OMB# 0910-0796
Exp.
07/31/2021
SCREENER
TITLE OF INFORMATION COLLECTION: Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (General Population)
Overview:
Recruitment will be conducted by telephone, online, or in person by recruiters from a vetted professional marketing company. Individuals from a diverse range of racial/ethnic groups and socioeconomic backgrounds are eligible to participate. Recruitment will continue until a representative sample of the required number of participants for each group is obtained. Vetted professional marketing company will draw from its own existing database of individuals interested in research participation using a participant database, which generates call lists of individuals who have voluntarily signed up to participate in research. Vetted professional marketing company has demonstrated capability in recruiting individuals from diverse demographic backgrounds.
Before recruiting commences, all recruiters will attend training to ensure the screening procedures are administered consistently.
Justification for Screener Questions
Item(s) |
Rationale/Justification |
1 |
Assess if adult is within the age range of 19 – 54 |
|
Termination point if not within the appropriate age range |
2 |
Gender |
3 |
Location |
4 |
Preferred Language |
5 -6 |
Verify race/ethnicity |
7 |
Education |
8 – 10 |
Determine income level of household |
11 – 12 |
Relationship with tobacco company, market research company, ad agency, media, or health care |
|
Termination point for individuals who work for a tobacco company or have friends or family who work for a tobacco company |
13 - 14 |
Verify cigarette use status |
|
Termination point for adults who do not meet criteria |
15 – 16 |
Verify quitting status |
|
Termination point for adults who do not meet criteria |
17 – 18 |
Identify adults who use other tobacco products and frequency of use |
19 |
Adult willing to be audio recorded during focus group as part of this study |
20 |
Adult willing to be live streamed during focus group as part of this study |
21 |
Adult willing to participate in the study |
|
Termination point for eligible adults who are not willing to comply with 19 – 21 |
22 |
Collect name, phone number, email address, and home address (for scheduling purposes only; this information will be deleted on a weekly basis) |
23 |
Unique identification number created at this point. |
INTRODUCTION:
Hello, my name is ___________, and I am calling on behalf of vetted professional marketing research company. We are currently inviting people to participate in a focus group. We’re hoping there may be someone in your household who may qualify. Please be assured that this research does not involve sales of any kind, we are just interested in your opinions. The focus group will be held on ________ and will last approximately 95 minutes. Those who participate will receive a $75 prepaid debit card as a token of appreciation. May I please ask you a few questions to see if someone in your household qualifies for this study?
Yes
No → [Read and end call; Does NOT Qualify] That’s okay. Thank you for your time!
SECTION 1
1. How old are you? [Open end text]
18 years or younger TERMINATE
19 to 54 years
55 years or older TERMINATE
Prefer not to say/Refuse to answer TERMINATE
2. Are you…?
Female 1 CONTINUE
Male 2 CONTINUE
3. What is the 5-digit zip code where you CURRENTLY live?
4. Will you be comfortable discussing this project in English?
Yes CONTINUE
No TERMINATE
We are hoping to speak to people from households that represent various races and/or ethnicities.
5. Would you consider yourself Hispanic or Latino?
Yes CONTINUE
No CONTINUE
6. What race or races best describes you? (You can choose one answer or more than one answer)
American Indian or Alaska Native 1 CONTINUE
Asian 2 CONTINUE
Black or African American 3 CONTINUE
Native Hawaiian or Other Pacific Islander 4 CONTINUE
White 5 CONTINUE
Prefer not to answer 6 CONTINUE
7. What is the highest grade or level of school that you have completed?
Less than high school 1 CONTINUE
Some high school, no diploma 2 CONTINUE
GED 3 CONTINUE
High school graduate – diploma 4 CONTINUE
Some college but no degree 5 CONTINUE
Associate degree – occupational/vocational 6 CONTINUE
Associate degree – academic program 7 CONTINUE
Bachelor’s degree (ex: BA, AB, BS) 8 CONTINUE
Master’s degree (ex. MA, MS, MEng, Med, MSW)9 CONTINUE
Professional school degree (ex: MD, DDS, DVM, JD 10 CONTINUE
Doctorate degree (ex: PhD, EdD) 11 CONTINUE
Don’t know 12 CONTINUE
Prefer not to answer 13 CONTINUE
8. Including yourself, how many people currently live your household? [Do not read answer choices. Select one response]
1
2
3
4
5
6
7
8 or more
Prefer not to say/refuse to answer
What is the total yearly income for your entire household before taxes? This should include the total income of everyone that lives in your home, including income from work, but also including benefits received such as social security, TANF, LEAP, unemployment insurance, child support or any other source of income. If you do not know the exact amount, your best estimate is fine. __________ [Open ended. Do not read answer choices, categorize based on response entered into open-end field. Select one response]
Respondent provides a dollar amount
Prefer not to say / Refuse to answer
[Low SES eligibility based on 200% FPL]
# of People in Household (From Question 17) |
Income (From Question 18) |
1 |
$24,980 or less |
2 |
$33,820 or less |
3 |
$42,660 or less |
4 |
$51,500 or less |
5 |
$60,340 or less |
6 |
$69,180 or less |
7 |
$78,020 or less |
8 or more |
$86,860 or less |
[Recruiter does NOT read this question, but uses it to determine qualification] Based on number of people in household and income:
Respondent’s household income is lower than or equal to 200% FPL
Respondent’s household income is higher than 200% FPL
[IF LESS Q10 IS “A”, QUALIFY FOR LOWER SES GROUPS]
Do you, or any member of your immediate family or a close friend work for...? (Select all that apply)
A market research company
A tobacco company (manufacturer, grower, producer, or importer of tobacco productsTERMINATE
An advertising agency or public relations firm
The media (TV/radio/newspapers/magazines)
A health care professional (doctor, nurse, pharmacist, dietitian, etc.)
None of these
12. Have you received money or gift cards from a company for sharing your opinions in a discussion group, interview or survey about tobacco?
Yes, within the past 6 months TERMINATE
Yes, more than 6 months ago
No
I’m not sure
HEALTH BEHAVIORS
13. Have you smoked at least 100 cigarettes in your entire life?
Yes
No TERMINATE
Don’t know
14. On how many of the past 30 days did you smoke cigarettes?
0 days TERMINATE
1 – 30 days
Don’t know TERMINATE
15. Are you thinking about trying to quit smoking cigarettes?
Yes
No TERMINATE
Don’t know TERMINATE
16. In the past 12 months, have you stopped smoking for one day or longer because you were trying to
stop smoking cigarettes for good?
Yes
No TERMINATE
Prefer not to say/Refuse to answer TERMINATE
Some people that smoke cigarettes also use other tobacco products. I am curious about your past and current use of other types of tobacco products.
17. Have you ever [do not read answer choices. Record responses as a. Yes, b. No, C. Prefer not to
say/refuse to answer
Used an electronic cigarette, e-cigarette, vape, vape pen, or hookah pen, such as Juul, Fin, NJOY, Blu, e-Go, or Vuse, in your entire life, even one or two puffs?
Smoked a cigar, even one or two puffs?
Smoked a cigarillo or little cigar (for example, Black & Mild or Swisher Sweets), even one or two puffs?
Used or tried any smokeless tobacco products such as chewing tobacco, snuff, or snus? Note: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches, that is placed under the lip against the gum.
[IF “YES” TO Q17, QUALIFY FOR DUAL USER GROUP]
18. Ask for each “YES” in question 17. On how many of the past 30 days did you [Open-ended. Write response from 0 to 30]:
Used an electronic cigarette, e-cigarette, vape, vape pen, or hookah pen, such as Juul, Fin, NJOY, Blu, e-Go, or Vuse, in your entire life, even one or two puffs?
Smoked a cigar, even one or two puffs?
Smoked a cigarillo or little cigar (for example, Black & Mild or Swisher Sweets), even one or two puffs?
Used or tried any smokeless tobacco products such as chewing tobacco, snuff, or snus? Note: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches, that is placed under the lip against the gum.
19. We would like to audio record the focus groups. Would you be willing to be audio recorded during the focus group as part of this study?
Yes CONTINUE
No TERMINATE
20. We would like to live-stream the focus group. This means that while the group is taking place, members of our research team who could not be there in person would be able to watch the groups remotely. Groups will not be video recorded. Would you be willing to be live streamed during the focus group?
Yes CONTINUE
No TERMINATE
21. Do you consent to taking part in the focus group at ___________ (INSERT FACILITY LOCATION)?
Yes CONTINUE
No TERMINATE
[QUALIFY SCRIPT – TELEPHONE RECRUITMENT]
Thank you for your responses! We would like to invite you to participate in this study.
The face-to-face focus group is where you will be joined by others. The focus group would be taking place at [INSERT FACILITY LOCATION] in the [INSERT DATE/TIME]. The group will last approximately 95 minutes or a little more than 1.5 hours. We are inviting only a small number of individuals to be a part of this research project, so your opinions and participation are very important to us. You will receive a $75 gift card for your participation). Because we are only inviting a limited number of people to take part in this study, it is vital that everyone participates. However, if for any reason you are unable to participate in this study or have any further questions about this study, please call _____________.
22. Because we need to call you back with the focus group date and time, please confirm your contact details. [Refer to Screener Contact Sheet]
23. Unique identification number ID: [ ]
[QUALIFY SCRIPT – ONLINE RECRUITMENT] - Thank you for your responses! If you qualify, we will call you to confirm your participation and schedule you for your group within 24 hours of when you take this online survey. Because we are only inviting a limited number of people to take part in this study, it is vital that everyone we invite participates. However, if for any reason you are unable to participate in this study or have any further questions about this study, please call _____________.
[TERMINATION SCRIPT] – Thank you for answering our questions!. Unfortunately, you don’t qualify to participate in our focus groups at this time. Thank you for your time and have a great day!
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 minutes per response to complete the screening survey (the time estimated to listen or read and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov
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File Modified | 0000-00-00 |
File Created | 0000-00-00 |