verbal Consent for North Carolina Respondents

Public reporting burden for this collection of information is estimated to average thirty-five 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 (0925-0406).  Do not return the completed form to this address.

Subject ID 6 Digits P or S

Subject Name First_Middle Initial_Last

Gender from Coordinating Center

Participant Type P (private applicator), or S (spouse)

Enrollment Date from Coordinating Center

Last Interviewed from Coordinating Center

Menopausal status from Coordinating Center

Address from AHS database

Spouse’s name from AHS database

Reaching the Respondent

Hello, (may I speak to / have I reached) <Participant 1^st name, middle initial, last name>?

WHO IS CALLING? This is (FIRST NAME/LAST NAME). I am trying to reach <R’s full NAME>, who completed an interview with us several years ago about work and health. Is (he/she) available?

NOT AVAILABLE: When would be the best time to reach <Mr/Ms LAST NAME>?

Introduction to Respondent

Have I reached (FIRST NAME/ MIDDLE INITIAL/ LAST NAME)?

Hello, (Mr/Mrs LAST NAME). This is (FIRST NAME/LAST NAME) with the

Agricultural Health Study.

Thank you for taking part in the Agricultural Health Study in the past.

It’s been a long time since we contacted you. Things change over time so we are contacting you (today/tonight) to ask you a few questions that will update the information you gave us earlier. We sent you a letter letting you know that we would try to call. Let me explain that the interview includes questions about work and certain health conditions you and your family may have experienced since you were last contacted.

If this is a good time, we could do the interview now. The interview takes (APPLICATORS: usually less than 30 minutes) (SPOUSES: about 20 minutes) but for those who are not fully engaged in farming activities, the interview is shorter. Would that be alright? Is this a good time?

YES: START SURVEY

IF RELUCTANT: We could get started and see how it goes. You can stop me at any time. Would that be alright?

_______________________________________________________________________

STUDY DESCRIPTION SCRIPT

The Agricultural Health Study is a long-term study designed to follow farmers and their families over a period of time to study protective aspects of health and possible factors of disease. Various diseases among farm families which are of interest to scientists in this and other countries are being studied, including the incidence of cancer. You completed a questionnaire for us either at a pesticide certification site, over the phone, or by mail several years ago. We are calling now just to update the information you already provided.

SPONSORS:

The study is sponsored by the National Cancer Institute and the National Institute of Environmental Health Sciences, of the National Institutes of Health, with collaborators, the United States Environmental Protection Agency and the National Institute for Occupational Safety and Health.

REFUSAL SCRIPT

IF REASON NOT EXPRESSED: To strengthen the study, would you mind telling us why you are unable to participate?

RECORD / RESPOND TO OBJECTIONS

You are especially valuable to the study. And whatever you are able to do for us would be greatly appreciated. By continuing to follow our earlier study participants as they grow older, the study becomes much more valuable to everyone. The answers you give us could help study scientists find answers to questions that would be very important to farmers and others – even to future generations.

All participation is voluntary, but we do hope that you will take part. If you would be willing to answer a few questions we could get started and you can stop me at any time. Would that be OK?

NO TIME

Since you have done a lot already, we have made a special effort to keep this interview as brief as possible. We can set appointments if there is a better time or we could ask a few questions and you could stop anytime you need to. Would that be alright?

NOT FARMING: ________

Some people may think the study does not need them since they do not farm but the continued participation of all individuals who took part earlier is very important. The interview will be much shorter if you are not farming but updating other information is still very important. We could ask a few questions and see how it goes. You could stop me at any time. Would that be OK?

FEMALE NOT FARMING/NOT USING PESTICIDES: The study is interested in updating the information about the health of all of the agricultural population - including the females. Some women feel that the study is not interested in them because they may be less active in agriculture than men but the study is very interested in understanding more about the issues that affect the health of men and women. Your answers could help scientists answer questions about health that could help our children and grandchildren.

If you would be willing, we could start the interview and see how it goes. You can stop me anytime. Would that be OK?

STILL REFUSING: _____

Alright. I’ll be glad to add what you have said. Thank you for all the help you have already given and thank you for talking with me (today/tonight).

________________________________________________________________________

DECEASED SCRIPT

DECEASED: _______

We’re so sorry to hear that. We wouldn’t have called if we had known. It would help the study if you would tell us when that occurred. RECORD INFORMATION

We really appreciate all the help (he/she) gave to the study. Thank you for speaking with me today.

_______________________________________________________________________

REMAIL LETTER SCRIPT

LETTER REMAIL REQUESTED:_______

We will be glad to send you the study letter. You should receive it in a few days. Let me check the address we have on record.

Is your address…..? EDIT NEW ADDRESS.

CONTINUE INTERVIEW UNLESS ASKED NOT TO.

SCHEDULE APPOINTMENT SCRIPT

Is there a day of the week or a time of day that is best for us to reach you?

IF RESPONDENT IS UNWILLING TO SUGGEST A TIME: Thank you for speaking with me.

I’m sorry this was not a good time.

I can understand you are busy now.

Sometimes it’s hard to anticipate how things will go.

WRONG RESPONDENT SCRIPT

I___I R SAYS DID NOT PARTICIPATE IN AHS

I___I R LIVES IN DIFFERENT PART OF THE STATE

I___I NAME NOT EXACTLY THE SAME

I___I NAME IS THE SAME

AND

I___I DATE OF BIRTH IS DIFFERENT

That’s all the questions I have at this time. I hope it will be OK for us to call later if we need to ask other questions. Before we ask you to participate in this interview, we need to check our records to see that we have reached the right person. Thank you for speaking with me.

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