Cell Phone Screener
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RELEVANT STAFF: A RESPONDENT, ESPECIALLY A CELL PHONE RESPONDENT,
COULD ASK TO BE CALLED BACK AT A DIFFERENT TIME OR A DIFFERENT
NUMBER AT ANY TIME DURING THE SURVEY. PLEASE ENSURE THAT THERE IS
A STANDARD PROCEDURE, SEPARATE FROM INDIVIDUAL QUESTIONS, FOR THIS
CONTINGENCY, SINCE IT COULD OCCUR AT ANY QUESTION.
INTERVIEWER: THROUGHOUT THIS qUESTIONNAIRE,
only TEXT THAT APPEARS IN upper and lower case LETTERS should BE
READ ALOUD TO RESPONDENTS. text THAT APPEARS in upper case only
should not be read aloud.
|
clintro
interviewer: if respondent expresses
concerns about the survey, please read one or more of the
following, as appropriate:
The survey takes about nn to nn minutes to complete, depending on
your situation.
Your number was selected by chance from a list of all cell
telephone numbers in the US.
The CDC uses the data collected by this study to develop more
effective public health programs to help people quit smoking and
to help keep people from starting to smoke.
I can give you a 1-800 number to call to verify that this is a
legitimate survey. Would you like that 1-800 number?
IF YES: 1‑800‑xxx‑xxxx.
If you are eligible for the study, you will receive a gift
code worth $10 at Amazon-dot-com at the end of the interview.
C1. Hello, my name is [NAME FILL]. I'm calling for the CDC, the
Centers for Disease Control and Prevention. We're gathering
information on health and tobacco from selected cell phone users
across the United States. Your phone number has been chosen
randomly from a list of all cell phone numbers in the US.. If you
are eligible for the study, you will receive a $10 gift for
responding to our questions.
Is respondent continuing
with the interview?
1. YES
2. NO à
Assign disposition code
|
Cltelno
interviewer: if respondent expresses
concerns about the survey, please read one or more of the
following, as appropriate:
The survey takes about 15 to 25 minutes to complete, depending on
your situation.
Your number was selected by chance from a list of all cell
telephone numbers in the US.
The CDC uses the data collected by this study to develop more
effective public health programs to help people quit smoking and
to help keep people from starting to smoke.
I can give you a 1-800 number to call to verify that this is a
legitimate survey. Would you like that 1-800 number?
IF YES: 1‑800‑xxx‑xxxx.
C2. First, I need to confirm that this is a cell phone. Is this a
cell phone?
INTERVIEWER: PLEASE CONFIRM NEGATIVE
RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD
CORRECTLY.
INTERVIEWER: if 2. no, read:
Thank you very much but we are only interviewing people who we
reach on cell phones at this time.
INTERVIEWER: if 4. not a safe time—driving
or other reason, read:
Thank you very much. We will contact you at a later time.
INTERVIEWER: IF 7. DON’T KNOW/NOT
SURE, read:
Is there someone else who uses this telephone that I can speak to?
PROVIDE TEXT?
1. YES
2. NO
Assign disposition code
3. DOES NOT WANT TO BE CALLED AT THIS NUMBER
GO TO C5 CLCALLBACK
4. NOT A SAFE TIME—DRIVING OR OTHER REASON
Assign disposition code
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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cldriving
C3. Your safety is important to us. Are you driving a car or other
vehicle right now?
interviewer: if 1. yes, read:
Thank you very much. We will contact you at a later time.
1. YES à
Assign disposition code
2. NO
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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clcanttalk
C4. Are you in a location or situation where talking on the phone
is safe and where you can talk freely?
interviewer: if 2. NO, read:
Thank you very much. We will contact you at a later time.
1. YES
go to C10 CTELNOCORR
2. NO à
Assign disposition code
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
|
clcallback
IF C2 CLTELNO EQ 3
C5. Is there a better number at which we can call you back?
1. YES
2. NO
Assign disposition code
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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clbetterno
C6. What is that telephone number?
_ _ _ - _ _ _ -_ _ _ _ TELEPHONE
NUMBER
9999. REFUSED à
Assign disposition code
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clbesttime
C7. What would be the best time to try to call back?
_ _ : _ _ _ m
9999. REFUSED à
Assign disposition code
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clname
C8. To make sure that we talk to you when we call back,
please give us a name to ask for? You can make up a name if you
like. A first name only is fine.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
9999. REFUSED à
Assign disposition code
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clINTRO2
C9. Hello, my name is [NAME FILL]. I'm calling for the CDC, the
Centers for Disease Control and Prevention. We're gathering
information on health and tobacco from selected people across the
United States. May I speak with [FILL: CLNAME]?
[IF CLNAME DID NOT ANSWER PHONE Hello, my name is [NAME FILL].
I’m calling for the CDC, the Centers for Disease Control and
Prevention.] We are calling because you asked us to call you at
this time on this number to answer questions on health and
tobacco.
IS RESPONDENT CONTINUING WITH THE INTERVIEW?
1. YES
2. NO à
Assign disposition code
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cltelnocorr
interviewer: if respondent expresses
concerns about the survey, please read one or more of the
following, as appropriate:
The survey takes about nn to nn minutes to complete, depending on
your situation.
Your number was selected by chance from a list of all cell
telephone numbers in the US.
The CDC uses the data collected by this study to develop more
effective public health programs to help people quit smoking and
to help keep people from starting to smoke.
I can give you a 1-800 number to call to verify that this is a
legitimate survey. Would you like that 1-800 number?
IF YES: 1‑800‑xxx‑xxxx.
C10. [IF C4 CLCANTTALK = 2] I need to verify that we have dialed
the number correctly. Is this [phone
number FILL]?
[ELSE] I need to verify that we dialed the original number
correctly. Was the telephone number we originally called you at,
[FILL ORIGINAL CELL PHONE NUMBER]?
INTERVIEWER: PLEASE CONFIRM NEGATIVE
RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD
CORRECTLY.
INTERVIEWER: IF 2. NO, read:
Thank you very much, but we seem to have dialed the wrong number.
It's possible that your number may be called at a later time.
1. YES
2. NO à
Assign disposition code
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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clbusonly
C11. Is [FROM CALLED NUMBER: this/FROM RESPONDENT-DIRECTED NUMBER:
the] cell phone number used for business calls only, personal
calls only, or for both business and personal calls?
INTERVIEWER: IF 1. business calls only,
read:
Thank you very much, but we are only interviewing people at cell
phone numbers that are used for personal calls.
1. BUSINESS CALLS ONLY
Assign disposition code
2. PERSONAL CALLS ONLY
3. BOTH BUSINESS AND PERSONAL CALLS
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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cllandline
INTERVIEWER: If respondent asks what a home
landline telephone is, read:
By ”home landline telephone,” we mean a telephone
that can only be used in your home or just outside your home. It
can be corded or cordless. Calls made to a home computer should be
counted as being made to a home landline number.
C12. Is there also a home landline telephone number at which you
can be reached?
INTERVIEWER: IF 1. YES, read:
Thank you very much, but we are only interviewing people who can
be reached only by cell phone.
1. YES
Assign disposition code
2. NO
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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cladult
C13. Are you 18 years of age or older?
INTERVIEWER: IF 2. no, read:
Thank you very much, but we are only interviewing people 18 years
of age or older.
1. YES
2. NO à
Assign disposition code
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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clprivres
interviewer: if respondent is unsure about
WHAT a “private residence” IS, read:
Examples of places where people live that are not private
residences are barracks, dormitories, and nursing homes. Is the
place where you live more like a house, an apartment or
condominium, or more like a barracks, a dormitory, or a nursing
home?
C14. Do you live in a house, an apartment, a condominium, or other
type of private residence?
INTERVIEWER: IF 2. NO, read:
Thank you very much, but we are only interviewing people who live
in private residences.
1. YES
2. NO à
[AUTOMATICALLY Assign disposition code 420]
7. DON’T KNOW/NOT
SURE à
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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clconfidential
C15. You are eligible to be interviewed. I won't ask for your
name, address, or other personal information that can identify
you. You don’t have to answer any question you don’t
want to, and you can end the interview at any time. The interview
may take up to about nn to nn minutes, depending on your
situation, and any information you give me will be confidential.
If you have any questions about this survey, I will provide a
telephone number for you to call to get more information.
Is respondent continuing
with the interview?
1. YES
2. NO
Assign disposition code
|
Landline Screener
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lintro
L1. Hello, my name is [NAME FILL]. I'm calling for the CDC, the
Centers for Disease Control and Prevention. We're gathering
information on health and tobacco from selected people across the
United States. Your phone number has been chosen randomly.
Is respondent continuing
with the interview?
1. YES
|
ltelnocorr
interviewer: if respondent expresses
concerns about the survey, please read one or more of the
following, as appropriate:
The survey takes about nn to nn minutes to complete, depending on
your situation.
Your number was selected by chance from a list of all cell
telephone numbers in the US.
The CDC uses the data collected by this study to develop more
effective public health programs to help people quit smoking and
to help keep people from starting to smoke.
I can give you a 1-800 number to call to verify that this is a
legitimate survey. Would you like that 1-800 number?
IF YES: 1‑800‑xxx‑xxxx.
L2. First, I need to verify that we have dialed the number. Is
this [phone number
FILL]?
INTERVIEWER: IF 2. NO, read:
Thank you very much, but I seem to have dialed the wrong number.
It's possible that your number may be called at a later time.
INTERVIEWER: IF 7. DON’T KNOW/NOT
SURE, Ask to speak to someone else.
PROVIDE TEXT?
1. YES
2. NO
7. DON’T KNOW/NOT
SURE
9. REFUSED (Including
hang-up)
Assign disposition code
|
LCELLPHONE
L3 Is this a cellular telephone?
INTERVIEWER: if necessary, Read:
By cellular telephone we mean a
telephone that is mobile and usable outside of your neighborhood.
1. YES
2. NO
7. DON’T KNOW/NOT
SURE
9. REFUSED (Including
hang-up)
Assign disposition code
Thank you very much, but we are
only interviewing people on landline telephones.
|
lprivres
interviewer: if respondent is unsure about
WHAT a “private residence” IS, read:
Examples of places where
people live that are not
private residences are barracks, dormitories, and nursing homes.
Is the place where you live more like a house, an apartment or
condominium, or more like a barracks, a dormitory, or a nursing
home?
L4. Is this a house, an apartment, a condominium, or other type of
private residence?
INTERVIEWER: IF 2. NO, read:
Thank you very much, but we are only interviewing private
residences.
INTERVIEWER: IF DON’T 7. KNOW/NOT
SURE, Ask to speak to someone else.
PROVIDE TEXT?
1. YES
2. NO
[AUTOMATICALLY Assign disposition code 420]
7. DON’T KNOW/NOT SURE
9. REFUSED (Including
hang-up)
Assign disposition code
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lnoadult
L5. I need to randomly select one adult who lives in your
household to be interviewed. How many members of your household,
including yourself, are 18 years of age or older?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
_ _. Number of adults
If noadult >1 Go to L10 NOMEN
77. DON’T KNOW/NOT SURE
99. REFUSED (Including
hang-up)
Assign disposition code
[RANGE: 1-76]
|
lareyouadult
L6. Are you the adult?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
1. YES
2. NO.
Go to L8 ISADULTMW
7. DON’T KNOW/NOT SURE
9. REFUSED (Including
hang-up)
Assign disposition code
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lareyoumf
INTERVIEWER: Ask only if necessary.
L7. Then you are the person I need to speak with. Are you male or
female?
1. Male
Go to L14 LSELRESPINTRO
2. Female
Go to L14 LSELRESPINTRO
7. DON’T KNOW/NOT
SURE
Assign disposition code
9. REFUSED (Including
hang-up)
Assign disposition code
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lisadultmw
L8. Is the adult a man or a woman?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
1. A man
2. A woman
7. DON’T KNOW/NOT SURE
9. REFUSED (Including
hang-up)
Assign disposition code
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lspeakadult
L9. May I speak with [fill
in: him OR her from
previous question]?
INTERVIEWER: IF NO, TRY TO SCHEDULE AN
APPOINTMENT. PROVIDE TEXT?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
1. YES
Go to S13 SELRESPINTRO
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED (Including
hang-up)
Assign disposition code
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lnomen
L10. You said there are [FILL NUMBER OF ADULTS] adults in your
household? How many are men?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
_ _ Number of men
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED (Including
hang-up)
Assign disposition code
IF NUMBER OF MEN EQUALS THE NUMBER OF ADULTS, GO TO LSELRESP
[RANGE: 1-76]
[Verification screen if
Lnomen >=5]
|
lnowomen
L11. How many of these adults are women?
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
_ _ Number of women
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED (Including
hang-up)
Assign disposition code
[RANGE: 1-76]
[Verification
screen if Lnowomen >=5]
|
lselresp
[CATI PROGRAMMER: RANDOMLY SELECT RESPONDENT BY AGE RANK AND
GENDER. USE CODE BELOW TO IDENTIFY SELECTED RESPONDENT IN
SUBMITTED DATA SET.]
101. Oldest male
102. Second oldest male
103. Third oldest male
…
199. Ninety-ninth oldest male
201. Oldest female
202. Second oldest female
203. Third oldest female
…
299. Ninety-ninth oldest female
|
Lselrespphone
L12. The person in your household that I need to speak with is the
[age rank and gender of
selected respondent FILL]. Are you the [age
rank and gender of selected respondent FILL]?
INTERVIEWER: IF YES, read:
Then you are the person I need to speak with.
INTERVIEWER: IF DON’T KNOW/NOT SURE,
Ask to speak to someone else. PROVIDE
TEXT?
1. YES
Go to L14 LCONFIDENTIAL
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED (Including
hang-up)
Assign disposition code
|
lselrespintro
L13. Hello, my name is [NAME FILL]. I'm calling for the CDC, the
Centers for Disease Control and Prevention. We're gathering
information on health and tobacco from selected people across the
United States. Your phone number has been chosen randomly.
Is respondent continuing
with the interview?
1. YES
2. NO à
Assign disposition code
|
lconfidential
L14. I won't ask for your name, address, or other personal
information that can identify you. You don’t have to answer
any question you don’t want to, and you can end the
interview at any time. The interview may take up to about 20
minutes and any information you give me will be confidential. If
you have any questions about this survey, I will provide a
telephone number for you to call to get more information.
Is respondent continuing
with the interview?
1. YES
2. NO
Assign disposition code
|
General Health
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genhealth
Rationale: Provides an easy opening to the survey and can prove a
useful covariate in analysis. Is a Healthy People 2010 overarching
quality of life measure.
1. Would you say that in
general your health is…?
1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
7. DON’T KNOW/NOT SURE
9. REFUSED
|
TOBACCO USE
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cigarette smoking
|
smok100
Rationale: Key Outcome Indicators 2.08.3, 3.14.1(Core), 1.14.2
HELP: 100 CIGARETTES = 5 PACKS
2. Have you smoked at
least 100 cigarettes in your entire life?
1. YES
2. NO GO TO Q5
SMOKEVER
7. DON’T KNOW/NOT SURE
Go to Q5 SMOKEVER
9. REFUSED
Go to Q30 SLTEVER2
|
smoknow
Rationale: Key Outcome Indicators 2.08.3, 3.14.1(Core)
3. Do you now smoke
cigarettes every day, some days, or not at all?
1. Every day
2. Some days à
Go to Q8
SMOKDAYS30
3. Not at all à
Go to q6 smoklast
9. REFUSED à
Go to Q30 SLTEVER2
|
smokperday
Rationale: Key
Outcome Indicator 2.08.2
interviewer: if respondent is unsure or
states a range, read:
[You said you smoke about x to y cigarettes a day.] Your answer
doesn’t have to be exact, but I do need to report one
number. What is your best guess of the average number of
cigarettes you smoke in one day?
4. On the average, about
how many cigarettes a day do you now smoke?
HELP: 1 PACK = 20 CIGARETTES.
_ _ _. Number of
cigarettes à
Go to Q13
SMOKWHOLAGE
666. Less than one
cigarette a day à
Go to Q13 SMOKWHOLAGE
888. NONE à
Go to Q13 SMOKWHOLAGE
777. DON’T KNOW/NOT SUREà
Go to Q13 SMOKWHOLAGE
999. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 1-180]
[Verification screen if number of cigarettes >= 61]
|
smokever
Asked of respondents who have not smoked at least 100 cigarettes
in their entire life or who don’t know if they have smoked
at least 100 cigarettes in their entire life.
Rationale: Identification of episodic smokers and screener for Key
Outcome Indicators 1.10.5 (Youth, Core), 1.13.2 (Youth)
5. Have you ever tried
cigarette smoking, even one or two puffs?
1. YES
2. NO à
Go to q18 FUTURSMOK2
7. DON’T KNOW/NOT SURE
à
Go to Q30 SLTEVER2
9. REFUSED à
Go to Q30 SLTEVER2
|
smoklast
Asked of respondents (who have not smoked at least 100 cigarettes
in their entire life and have smoked at least one or two puffs) or
(who have smoked 100 or more cigarettes and do not smoke now).
Rationale: Key Outcome Indicators 3.13.1, 3.13.2
interviewer: Pause between each response
category to allow respondent to answer “yes” or “No”
to each category. enter the response code for the first “yes”
and then continue to the next question.
6. For the next question,
I’m going to read to you a set of possible answers. Please
answer “Yes” or “No” to each answer. Was
the last time you smoked a cigarette, even one or two puffs…?
01. Within the past 24 hours
à
Go to Q8 SMOKDAYS30
02. Within the past 7 days
03. Within the past 30 days
04. Within the past 3 months
05. Within the past 6 months
06. Within the past 1 year
07. Within the past 5 years
à
Go to q12 SMOKWHOLCIG
08. Within the past 10 years
à
Go to q12 SMOKWHOLCIG
09. Within the past 15 years
à
Go to q12 SMOKWHOLCIG
10. More than 15 years ago
à
Go to q12 SMOKWHOLCIG
77. DON’T KNOW/NOT SURE
à
Go to q18 FUTURSMOK2
99. REFUSED à
Go to Q30 SLTEVER2
|
smokorquit
Asked of respondents who last smoked a cigarette more than 24
hours ago and within the past 1 year.
Rationale: Key Outcome Indicator 3.13.2
7. You said that you last
smoked [Q6 SMOKLAST].
Have you not smoked [Q6
SMOKLAST] because you are trying to quit smoking for good?
1. yes, RESPONDENT is trying TO QUIT SMOKING for good
à
Go to Q12 SMOKWHOLCIG
2. no, RESPONDENT is not trying TO QUIT SMOKING for good.
7. DON’T KNOW/NOT
SURE
9. REFUSED
IF Q6 SMOKLAST EQ 05 OR
06, GO TO Q10 SMOKPASTYR
|
smokdays30
Asked of respondents who (have at least puffed on a cigarette in
the past 30 days or who now smoke some days) and who want to
continue smoking.
Rationale: Key Outcome Indicators 1.14.2, 2.08.2
interviewer: if respondent is unsure or
states a range, read:
[You said you smoked cigarettes on x to y days.] Your answer
doesn’t have to be exact, but I do need to report one
number. What is your best guess of the number of days you smoked
cigarettes in the past 30 days?
8. During the past 30
days, that is, since [DATE FILL], on how many days did you smoke
cigarettes?
_ _. Number of Days
88. NONE à
Go to q12 SMOKWHOLCIG
77. DON’T KNOW/NOT
SURE à
Go to q12 SMOKWHOLCIG
99. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 1-30]
|
smoksomeday
Rationale: Key Outcome Indicator 2.08.2
interviewer: if respondent is unsure or
states a range, read:
[You said you smoke about x to y cigarettes a day on days when
you smoke cigarettes.] Your answer doesn’t have to be exact,
but I do need to report one number. What is your best guess of the
average number of cigarettes you smoked in one day on days when
you smoked cigarettes in the past 30 days?
9. On the average, on
days when you smoked during the past 30 days, that is, since [DATE
FILL], about how many cigarettes did you smoke a day?
HELP: 1 pack=20 cigarettes.
_ _ _. Number of
cigarettes
666. Less than one
cigarette a day
888. NONE
777. DON’T KNOW/NOT SURE
999. REFUSED à
Go to Q30 SLTEVER2
if q2
smok100 = (2 or 7), go to q12
smokwholecig;
else if q2 smok100
= 1, go to q13
smokwholage
[RANGE: 1-180]
[Verification screen if number of cigarettes >= 061]
|
smokpastyr
Asked of respondents who last smoked 31 days ago to 1 year ago and
who want to continue smoking.
Rationale: To identify occasional smokers who might be missed by
current measures and programs.
interviewer: if respondent is unsure or
states a range, read:
[You said you smoked cigarettes on x to y days.] Your answer
doesn’t have to be exact, but I do need to report one
number. What is your best guess of the number of days you smoked
cigarettes in the past year?
10. In the past year,
that is, since [DATE FILL], on about how many days did you smoke
cigarettes, even just one puff?
_ _. Number of Days
88. NONE
77. DON’T KNOW/NOT
SURE
99. REFUSED
|
smokYRNUM
Rationale: Key Outcome Indicator 2.08.2
interviewer: if respondent is unsure or
states a range, read:
[You said you smoke about x to y cigarettes a day.] Your answer
doesn’t have to be exact, but I do need to report one
number. What is your best guess of the average number of
cigarettes you smoked in one day on days when you smoked
cigarettes in the past year?
11. On the average, on
days when you smoked during the past year, that is, since
[DATE FILL], about how many cigarettes did you smoke a day?
HELP: 1 pack=20 cigarettes.
_ _ _. Number of
cigarettes
666. Less than one
cigarette a day
888. NONE
777. DON’T KNOW/NOT SURE
999. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 1-180]
[Verification screen if number of cigarettes >= 061]
|
smokwholcig
Asked of respondents who have not smoked at least 100 cigarettes
in their entire life and who have smoked at least one or two
puffs.
Rationale: Screener for Key Outcome Indicator 1.13.1 (Youth, Core)
12. Have you ever smoked
a whole cigarette?
1. YES
2. NO à
IF q6 smoklast <= 6 go
to q17 SMOKYRago,
else
if q6 smoklast >= 7 go
to q18 futursmok2
7. DON’T KNOW/NOT SURE
à
IF q6 smoklast <= 6 go
to q17 SMOKYRago,
else
if q6 smoklast >= 7 go
to q18 futursmok2
9. REFUSED à
Go to Q30 SLTEVER2
|
smokwholage
Rationale: Key
Outcome Indicator 1.13.1 (Youth, Core)
13. How old were you when
you smoked a whole cigarette for the first time?
_ _. age in years à
if q3 smoknow = 1, go to
q15 smok30dage
88. RESPONDENT HAS NEVER
SMOKED A WHOLE CIGARETTE à
IF q6 smoklast <=
6 go to q17
SMOKYRago,
else if q6
smoklast >= 7 go to q18 futursmok2
77. DON’T KNOW/NOT SURE
99. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 1-76]
[Verification screen if number of years <= 9]
[Verification screen if number of years >= 30]
[Verification screen if number of years > age]
|
smok30dever
Asked of respondents (who have smoked fewer than 100 cigarettes in
their entire life and have smoked a whole cigarette) or (who have
smoked 100 or more cigarettes and do not smoke now) or (who have
smoked 100 or more cigarettes and now smoke some days).
Rationale: To identify all respondents who are former daily
smokers.
14. Have you ever smoked
at least one cigarette every day for 30 days in a row?
1. YES
2. NO à
IF q6 smoklast >=
7,GO TO Q18
FUTURSMOK2;
ELSE IF
q6 smoklast <=
6 GO TO Q17 SMOKYRAGO
7. DON’T KNOW/NOT SURE à
IF q6 smoklast >=
7,GO TO Q18 FUTURSMOK2;
ELSE
IF q6
smoklast <= 6 GO TO Q17
SMOKYRAGO
9. REFUSED à
Go to Q30 SLTEVER2
|
smok30dage
Rationale: Used to
estimate the number of persons who become regular smokers each
year.
15. How old were you when
you first smoked at least one cigarette every day for 30
days in a row?
_ _. age in years
77. DON’T KNOW/NOT SURE
99. REFUSED à
Go to Q30 SLTEVER2
IF Q3 SMOKNOW = 1, GO TO
Q17 SMOKYRAGO
[RANGE: 1-76]
[Verification screen if number of years <= 9]
[Verification screen if number of years >= 30]
[Verification screen if number of years > age]
|
smok30dlast
Rationale: To accurately measure successful quiting.
interviewer: Pause between each response
category to allow respondent to answer “yes” or “No”
to each category. enter the response code for the first “yes”
and then continue to the next question.
16. For the next
question, I’m going to read to you a set of possible
answers. Please answer “Yes” or “No” to
each answer. Think about the last time you smoked at least
one cigarette every day for 30 days in a row. How long ago was the
last day of those 30 days? Was it…?
01. Today or yesterday
02. In the past 7 days
03. In the past 30 days
04. In the past 1 year
05. In the past 5 years à
Go to q18 futursmok20
06. In the past 10 years à
Go to q18 futursmok2
07. In the past 15 years à
Go to q18 futursmok2
08. More than 15 years ago
à
Go to q18 futursmok2
77. DON’T KNOW/NOT SURE
à
Go to q18 FUTURSMOK2
99. REFUSED à
Go to Q30 SLTEVER2
|
smokyrago
Asked of respondents (who have at least puffed on a cigarette in
the past year) or (who now smoke every day or some days).
Rationale: Smoking status in the prior year indicates whether
smoking status has changed.
17. Around this time last
year, were you smoking cigarettes every day, some days, or not at
all?
1. Every day
2. Some days
3. Not at all
7. Don't know/Not sure
9. REFUSED à
Go to Q30 SLTEVER2
[IF Q3 SMOKNOW = 1 OR 2
GO TO Q19 SMOKEWAKE]
|
futursmok2
Asked of respondents who have not smoked at least 100 cigarettes
in their entire life or who don’t smoke now.
Rationale: Key Outcome Indicator 1.10.5 (Youth, Core),
Susceptibility
18. How likely are you to
smoke a cigarette in the next year—…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Very likely
2. Somewhat likely
3. Not at all likely
7. DON’T KNOW/NOT SURE
9. REFUSED
[IF Q5 SMOKEVER = 2 OR q6
smoklast >= 4,
Go to Q30 SLTEVER2
[IF q6
smoklast <= 3, GO TO Q23
BGHTPAST30D]
Gilpin EA, White, VM, Pierce JP. Nicotine and Tobacco Research 7
(Oct 2005): 747-759.
|
smokwake
Asked of respondents who now smoke every day or some days.
Rationale: Provides an indicator of addiction (Heaviness of
Smoking Index, or HSI) to nicotine when used with Q4
SMOKPERDAY.
19. How soon after you
wake up do you usually have your first cigarette…?
1. Within 5 minutes
2. From 6 to 30 minutes
3. From more than 30 minutes to 1 hour
4. After more than 1 hour
7. DON’T KNOW/NOT SURE
9. REFUSED à
Go to Q30 SLTEVER2
|
mentholcigs2
Asked of respondents who now smoke some days or every day.
Rationale: To track changes in industry marketing strategies.
20. During the past 30
days, that is, since [DATE FILL], were the cigarettes that you
usually smoked menthol?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED à
Go to Q30 SLTEVER2
|
cigflavor
Rationale: To determine prevalence of flavored cigarette use.
21. Were any of the
cigarettes that you smoked in the past 30 days flavored to taste
like candy, fruit, chocolate, or other sweets?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
|
brand2
Rationale: To track changes in cigarette brand use.
22. During the past 30
days, that is, since [DATE FILL], what brand of cigarettes did you
smoke most often?
INTERVIEWER: Do not read response
categories, SELECT only one.
01. Basic (Branded discount)
02. Camel
03. Doral (Branded discount)
04. Forsyth (Private label)
05. GPC (Branded discount)
06. Kool
07. Marlboro
08. Misty (Branded discount)
09. Newport
10. Pall Mall
11. Parliament
12. Salem
13. Sonoma (Branded discount)
14. USA Gold (Branded discount)
15. Virginia Slims
16. Winston
17. Other (specify)
66. DID NOT SMOKE A USUAL BRAND DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED à
Go to Q30 SLTEVER2
[GO TO Q25 BUYQUANT2]
|
bghtpast30d
Asked of respondents (who have smoked fewer than 100 cigarettes in
their entire life and have at least puffed on a cigarette in the
past 30 days) or (who have smoked 100 or more cigarettes in their
entire life, do not smoke now, and have at least puffed on a
cigarette in the past 30 days).
Rationale: Screener for Q24
BRANDPAST30D.
23. Have you bought any
cigarettes for yourself in the past 30 days (that is, since [DATE
FILL])?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED à
Go to Q30 SLTEVER2
|
brandpast30d
Rationale: To track changes in cigarette brand use.
24. During the past 30
days, that is, since [DATE FILL], what brand of cigarettes did you
buy most often?
INTERVIEWER: Do not read response
categories, SELECT only one.
01. Basic (Branded discount)
02. Camel
03. Doral (Branded discount)
04. Forsyth (Private label)
05. GPC (Branded discount)
06. Kool
07. Marlboro
08. Misty (Branded discount)
09. Newport
10. Pall Mall
11. Parliament
12. Salem
13. Sonoma (Branded discount)
14. USA Gold (Branded discount)
15. Virginia Slims
16. Winston
17. Other (specify)
66. DID NOT BUY ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED à
Go to Q30 SLTEVER2
|
buyquant2
Asked of respondents (who have at least puffed on a cigarette in
the past 30 days) or (who now smoke some days or every day).
Rationale: Screener for Q26
COSTPACK2 AND Q27
COSTCARTON2.
25. The last time you
bought cigarettes for yourself, did you buy them by the pack or by
the carton?
1. By the pack
2. By the carton à
Go to q27 COSTCARTON2
3. OTHER (SPECIFY) à
Go to Q30 SLTEVER2
7. DON’T KNOW/NOT SURE
à
Go to Q30 SLTEVER2
9. REFUSED à
Go to Q30 SLTEVER2
|
costpack2
Rationale: To measure the effect of price on cigarette
consumption.
26. What price did you
pay for the last pack of cigarettes you bought?
Interviewer: If respondent asks about
discounts or coupons, READ:
Please
report the cost after discounts or coupons.
_ _ _ _. Amount paid for
last pack of cigarettes (in cents,
2 implied decimals)
à
IF Q3 SMOKNOW = (1
OR 2) GO TO Q28
SPECOFFERS, ELSE Go to
Q30 SLTEVER2
7777. DON’T KNOW/NOT SURE à
IF Q3 SMOKNOW = (1
OR 2) GO TO Q28
SPECOFFERS, ELSE Go to
Q30 SLTEVER2
9999. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 0001-2000]
[Verification screen if amount paid <= 0199]
[Verification screen if amount paid >= 0400]
|
costcarton2
Rationale: To measure the effect of price on cigarette
consumption.
27. What price did you
pay for the last carton of cigarettes you bought?
Interviewer: If respondent asks about
discounts or coupons, READ:
Please
report the cost after discounts or coupons.
_ _ _ _. Amount paid for
last carton of cigarettes (in cents, 2 implied decimals) à
IF Q3 SMOKNOW <> (1 OR 2),
GO TO Q30 SLTEVER2
7777. DON’T KNOW/NOT SURE à
IF Q3 SMOKNOW <> (1 OR 2),
GO TO Q30 SLTEVER2
9999. REFUSED à
Go to Q30 SLTEVER2
[RANGE: 0100-4000]
[Verification screen if amount paid <= 01500]
[Verification screen if amount paid >= 10000]
|
specoffers
Asked of respondents who now smoke some days or every day.
Rationale: To track changes in industry marketing strategies.
28. The last time you
bought cigarettes, did you take advantage of coupons, rebates, buy
1 get 1 free, 2 for 1, or any other special promotions for
cigarettes?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED à
Go to Q30 SLTEVER2
|
buynet2
Rationale: To determine the extent to which smokers are by-passing
restrictions on cost and availability of cigarettes.
29. In the past 12
months, that is, since [DATE FILL], have you bought cigarettes
over the Internet?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
other tobacco use
|
Now I would like to ask you some questions about your use of other
tobacco products.
|
sltever2
Asked of all respondents.
Rationale: Key Outcome Indicators 1.13.2 (Youth), Skip for 1.14.2
(Youth), 3.14.1
interviewer: pronounce “levi” as
lee-vie
30. Have you ever tried
chewing tobacco, snuff, or dip, such as Skoal, Copenhagen,
Grizzly, Levi Garrett, Red Man, or Day’s Work, even just one
time in your entire life?
1. YES
2. NO à
Go to Q33 SNUSEVER
7. DON’T KNOW/NOT SURE
à
Go to Q33 SNUSEVER
9. REFUSED à
Go to Q33 SNUSEVER
|
sltnodays
Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1
31. During the past 30
days, that is, since [DATE FILL], on how many days did you use
chewing tobacco, snuff, or dip?
_ _ NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 1-30]
|
sltbrand
Rationale: To track changes in smokeless tobacco brand use.
32. During the past 30
days, that is, since [DATE FILL], what brand of smokeless tobacco
did you use most often?
INTERVIEWER: Do not read response
categories, SELECT only one.
01. Beech-Nut Regular
02. Copenhagen
03. Grizzly
04. Kodiak
05. Levi Garrett
06. Longhorn
07. Morgan's
08. Red Man
09. Red Man Golden Blend
10. Red Seal
11. Skoal
12. Southern Pride
13. Stoker Chew
14. Taylor's Pride
15. Timber Wolf
16. Other (specify)
66. DID NOT USE ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED
|
snusever
Asked of all respondents.
Rationale: Key Outcome Indicators 1.13.2 (Youth), Skip for 1.14.2
(Youth), 3.14.1
INTERVIEWER: Pronounce “snus” to
rhyme with goose
33. “Snus” is
moist, smokeless tobacco, usually sold in individual or
pre-packaged small pouches that are placed under the lip against
the gum. Have you ever tried snus, even just one time in your
entire life?
1. YES
2. NO à
Go to q36 CIGAREVER
7. DON’T KNOW/NOT SURE
à
Go to q36 CIGAREVER
9. REFUSED à
Go to q36 CIGAREVER
|
snusnodays
Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1
34. During the past 30
days, that is, since [DATE FILL], on how many days did you use
snus?
_ _ NUMBER OF DAYS
88. NONE à
Go to q36 CIGAREVER
77. DON’T KNOW/NOT SURE
à
Go to q36 CIGAREVER
99. REFUSED à
Go to q36 CIGAREVER
[RANGE: 1-30]
|
sltsub
Rationale: To measure substitution of smokeless tobacco for
smoking in places where smoking is restricted.
35. Have you ever used
chewing tobacco, snuff, dip, or snus instead of smoking a
cigarette or other tobacco product because you were in a place
where smoking was not allowed?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
cigarever
Rationale: Key Outcome Indicator 1.13.2 (Youth), Skip for 1.14.2
(Youth), 3.14.1
36. Have you ever tried
smoking cigars, cigarillos, or very small cigars that look like
cigarettes in your entire life, even one or two puffs?
1. YES
2. NO à
Go to q39 PIPEwtrEVER
7. DON’T KNOW/NOT SURE
à
Go to q39 PIPEwtrEVER
9. REFUSED à
Go to q39 PIPEwtrEVER
|
cigarnodays
Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1
37. During the past 30
days, that is, since [DATE FILL], on how many days did you smoke
cigars, cigarillos, or very small cigars that look like
cigarettes?
_ _ NUMBER OF DAYS
88. NONE à
Go to q39 PIPEwtrEVER
77. DON’T KNOW/NOT SURE
à
Go to q39 PIPEwtrEVER
99. REFUSED à
Go to q39 PIPEwtrEVER
|
cigarflavr
Rationale: Candy and fruit flavored cigars/cigarillos are popular
with some young adults and youth. Knowledge of the extent of use
will allow programs to assess initiation and evaluate and inform
future communication and education campaigns, and tax,
advertising, and other policy initiatives.
38. Were any of the
cigars, cigarillos, or very small cigars that look like cigarettes
that you smoked in the past 30 days flavored to taste like candy,
fruit, chocolate, or other sweets?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
pipewtrever
Rationale: Key Outcome Indicator 1.13.2 (Youth), Skip for 1.14.2
(Youth), 3.14.1
39. The next question
asks you about smoking tobacco in a water pipe. A water pipe is
also called a hookah. Have you ever tried smoking tobacco in a
water pipe in your entire life, even one or two puffs?
1. YES
2. NO à
Go to q41 PIPEOTHEVER
7. DON’T KNOW/NOT SURE
à
Go to q41 PIPEOTHEVER
9. REFUSED à
Go to q41 PIPEOTHEVER
|
pipewtrdays
Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1
40. During the past 30
days, that is, since [DATE FILL], on how many days did you smoke
tobacco in a water pipe?
_ _ NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 1-30]
|
pipeothever
Rationale: Key Outcome Indicator 1.13.2 (Youth) , Skip for 1.14.2
(Youth), 3.14.1
41. Have you ever smoked
tobacco in a pipe other than a water pipe in your entire life,
even one or two puffs?
1. YES
2. NO à
IF [Q2 SMOK100 = (2 OR 7
OR 9) OR Q3 SMOKNOW = 3]
AND [Q5 SMOKEVER = 2 OR
q6 smoklast >=4], Go
to q43 qtlineawrnt; else
go to q44 qtlineawrt
7. DON’T KNOW/NOT SUREà
IF [Q2 SMOK100 = (2 OR 7
OR 9) OR Q3 SMOKNOW
= 3] AND [Q5 SMOKEVER = 2
OR q6 smoklast >=4],
Go to q43 qtlineawrnt;
else go to q44 qtlineawrt
9. REFUSED à
IF [Q2 SMOK100 = (2 OR 7
OR 9) OR Q3 SMOKNOW = 3]
AND [Q5 SMOKEVER = 2 OR
q6 smoklast >= 4],
Go to q43 qtlineawrnt;
else go to q44 qtlineawrt
|
pipeothdays
Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1
42. During the past 30
days, that is, since [DATE FILL], on how many days did you smoke
tobacco in a pipe other than a water pipe?
_ _ NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 1-30]
IF [Q2
SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3]
AND [Q5 SMOKEVER = 2
OR q6 smoklast >= 4],
Go to q43 qtlineawrnt;
else go to q44 qtlineawrt
|
Cessation
|
awareness of quitlines and counter-marketing
|
qtlineawrnt
Asked of respondents (who have smoked fewer than 100 cigarettes in
their life or who now smoke not at all) and (who have not puffed
on a cigarette ever or in the last 30 days).
Rationale: Non-users of tobacco can influence tobacco users to use
quitline services
43. A telephone quitline
is a free telephone-based service that connects people who smoke
cigarettes with trained counselors who can help them quit. Are you
aware of any telephone quitline services that are available to
help people quit smoking?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
[IF Q6 SMOKLAST EQ (4, 5,
OR 6), GO TO Q48 QTATT2;
ELSE GO TO Q58 HCWCARE2]
|
qtlineawrt
Asked of respondents (who have smoked at least 100 cigarettes in
their entire life and who now smoke every day or some days) or
(who have at least puffed on a cigarette in the past 30 days).
Rationale: Key Outcome Indicator 3.08.6
44. A telephone quitline
is a free telephone-based service that connects people who smoke
cigarettes with trained counselors who can help them quit. Are you
aware of any telephone quitline services that are available to
help you quit smoking?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtasstawr
Rationale: Key Outcome Indicator 3.08.6
45. Are you aware of any
individual or group counseling services, other than quitlines,
that are available to help you quit smoking cigarettes?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtads
Asked of respondents (who have smoked at least 100 cigarettes in
their entire life and who now smoke every day or some days) or
(who have at least puffed on a cigarette in the past 30 days).
Rationale: Key Outcome Indicator 3.08.1
46. In the past 30 days,
have you seen, read, or heard any ads about quitting cigarettes?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtexads
Rationale: Key Outcome Indicator 3.08.1
47. Have you ever seen or
heard the slogan “Become an EX” in an ad? "EX"
is spelled E-X.
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
[IF q6
smoklast >= 7, GO TO Q58
HCWCARE2]
|
quit attempts
|
qtatt2
Asked of respondents (who have smoked at least 100 cigarettes in
their entire life and who now smoke every day or some days) or
(who have at least puffed on a cigarette in the past 12 months).
Rationale: To identify lifetime prevalence of quit attempts.
interviewer: if respondent is unsure or
states a range, read:
You said you have tried to quit smoking cigarettes about x to y
times in your entire life. Your answer doesn’t have to be
exact, but I do need to report one number. What is your best guess
of the number of times in your whole life that you have stopped
smoking for one day or longer because you were trying to quit
smoking cigarettes for good?
48. In your whole life,
how many times have you stopped smoking for one day or longer
because you were trying to quit smoking cigarettes for good?
_ _. Number of times
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 01-76]
[VERIFICATION SCREEN IF NUMBER OF TIMES >= 10]
[IF [Q48 QTATT2 = (88 OR
77 OR 99) AND q6
smoklast <= 5 GO TO Q53 QTWANT,
ELSE GO TO q58 HCWCARE2]
|
qt12mos
Rationale: Key Outcome Indicator 3.11.1 (Core), Skip question for
3.11.3 (Core)
interviewer: if respondent is unsure or
states a range, read:
You said you have tried to quit smoking cigarettes about x to y
times in the past twelve months. Your answer doesn’t have to
be exact, but I do need to report one number. What is your best
guess of the number of times in the past 12 months that you have
stopped smoking for one day or longer because you were trying to
quit smoking cigarettes for good?
49. During the past 12
months, that is, since [DATE FILL], how many times have you
stopped smoking for one day or longer because you were trying to
quit smoking cigarettes for good?
_ _. Number of times
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 01-76]
[IF [Q49 QT12MOS = (88 OR
77 OR 99) GO TO Q53 QTWANT]
|
|
qtline
Rationale: Key Outcome Indicator 3.11.3 (Core)
50. [IF q6
smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF
Q3 SMOKNOW = (1 OR 2) OR
q6
smoklast <=3:] The last time you tried to quit
smoking,…]
did you call a
telephone quitline?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtasst2
Rationale: Key Outcome Indicators 3.11.3 (Core), 3.07.4
51. [IF q6
smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF
Q3 SMOKNOW = (1 OR 2) OR
q6
smoklast <=3:] The last time you tried to quit
smoking,…]
did you use a class or program or one-on-one counseling from a
healthcare provider to assist you in quitting?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
IF Q6 SMOKLAST =6 GO TO Q59 HCWCARE2
|
qtmed2
Rationale: Key Outcome Indicator 3.11.3 (Core)
52. [IF q6
smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF
Q3 SMOKNOW = (1 OR 2) OR
q6
smoklast <=3:] The last time you tried to quit
smoking,…]
INTERVIEWER: PRONOUNCE “Wellbutrin”
AS Well BYOU trin, “Zyban” AS
Z‑EYE ban, “BU PRO PRI ON”
as byou pro pri on, “Chantix” AS
SHAN tix, and “varenicline” as var en ih clean.
interviewer: please read the list slowly.
did you use any of the following medications: a nicotine
patch, nicotine gum, nicotine lozenges, nicotine nasal spray, a
nicotine inhaler, or pills such as Wellbutrin, Zyban, buproprion,
Chantix, or varenicline to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtwant
Asked of respondents who now smoke some days or every day or who
have smoked in the past six months.
Rationale: Key Outcome Indicator 3.08.3
53. Do you want to quit
smoking cigarettes for good?
1. YES
2. NO à
Go to q58 HCWCARE2
7. DON’T KNOW/NOT SURE
à
Go to q58 HCWCARE2
9. REFUSED à
Go to q58 HCWCARE2
|
qtframe
Rationale: Key Outcome Indicator 3.08.3
54. Do you have a time
frame in mind for quitting?
1. YES
2. NO à
Go to q58 HCWCARE2
7. DON’T KNOW/NOT SURE
à
Go to q58 HCWCARE2
9. REFUSED à
Go to q58 HCWCARE2
|
qtwhen
Rationale: Key Outcome Indicator 3.08.3
interviewer: Pause between each response
category to allow respondent to answer “yes” or “No”
to each category. enter the response code for the first “yes”
and then continue to the next question.
55. For the next
question, I’m going to read to you a set of possible
answers. Please answer “Yes” or “No” to
each answer. Do you plan to quit smoking cigarettes for good …
1. in the next 7 days,
2. in the next 30 days,
3. in the next 6 months,
4. in the next 1 year,
5. more than 1 year from now?
7. DON’T KNOW/NOT SURE
à
Go to q58 HCWCARE2
9. REFUSED à GO TO Q58
HCWCARE2
|
qtfutasst
Rationale: Key Outcome Indicator 3.08.4
56. When you try to quit
smoking, do you plan to use a telephone quitline, a class or
program or one-on-one counseling from a healthcare provider to
help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
qtfutmed
Rationale: Key Outcome Indicator 3.08.4
INTERVIEWER: PRONOUNCE “Wellbutrin”
AS Well BYOU trin, “Zyban” AS
Z‑EYE ban, “BU PRO PRI ON”
as byou pro pri on, “Chantix” AS
SHAN tix, and “varenicline” as var en ih clean.
interviewer: please read the list slowly.
57. When you try to quit
smoking, do you plan to use a nicotine patch, nicotine gum,
lozenges, nasal spray, an inhaler, or pills such as Wellbutrin,
Zyban, buproprion, Chantix, or varenicline to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
health professional advice to quit
|
hcwcare2
Asked of respondents who have at least puffed on a cigarette in
the past year or who now smoke every day or some days.
Rationale: Screener for Key Outcome Indicators 3.09.2 –
3.09.6
58. In the past 12
months, that is, since [DATE FILL], have you seen a doctor,
dentist, nurse, or other health professional?
1. YES
2. NO à
Go to q69 hccoverage
7. DON’T KNOW/NOT SURE
à
Go to q69 hccoverage
9. REFUSED à
Go to q69 hccoverage
|
hcwadvise2
Rationale: Key Outcome Indicator 3.09.3
59. In the past 12
months, that is, since [DATE FILL], did any doctor, dentist,
nurse, or other health professional advise you to quit smoking
cigarettes or using any other tobacco products?
1. YES
2. NO à
Go to q68 HCWASK
7. DON’T KNOW/NOT SURE
à
Go to q68 HCWASK
9. REFUSED à
Go to q68 HCWASK
|
hcwqtask
Rationale: Key Outcome Indicator 3.09.4
60. The last time
a health professional advised you to quit using tobacco, did they
also ask if you wanted to try to quit?
1. YES
2. NO à
Go to q62 hcwmoradvice
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hcwqtresp
Rationale: Screener for Key Outcome Indicator 3.09.5
61. When the health
professional asked if you wanted to try to quit, did you say…?
1. That you did want to quit, or
2. That you did not want to quit
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hcwmoradvice
Rationale: Key Outcome Indicator 3.09.5
62. The last time
a health professional advised you to quit using tobacco, did they
also offer any assistance, information, or additional advice to
help you quit?
1. YES
2. NO à
IF Q3 SMOKNOW = (1
OR 2) OR q6
smoklast <=3 Go
to q69 HCcoverage, else
go to q72 smokhome7d2
7. DON’T KNOW/NOT SURE
à
IF Q3 SMOKNOW = (1
OR 2) OR q6
smoklast <=3 Go
to q69 HCcoverage, else
go to q72 smokhome7d2
9. REFUSED à
IF Q3 SMOKNOW = (1
OR 2) OR q6
smoklast <=3 Go
to q69 HCcoverage, else
go to q72 smokhome7d2
|
hcwmaterials2
Rationale: Key Outcome Indicator 3.09.5
63. The last time
a health professional advised you to quit using tobacco, did they
provide you with booklets, videos, website addresses, or other
information to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hcwsugasst2
Rationale: Key Outcome Indicator 3.09.5
64. (The last time
a health professional advised you to quit using tobacco,) Did they
put you in contact with, or tell you how to contact, a telephone
quitline, a class or program, or one-on-one counseling?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
[IF Q61 HCWQTRESP = (2 OR
7 OR 9) GO TO Q69
HCCOVERAGE]
|
hcwsetdate2
Rationale: Key Outcome Indicator 3.09.5
65. Did they help you
set a specific date to quit using tobacco products?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hcwmed2
Rationale: Key Outcome Indicator 3.09.5
INTERVIEWER: PRONOUNCE “Wellbutrin”
AS Well BYOU trin, “Zyban” AS
Z‑EYE ban, “BU PRO PRI ON”
as byou pro pri on, “Chantix” AS
SHAN tix, and “varenicline” as var en ih clean.
interviewer: please read the list slowly.
66. (Did they) Recommend
or prescribe a nicotine patch, nicotine gum, lozenges, nasal
spray, an inhaler, or pills such as Wellbutrin, Zyban, buproprion,
Chantix, or varenicline?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hcwfollowup
Rationale: Key Outcome Indicator 3.09.6
67. (Did they) Schedule
any follow-up contacts, either in person or by phone, or arrange
for someone else to call you to see how your quit attempt was
going?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
[GO TO Q69 HCCOVERAGE]
|
hcwask
Rationale: Key Outcome Indicator 3.09.2
68. In the past 12
months, that is, since [DATE FILL], did any doctor, dentist,
nurse, or other health professional ask if you smoke cigarettes or
use any other tobacco products?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
insurance for cessation
|
hccoverage
Asked of respondents who have at least puffed on a cigarette in
the past 30 days or who now smoke every day or some days or who,
in the past 30 days, have used chewing tobacco, snuff, dip, or
snus or have smoked a cigar, a cigarillo, a little cigar, or a
pipe.
Rationale: Screener for Key Outcome Indicator 3.08.7
69. Now I am going to ask
some questions about health insurance and quitting tobacco. Do you
have any kind of health insurance, including
prepaid plans such as HMOs or government plans such as Medicare or
Medicaid?
1. YES à
IF Q5 SMOKEVER >=
2 OR Q6 SMOKLAST >=
04, GO TO Q71 HCCPAYQO
2. NO à
Go to q72 SMOKHOME7D2
7. DON’T KNOW/NOT SURE
à
Go to q72 SMOKHOME7D2
9. REFUSED à
Go to q72 SMOKHOME7D2
|
hccpayqs
Asked of respondents who have at least puffed on a cigarette in
the past 30 days or who now smoke every day or some days.
Rationale: Key Outcome Indicator 3.08.7
70. Does your health
insurance help pay for counseling or medications to help people
stop smoking cigarettes?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
[IF Q30 SLTEVER2 >= 2
AND Q33 SNUSEVER >= 2
AND Q36 CIGAREVER >= 2
AND Q39 PIPEWTREVER >=
2 AND Q41 PIPEOTHEVER
>=2, GO TO Q72 SMOKHOME7D2]
|
hccpayqo
Asked of respondents who, in the past 30 days, have used chewing
tobacco, snuff, dip, or snus or have smoked a cigar, a cigarillo,
a little cigar, or a pipe.
Rationale: Key Outcome Indicator 3.08.7
71. Does your health
insurance help pay for counseling or medications to help people
stop using tobacco products other than cigarettes?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hccpayqcopn
Asked of all respondents.
Rationale: Key Outcome Indicator 3.08.8
. The next question asks for your
opinion about what health insurance should
cover. For people who want to quit using cigarettes or other
tobacco products, should health insurance help pay for treatments
that can help them quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
secondhand smoke and tobacco-free policies
|
at home
|
Now I’m going to ask you some questions about smoking inside
the home.
|
smokhome7d2
Asked of all respondents.
Rationale: Numerator for Key Outcome Indicators 2.06.4, 2.07.3
(Core), 2.07.5 (Core)
72. Not counting decks,
porches, or garages, during the past 7 days, that is, since
[DATEFILL], on how many days did someone other than you
smoke tobacco inside your home while you were at home?
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 01-07]
|
homerules2
Rationale: Key Outcome Indicator 2.04.4 (Core)
73. Not counting decks,
porches, or garages, inside your home, is smoking …?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
à
Go to q75 homerulesopn
2. Allowed only at some times or in some
places
3. Never allowed
à
if q72 smokhome7d2 =
(1-7) Go to q75
homerulesopn
7. DON’T KNOW/NOT SURE
à
Go to q75 homerulesopn
9. REFUSED à
Go to q75 homerulesopn
|
homecmpl
Asked of respondents
who were not exposed to secondhand smoke in the home in the past 7
days or who live in homes where smoking is allowed at some times
or in some places.
Rationale: Key
Outcome Indicator: 2.06.4
74. Not counting decks,
porches, or garages, to your knowledge, during the past 7 days,
that is, since [DATEFILL], has anyone, including yourself, smoked
tobacco inside your home when he or she was not supposed to?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
homerulesopn
Rationale: Key Outcome Indicator 2.03.8
75. In your opinion,
inside a home, should smoking….
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always be allowed
2. Be allowed only at some times or in some
places
3. Never be allowed
4. SMOKING RESTRICTIONS INSIDE A HOME SHOULD BE WHATEVER THE
PEOPLE WHO LIVE THERE DECIDE (Note to reader: The interviewer will
not read this response. It will only be coded if the respondent
volunteers the response.)
7. DON’T KNOW/NOT SURE
9. REFUSED
|
in the workplace
|
Now I am going to ask you about some questions about policies on
tobacco use in the place where you work. But first, I need to know
about your employment status.
|
employ2
Asked of all respondents.
Rationale: Screener for Key Outcome Indicators 2.04.3 (Core),
2.06.1 (Core), and 2.07.1 (Core)
76. Are you currently
working for pay or are self-employed, either part-time or
full-time?
1. YES
2. NOà GO TO Q86
SHSVEHEXP
7. Don’t know à
Go to Q86
SHSVEHEXP
9. REFUSEDà
Go to Q86
SHSVEHEXP
|
nojobs
Rationale: Screener for Key Outcome Indicators 2.04.3 (Core),
2.06.1 (Core), and 2.07.1 (Core)
77. Do you currently have
one job or more than one job?
1. ONE JOB
2. MORE THAN ONE JOB
7. Don’t know à
Go to Q86
SHSVEHEXP
9. REFUSEDà
Go to Q86
SHSVEHEXP
INTERVIEWER: IF RESPONDENT HAS MORE THAN ONE
JOB, PLEASE READ THE FOLLOWING SENTENCE:
Please answer the following questions for the job at which you
spend the most time.
interviewer: if the respondent spends the
most time at two or more jobs equally, ask them to choose the one
at which they have been working the longest. if they still can’t
choose one job, ask them to choose the one they like the most.
|
workplace
Rationale: Screener for Key Outcome Indicators 2.04.3 (Core),
2.06.1 (Core), and 2.07.1 (Core)
78. Most of the time, do
you work…?
1. Outdoors
2. In a vehicle
3. Indoors at home
4. Indoors in a place like an office building, retail store,
restaurant, or factory
5. Somewhere else (Specify)
7. Don’t know/NOT
SURE à
Go to Q86
SHSVEHEXP
9. REFUSEDà
Go to Q86
SHSVEHEXP
INTERVIEWER: IF RESPONDENT works in more
than one, PLEASE READ THE FOLLOWING SENTENCE:
Please choose the setting in which you spend the most time.
interviewer: if the respondent spends the
most time at two or more settings equally, ask them to choose the
one at which they have been working the longest. if they still
can’t choose, ask them to choose the one they like the most.
|
shsexpwork
Rationale: Key Outcome Indicators 2.07.1 (Core), 2.07.5 (Core)
79. Now I’m going
to ask you about smoke you might have breathed at work because
someone else was smoking, either indoors or outdoors.
During the past 7 days, that is, since [DATE FILL], either indoors
or outdoors at your workplace, on how many days did you breathe
the smoke from someone other than you who was smoking
tobacco?
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
IF Q78 WORKPLACE = 1, GO
TO Q81 WORKSMOKOUT
[RANGE: 01-07]
|
worksmokind
Rationale: Key Outcome Indicator 2.04.3 (Core)
80. At your workplace, is
smoking in indoor areas…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SUREà
Go to Q84
WORKINDOPN2
9. REFUSEDà
Go to Q84
WORKINDOPN2
|
worksmokout
Rationale: Key Outcome Indicator 2.04.3 (Core)
81. At your workplace, is
smoking in outdoor areas…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SUREà
Go to Q84
WORKINDOPN2
9. REFUSEDà
Go to Q84
WORKINDOPN2
|
worksmokless
Rationale: Key Outcome Indicator 2.04.3 (Core)
82. At your workplace, is
the use of chewing tobacco, snuff, dip, or snus …?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SUREà
Go to Q84
WORKINDOPN2
9. REFUSEDà
Go to Q84
WORKINDOPN2
[IF Q80 WORKSMOKIND = 1
AND Q81 WORKSMOKOUT = 1
AND Q82 WORKSMOKLESS
= 1, GO TO Q84
WORKINDOPN2]
|
shscompwork
Rationale: Key Outcome Indicator 2.06.1 (Core)
83. To your knowledge,
during the past 30 days, that is, since [DATE FILL], has anyone,
including yourself, used tobacco of any kind at your work when he
or she was not supposed to?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
workindopn2
Rationale: Key Outcome Indicator 2.03.7 (Core)
84. At workplaces, do you
think smoking indoors should be…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
|
workoutdopn2
Rationale: Key Outcome Indicator 2.03.7 (Core)
85. At workplaces, do you
think smoking outdoors should be…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
|
in vehicles
|
Now we have two questions about smoking in vehicles.
|
shsvehexp
Asked of all respondents.
Rationale: Key Outcome Indicators 2.07.3 (Core), 2.07.5 (Core)
86. During the past 7
days, that is, since [DATE FILL], on how many days did you ride in
a vehicle where someone other than you was smoking tobacco?
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 01-07]
|
shsvehpol
Rationale: Key Outcome Indicator 2.04.4 (Core)
87. Not counting
motorcycles, in the vehicles that you or family members who live
with you own or lease, is smoking…
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always allowed in all vehicles
2. Sometimes allowed in at least one vehicle
3. Never allowed in any vehicle
8. RESPONDENT’S FAMILY DOES NOT OWN A VEHICLE
7. DON’T KNOW/NOT SURE
9. REFUSED
|
in public places
|
The next several questions ask about tobacco use in indoor and
outdoor public places. Examples of indoor public places are the
indoor areas of stores, restaurants, bars, casinos, clubs, and
sports arenas. Examples of outdoor public places are stadiums and
parks.
|
shsexppub
Rationale: Key Outcome Indicator 2.07.2, 2.07.5 (Core)
88. [IF Q76
EMPLOY2 = 1: Not counting times while you were at work,] during
the past 7 days, that is, since [DATE FILL], on how many days did
you breathe the smoke from someone else who was smoking in
an indoor or outdoor public place?
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[RANGE: 01-07]
|
shscomppub
Rationale: Key Outcome Indicator 2.06.2
89. [IF Q76
EMPLOY2 = 1: Not counting times while you were at work,] to your
knowledge, during the past 7 days, that is, since [DATE FILL], has
anyone, including yourself, used tobacco of any kind in an indoor
or outdoor public place when he or she was not supposed to?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
Now we have three questions about your opinions on smoking in
indoor and outdoor public places.
|
shsindropn1
Rationale: Key Outcome Indicator 2.03.7 (Core). Restricting
smoking in restaurants is currently an important issue.
90. Should smoking
indoors in restaurants…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always be allowed
2. Be allowed only at some times or in some
places
3. Never be allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
|
shsindropn2
Rationale: Key Outcome Indicator 2.03.7 (Core). Bars, casinos, and
clubs are the indoor public places for which there is the least
support for smoke-free policies. Support for smoke-free policies
in these venues is the cutting edge in support for smoke-free
policies in all public places.
91. Should smoking
indoors in bars, casinos, or clubs…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always be allowed
2. Be allowed only at some times or in some
places
3. Never be allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
|
shsoutdropn
Rationale: Key Outcome Indicator 2.03.7 (Core)
92. Should smoking at
parks…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Always be allowed
2. Be allowed only at some times or in some
places
3. Never be allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
|
general knowledge and attitudes
|
Now we have some general questions about smoking and tobacco use.
|
shsasknot
Rationale: Key Outcome Indicator 2.03.4
93. How likely would you
be to ask a stranger not to smoke around you if you couldn’t
move away from their smoke—…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Very likely
2. Somewhat likely
3. Not at all likely
7. DON’T KNOW/NOT SURE
9. REFUSED
|
shsharmopn
Rationale: Key Outcome Indicator 2.03.5
94. Do you think that
breathing smoke from other people's cigarettes or from other
tobacco products is…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Not at all harmful to one's health
2. Somewhat harmful to one's health
3. Very harmful to one's health
7. DON’T KNOW/NOT SURE
9. REFUSED
|
shspubopn
Rationale: Key Outcome Indicator 2.03.9
95. Should policies that
don’t allow tobacco use in indoor or outdoor public places
be strictly enforced?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
Demographic Items
|
Now I would like to ask you some questions about yourself and your
family. Please remember that your answers will be strictly
confidential and that no one will be able to identify you from any
published reports.
|
marital2
Rationale: Key covariate
Interviewer: if respondent answers “single,”
please verify that s/he was never married. if respondent is unsure
between “living with a
partner” and any other response category, code as
“living with a partner.”
96. Are you now…?
01. Married
02. Living with a partner
03. Divorced
04. Widowed
05. Separated
06. Single, that is, never married and not now living with
a partner
07. Other (specify)
77. DON’T KNOW/NOT SURE
99. REFUSED
|
|
childle17
Rationale: To determine exposure to secondhand smoke.
97. How many children
aged 17 or younger live in your household 6 months or more of the
year?
_ _ Number of children
88. NONE
99. REFUSED
[RANGE: 01-30]
[Verification screen if number of children >= 08]
|
hispanic
Rationale: Key covariate
98. Are you Hispanic or
Latino?
1. YES
2. NO à
Go to Q100
RACEMULTI
7. DON’T KNOW/NOT SURE
à
Go to Q100
RACEMULTI
9. REFUSED à
Go to Q100
RACEMULTI
|
hispgroup
Rationale: Key covariate
99. Which one
or more of the following groups best describes you?
INTERVIEWER: Mark all that apply. CODE ANY
HYPENATED RESPONSE ENDING IN “-AMERICAN” to the first
group mentioned.
01. Mexican
02. Puerto Rican
03. Cuban
04. Central or South American
05. Dominican
06. Some other Hispanic or Latino group (SPECIFY)
77. DON’T KNOW/NOT SURE
99. REFUSED
iNTERVIEWER: IF A RESPONDENT MENTIONS A
COUNTRY IN CENTRAL OR SOUTH AMERICA, CODE AS 04.
[PROGRAMMER: PROVIDE A LIST OF CENTRAL AND SOUTH AMERICAN
COUNTRIES FOR THE INTERVIEWER TO SEE HERE.]
|
racemulti
Rationale: Key covariate
100. I’m going to
read a list of racial categories. Which one or more
of the following groups best describes you?
INTERVIEWER: Mark all that apply.
01. White
02. Black or African American
03. Asian
04. Native Hawaiian
05. Pacific Islander, other than Hawaiian
06. American Indian
07. Alaska Native
08. OTHER (SPECIFY)
09. NONE OF THE ABOVE
77. DON’T KNOW/NOT SURE
99. REFUSED
[IF Q100 RACEMULTI DOES
NOT INCLUDE 03 GO TO Q102
EDUCA2
|
asian01
Rationale: Key covariate
101. Which one or
more of the following groups best describes you?
01. Asian Indian
02. Chinese
03. Filipino
04 Japanese
05. Korean
06. Vietnamese
07. Other (SPECIFY)
77. DON’T KNOW/NOT SURE
99. REFUSED
|
educa2
Rationale: Key covariate
102. What is the highest
level of school you have completed or the highest degree you have
received?
INTERVIEWER: Read only if necessary.
01. 5TH GRADE OR LESS
02. 6TH GRADE
03. 7TH GRADE
04. 8TH GRADE
05. 9TH GRADE
06. 10TH GRADE
07. 11TH GRADE
08. 12TH GRADE, NO DIPLOMA
09. GED OR EQUIVALENT
10. HIGH SCHOOL DIPLOMA
11. SOME COLLEGE, NO DEGREE
12. CERTIFICATE, DIPLOMA, OR ASSOCIATE DEGREE: OCCUPATIONAL,
TECHNICAL, OR VOCATIONAL PROGRAM
13. ASSOCIATE DEGREE: ACADEMIC PROGRAM
14. BACHELOR’S DEGREE
15. MASTER’S DEGREE
16. PROFESSIONAL SCHOOL DEGREE (EXAMPLES: MD, DDS, DVM, LLB, JD)
17. DOCTORAL DEGREE (EXAMPLES: PHD, EDD)
77. DON’T KNOW/NOT SURE
99. REFUSED
|
age
Rationale: Key covariate.
103. What is your age?
_ _ _ . Age in years
007. DON’T KNOW/NOT SURE
009. REFUSED
[RANGE: 018-130]
[VERIFICATION SCREEN IF AGE >=085]
|
gender
Rationale: Key covariate
INTERVIEWER: Ask only if necessary.
104. Are you male or
female?
1. Male
2. Female
3. other (specify)
7. DON’T KNOW/NOT SURE
9. REFUSED
|
telnosgt1
Rationale: Needed for weighting.
105. Now I’m going
to ask you about how many different telephone numbers your
household has. Do not include numbers that are only used by a
computer or fax machine. Also, do not include cell phone
telephone numbers. Do you have more than one landline telephone
number in your household?
1. YES
2. NO à
Go to q107 STATERES
7. DON’T KNOW/NOT SURE
à
Go to q107 STATERES
9. REFUSED à
Go to q107 STATERES
|
telnosres
Rationale: Needed for weighting.
106. How many of these
are residential numbers?
INTERVIEWER: enter 6 if number of
residential telephone numbers is 6 or more.
_. Number of residential
telephone numbers
8. NONE
7. DON’T KNOW/NOT SURE
9. REFUSED
[RANGE: 0-6]
|
stateres
Rationale: To assign respondents to states.
107. What state do you
live in?
01-56. State FIPS code
77. DON’T KNOW/NOT SURE
99. REFUSED
|
countyfips
Rationale: To allow states to make regional estimates.
108. What county do you
live in?
NNN. County FIPS code
777. DON’T KNOW/NOT SURE
999. REFUSED
[CATI PROGRAMMER: THE RESPONSE CATEGORIES ABOVE INDICATE THAT
COUNTY FIPS CODES SHOULD BE PUT ON THE DATA FILE TO INDICATE
COUNTY OF RESIDENCE IF RESPONDENTS KNOW THE COUNTY THAT THEY LIVE
IN, THEY WILL, OF COURSE, RESPOND WITH THE NAME OF THE COUNTY.
THERE ARE A VARIETY OF WAYS THAT THE COUNTY FIPS CODE CAN BE
DETERMINED. IF A STATE HAS NO MORE THAN 10-12 COUNTIES, THE
INTERVIEWER MAY BE ABLE TO ENTER THE FIPS CODE FROM A LIST OF
COUNTY NAMES AND FIPS CODES THAT APPEARS ON THE SCREEN FOR THIS
QUESTION. IF A STATE HAS TOO MANY COUNTIES TO MAKE THIS WORK WELL,
IT IS BEST TO HAVE THE INTERVIEWER JUST ENTER WHATEVER THE
RESPONDENT SAYS. THEN, AT THE END OF THE SURVEY, DISPLAY THE TEXT
TYPED AND HAVE THE INTERVIEWER LOOK UP (ON A PAPER LIST) THE NAME
AND ENTER THE APPROPRIATE NUMBER. ASKING THE INTERVIEWER TO ENTER
A CODE FROM A LIST WHILE THE RESPONDENT IS ON THE PHONE CAN CAUSE
THE RESPONDENT TO BREAK OFF THE INTERVIEW IF THE INTERVIEWER TAKES
TOO LONG OR THE INTERVIEWER TO COMMIT AN ERROR IF THE INTERVIEWER
HURRIES TOO MUCH.]
|
zipcode
Rationale: To allow coding of respondents as residing in urban,
suburban, or rural areas through the use of Rural Urban Commuting
Area (RUCA) codes.
. What is the ZIP Code where you live?
_ _ _ _ _ ZIP Code
77777 Don’t know/Not sure
99999 Refused
|
Existing chronic conditions and diseases
|
Now I want to ask you some questions about chronic conditions or
diseases you might have.
|
heartdisease
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with heart disease.
109. Have you ever been
told by a doctor or other health professional that you have heart
disease?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
cancer
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with cancer.
110. (Have you ever been
told by a doctor or other health professional that you have)
cancer, other than skin cancer?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
diabetes
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with diabetes.
111. (Have
you ever been told by a doctor or other health professional that
you have) diabetes, or sugar diabetes?
interviewer: If “YES” and
respondent is female, ask: “Was
this only when you were pregnant?”
1. YES
2. YES, but female told
only during pregnancy
3. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
respdisease
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with chronic lung disease.
112. (Have you ever been
told by a doctor or other health professional that you have) a
chronic lung disease, such as emphysema, chronic bronchitis, or
chronic obstructive pulmonary disease, also known as c-o-p-d?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
asthma
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with asthma.
113. (Have you ever been
told by a doctor or other health professional that you have)
asthma?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
cholesterol
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with high cholesterol.
114. (Have you ever been
told by a doctor or other health professional that you have) high
cholesterol?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
hypertension
Rationale: To identify smoking histories and adherence to AHRQ
guidelines among respondents with hypertension.
115. (Have you ever been
told by a doctor or other health professional that you have) high
blood pressure, or hypertension?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
opinions and attitudes related to tobacco
|
excise taxes
|
Now I would like to ask you a few more questions about your
opinions and attitudes related to tobacco.
|
rskaddictopn2
Rationale: Programs try to communicate the addictive nature of
tobacco. There are often important differences in this perception
by sociodemographic categories.
116. How addictive
do you think cigarette smoking is—…?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Not at all addictive
2. Moderately addictive
3. Very addictive
7. DON’T KNOW/NOT SURE
9. REFUSED
[RANGE: 1-5]
|
cigtaxopn2
Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)
117. Would you be in
favor of an increase in the tax on a pack of cigarettes if the
money were used to improve the public’s health?
1. YES
2. NO à
Go to Q119
SLTTAXOPN
7. DON’T KNOW/NOT SURE à
Go to Q119
SLTTAXOPN
9. REFUSED à
Go to Q119
SLTTAXOPN
|
cigtaxopn3
Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)
interviewer: Pause between each response
category to allow respondent to answer “yes” or “No”
to each response alternative. enter the response code for the
first “yes” and then continue to the next question.
118. For the next
question, I’m going to read to you a set of possible
answers. Please answer “Yes” or “No” to
each answer. Current prices for a pack of cigarettes range from
about four to six dollars. Would you be in favor of an additional
tax on a pack of cigarettes of…
1. More than two dollars a pack?
2. Up to two dollars a pack?
3. Up to one dollar a pack?
4. Up to fifty cents a pack?
7. DON’T KNOW/NOT SURE
9. REFUSED
|
slttaxopn
Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)
119. Would you be in
favor of an increase in the tax on chewing tobacco, snuff, dip, or
snus if the money were used to improve the public’s health?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
|
youth issues
|
teensellopn
Rationale: Key Outcome Indicator 1.06.4
120. How important is it
to prevent sales of tobacco products to youth under 18— …?
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Not at all important
2. Somewhat important
3. Very important
7. DON’T KNOW/NOT SURE
9. REFUSED
|
schoolopn2
Rationale: Key Outcome Indicator 1.06.7, 2.03.10
121. Should tobacco use
be completely banned on school grounds, including fields
and parking lots, and at all school events, even for
teachers and other adults?
1. Yes
2. No
7. DON’T KNOW/NOT SURE
9. REFUSED
IF Q103 AGE >= 30, GO
TO Q123 PARENTING
|
sponsorship and marketing
|
weartobco
Asked of respondents 18-29.
Rationale: Key Outcome Indicator 1.06.3 (Youth)
122. How likely is it
that you would ever use or wear something--such as a lighter,
t-shirt, hat or sunglasses--that has a tobacco company name or
picture on it—
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Very likely
2. Somewhat likely
3. Somewhat unlikely
4. Very unlikely
7. DON’T KNOW/NOT SURE
9. REFUSED
|
importance of discussing tobacco use with children
|
parenting
Asked of all respondents.
Rationale: Screener for Key Outcome Indicator 1.06.6
123. Now I want to ask
you about the importance of discussing tobacco use with childen
that you have a parental relationship with. Are you currently
parenting any children aged 17 or younger?
1. Yes
2. No à
IF (Q2 SMOK100 = 1
AND Q3 SMOKNOW = (1
OR 2)) OR q6
smoklast <= 3, go to q126
HELPSMOKER, else go to q125 helpnonsmok
7. DON’T KNOW/NOT SURE à
IF (Q2 SMOK100 = 1
AND Q3 SMOKNOW = (1
OR 2)) OR q6
smoklast <= 3, go to q126
HELPSMOKER, else go to q125 helpnonsmok
9. REFUSED à
IF (Q2 SMOK100 = 1
AND Q3 SMOKNOW = (1
OR 2)) OR q6
smoklast <= 3, go to q126
HELPSMOKER, else go to q125 helpnonsmok
|
tobusediscuss
Asked of adults in a parental relationship with a child <=17.
Rationale: Key Outcome Indicator 1.06.6
124. Is talking with
these children about not using tobacco
INTERVIEWER: THE ORDER OF THE RESPONSE
CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED
1. Not at all important to you
2. Somewhat important to you
3. Very important to you
7. DON’T KNOW/NOT SURE
9. REFUSED
IF (Q2 SMOK100 = 1
AND Q3 SMOKNOW = (1
OR 2)) OR q6
smoklast <= 3,
go to q126
HELPSMOKER
|
smoker assistance
|
helpnonsmok
Asked of respondents (who have smoked fewer than 100 cigarettes in
their life or who now smoke not at all) and (who have not puffed
on a cigarette ever or in the last 30 days).
Rationale: To provide quitline telephone number and url for
respondents who want to encourage someone else to quit
smoking
125. In order to help a
smoker you know to stop smoking, would you like the 1-800 quitline
telephone number or the address for a website?
1. YES
The quitline number is 1-800-QUIT NOW.
A website that tells smokers about the help they can get to stop
smoking is www.smokefree.gov.
2. NO
[GO TO Q127 INCOME2]
|
helpsmoker
Asked of respondents (who have smoked at least 100 cigarettes in
their entire life and who now smoke every day or some days) or
(who have at least puffed on a cigarette in the past 30 days).
Rationale: To provide national quitline telephone number and url
for respondents who want to quit using tobacco
126. In order to get help
to stop using tobacco for good, would you like the 1‑800
quitline telephone number or the address for a website?
1. YES
The quitline number is 1-800-QUIT NOW.
A website that tells you about help you can get to stop smoking is
www.smokefree.gov.
2. NO
|
Sensitive sociodemograhpic Questions
|
I have two final questions that could be sometimes considered
sensitive but that are important to the CDC to develop effective
programs. We hope you will be willing to answer these questions.
Please remember that all answers are confidential.
|
income2
Rationale: Key covariate
Note: 2006 median U.S. income = $48,201
127. Is your annual
household income from all sources…?
04. Less than $50,000 If "no," ask 05; if "yes,"
ask 03
($40,000 to less than $50,000)
03. Less than $40,000 If "no," code 04; if "yes,"
ask 02
($30,000 to less than $40,000)
02. Less than $30,000 If "no," code 03; if "yes,"
ask 01
($20,000 to less than $30,000)
01. Less than $20,000 If "no," code 02
05. Less than $70,000 If "no," ask 06
($50,000 to
less than $70,000)
06. Less than $100,000 If "no," ask 07
($70,000 to
less than $100,000)
07. Less than $150,000 If "no," code 08
($100,000
to less than $150,000)
08. $150,000 or more
77. DON’T KNOW/NOT SURE
99. REFUSED
|
sexualpref
Rationale: Key covariate
INTERVIEWER: AS THE QUESTION IS READ, READ
ALOUD THE NUMBERS, that is, "1.
Heterosexual or straight; 2. Gay or lesbian; 3. Bisexual, 4.
Transgendered." THIS ALLOWS THE RESPONDENT TO reply
with A NUMBER IF, FOR WHATEVER REASON, THEY ARE UNCOMFORTABLE
SAYING THE WORDS.
128. Do you consider
yourself to be…?
1. Heterosexual, or straight
2. Gay or lesbian
3. Bisexual
4. Transgendered
5. OTHER (SPECIFY)
6. respondent Does not understand responses
7. DON’T KNOW/NOT SURE
9. REFUSED
|
Closing
|
That’s my last question. Everyone’s answers will be
combined to give us information about tobacco in the U.S. The
information will be used to help keep non-smokers from being
exposed to tobacco smoke, to help young people make healthy
choices about tobacco use, and to help smokers and users of other
tobacco products stop using tobacco.
GIVE AMAZON.COM GIFT CODE TO RESPONDENT FOR COMPLETING THE
INTERVIEW.
Thank you very much for your time and cooperation.
|
language
129. In
what language was the interview conducted? If more than one,
indicate the predominant language used.
01. English
02. Spanish
|
