Adult smokers ages 25 to 54; Telephone Verification, Questionnaires 1 - 4

ATTACHMENT 13. TELEPHONE VERIFICATION SURVEY FOR THE POINT OF SALE INTERVENTION FOR TOBACCO EVALUATION (POSITEv)

Programming conventions and specifications notes

• Don’t Know/Refused are not allowed in combination with other responses

• Variable names and section headings are not displayed on screen

• Response options should not be labeled with numbers

• Bolding conveys emphasis while capital letters convey instructions for programmers or interviewers

• Questionnaire will include a progress bar

• All items are required

• “Next” buttons will be displayed on every survey screen as appropriate

• All images should be arranged in such a way that focus on usability and layout

• Images should be aligned and of similar sizes as one another

Information needed for verification

Ineligible Cases [Screener Cases]

2601 (No One Selected - No HH Members 18 years of age or older)

2605 (No Tobacco Users in Household)

Completed Cases

2690 (Survey Completed)

2691 (Interview Complete-App Consented)

Roster Information:

(numberrostered1): total number of adults in roster (SCC3 from Screener)

Program fill for (HH Adult Count Noun)

If number rostered is 0, then fill ‘no’

If number rostered is 1 = person

If number rostered is >1 = people

Screening Information:

(Screening Date) fill: Date of final Screening Code (MMDDYYYY)

Case Information:

(Street Num, Street Name, Apt/Unit, city, state and zip code): Street number, Street address, Apt/Unit, city, state and zip code for address

Screening Information Provided:

CaseID

Phone number provided in variable [if status 2601 or 2605 = SCEXIT3END_PHONE; if 2690 = SCF9] Screener Phone Number Provided in SCF2A [blank if Screener is Respondent]

Address

Sample Member Name provided in SCF2

[Panel Member Name] provided in variable SCF2 in screener instrument

[Screening Respondent Name] provided in variable SCEXIT3END_NAME for Ineligible Households

CALL-IN: [IF CALL-IN]

Thank you for calling us about the study sponsored by the U.S. Food and Drug Administration at RTI. This is _____________. In case we get cut off, let me get the telephone number you are calling from. (On behalf of the U.S. Food and Drug Administration, I am trying to reach [FILL: Panel Member Name/Screening Respondent Name].)

INTERVIEWER: THE ROSTER WILL BE DISPLAYED NEXT. IF THE PHONE NUMBER EXISTS ON THE ROSTER FOR THE SUBJECT AND HAS NOT BEEN CODED OUT, SELECT THAT NUMBER. OTHERWISE, ADD A NEW ROSTER LINE.

0 GO TO ROSTER INFO SCREEN TO SELECT CORRECT ROSTER LINE  GO TO INTRO7A

4 NEVER HEARD OF SUBJECT GO TO INTRO6

9 MORE CODES  GO TO SUBJ_CODES

ASK: Respondents who initiate a call to the verification staff

_________________________________________________________________________

INTRO6

NOTE: IF THIS CALL IS A CALL-IN CASE, SIMPLY VERIFY THEIR PHONE NUMBER.

Let me make sure that I dialed the correct number. Is this [FILL: PHONE NUMBER]

1 YES  GO TO EVEND

2 NO  GO TO EVEND

5 LANGUAGE BARRIER GO TO EVEND

6 REFUSED GO TO WHO_REF

9 MORE CODES  GO TO SUBJ_CODES

ASK: Respondents who initiate a call to the verification staff but do not know the case’s listed subject.

_________________________________________________________________________

INTRO7A

IF NOT ALREADY SPEAKING WITH THE PERSON OR ENROLLED PM, ASK: Can I speak with [FILL: Panel Member Name/Screening Respondent Name]

IF CALL-IN CASE AND SCREENED/PM HAS NOT ALREADY TOLD YOU: What can I help you with today?

1 YES SUBJECT IS AVAILABLE NOW  GO TO INTRO1

3 SUBJECT NOT AVAILABLE NOW – SET APPT  GO TO CALLBACK

8 KNOWS SUBJECT, WILL GIVE INFO (THIS WILL ADD A NEW ROSTER LINE)  GO TO EVEND

9 MORE CODES GO TO SUBJ_CODES

ASK: Respondents who initiate a call to the verification staff who know the case’s listed subject

_________________________________________________________________________

CELL_RESP. (Hello, my name is ________________. I am calling from RTI International regarding a study sponsored by the U.S. Food and Drug Administration.) Are you driving a vehicle at this moment?

IF YES, ASK FOR A BETTER TIME TO CALL AND SET A CALLBACK. IF YES, AND RESPONDENT INDICATES S/HE IS WILLING TO TALK NOW, SAY "I'm sorry but for your safety I'm not able to conduct the survey while you're driving. When would be a better time to call you?"

1 YES  GO TO CALLBACK

2 NO  GO TO INTRO1

9 MORE CODES  GO TO SUBJ_CODES

ASK: All respondents who are calling from a phone number listed as a mobile phone.

_________________________________________________________________________

INTRO1.

(Hello, my name is ________________. I am calling from RTI International regarding a study sponsored by the U.S. Food and Drug Administration.) May I please speak to [FILL: Panel Member Name/Screening Respondent Name]?

1 YES, SPEAKING TO PANEL MEMBER OR SCREENING RESPONDENT  GO TO INTRO3

2 PANEL MEMBER AVAILABLE  GO TO INTRO1A

3 PANEL MEMBER UNAVAILABLE [If Enrollment  GO TO CALLBACK, If Screener  GO TO INTRO2]

4 PANEL MEMBER UNAVAILABLE - OUT OF THE COUNTRY  GO TO OTC_WHY

5 PANEL MEMBER/SCREENING RESPONDENT UNKNOWN  GO TO INTRO2

6 RESPONDENT/PANEL MEMBER KNOWN, BUT WILL NEVER BE AVAILABLE [If Enrollment  GO TO INTRO1B, If Screener  GO TO INTRO2]

7 OTHER  GO TO INTRO1B

8 LANGUAGE BARRIER  GO TO EVEND

9 MORE CODES  GO TO SUBJ_CODES

ASK: All respondents

GO TO: If the person on the phone is the sample or screening member, go to INTRO3. If the panel member is available, go to INTRO1A. If the Panel member is unavailable, go to INTRO2, unless they are out of the country, then go to OTC_WHY, or if they will otherwise never be available, then go to INTRO1B.

_________________________________________________________________________

OTC_WHY. Is [FILL: Panel Member Name/Screening Respondent Name] out of the country due to:

INTERVIEWER: TRY TO DETERMINE REASON SUBJECT IS OUT OF THE COUNTRY AND ENTER BELOW.

1 MILITARY SERVICE

2 SCHOOL

3 OTHER REASON?

9 DON'T KNOW/DOESN'T WANT TO TELL

ENTER REASON.

[500 CHAR]

[CONTINUE  GO TO OTC_INFO]

ASK: Respondents who report the panel member is out of the country.

_________________________________________________________________________

OTC_INFO.

Can you give me any address or telephone information or an email address for contacting [FILL Panel Member Name/Screening Respondent Name ] ?

[CONTINUE  GO TO EVEND]

ASK: Respondents who report the panel member is out of the country.

_________________________________________________________________________

INTRO1A.

May I speak with this person?

1 YES  GO TO INTRO3

2 NO  GO TO CALLBACK

ASK: Respondents who report panel member is available to speak with.

GO TO: If the survey respondent/screener is available to speak to, go to INTRO3. If they are not available to speak to, schedule a time for a call back, go to CALLBACK.

_________________________________________________________________________

INTRO1B.

INTERVIEWER: ENTER RESPONDENT’S ANSWER VERBATIM. [500 CHAR]

[CONTINUE: If Enrollment  GO TO CALLBACK, If Screener  GO TO INTRO2]

ASK: Cases where a verification call will not be possible with the survey respondent.

GO TO: If the verification call is for survey verification, go to CALLBACK. If the verification call is for screening only, go to INTRO2

_________________________________________________________________________

INTRO2A

[If Screener AND INTRO1 = 3, 4, 5, FILL: Perhaps you can help me.] My name is ____________. I am calling from RTI International regarding a study sponsored by the U.S. Food and Drug Administration.

Our records indicate that [FILL: IF Screener: you or someone at this number; IF Enrollment: Panel Member Name] was [FILL: IF SCREENING: contacted concerning [FILL: address]; IF ENROLLMENT: contacted about an important research study sponsored by the U.S. Food and Drug Administration].

This call is to verify the quality of our interviewer’s performance. It will take just a few minutes of your time. For training and quality assurance purposes, this call may be monitored.

1 CONTINUE

ASK: Cases where a verification call will not be possible with the survey respondent.

GO TO: If the verification call is for survey verification, go to CALLBACK. If the verification call is for screening only, go to INTRO2

_________________________________________________________________________

INTRO2B

[FILL: IF SCREENER: Are you (or anyone else at this number) familiar with [FILL: address]?]

[FILL: IF ENROLLMENT: Is this the correct phone number for [FILL: Panel Member Name?]

PROBE: (This is a scientific research study and the quality of data is essential. We monitor our interviewer’s work in several ways. One very important check is to call some of the residences that were contacted to ensure the interviewer followed proper procedures and behaved professionally.)

1 YES, RESPONDENT IS AVAILABLE  GO TO INTRO3

2 PANEL MEMBER LOCATED  GO TO INTRO3

3 SOMEONE ELSE IS AVAILABLE GO TO INTRO1A

4 PANEL MEMBER UNKNOWN  GO TO EVEND

5 NO=  GO TO SV1

-1 DON’T KNOW  GO TO SV1

9 MORE CODES  GO TO SUBJ_CODES

ASK: All respondents

GO TO: If the survey respondent is available to speak to, go to INTRO3, if they are not available but someone else can verify the call, go to INTRO1a. If the respondent reports a survey did not occur, go to SV1. If the respondent does not recognize the person we are asking to verify with, go to EVEND.

_________________________________________________________________________

INTRO3.

[FILL if INTRO1 =/= 1: Hello, my name is _______________. I am calling from RTI International regarding a study sponsored by the U.S. Food and Drug Administration.]

[FILL IF Screener: “Our records indicate that someone at this number was contacted concerning [Fill: address]”]

[FILL IF Enrollment: “Our records indicate that you were interviewed for the Point of Sale Intervention for Tobacco Evaluation (POSITEv)”.]

This call is to verify the quality of our interviewer’s performance. It will take just a few minutes of your time. For training and quality assurance purposes, this call may be monitored.

[FILL IF Enrollment: Did you complete an interview for this study?]

[FILL IF Enrollment: 1 YES  GO TO EV3

[FILL IF Enrollment: 2 NO  GO TO EV2A

[FILL IF Screener: Are you or anyone else at this number familiar with [FILL: address];?]

[FILL IF Screener: 3 YES  GO TO SNVCODE]

[FILL IF Screener: 4 NO  GO TO EVEND]

[FILL IF Screener: 5 SCHEDULE A CALLBACK  GO TO CALLBACK]

[FILL IF Screener: 9 OTHER CODES  GO TO EVEND]

PROBE: This is a scientific research study and the quality of data is essential. We monitor our interviewer’s work in several ways. One very important check is to call some of the residences that were contacted to ensure the interviewer followed proper procedures and behaved professionally.

ASK: All respondents

GO TO: If the verification call is to verify a survey, go to EV3 if the person reports completing the survey, or EV2A if the person does not report completing the survey. IF the verification call is to verify the screening of the address, then go to SNVCODE if the person is familiar with the address. If the person familiar with the address is not available, go to CALLBACK to schedule a call when they are available. If no person is familiar with the address on file, go to EVEND.

_________________________________________________________________________

SV1. Just to confirm, I was given this telephone number to verify that our interviewer made contact with someone that either lives at or is knowledgeable about [FILL: address]. Is there anyone at this number who might be familiar with [FILL: address]?

1 YES, RESPONDENT IS  GO TO SV4

2 YES, SOMEONE ELSE IS  GO TO INTRO1A

3 NO  GO TO SV2

-1 DON’T KNOW  GO TO SV2

9 MORE CODES  GO TO SUBJ_CODES

ASK: Respondents who report not being familiar with the sampled address

GO TO: If the person is familiar with the sample address, go to SV4, if someone else is, go to SV3, if no one is, go to SV2

_________________________________________________________________________

SV2. Is there anyone at this number who might be familiar with our interviewer?

1 YES, RESPONDENT IS  GO TO SV4

2 YES, SOMEONE ELSE IS  GO TO SV3

3 NO  GO TO EVEND

-1 DON’T KNOW  GO TO EVEND

9 MORE CODES  GO TO SUBJ_CODES

ASK: Respondents who report not being familiar with the sampled address

GO TO: If the person is familiar with the interviewer, go to SV4, if someone else is, go to INTRO1a, if no one is, go to EVEND

_________________________________________________________________________

SV3. May I speak with this person?

1 YES  GO TO SV4

2 NO  GO TO SV4A

ASK: Respondents who report not being familiar with the sampled address, but identify another person able to answer the questions.

GO TO: If the person is available, go to SV4, if not one is, go to SV4A

_________________________________________________________________________

EV2A. You may have answered questions concerning your use of tobacco products, and provided some basic demographic information. The interviewer would have used a computer to record your responses. Does this sound familiar?

1 YES  GO TO EV3

2 NO  GO TO EV2B

ASK: Respondents who report not completing a survey

GO TO: If the person does not recall the survey, go to EV2B, if they do, go to EV3

_________________________________________________________________________

EV2B. Were you ever contacted by one of our interviewers?

1 YES, BUT RESPONDENT DOES NOT REMEMBER COMPLETING INTERVIEW  GO TO EV2C

2 YES, AND RESPONDENT DOES REMEMBER COMPLETING INTERVIEW  GO TO EV3

3 NO  GO TO EV2C

ASK: Respondents who report not completing a survey

GO TO: If the person was not contacted by an interviewer or did not complete the survey, go to EV2C, if they recall completing the survey, go to EV3

_________________________________________________________________________

EV2C. Our interviewer would have been wearing a white badge with a picture I.D. (He or she may have been carrying a tablet computer. Did this person ever contact you?

1 YES, BUT RESPONDENT DOES NOT REMEMBER COMPLETING INTERVIEW  GO TO EVEND

2 YES, AND RESPONDENT DOES REMEMBER COMPLETING INTERVIEW  GO TO EV3

3 NO  GO TO EVEND

ASK: Respondents who report not being contacted by our interviewers

GO TO: If the person was contacted by an interviewer but did not complete the survey, go to EV3, if they do not recall being contacted by the interviewer or completing the survey, go to EVEND.

_________________________________________________________________________

EV3. It is important that the interviewer visited the correct address. Please provide the full address where you lived when the interviewer contacted you. Please tell me the full address including any apartment number, city, state, and zip code.

TI NOTE: DO NOT READ ADDRESS TO RESPONDENT. IF THE ADDRESS PROVIDED MATCHES THE BELOW INFORMATION, SELECT CORRECT. IF IT DOES NOT MATCH SELECT INCORRECT.

[FILL: address]

TI NOTE: IF RESPONDENT PROVIDES ONLY PARTIAL INFORMATION, YOU SHOULD PROVIDE THE MISSING INFORMATION TO THE RESPONDENT TO CONFIRM IT IS ACCURATE.

1 CORRECT  GO TO EV4

2 INCORRECT  GO TO EV3A

-1 DON’T KNOW  GO TO EVEND

-2 REFUSE  GO TO WHO_REF

ASK: Verification call respondents who report completing the survey

GO TO: If the person verifies the address on file, go to EV4. If the person states the address on file does not match where they lived when contacted by the interviewer, go to EV3A. Otherwise go to EVEND.

_________________________________________________________________________

EV3A. Can you please repeat that?

ENTER ADDITIONAL COMMENTS UP TO 500 CHARACTERS.

ENTER RESPONDENT’S ADDRESS VERBATIM. [500 CHAR]

ASK: Verification call respondents who report completing the survey but provide an address that does not match records

_________________________________________________________________________

EV4. Did the interviewer ask you questions about topics such as your use of tobacco products and tobacco advertisements you have seen in stores?

1 YES  GO TO EV6

2 NO  GO TO EV5

ASK: Verification call respondents who report the survey was completed at the listed address

GO TO: If the person recalls being asked questions with content matching the survey, go to EV6, if not, go to EV5.

_________________________________________________________________________

EV5. Just to be sure, were you asked questions about the type of tobacco products you use (such as cigarettes, cigars, or smokeless tobacco products) as well as questions about tobacco advertisements you have seen in stores?

1 YES  GO TO EV6

2 NO  GO TO EV7

ASK: Verification call respondents who report the correct survey content was not asked

GO TO: If the person recalls being asked questions with content matching the survey, go to EV6, if not, go to EV7.

_________________________________________________________________________

EV6. Did you receive $25 in cash for your participation?

1 YES  GO TO EVEND

2 NO  GO TO EVEND

3 DECLINED CASH INCENTIVE

-1 DON’T KNOW/DON’T REMEMBER  GO TO EVEND

ASK: All verification call respondents who recall being asked survey questions.

_________________________________________________________________________

EV7. Did you receive $25 in cash when the interviewer visited you?

1 YES  GO TO EVEND

2 NO  GO TO EVEND

3 DECLINED CASH INCENTIVE

-1 DON’T KNOW/DON’T REMEMBER  GO TO EVEND

ASK: All verification call respondents who do not recall being asked survey questions.

_________________________________________________________________________

SNVCODE.

[IF SCREENING CODE 2601 OR 2605 OR 2606 OR 2610 OR 2620  GO TO SV4]

[IF SCREENING CODE 2301 VACANT GO TO SNV6A]

[IF SCREENING CODE 2310 NOT A HOUSING UNIT GO TO SNV8A]

ASK: All verification call respondents who report being screened

GO TO: Automatically route the survey based on assigned status code, if recorded as Vacant, go to SNV6A, if recorded as not a housing unit, go to SNV8A, all other status codes go to SV4

_________________________________________________________________________

SV4. I’d like to verify what the interviewer reported. First, according to our interviewer, there are [FILL: numberrostered1] [FILL: HH Adult Count Noun] age 18 or older living in your household. Is this correct?

1 YES  GO TO SV5

2 NO  GO TO SV4A

-1 DON’T KNOW  GO TO SV5

-2 REFUSED  GO TO SV5

ASK: Verification call respondents who report being screened at a valid housing unit

GO TO: If the number of people reported living at the household matches our records, go to SV5, if a different number is reported, go to SV4A, if the respondent does not know or refuses, go to SV5.

_________________________________________________________________________

SV4A. Would you please describe what is incorrect about the information?

ENTER ADDITIONAL COMMENTS UP TO 500 CHARACTERS. IF IT BECOMES CLEAR THE RESPONDENT WAS CONFUSED BY THE QUESTION, GO BACK TO THE QUESTION AND REREAD/PROBE FOR CLARITY. ENTER RESPONDENT’S ANSWER VERBATIM [500 CHAR]

[CONTINUE  GO TO SV5]

ASK: Verification call respondents who report the number of adults living at the household does not match our records

_________________________________________________________________________

SV5.

[IF SCREENER 1, FILL: Do you / IF ENROLLMENT FILL: Does [Panel Member Name]) smoke cigarettes every day, some days, or not at all?

1 EVERY DAY

2 SOME DAYS

3 NOT AT ALL

-1 DON’T KNOW

-2 PREFER NOT TO ANSWER

ASK: Verification call respondents who report being screened

_________________________________________________________________________

SV6. Is the home at [FILL: address] owned by you or someone in your household, rented, or occupied without payment of rent?

1 OWNED BY YOU OR SOMEONE ELSE IN THE HOUSEHOLD

2 RENTED

3 OCCUPIED WITHOUT PAYMENT OR RENT

ASK: Verification call respondents who report being screened

_________________________________________________________________________

SV7. It is important that the interviewer visited the correct address. Please provide the full address where you lived when the interviewer contacted you. Please tell me the full address including any apartment number, city, state, and zip code.

TI NOTE: DO NOT READ ADDRESS TO RESPONDENT. IF THE ADDRESS PROVIDED MATCHES THE BELOW INFORMATION, SELECT CORRECT. IF IT DOES NOT MATCH SELECT INCORRECT.

[FILL: address]

TI NOTE: IF RESPONDENT PROVIDES ONLY PARTIAL INFORMATION, YOU SHOULD PROVIDE THE MISSING INFORMATION TO THE RESPONDENT TO CONFIRM IT IS ACCURATE.

1 CORRECT  GO TO SV8

2 INCORRECT  GO TO SV7A

-1 DON’T KNOW  GO TO EVEND

-2 REFUSED  GO TO WHO_REF

ASK: Verification call respondents who report being screened

GO TO: If the person confirms the address we have on file is correct, go to SV8. If they report it is incorrect, go to SV7A. If they provide no information, go to EVEND

_________________________________________________________________________

SV7A. Can you please repeat that?

ENTER ADDITIONAL COMMENTS UP TO 500 CHARACTERS.

ENTER RESPONDENT’S ADDRESS VERBATIM. [500 CHAR]

ASK: Verification call respondents who report being screened at an address that does not match our records

_________________________________________________________________________

SV8. Was the interviewer polite and did the interviewer treat you professionally?

1 YES  GO TO EVEND

2 NO  GO TO SV8A

ASK: Verification call respondents who report being screened at the address on record

GO TO: If the person reports the interviewer acted professionally, go to EVEND. If they report the interviewer acted unprofessionally, go SV8A

_________________________________________________________________________

SV8A. Would you please tell me more about that?

ENTER ADDITIONAL COMMENTS UP TO 500 CHARACTERS.

ENTER RESPONDENT’S ANSWER VERBATIM.
[500 CHAR]

IF NO COMMENTS, ENTER NONE

[CONTINUE  GO TO EVEND]

ASK: Verification call respondents who report the interviewer did not act professionally

_________________________________________________________________________

SNV6A. Has [FILL: address] been vacant any time within recent weeks?

1 YES  GO TO SNV9A

2 NO  GO TO SNV6B

-1 DON’T KNOW  GO TO SNV6B

ASK: Verification call respondents who report being at a vacant address

GO TO: If the person does not report the address was vacant in recent weeks, go to SNV6B, otherwise go to SNV9A

_________________________________________________________________________

SNV6B. Let me verify, was [FILL: address] vacant on or around [FILL: Screening Date]?

1 YES  GO TO SNV9A

2 NO  GO TO SNV9A

-1 DON’T KNOW  GO TO SNV9A

-2 REFUSED  GO TO SNV9A

ASK: Verification call respondents who report being at a vacant address that was not vacant within the recent weeks

_________________________________________________________________________

SNV8A. Is [FILL: address] a business, military barracks, hotel or motel, a place that was demolished or does not exist, or another type of place that is not a residence?

1 YES  GO TO SNV9A

2 NO  GO TO SNV8B

-1 DON’T KNOW  GO TO SNV8B

ASK: Verification call respondents for addresses coded non-housing units

GO TO: If the person reports the address is for a non-residence, go to SNV9A, otherwise go to SNV8B

_________________________________________________________________________

SNV8B. We are trying to distinguish places that are residences such as houses, town houses, apartments, and college dormitories from the types of places I just mentioned.

To the best of your knowledge, is [FILL: address] a business, military barracks, hotel or motel, a place that was demolished or does not exist, or another type of place that is not a residence?

1 YES  GO TO SNV9A

2 NO  GO TO SNV9A

-1 DON’T KNOW  GO TO SNV9A

-2 REFUSED  GO TO SNV9A

ASK: Verification call respondents for addresses coded non-housing units who report the address does not fit one of our categories for non-housing unit

_________________________________________________________________________

SNV9A. Did you personally speak with our interviewer?

1 YES  GO TO SNV9B

2 NO  GO TO EVEND

ASK: Verification call respondents for addresses coded non-housing units who report the address fits one of our categories for non-housing unit

GO TO: If the person reports they spoke to our interviewer, go to SNV9B, otherwise go to EVEND.

_________________________________________________________________________

SNV9B. Was the interviewer polite and did the interviewer treat you professionally?

1 YES  GO TO EVEND

2 NO  GO TO SNV9B1

ASK: All verification call respondents

GO TO: If the person reports the interviewer acted professionally, go to EVEND. If they report the interviewer acted unprofessionally, go to SNV9B1

_________________________________________________________________________

SNV9B1. Would you please tell me more about that?

ENTER ADDITIONAL COMMENTS UP TO 500 CHARACTERS.

ENTER RESPONDENT’S ANSWER VERBATIM. [500 CHAR]

IF NO COMMENTS, ENTER “NONE”.

[CONTINUE  GO TO EVEND]

ASK: Verification call respondents who report the interviewer did not act professionally

_________________________________________________________________________

CALLBACK.

Thank you very much for your time, I will call back at a later time. Have a good (evening/day).

[SET FOR CALLBACK]

ASK: Verification call respondents that will need to receive a call back

_________________________________________________________________________

EVEND. Those are all of the questions I have. Thank you very much for your time. Have a good (evening/day).

[EXIT SURVEY.

ASSIGN PENDING 2589 IF SV2 = 3 OR - 1 (BAD TELEPHONE NUMBER) || EV2C = 1 OR 3 (DOES NOT REMEMBER INTERVIEWER CONTACT) || EV3 =2 OR -1 OR -2 (REMEMBERS INTERVIEW, BUT ADDRESS INFORMATION IS INCORRECT) || EV5 = 2 (DOES NOT REMEMBER BEING ASKED SURVEY CONTENT) || EV6 OR EV7 = 2 (DID NOT RECEIVE INCENTIVE) || INTRO2B = 4 (PANEL MEMBER NAME NOT RECOGNIZED) || SV4 = 2 (HOUSEHOLD COUNT DOES NOT MATCH) || SV8 = 2 (INTERVIEWER UNPROFESSIONAL) || SNV9B = 2 (INTERVIEWER UNPROFESSIONAL) || SNV6B = 2 (ADDRESS CODED VACANT WAS NOT VACANT DURING SCREENING) || SNV8B = 2 (ADDRESS CODED INELIGIBLE ADDRESS TYPE WAS NOT INELIGIBLE DURING SCREENING) ;

ELSE ASSIGN FINAL CODE 2690]

ASK: Verification call respondents at the end of the call

_________________________________________________________________________

SUBJ_CODES

SUBJECTS NAME <FILL NAME>

1 SUBJECT OUT OF THE COUNTRY (NOT IN CALLING AREA

2 SUBJECT INSTITUTIONALIZED OR INCARCERATED

3 SUBJECT OTHERWISE UNAVAILABLE

4 SUBJECT DECEASED

5 LANGUAGE BARRIER

6 REFUSED

7 SET CALLBACK FOR SUBJECT (ONLY IF YOU SPOKE WITH THE SM OR A CONTACT)

9 PERSON HUNG UP BEFORE / DURING INTRO

12 SUBJECT INCAPABLE (INCAPACITATED)

13 SUBJECT HAS NO PHONE

14 SUBJECT IS HEARING IMPAIRED

0 RETURN TO MAIN MENU

[EXIT SURVEY]

ASK: Screen administered to the Telephone Interviewer after a call was terminated and the reason for the termination needs to be coded.

_________________________________________________________________________

WHO_REF

(Thank you very much for your time)

INTERVIEWER:

WAS THE REFUSAL BY THE SAMPLE MEMBER?

PLEASE NOTE THAT TWO SUCH REFUSALS WOULD MAKE THIS A FINAL REFUSAL CASE

1 YES, SAMPLE MEMBER REFUSED….VERIFIED NAME

2 NO / DON’T KNOW

[CONTINUE]

ASK: Screen administered to the Telephone Interviewer after a call was terminated as a refusal.

_________________________________________________________________________

PREREF

INTERVIEWER: DETERMINE THE STRENGTH OF THE REFUSAL

1 SOFT

2 HARD (FIRM)

3 HOSTILE

[CONTINUE]

ASK: Screen administered to the Telephone Interviewer after a call was terminated as a refusal.

_________________________________________________________________________

REF

INTERVIEWER: DESCRIBE WHAT HAPPENED DURING REFUSAL (CHECK ALL THAT APPLY)

1 SM DOES NOT DO PHONE SURVEYS

2 SM DOES NOT PARTICIPATE IN SURVEYS

3 HUNG UP DURING INTRO (AFTER AFFILIATION)

4 HUNG UP AT SAMPLE MEMBER VERIFICATION SCREENS

5 “TOO BUSY” / “NO TIME”

6 “NO INTERESTED” (NO MENTION OF STUDY)

7 NOT INTERESTED IN DOING STUDY (AGAIN)

8 QUESTIONED PURPOSE OF STUDY

9 CONCERNED ABOUT LENGTH OF INTERVIEW

10 CONCERNED ABOUT LEGITIMACY OR CONFIDENTIALITY OF DATA

11 OTHER SPECIFY [ENTER 500 CHARACTERS]

12 SUBJECT REFUSED BECAUSE DID NOT GET INCENTIVE FROM PRIOR STUDY

13 CONTACT WILL NOT LET US SPEAK WITH SM

[EXIT SURVEY]

ASK: Screen administered to the Telephone Interviewer after a call was terminated as a refusal.

_________________________________________________________________________

OMB No. ####-####
Exp. Date XX/XX/XXXX

RIHSC No. 17-082CTP

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 10 minutes per response to complete the survey questions. Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.

ASK: Screen administered to the Telephone Interviewer when accessing help menu.

_________________________________________________________________________

END SURVEY

VOICE MAIL SCRIPTS:

 SCREENER /INELIGIBLE VERSION: My name is ____________. I am calling from RTI International regarding an important research study sponsored by the U.S. Food and Drug Administration. This call is to verify the quality of our interviewer’s performance. Please call me back at your convenience at 1-xxx-xxx-xxxx.

 ENROLLMENT VERSION: My name is ____________. I am calling for [fill panel member] from RTI International regarding an important research study sponsored by the U.S. Food and Drug Administration. This call is to verify the quality of our interviewer’s performance. Please call me back at your convenience at 1-xxx-xxx-xxxx.

 MESSAGE LEFT WITH LIVE PERSON: My name is___________. I am calling from RTI International regarding an important research study sponsored by the U.S. Food and Drug Administration. Please ask him/her to call me at his/her earliest convenience at 1-xxx-xxx-xxxx.

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