Form 4 Attachment 20-1 BEEA CATI Script Random Select Group

Attachment 20-1: BEEA CATI Script for the Random Select Group
Study of Biomarkers of Exposures and Effects in Agriculture
Intro/Eligibility Telephone Script (Random Select Group)
OMB #: 0925-0406
Expiration date: 09/30/2016
Public reporting for this collection of information is estimated to average twenty 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.

Hello, I am trying to reach (APPLICATOR’S FIRST, MIDDLE INITIAL, LAST, SUFFIX).
IF THE PESTICIDE APPLICATOR IS NOT AVAILABLE NOW, ASK ABOUT AND RECORD A
BETTER TIME TO REACH HIM.
IF ASKED “WHO IS CALLING?” BEFORE YOU GET TO THE RESPONDENT:
This is _________________. I am calling about a health study. This number is the number Mr.
(First/Last Name) gave us to use to contact him. Is he there? Thank you very much.
TO RESPONDENT:
Am I speaking to (APPLICATOR’S FIRST, MIDDLE INITIAL, LAST, SUFFIX)?
Hello, my name is _________________. I am calling from the Agricultural Health Study (at the
University of Iowa). You should have received a letter from (Marsha Dunn, Study Director in
North Carolina/Dr. Charles Lynch, Study Director in Iowa) recently, to let you know that I would
be calling. Do you recall seeing that in your mail? (PAUSE FOR RESPONSE)
Do you have a moment now to talk with me about that project?
CALL BACK: Record better day and better time.
TOO BUSY: This initial phone call will take only about 10 minutes. We can schedule for
a better time (NOTE TIME). Or if you would like, we could get started and see how it
goes. You could stop me at any time. Would that be OK?
REFUSING: (Try to respond to concerns.)
NOTE: CATI TO START HERE – INTERVIEWER WILL FIRST INDICATE IN CATI WHETHER
RESPONDENT IS STILL REFUSING OR IS ALLOWING THE CONTACT TO CONTINUE.
STILL REFUSING:

Go to Additional Questions (Direct Refusal).

IF CONTINUING CONTACT:
Thank you. First let me make certain that I have reached the correct individual.
C1. Is your name (First/Last Name) and is your date of birth (Birthdate)?
a) Yes
b) No

Go to Eligibility Questions

C2. What is your correct date of birth?

______/_______/________
MM
DD
YYYY

C3. [INTERVIEWER] IS IT POSSIBLE THAT THE NUMBERS IN THE DATE OF BIRTH FROM
OUR RECORDS (BIRTHDATE), COMPARED TO THE BIRTHDATE GIVEN
(RESPONDENT BIRTHDATE) COULD HAVE BEEN TRANSPOSED, MISREAD, OR ARE
REVERSED?
a) YES
Go to Eligibility Questions
b) NO
c) NOT SURE
THANK YOU FOR YOUR HELP. I’LL PROVIDE THIS
INFORMATION TO MY SUPERVISOR.
C4. Does another person with a similar name but a different date of birth live there?
a) Yes
b) No (QC5a)
C4a. May I please speak to the other (FULL NAME)?
a)

Yes

b)

No

THANK INITIAL/INCORRECT RESPONDENT; WAIT TO RECORD
“YES” WHEN THE RESPONDENT IS ON THE PHONE.

C4b. Do you know a better time when we can reach the other (FULL NAME)?
________________________________________
Record information on how to reach (collect phone and best time to reach); then
go to Closings.
C5a. Was there a person with a similar name but a different date of birth living there in the
past?
a) Yes
b) No (Closings)

C5. Do you know how we can reach the other (FULL NAME)?
________________________________________
Record information on how to reach (collect phone and best time to reach); then
go to Closings.

ELIGIBILITY QUESTIONS
I’m calling you today about a new project with the Agricultural Health Study. This part of the
Agricultural Health Study is designed to directly measure biologic effects that may be related to
various farming activities and exposures, and would involve a visit to your farm during the year
by people who specialize in this type of research. I’m happy to tell you that we do have some
money to pay you for your participation.
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To determine if you are eligible, I need to ask you several questions. Again, please know that
your answers are confidential, and that you may refuse to answer any particular question.
E1. According to your birthdate that we have on record, you should be (see age of AHS private
pesticide applicator on front of call sheet) years old. Is this accurate?
a)
b)
c)
d)

Yes
No
Dk
Ref

Go to E3

E2. What is your current age?

___________

IF less than 50 years old, go to INELIGIBLE 1 statement. IF 50 years old or older, continue:
E3. Do you have a blood clotting disorder such as hemophilia?
a)
b)
c)
d)

Yes
No
Dk
Ref

Go to Ineligible 2

E4. Not including non-melanoma skin cancer, have you been diagnosed by a doctor with any
type of cancer in the last three years?
a)
b)
c)
d)

Yes
No
Dk
Ref

Proceed to END OF ELIGIBILITY INTERVIEW

E5. In what organ or part of the body did your cancer start? (If you are not sure of the answer,
please give me your best guess.)
_____________________________ ____________________________
E6. In what year were you first diagnosed by a doctor with this cancer?
YEAR: |___|___|___|___|
Go to Ineligible 3

END OF ELIGIBILITY INTERVIEW
IF ELIGIBLE: Based on your answers, you are eligible for this part of the Agricultural Health
Study. Did you have a chance to read the study fact sheet that was enclosed with the letter you
received from (Dr. Lynch/Ms. Dunn)? Do you have any questions about this study? [IF NOT, OR
IF SUBJECTS HAS QUESTIONS; READ INFORMATION FROM FACT SHEET] This part of the
Agricultural Health Study will involve a home visit by a person who specializes in collecting
specimens. The home visit will consist of an interview using a laptop computer, urine, blood,
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saliva, and vacuum dust sample collection. You will receive $100.00 as a thank you for your
participation.
Would you be willing to participate in this study?
a) Yes
b) No
Refusing: Do you have any questions or concerns about the study that you would like to
speak to one of the researchers about? [TRY TO ALLEVIATE CONCERNS OR
SCHEDULE TIME TO TALK TO NCI RESEARCHERS] Go to Screening Questions.
Still Refusing

Go to Additional Questions (Participating/Ineligible/Indirect Refusal)

IF “YES”:
A1. Let me verify your street address. Is it (READ ADDRESS, CITY, STATE, AND ZIP CODE)?
a) Yes
b) No

Go to A4

A2. What is the address of your current residence?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
A3. In what year did you move to this address? _________
A4. [INTERVIEWER] ENTER THE CURRENT PHONE NUMBER FROM THE CALL RECORD.
___-___-____
IF PHONE NUMBER CANNOT BE FOUND, GO TO A6.
A5. Is (CURRENT PHONE) the best number to contact you?
a) Yes
Go to A7
b) No
A6. Can you please give us the best number to contact you about the visit to your home?
___-___-____
A7. Is there another number like a cell phone or second number to contact you about this visit?
___-___-____
Thank you. This study would involve a visit to your home on a date that is convenient for you.
Can I schedule a time during (MONTH) or (MONTH) for the visit?
Record date and time of visit:

Date: ___/___/_____ Time: ______am or pm

Proceed to Additional Questions (Participating/Ineligible/Indirect Refusal)

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INELIGIBLE 1: I apologize. Our records indicated that you were within the age range we are
including in the study. However, based on this updated information on your age, you are not
eligible for this part of the Agricultural Health Study.
Go to Additional Questions
(Participating/Ineligible/Indirect Refusal).
INELIGIBLE 2: Unfortunately, you are not eligible for this part of the Agricultural Health Study:
we are looking for a group of men who are able to provide blood samples. Go to Additional
Questions (Participating/Ineligible/Indirect Refusal).
INELIGIBLE 3: Unfortunately, you are not eligible for this part of the Agricultural Health Study:
we are looking for a group of men who have never been diagnosed with cancer. Go to
Additional Questions (Participating/Ineligible/Indirect Refusal).

ADDITIONAL QUESTIONS
DIRECT REFUSAL:
Thank you, I understand. Would you have time to answer a few quick questions about health
screening for us? It will take about two minutes of your time, if that.
a) Yes
b) No

Go to Closings

IF ”YES”, continue:
Thank you. First let me make certain that I have reached the correct individual.
C1. Is your name (Full Name) and is your date of birth (Birthdate)?
a) Yes
b) No

Go to Additional Questions Intro

C2. What is your correct date of birth?

______/_______/________
MM
DD
YYYY

C3. [INTERVIEWER] IS IT POSSIBLE THAT THE NUMBERS IN THE DATE OF BIRTH, HAVE
BEEN TRANSPOSED, MISREAD, OR ARE REVERSED?
a) YES
b) NO
c) NOT SURE

Go to Additional Questions Intro
THANK YOU FOR YOUR HELP. I’LL PROVIDE THIS
INFORMATION TO MY SUPERVISOR.

C4. Does another person with a similar name but a different date of birth live here?
a) Yes
b) No (QC5a)
C4a. May I please speak to the other (FULL NAME)?
a)

Yes

THANK INITIAL/INCORRECT RESPONDENT; WAIT TO RECORD
“YES” WHEN THE RESPONDENT IS ON THE PHONE.

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b)

No

C4b. Do you know a better time when we can reach the other (FULL NAME)?
________________________________________
Record information on how to reach (collect phone and best time to reach); then
go to Closings.
C5a. Was there a person with a similar name but a different date of birth living there in the
past?
a) Yes
b) No (Closings)
C5. Do you know how we can reach him? ________________________________________
Record information on how to reach (collect phone and best time to reach); then
go to Closings.

PARTICIPATING OR INELIGIBLE OR INDIRECT REFUSAL:
Before we finish, would you have time to answer three more quick questions about health
screening for us? It will take about two minutes of your time, if that.
a) Yes
b) No

Go to Closings

IF ”YES”, continue:

ADDITIONAL QUESTION INTRO:
These questions are aimed toward improving our understanding of cancer screening practices
among participants in the Agricultural Health Study, and they are a separate part of the substudy. As always, your answers are confidential, and you may refuse to answer any particular
question.
S1. Have you ever had a blood test for prostate cancer, for example PSA? Would you say:
a)
b)
c)
d)
e)

Never,
Once, or
More than once?
DK
REF

S2. Have you ever had a digital rectal examination of the prostate? Would you say:
a)
b)
c)
d)
e)

Never,
Once, or
More than once?
DK
REF

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S3. Have you ever had a colonoscopy or sigmoidoscopy to examine the colon and rectum?
a)
b)
c)
d)
e)

Never,
Once, or
More than once?
DK
REF

CLOSINGS
ELIGIBLE, WILLING TO PARTICIPATE:
Thank you. Those are all the questions I have for you today. The home visit will consist of an
interview, urine, blood, saliva, and vacuum dust sample collection. The urine collection
materials and a questionnaire about the vacuum dust sample collection will be sent to you about
two weeks before your visit with the appointment confirmation letter. You may use your vacuum
cleaner as you normally would, but we ask that you not empty it or change bags before the visit.
If you do need to change bags or empty the vacuum canister, we ask that you try to use the
vacuum at least once with the new bag or empty canister before your visit, so there is dust
available in the machine. You can eat and take medications as you normally would.
Meanwhile, please contact us at (800-217-1954/800-424-7883) if you have any questions about
this study. We sincerely appreciate all of your help with our research.
INELIGIBLE:
Thank you for your time today and thanks again for taking part in the Agricultural Health Study.
REFUSAL:
Thank you for your time today and thanks again for taking part in the Agricultural Health Study.
RECORD REASON FOR REFUSAL.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
NOT CORRECT RESPONDENT:
I’m sorry for the confusion. That is all the questions I have for you at this time. Thank you for
speaking with me today.

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