Parent Screener - English

OMB No: [FILL NUMBER]

Expiration Date: [FILL DATE]

ATTACHMENT 1: PARENT SCREENER TO DETERMINE YOUTH ELIGIBILITY

(VERSION 2-4-2025)

Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The public reporting burden for this collection of information has been estimated to average 3 minutes per response. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. 

SCREENING QUESTIONNAIRE

Scripter: Suppress PREFER_LANG and auto-punch English until Spanish translation is prepared

BASE: KnowledgePanel members who have not responded the cookie policy found in the Ipsos Privacy Policy (policies remain accessible on the Panel Member Website).

COOKIES [S; prompt once]

Thank you for your interest in on Media and Advertisement Study!

By taking this survey, you agree to our Privacy Policy and use of cookies.

Thank you for your time.

1. Accept and continue to the survey

2. No, thank you

Scripter: Terminate if COOKIES=2 or refused after prompt.

[SCRN_ASSNT] [IF COOKIES = 1]

Click next to answer a few questions to see if your child or children are eligible to participate in the Media and Advertisement Study.

[NEXT]

BASE: Ask All

Thank you for your interest in the Media and Advertisement Study!

[INTRO]

Because you are a KnowledgePanel member, you have been selected to see if your child qualifies for a new study. The United States Food and Drug Administration (FDA) is sponsoring the Media and Advertisement Study. RTI International (RTI) has been selected by the FDA to conduct this study. If selected to participate in the study, your child will be asked to complete an online survey.

We would like to ask you a few questions to see if your child is eligible for this survey. Please try to answer all questions to the best of your ability. Your answers will be kept private. Please click “Next” to continue.

1. Next

BASE: ALL RESPONDENTS

R01. Thanks for taking our survey! First, how many children between the ages of 12 and 20 are living in your household? Please only include the children for whom you are the parent or legal guardian. If there are no children between the ages of 12 and 20 in your household, please answer “0”.

INSERT NUMBER BOX RANGE 0-10

_____ child/children between 12 and 20 years old

[RECORD RESPONSE; IF 0 IS ENTERED OR REFUSED, TERMINATE]

Scripter to show this language before terminating: Thank you for your time. Unfortunately, you do not qualify for this survey. You may now close your browser window and exit this survey.

Base: if R01 = 1

R02A [S] PROMPT up to 2 times for answers to Age and Sex

PROMPT: We would really like your answer to this question.

How old is the child and what is their sex?

Household members in row:

1. Child 1

2. Child 2

Answers in second column:

1. Male

2. Female

SCRIPTER: TERMINATE IF REFUSE

SCRIPTER: First column: heading “Age” min.=12, max.=20. Second column: heading “Sex”, show radio buttons.

Base: if R01 > 1

R02 [S] PROMPT up to 2 times for answers to Age and Sex

PROMPT: We would really like your answer to this question.

For each child aged 12 – 20 in your household, how old is the child and what is their sex?

[SCRIPTER INSERT NUMBER OF ROWS EQUAL TO NUMBER OF CHILDREN IN R01]

ALL_S4 [Grid, S across]

Next, we’d like some brief information about you [ELIGIBILITY CRITERIA]. [INSERT IF ALL_S2=2-5: For each child, please answer the following questions.]

Scripter: Populate as many rows as number of adults indicated at ALL_S2, with maximum of 5. Prompt up

to two times if any cell refused.

1. For Age, show number boxes with range 18-99; do not show range in instruction text.

2. For "Sex", show "Male" and "Female"

SCRIPTER: TERMINATE IF REFUSE

SCRIPTER: Show grid with same number of lines as R01 response. First column: heading “Age” min.=12, max.=20. Second column: heading “Sex”, show radio buttons.

777

SCRIPTER: create DOV_ Parent1220. If respondent has child age 12 through age 20, DOV_Parent1220 = 1; else = 0

Household members in row	Numeric Age	Sex
Child 1
Child 2
Child 3
Child 4
Child 5 or more

SCRIPTER CREATE DATA VARIABLE: DOV_CHILDSELECT
IF R02A OR R02 HAS 1 CHILD GE 12 RECORD AGE AND CHILD SEX
IF R02 HAS MORE THAN 1 CHILD GE 12, RANDOMLY SELECT 1 CHILD AND RECORD AGE AND CHILD SEX

III. PARENTAL PERMISSION & SCREENER – SHOW ON SAME SCREEN AS CHILDDEMO1

IF DOV_CHILDSELECT AGE GE 12 AND LE 17, INSERT: Thank you for your participation! We would like to invite your child to complete our survey. Please click “Next” if you would like your child to participate. After clicking “Next,” if your child is ready, please hand your device to them so that they can continue with their questions. If they are not available now, please have them take the survey as soon as possible. They can also access the survey through your Member Page. Please remind them to take only this survey and not to complete any other surveys. Thank you!

1. Next

III. PARENTAL PERMISSION & SCREENER – SHOW ON SAME SCREEN AS CHILDDEMO1

IF DOV_CHILDSELECT AGE GE 18 AND LE 20, INSERT: Thank you for your participation! We would like the person who is between 18 and 20 to complete a part of this survey. If this person is currently available, please hand your device to them to continue. They can click “Next” when they are ready to continue with their questions. If they are not available now, please ask them to take the survey as soon as possible. They can also access the survey through your Member Page. Please remind them to take only this survey and not to complete any other surveys. Thank you!

1. Next

Scripter: Respondents who report having more than one child ages 12-20

Thank you for your participation! Every child is different, but we would like to invite only one of your children to complete our survey. We have randomly selected your [DOV_CHILDSELECT_AGE] year old [IF DOV_CHILDSELECT_SEX = 1 INSERT: son] [IF DOV_CHILDSELECT_SEX = 2 INSERT: daughter] to complete our survey. Please click “Next” if you would like for your [IF DOV_CHILDSELECT_SEX = 1 INSERT: son; IF DOV_CHILDSELECT_SEX = 2 INSERT: daughter] to participate. After clicking “Next,” if your child is ready, please hand your device to them so they can continue with their questions. If they are not available now, please have them take the survey as soon as possible. They can access the survey through your Member Page or through the invite you received. Please have them take the survey as soon as possible. Remind them to take only this survey and not to complete any other surveys. Thank you!

1. Next

[SURVEY BEGINS BELOW]