Appendix D - Item-level justification NATS

D. Item-level Justification – National Adult Tobacco Survey

The NATS questionnaire is built around key outcome indicators from each of three goal areas. For Goal Area 1, Preventing Initiation of Tobacco Use among Young People (defined as age 18 to 29), the questionnaire addresses 9 key indicators. For Goal Area 2, Eliminating Nonsmokers' Exposure to Secondhand Smoke, the NATS questionnaire addresses 17 additional key indicators. Finally, for Goal Area 3, Promoting Quitting among Adults and Young People, NATS addresses 17 additional key indicators. In total, the NATS is supported by 44 measureable key outcome indicators developed or selected precisely to evaluate TCPs. Goal area 4, Identifying and Eliminating Tobacco-Related Disparities, will be examined by analyzing key indicator data in conjunction with demographic data.

Goal Area 1: Preventing Initiation of Tobacco Use Among Young People

Outcome 6: Increased knowledge of, improved anti-tobacco attitudes toward, and increased support for policies to reduce youth initiation

 

1.06.3 (Youth) -Proportion of students who would ever wear or use something with a tobacco company name or picture

Q.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—

 

1.06.4 - Level of support for policies, and enforcement of policies, to decrease young people's access to tobacco

Q.120. How important is it to prevent sales of tobacco products to youth under 18— …?

 

1.06.5 - Level of support for increasing excise tax on tobacco products

Q.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?

Q.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…

Q.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?

 

1.06.6 - Level of awareness among parents about the importance of discussing tobacco use with their children

Q.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?

Q.124. Is talking with these children about not using tobacco . . .

 

1.06.7 - Level of support for creating policies in schools

Q.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?

 

Outcome 10: Reduce susceptibility to experimentation with tobacco products

 

1.10.5 (Youth) - Proportion of young people who are susceptible never smokers

Q.5. Have you ever tried cigarette smoking, even one or two puffs?

Q.18. How likely are you to smoke a cigarette in the next year—…?

 

Outcome 13: Reduce initiation of tobacco use by young people

 

1.13.1 (Youth) - Average age at which young people first smoked a whole cigarette

Q.12. Have you ever smoked a whole cigarette?

Q.13. How old were you when you smoked a whole cigarette for the first time?

 

1.13.2 (Youth) - Proportion of young people who report never having tried tobacco

Q.5. Have you ever tried cigarette smoking, even one or two puffs?

Q.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?

Q.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?

Q.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?

Q.41. Have you ever smoked tobacco in a pipe other than a water pipe in your entire life, even one or two puffs?

 

Outcome 14: Reduced tobacco-use prevalence among young people

 

1.14.2 - Proportion of established young tobacco users

Q.2. Have you smoked at least 100 cigarettes in your entire life?

Q.8. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke cigarettes?

Q.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?

Q.31. During the past 30 days, that is, since [DATE FILL], on how many days did you use chewing tobacco, snuff, or dip?

Q.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?

Q.34. During the past 30 days, that is, since [DATE FILL], on how many days did you use snus?

Q.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?

Q.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?

Q.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?

Q.40. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke tobacco in a water pipe?

Q.41. Have you ever smoked tobacco in a pipe other than a water pipe in your entire life, even one or two puffs?

Q.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?

 

Goal Area 2: Eliminating Nonsmokers' Exposure to Secondhand Smoke

Outcome 3: Increased knowledge of, improved attitudes toward, and increased support for the creation and active enforcement of tobacco-free polices

 

2.03.4 - Proportion of the population willing to ask someone not to smoke in their presence

Q.93. How likely would you be to ask a stranger not to smoke around you if you couldn’t move away from their smoke—…?

 

2.03.5 - Proportion of the population that thinks secondhand smoke is harmful

Q.94. Do you think that breathing smoke from other people's cigarettes or from other tobacco products is…?

 

2.03.7 - Level of support for creating smoke-free policies in public places and workplaces

Q.84. At workplaces, do you think smoking indoors should be…?

Q.85. At workplaces, do you think smoking outdoors should be…?

Q.90. Should smoking indoors in restaurants…?

Q.91. Should smoking indoors in bars, casinos, or clubs…?

Q.92. Should smoking at parks…?

 

2.03.8 - Level of support for adopting smoke-free policies in homes and vehicles

Q.75. In your opinion, inside a home, should smoking….

 

2.03.9 - Level of support for active enforcement of tobacco-free public policies

Q.95. Should policies that don’t allow tobacco use in indoor or outdoor public places be strictly enforced?

2.03.10 - Level of support for creating tobacco-free policies in schools

Q.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?

 

Outcome 4: Creation of tobacco-free policies

 

2.04.3 - Proportion of the population that works in environments with tobacco-free policies

Q.76. Are you currently working for pay or are self-employed, either part-time or full-time?

Q.77. Do you currently have one job or more than one job?

Q.78. Most of the time, do you work…?

Q.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?

Q.80. At your workplace, is smoking in indoor areas…?

Q.81. At your workplace, is smoking in outdoor areas…?

Q.82. At your workplace, is the use of chewing tobacco, snuff, dip, or snus …?

 

2.04.4 - Proportion of the population reporting voluntary smoke-free home or vehicle policies

Q.73. Not counting decks, porches, or garages, inside your home, is smoking …?

Q.87. Not counting motorcycles, in the vehicles that you or family members who live with you own or lease, is smoking…

 

Outcome 6: Enforcement of tobacco-free public policies

 

2.06.1 - Perceived compliance with tobacco-free policies in workplace

Q.76. Are you currently working for pay or are self-employed, either part-time or full-time?

Q.77. Do you currently have one job or more than one job?

Q.78. Most of the time, do you work…?

Q.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?

 

2.06.2 - Perceived compliance with tobacco-free policies in indoor and outdoor public places

Q.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?

 

2.06.4 - Perceived compliance with voluntary smoke-free home or vehicle polices

Q.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?

Q.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?

 

Outcome 7: Reduced exposure to secondhand smoke

 

2.07.1 - Proportion of the population reporting exposure to secondhand smoke in the workplace

Q.76. Are you currently working for pay or are self-employed, either part-time or full-time?

Q.77. Do you currently have one job or more than one job?

Q.78. Most of the time, do you work…?

Q.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?

 

2.07.2 - Proportion of the population reporting exposure to secondhand smoke in public places

Q.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?

 

2.07.3 - Proportion of the population reporting exposure to secondhand smoke at home or in vehicles

Q.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?

Q.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?

 

2.07.5 - Proportion of nonsmokers reporting overall exposure to secondhand smoke

Q.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?

Q.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?

Q.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?

Q.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?

 

Outcome 8: Reduced tobacco consumption

 

2.08.2 - Average number of cigarettes smoke per day by smokers

Q.4. On the average, about how many cigarettes a day do you now smoke?

Q.8. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke cigarettes?

Q.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?

Q.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?

 

2.08.3 - Smoking prevalence

Q.2. Have you smoked at least 100 cigarettes in your entire life?

Q.3. Do you now smoke cigarettes every day, some days, or not at all?

 

Goal Area 3: Promoting Quitting Among Adults and Young People

 

Outcome 7: Establishment or increased use of cessation services

 

3.07.4 - Proportion of smokers who have used group cessation programs

Q.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?

Outcome 8: Increased awarenss, knowledge, intention to quit, and support for policies that suport cessation

 

3.08.1 - Level of confirmed awareness of media campaign messages on the dangers of smoking and the benefits of cessation

Q.46. In the past 30 days, have you seen, read, or heard any ads about quitting cigarettes?

Q.47. Have you ever seen or heard the slogan “Become an EX” in an ad? "EX" is spelled E-X.

 

3.08.3 - Proportion of smokers who intend to quit

Q.53. Do you want to quit smoking cigarettes for good?

Q.54. Do you have a time frame in mind for quitting?

Q.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 …

 

3.08.4 - Proportion of smokers who intend to quit smoking
Q.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?
Q.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?
3.08.5 - Level of support for increasing excise tax on tobacco products
Q.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?
Q.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…
Q.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?
3.08.6 - Proportion of smokers who are aware of the cessation services available to them
Q.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?
Q.45. Are you aware of any individual or group counseling services, other than quitlines, that are available to help you quit smoking cigarettes?
3.08.7 - Proportion of smokers who are aware of their insurance coverage for cessation treatment
	Q.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?
	Q.70. Does your health insurance help pay for counseling or medications to help people stop smoking cigarettes?
	Q.71. Does your health insurance help pay for counseling or medications to help people stop using tobacco products other than cigarettes?
	Outcome 9: Increase in the number of health care providers and health care systems following the Public Health Service (PHS) guidelines
	3.09.2 -Proportion of adults who have been asked by a health care professional about smoking
	Q.58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
	Q.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?
	3.09.3 - Proportion of smokers who have been advised to quit smoking by a health care professional
	Q.58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
	Q.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?
	3.09.4 - Proportion of smokers who have been assessed regarding their willingness to make a quit attempt by a health care professional
	Q.58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
	Q.60. The last time a health professional advised you to quit using tobacco, did they also ask if you wanted to try to quit?
	3.09.5 - Proportion of smokers who have been assisted in quitting smoking by a health care professional
	Q.58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
	Q.61. When the health professional asked if you wanted to try to quit, did you say…?
	Q.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?
	Q.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?
	Q.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?
	Q.65. Did they help you set a specific date to quit using tobacco products?
	Q.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?
	3.09.6 - Proportion of smokers for whom a health care professional has arranged for followup contact regarding a quit attempt
	Q.58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
	Q.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?

Outcome 11: Increased number of quit attempts and quit attempts using proven cessation methods

 

3.11.1 - Proportion of adult smokers who have made a quit attempt

Q.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?

 

3.11.3 - Proportion of adult and young smokers who have made a quit attmpt using proven cessation methods

Q.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?

Q.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?

Q.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?

Q.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,…] 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?

 

Outcome 13: Increased cessation among adults and young people

 

3.13.1 - Proportion of smokers who have sustained abstinence from tobacco use

Q.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…?

 

3.13.2 - Proportion of recent successful quit attempts

Q.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…?

Q.7. You said that you last smoked [Q6 SMOKLAST]. Have you not smoked [Q6 SMOKLAST] because you are trying to quit smoking for good?

 

Outcome 14: Reduced tobacco-use prevalence and consumption

 

3.14.1 – Tobacco use prevalence

Q.2. Have you smoked at least 100 cigarettes in your entire life?

Q.3. Do you now smoke cigarettes every day, some days, or not at all?

Q.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?

Q.31. During the past 30 days, that is, since [DATE FILL], on how many days did you use chewing tobacco, snuff, or dip?

Q.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?

Q.34. During the past 30 days, that is, since [DATE FILL], on how many days did you use snus?

Q.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?

Q.40. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke tobacco in a water pipe?

Q.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?