Cognitive Interview Screener

Experimental Study of Nutrition Facts Label Formats

Appendix A

COGNITIVE INTERVIEW SCREENER

Hello, my name is xxx and I work for Synovate, a local research firm. We're doing research for the Food and Drug Administration about food labels and nutrition. If you are eligible and you agree to participate, we will give you $75 to complete an in-person interview that should last about an hour. In order to find out if you are eligible to be interviewed, I’d like to get some background information.

Before I proceed, I must make sure that you are at least 18 years old.

UNDER 18 :___: [THANK AND END]

18 OR OLDER :___:

1. Do you work either full- or part-time in health services research, or for a food or nutrition company?

YES :___: [THANK AND END]

NO :___:

2. In an average week, how many hours would you say you use the Internet?

NONE: : [THANK AND END]

1 HOUR AND MORE : :

DON’T KNOW :___: [THANK AND END]

3. [RECORD GENDER. IF NOT OBVIOUS, ASK]

Are you male or female?

FEMALE :___:

[RECRUIT 4-5 OF EACH]

MALE :___:

4. What is your age? [CODE INTO ONE OF THE FOLLOWING CATEGORIES].

18-24 :___:

25-39 :___:

40-54 :___:

55-64 :___:

65 OR OLDER :___:

[RECRUIT A MIX]

5. What is the highest level of education that you have completed? [CODE INTO ONE OF THE FOLLOWING CATEGORIES].

LESS THAN A HIGH SCHOOL DIPLOMA :___:

HIGH SCHOOL GRADUATE OR GED :___:

SOME COLLEGE, ASSOCIATES DEGREE :___:

COLLEGE GRADUATE :___:

ADVANCED DEGREE :___:

[RECRUIT 2 WITH HIGH SCHOOL DIPLOMA OR LESS]

6. Are you of Hispanic or Latino origin?

YES: :

NO: :

7. What is your race? You may choose one or more categories as they apply.

WHITE :___:

BLACK OR AFRICAN AMERICAN :___:

ASIAN:___:

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER:___:

AMERICAN INDIAN OR ALASKA NATIVE

SOME OTHER RACE (specify)_______________________________________

[RECRUIT 3-4 WHO ARE NOT WHITE]

7. What is your occupation?

______________________________________________________________________

INVITATION

Thank you for answering all my questions. I’d like to invite you to participate in an in-person that will take about an hour to complete. We’ll pay you $75 for your time with us. Let me give you some available times and you tell me what would be best for you.

INTERVIEW DATE AND TIME:

The interview will be held at (location). I would like to send you directions. Where can I send them? Also, may I please have your phone number in case we need to get hold of you for any reason?

COLLECT RESPONDENT NAME, ADDRESS (IF APPLICABLE) AND PHONE

Name: _____________________________________________________________

Address: _____________________________________________________________

City: _________________________________ State: ______ Zip Code: __________

Phone: ________________________________________

In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx.

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