Form 2 Phase III Interview Script and Consent

ATTACHMENT 3

Phase III Interview Script and Verbal Consent
3A. Phase III Interview Script and Verbal Consent for Iowa
Respondents
3B.

Phase III Interview Script and Verbal Consent for North
Carolina Respondents

OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

Attachment 3A:

Phase III Interview Script and Verbal Consent for Iowa Respondents

Public reporting burden for this collection of information is estimated to average 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.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

AHS PHASE III INTERVIEW TELEPHONE SCRIPTS
Hello, have I reached (FIRST NAME – LAST NAME – JR/SR?)
IF NAMES ARE CONFUSING:
I am trying to reach (FIRST NAME – LAST NAME – JR/SR), who completed a telephone
interview or hard copy questionnaire with us several years ago about work and health factors
common in the farming community. Have I reached the right person?
INTRODUCTION

Hello Ms./Mr. _________. This is _________ with the Agricultural Heath Study at (the
University of Iowa/North Carolina). You were sent a letter from Dr. Michael Alavanja
recently, letting you know that I would be calling. Do you recall seeing that in your mail?
IF NO, DON’T REMEMBER STUDY>> It’s 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.
The reason I’m calling today (tonight) is to update your information. The questions deal
with your pesticide use and general health information. This should take no more than 37
minutes to complete. We appreciate all the time you have given to help with this study.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

ASK FOR INTERVIEW (Verbal Consent)
Would you be willing to participate? We could do it now or schedule a time that would be
more convenient for you.
IF YES TO INTERVIEW>>Is now a good time?
IOWA ONLY
Good, before we get started, I would like to ask if it is all right to tape-record this
interview. The purpose is to ensure that I’ve recorded your answers correctly. We do
erase the tapes after we have checked them. Please be assured that your answers are
strictly confidential to the extent of the law. Your participation in this or any part of the
Agricultural Health Study is voluntary and you may refuse to answer any question. Your
name will not be linked to any of your information in reports. If you have questions
about the study, you may call 1-800-4AG-STUDY. Is this all right with you?

IF YES TO TAPING >> Do you have any questions before we begin? Okay,
let’s get started.

IF NO TO TAPING>> That’s not a problem, I’ll leave the tape recorder off
then. Do you have any questions before we begin? Okay, let’s get started.

NORTH CAROLINA ONLY
Good, before we get started, my supervisor may listen in part of the interview to be sure I am
doing the best job possible. Please be assured that your answers are strictly confidential to the
extent of the law. Your participation in this or any part of the Agricultural Health Study is
voluntary and you may refuse to answer any question. Your name will not be linked to any of
your information in reports. If you have questions about the study, you may call 1-800-4247883. Is this all right with you?

IF NO TO NOW>>When would you like us to call you back?
IF NO TO INTERVIEW>>Okay, then, thank you very much.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

NO LONGER-FARMING
IF REFUSES INTERVIEW AT ANY POINT, DUE TO NO LONGER FARMING (retired or
other) >>
Even though you are no longer farming, your information is still very important to us. Many
of the diseases we are studying, such as cancer, may be due to exposures that occurred many
years ago. This means we need to look well into the past to study the causes of these
diseases. Also, since we are studying many types of exposures--not just farm exposures--it is
important for us to obtain information even after you quit farming. Would you be willing to
participate?
IF CONSENTS TO INTERVIEW, RESUME SCRIPT WHERE YOU LEFT OFF,
ABOVE
IF REFUSES INTERVIEW, okay, then, thank you very much for your past participation.

CLOSING SCRIPT
That completes the interview. You have made a valuable contribution to our research.
Thank you for taking the time to talk with me today.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

Attachment 3B:
Phase III Interview Script and Verbal Consent for North Carolina
Respondents

Public reporting burden for this collection of information is estimated to average 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.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

Subject ID
Subject Name
Gender
Participant Type
Enrollment Date
Last Interviewed
Menopausal status
Address
Spouse’s name

6 Digits P or S
First_Middle Initial_Last
from Coordinating Center
P (private applicator), or S (spouse)
from Coordinating Center
from Coordinating Center
from Coordinating Center
from AHS database
from AHS database

Reaching the Respondent
Hello, (may I speak to / have I reached) ?
WHO IS CALLING? This is (FIRST NAME/LAST NAME). I am trying to reach , 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 ?

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?
_______________________________________________________________________

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

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

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

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.

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OMB NO.: 0925-0406
EXPIRATION DATE: 10/31/2011

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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