Social Media Pilot Study Data Collection

Attachment 1b

National Health and Nutrition Examination Survey (NHANES)

Social Media Pilot Study

Data Collection Form

Form Approved

OMB No. 0920-1208

Notice - CDC estimates the average public reporting burden for this collection of information as 2 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0234).

Assurance of Confidentiality - We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note). This law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security weaknesses. If information sent through government networks triggers a cyber-threat indicator, the information may be intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the government.

Exp. Date: 12/31/2020

NHANES Social Media Questions

(Adult answering screener questionnaire)

Questions below will be administered by the field interviewer at the end of the screener module to all screened households (one adult per household).

NEW Q1.

Other than me (or my colleague) talking to you about the survey, have you ever heard about the National Health and Nutrition Examination Survey?

INTERVIEWER: READ ‘OR MY COLLEAGUE’ IF ANOTHER INTERVIEWER HAS VISITED THE HOUSE

Yes……………………………………………… 1 (NEW Q2)

No………………………………………………. 2 (NEW Q3)

DK………………………………………………. 99 (NEW Q3)

RF……………………………………………….. 77 (NEW Q3)

NEW Q2.

From where did you hear about the survey?

CODE ALL THAT APPLY

NEW HANDCARD 1 and

TV…………………………………………………. 1 (NEW Q3)

Radio……………………………………………… 2 (NEW Q3)

Newspaper (Print or online)…………………….. 3 (NEW Q3)

Social media……………………………………… 4 (NEW Q3)

Other website…………………………………….. 5 (NEW Q3)

Word of mouth……………………………………. 6 (NEW Q3)

Other………………………………………………. 7 (NEW Q3)

DK………………………………………………….99 (NEW Q3)

RF…………………………………………………. 77 (NEW Q3)

ALL SP’s GO TO NEW Q3.

DEFINITIONS FOR THE FOLLOWING TERMS AND/OR PROVIDE EXAMPLES). THESE TERMS WILL BE PUT IN THE HELP SCREEN

-Social media; Word of mouth

Definitions:

Social media refers to interactive electronic platforms that allow users to share ideas and information with a network of contacts (e.g., popular sites include Facebook, Twitter, Reddit, Snapchat, LinkedIn etc.)

Word of Mouth refers to oral communication from person-to-person which could be as simple as someone in your family or a neighbor telling you about the survey.

NEW Q3.

Do you have at least one social media account?

Yes……………………………………………… 1 (NEW Q4)

No………………………………………………. 2 (NEW Q4)

DK………………………………………………. 9 (NEW Q4)

RF……………………………………………….. 7 (NEW Q4)

ALL SP’s GO TO NEW Q4.

DEFINITION/EXAMPLES OF ‘SOCIAL MEDIA ACCOUNT’—.

The term social media account is used to describe a person having an account on one of the social media platforms such as Facebook, Twitter, Reddit, Snapchat, LinkedIn etc.

NEW Q4.

Did you or someone in your household see an ad for the National Health and Nutrition Examination Survey on Facebook or Instagram?

NEW HARDCARD 2 and

Yes……………………………………………… 1 (NEW Q5)

No………………………………………………. 2 (NEW Q5)

DK………………………………………………. 9 (NEW Q5)

RF……………………………………………….. 7 (NEW Q5)

ALL SP’s GO TO NEW Q5.

NEW Q5.

{Would seeing these ads on Facebook or Instagram/Did these ads} motivate you to learn more about the National Health and Nutrition Examination Survey?

CAPI INSTRUCTIONS: ‘WOULD SEEING THESE ADS’ IF NEW Q4=1; ‘DID THESE ADS’ IF NEW Q4=2,9,7)

Yes……………………………………………… 1 (SCQ.430)

No………………………………………………. 2 (SCQ.430)

DK………………………………………………. 9 (SCQ.430)

RF……………………………………………….. 7 (SCQ.430)