Appendix F (English language)
National Adult Tobacco Survey
Appendix F (English language) 10 06 09
National Adult Tobacco Survey Questionnaire
OMB: 0920-0828
Form Approved
OMB #0920-xxxx
Expiration Date: xx/xx/xxxx
National Adult Tobacco Survey Questionnaire – English
Public reporting burden of this collection of information is estimated to average 22 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS-74, Atlanta, GA 30333, ATTN: PRA (0920-XXXX).
/DATA PROECESSING: THE FOLLOWING LISTS INCLUDE CLIENT APPROVED SCREENER VARIABLES WHICH NEED TO BE DELIVERED IN dATA pROCESSING. oTHER sCREENER vARIABLES OUTSIDE OF THIS LIST DONOT NEED TO BE DELIVERED/
/cELL pHONE sCREENER VARIABLES FOR DELIVERY/
clintro
Cltelno
cldriving
clUNSAFE
cllandline
clINTRO2
cltelnocorr
clbusonly
cladult
clprivres
clconfidential
/LANDLINE SCREENER VARIABLES FOR DELIVERY/
lintro
ltelnocorr
LCELLPHONE
lprivres
lnoadult
lareyouadult
lareyoumf
lisadultmw
lspeakadult
lnomen
lnowomen
lselresp
Lselrespphone
lselrespintro
lconfidential
//PROGRAMMING FOR QUESTIONS USING ROTATING RESPONSE TEXT Q18, Q73, Q75, Q80, Q81, Q82, Q84, Q85, Q87, Q90, Q91, Q92, Q93, Q94, Q119, Q120, Q122, Q124 PLEASE ROTATE THESE AT THE RESPONDENT LEVEL, NOT AT THE RECORD LEVEL, MEANING ONCE A RESPONDENT STARTS THE SURVEY, S/HE WILL FOLLOW THE SAME PATTERN OF RESPONSE TEXT (FORWARD OR BACKWARD, BUT NOT DIFFERENT QUESTION TO QUESTION//
Answering Machine Text:
Hello, my name is _______. I'm calling on behalf of the Centers for Disease Control and Prevention, CDC, to conduct an important study on the health of U.S. residents. Please call us at (telephone number will be inserted here) at your convenience. Thank you.
/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
/ASK ALL/
[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.
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. [INTERVIEWER INSTRUCTION: READ SLOWLY AND DISTINCTLY] Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. The CDC is a federal agency charged with protecting and improving the public's health. 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. /CONTINUE/
2. NO /TERMINATE/
Cltelno
/ASK ALL/
[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.]
1. YES GO TO C3A CLDRIVING
2. NO GO TO THNKC1
3. DOES NOT WANT TO BE CALLED AT THIS NUMBER GO TO C5 CLCALLBACK
4. NOT A SAFE TIME—DRIVING OR OTHER REASON GO TO THNKC2
7. DON’T KNOW/NOT SURE GO TO elsec2
9. REFUSED (Including hang-up) /TERM/
/INTERVIEWER: if 2. no, read Thnkc1/
THNKC1
/ASK IF C2=2/
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: THNKC2/
THNKC2
/ASK IF C2=4/
Thank you very much. We will contact you at a later time.
/INTERVIEWER: IF 7. DON’T KNOW/NOT SURE, read ELSEc2/
ELSEC2
/ASK IF C2=7/
Is there someone else who uses this telephone that I can speak to?
1. YES
2. NO /GO TO THNKC1/
3. DOES NOT WANT TO BE CALLED AT THIS NUMBER /GO TO C5 CLCALLBACK/
4. NOT A SAFE TIME—DRIVING OR OTHER REASON / GO TO THNKC2/
7. DON’T KNOW/NOT SURE /TERM/
9. REFUSED (Including hang-up) /TERM/
MAYIa
/ASK IF ELSEC2=1/
May I speak with them?
01 YES TRANSFERRING /GO BACK TO CLINTRO/
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVIALABLE RIGHT NOW /GO TO C7/
99 REFUSED /TERMINATE/
clcallback
/C5 VARIABLE DOES NOT NEED TO BE DELIVERED/
/ASK IF C2 CLTELNO EQ 3/
C5. Is there a better number at which we can call you back?
1. YES /GO TO C5BISTHIS/
2. NO /TERM /
7. DON’T KNOW/NOT SURE /TERM /
9. REFUSED (Including hang-up) /TERM /
C5BISTHIS
/ASK IF C5 CLCALLBACK=1/
C5B. Is this other number a Landline phone number in your Home?
1. YES, A LANDLINE HOME NUMBER /TERM GO TO THNKDL/
2. NO, ANOTHER NUMBER (CELL, WORK, OR A LANDLINE NUMBER NOT IN RESPONDENT’S HOME) /GO TO C6/
7. DON’T KNOW/NOT SURE /TERM /
9. REFUSED (Including hang-up) /TERM /
cldriving
/ASK IF C2=1/
C3A. Your safety is important to us. Are you driving a car or other vehicle right now?
1. YES /GO TO THNKC3/
2. NO /GO TO C3B CLUNSAFE/
7. DON’T KNOW/NOT SURE / TERm/
9. REFUSED (Including hang-up) / TERm/
clUNSAFE
/ASK IF C3A=2/
C3B. Are you doing anything else that makes talking on the phone unsafe?
1. YES /GO TO THNKC3/
2. NO /GO TO C12 CLLANDLINE/
7. DON’T KNOW/NOT SURE / TERm/
9. REFUSED (Including hang-up) / TERm/
THNKC3
Thank you very much. We will contact you at a later time.
/TERMINATE/
cllandline
/ASK IF C3=2/
C12. In your home, is a cell phone the only way you can be reached by telephone?
1. YES /GO TO C10 CLTELNOCORR/
2. NO /Assign disposition code GO TO THNKDL/
7. DON’T KNOW/NOT SURE /Assign disposition code GO TO THNKDL/
9. REFUSED (Including hang-up) /Assign disposition TERM GO TO THNKDL/
clbetterno
/C6
VARIABLE DOES NOT NEED TO BE DELIVERED/
/ASK IF C5BISTHIS (C5B)= 2/)
C6. What is that telephone number?
_ _ _ - _ _ _ -_ _ _ _ TELEPHONE NUMBER
999999999. REFUSED /TERM/
clbesttime
/C7 VARIABLE DOES NOT NEED TO BE DELIVERED/
/ASK IF CLBETTERNO (C6) IS NOT BLANK /
C7. What would be the best time to try to call back?
_ _ : _ _ _ m
99999. REFUSED /TERM/
clname
/C8
VARIABLE DOES NOT NEED TO BE DELIVERED/
/ASK IF c7 is not Blank/
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.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _/TERM/
9999. REFUSED /TERM/
C8.5
/ASK IF C7 IS NOT BLANK
AND MAYIA=03/
Who should we ask for when we call (a first name
or initial is fine)?
___________ /ENTER NAME/
9999 REFUSED /TERM/
clINTRO2
/ASK IF C8 OR C8.5 IS NOT BLANK/
C9. [INTERVIEWER INSTRUCTION: READ SLOWLY AND DISTINCTLY] Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. The CDC is a federal agency charged with protecting and improving the public's health. We're gathering information on health and tobacco from selected cell phone users across the United States. May I speak with [FILL: CLNAME]?
[TO CLNAME, IF CLNAME DID NOT INITIALLY ANSWER THE 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 /TERM.
cltelnocorr
/ASK IF C12 CLLANDLINE=1 OR C9 CLINTRO2=1/
[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.
C10. [IF C12 CLLANDLINE=1] I need to verify that we have dialed the number correctly. Is this [phone number FILL]?
[IF C9 CLINTRO2=1] 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.]
1. YES
2. NO / GO TO THNKCWN AND TERM/
7. DON’T KNOW/NOT SURE / TERM/
9. REFUSED (Including hang-up) /TERM/
THNKCWN
/ASK IF C10=2 /
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.
/TERMINATE/
clbusonly
/ASK IF C10=1/
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?
1. BUSINESS CALLS ONLY / GO TO THNKCBS/
2. PERSONAL CALLS ONLY / GO TO C13 CLADULT
3. BOTH BUSINESS AND PERSONAL CALLS / GO TO C13 CLADULT
7. DON’T KNOW/NOT SURE / TERM/
9. REFUSED (Including hang-up) / code TERM/
THNKCBS
/ASK IF C11=1 /
Thank you very much, but we are only interviewing people at cell phone numbers that are used for personal calls.
THNKDL
/ASK IF CLLANDINE (C12) = 2, 7 or 9 OR CB5 =1, 7, or 9)
Thank you very much, but we are only interviewing people who can be reached only by cell phone.
cladult
/ASK IF clbusonly (c11) =2 OR 3/
C13. Are you 18 years of age or older?
1. YES
2. NO / GO TO THNK18/
7. DON’T KNOW/NOT SURE / GO TO THNK18/
9. REFUSED (Including hang-up) / GO TO THNK18 TERM/
THNK18
/ASK IF cladult (C13)= 2/
Thank you very much, but we are only interviewing people 18 years of age or older.
/TERMINATE/
clprivres
/ASK IF cladult (C13)=1/
C14. Do you live in a house, an apartment, a condominium, or other type of private residence?
[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?]
1. YES GO TO C15 CLCONFIDENTIAL
2. NO /AUTOMATICALLY 420 GO TO THNKPVT/
7. DON’T KNOW/NOT SURE /, GO TO THNKPVT then TERM/
9. REFUSED (Including hang-up) /Assign,GO TO THNKPVT then TERM/
THNKPVT
/ASK IF clprivres (c14)=2, 7 or 9/
Thank you very much, but we are only interviewing people who live in private residences.
/TERMINATE/
clconfidential
/ASK IF clprivres (C14) =1/
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 15 to 25
minutes, depending on your situation, and any information you give me
will be confidential kept
private, to the extent permitted by law. 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 / TERM/
/LANDLINE SCREENER/
lintro
L1. [INTERVIEWER INSTRUCTION: READ SLOWLY AND DISTINCTLY] Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. The CDC is a federal agency charged with protecting and improving the public's health. We're gathering information on health and tobacco from selected people across the United States. Your phone number has been chosen randomly from a list of all telephone numbers in the US.
[Is respondent continuing with the interview?]
YES
NO /TERM/
ltelnocorr
/ASK IF LINTRO (L1)=1
[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 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 correct number. Is this [phone number FILL]?
1. YES GO TO L3 LCELLPHONE
2. NO /GO TO THNKWRG/
7. DON’T KNOW/NOT SURE /GO TO MAYIB/
9. REFUSED (Including hang-up) / TERM/
THNKWRG
/ASK IF ltelnocorr (L2)= 2/
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.
MAYIb
/ASK IF ltelnocorr (L2)=7/
May I speak with someone else who might be able to verify the telephone number?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
LCELLPHONE
/ASK IF ltelnocorr (L2)=1/
L3 Is this a cell phone?
[INTERVIEWER: if necessary, Read:
By “cell phone” we mean a telephone that is mobile and usable outside of your neighborhood.]
1. YES /GO TO THNKCL /
2. NO
7. DON’T KNOW/NOT SURE / GO TO MAYILA/
9. REFUSED (Including hang-up) TERM/
MAYILA
/ASK IF LCELLPHONE (L3)=7/
May I speak with someone else who might be able tell me if the phone you are using is a cellular telephone?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
THNKCL
/IF L3=01/
Thank you very much, but we are only interviewing people on landline telephones.
/TERMINATE/
lprivres
/ASK IF LCELLPHONE (L3)=2/
L4. Is this a house, an apartment, a condominium, or other type of private residence?
[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.]
1. YES
2. NO [GO TO THNKPRV, THEN AUTOMATICALLY TERM AND Assign disposition code 420]
7. DON’T KNOW/NOT SURE /go to mayiC/
9. REFUSED (Including hang-up) /TERM/
THNKPRV
/ASK IF lprivres (L4)= 2/
Thank you very much, but we are only interviewing people we reach in private residences.
MAYIC
/ask if lprivres (l4)=7/
May I speak with someone else who might be able to tell me if you are speaking from a private residence?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lnoadult
/ASK IF lprivres (L4)=1/
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?
/RANGE: 1-76/
[USE 76 FOR 76 OR MORE PEOPLE]
_ _. Number of adults If noadult >1 Go to L10 NOMEN
88. 0/ NO ADULTS LIVING IN HOUSEHOLD /TERM/
77. DON’T KNOW/NOT SURE /go to mayid/
99. REFUSED (Including hang-up) / TERM/
MAYID
/ask if LNOADULT (L5)=77/
May I speak with someone who might be able to tell me how many adults 18 years of age or older live in your household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lareyouadult
/ASK IF NOADULT (L5)=1/
L6. Are you the adult?
1. YES
2. NO. /Go to L8 ISADULTMW/
7. DON’T KNOW/NOT SURE /go to mayie/
9. REFUSED (Including hang-up) / TERM/
MAYIE
/ask if LAREYOUADULT (l6)=7/
May I speak with someone who can tell me whether or not they are the adult 18 years of age or older who lives in your household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lareyoumf
/ASK IF LAREYOUADULT (L6)=1/
L7. Then you are the person I need to speak with.
[INTERVIEWER: Ask only if necessary.
Are you male or female?]
1. Male Go to L14 LCONFIDENTIAL
2. FEMALE GO TO L14 LCONFIDENTIAL
[INTERVIEWER ONLY CODE 7 or 9 IF RESPONDENT IS ASKED AND THEN STATES DON’t KNOW/NOT SURE OR REFUSED]
7. DON’T KNOW/NOT SURE /Go TO L14 LSELRESPINTRO/
9. REFUSED (Including hang-up) / TERM/
lisadultmw
/ASK
IF lareyouadult (L6)=2/
L8. Is the adult a man or a woman?
1. A man
2. A woman
7. DON’T KNOW/NOT SURE / go to mayih/
9. REFUSED (Including hang-up) / TERM/
MAYIH
/ask if l8=7/
May I speak with someone who can tell me whether or not they are the adult 18 years of age or older who lives in this household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lspeakadult
/ASK IF lisadultmw (L8)=1 or 2/
L9. May I speak with /fill in: [him] L8=1 or/ OR [her] if L8=2/ /?
1. YES Go to L13 LSELRESPINTRO
2. NO / GO TO set call back
7. DON’T KNOW/NOT SURE /go to mayif/
9. REFUSED (Including hang-up) / TERM/
MAYIf
/ask if LSPEAKADULT (l9)=7/
May I speak with someone else who can tell me whether or not I can speak with the adult who lives in this household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO ONE ELSE IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lnomen
/ ASK IF LNOADULT (L5) >1/
/RANGE: 1-76/
L10. You said there are /FILL NUMBER OF ADULTS FROM LNOADULT (L5)/ adults in your household? How many are men?
/IF LNOMEN EQUALS THE NUMBER OF ADULTS IN L5, GO TO LSELRESP/
_ _ Number of men
88. NONE
77. DON’T KNOW/NOT SURE /go to mayig/
99. REFUSED (Including hang-up) / TERM/
L10VERi
/ASK IF LNOMEN >=5/
I am sorry. I just want to make sure I recorded this correctly. You said that there are \\:L10: men living in your household. Is that correct?
01 Yes - /Continue/
02 No –/ skip back to L10/
MAYIG
/ask if l10=77/
May I speak with someone who might be able to tell me how many men 18 years of age or older live in this household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lnowomen
/ ASK IF LNOADULT (L5) >1/
/RANGE: 1-76/
L11. How many of these adults are women?
/L11VERI if Lnowomen >=5/
_ _ Number of women
88. NONE
77. DON’T KNOW/NOT SURE/go to mayih
99. REFUSED (Including hang-up) /TERM/
L11VERi
/ASK IF Lnowomen >=5/
I am sorry. I just want to make sure I recorded this correctly. You said that there are \\: lnowomen (L11): women living in your household. Is that correct?
01 Yes - /Continue/
02 No –/ skip back to lnowomen (L11)/
MAYIH1
/ask if lnowomen (l11)=77/
May I speak with someone who might be able to tell me how many women 18 years of age or older live in this household?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
ADLTVERI
/ASK IF ToTAL of L10 and L11 <> NUMBER REPORTED IN L5/
I am sorry. I just want to make sure I recorded this correctly. You said that there are \\: [L10 + L11]: MEN AND WOMEN living in your household. Is that correct?
01 YES, CORRECT AS IS /CONTINUE/
02 NO. /GO BACK TO L5/
lselresp
/CATI PROGRAMMER: RANDOMLY SELECT RESPONDENT BY AGE RANK AND GENDER. USE CODE BELOW TO IDENTIFY SELECTED RESPONDENT IN SUBMITTED DATA SET./
101. Oldest MAN
102. Second oldest MAN
103. Third oldest MAN
…
176. SEVENTY-SIXTH oldest MAN
201. Oldest WOMAN
202. Second oldest WOMAN
203. Third oldest WOMAN
…
276. SEVENTY-SIXTH oldest WOMAN
Lselrespphone
/ASK IF LSELRESp=101-276/
//Programming if only 1 Man or Woman in HH, exclude age identifier. e.g “I’d like to speak to the man of the household” or the “I’d like to speak to the woman of the household”//
L12. The person that I’d like to speak to is the [age rank and gender (USE “MAN” or “WOMAN”, NOT MALE/FEMALE) of selected respondent FILL] in your household. Are you the [age rank and gender of selected respondent FILL] in your household?
1. YES Go to YRTHE1
2. NO /go to mayiJ/
7. DON’T KNOW/NOT SURE /go to mayiK/
9. REFUSED (Including hang-up) / TERM/
YRTHE1
/ASK IF Lselrespphone (l12) =1/
Then you are the person I need to speak with./Go to L14 LCONFIDENTIAL/
MAYIJ
/ask if LSELRESPPHONE (l12)=2/
May I speak with the [age rank and gender of selected respondent FILL]?
01 YES TRANSFERRING /GO TO LSELRESPINTRO L13/
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
MAYIK
/ask if LSELRESPPHONE (l12)=7/
May I speak with someone else who lives in this household and might be able to tell me whether or not I can speak with the [age rank and gender of selected respondent FILL]?
01 YES TRANSFERRING /GO BACK TO INTRO/L1
02 NO, NO OTHER ADULT IN HOUSEHOLD /TERMINATE/
03 NO/NOT AVAILABLE RIGHT NOW /GO TO SET CALL BACK/
99 REFUSED /TERMINATE/
lselrespintro
/ASK IF MAYIJ = 1/
L13. [INTERVIEWER INSTRUCTION: READ SLOWLY AND DISTINCTLY] Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. The CDC is a federal agency charged with protecting and improving the public's health. We're gathering information on health and tobacco from selected people across the United States. Your phone number has been chosen randomly from a list of all telephone numbers in the US.
[Is respondent continuing with the interview?]
1. YES
2. NO // TERM/
lconfidential
/ASK IF LSELRESPINTRO (L13)=1 OR [L7 LAREYOUMF=1,2,OR 7]/
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 takes about 15 to 25 minutes and any information you give me will be kept private, to the extent permitted by law.If you have any questions about this survey, I will provide a telephone number for you to call to get more information.
This call may be monitored or recorded for quality assurance.
[Is respondent continuing with the interview?]
1. YES
2. NO / TERM/
genhealth
/ASK ALL/
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
smok100
/ASK ALL/
[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 PreQ30 SLTEVER2/
smoknow
/ASK IF SMOK100 (Q2) =1 AND NOT REFUSED FROM Q2 TO THIS POINT/
3. Do you now smoke cigarettes every day, some days, or not at all?
1. Every day
2. Some days /Go to Q8 SMOKDAYS30/
3. Not at all /Go to q6 smoklast/
7. DON”T KNOW /Go to Q6/
9. REFUSED /Go to PreQ30 SLTEVER2/
smokperday
/ASK IF SMOKNOW (Q3) =1 AND NOT REFUSED FROM Q2 TO THIS POINT//
[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?
/RANGE: 1-180/
/Q4VERI if number of cigarettes >= 61/
[HELP: 1 PACK = 20 CIGARETTES]
_ _ _. Number of cigarettes /Go to Q13 SMOKWHOLAGE/
666. Less than one cigarette a day /Go to Q13 SMOKWHOLAGE/
888. NONE /Go to Q13 SMOKWHOLAGE/
777. DON’T KNOW/NOT SURE /Go to Q13 SMOKWHOLAGE/
999. REFUSED /Go to Q30 SLTEVER2/
/ASK IF Q4 >= 61/
Q4VERi
I am sorry. I just want to make sure I recorded this correctly. You said that you now smoke about \\: Q4: cigarettes a day. Is that correct?
01 YES - /CONTINUE/
02 NO –/ SKIP BACK TO Q4/
smokever
/ASK IF SMOK100 (Q2)=(2 OR 7) AND NOT REFUSED FROM Q2 TO THIS POINT//
5. Have you ever tried cigarette smoking, even one or two puffs?
1. YES
2. NO Go to q18 FUTURSMOK2
7. DON’T KNOW/NOT SURE Go to Q30 SLTEVER2
9. REFUSED Go to Q30 SLTEVER2
smoklast
/( ASK IF SMOKNOW(Q3)=(3 OR 7) OR SMOKEVER (Q5)=1) AND NOT REFUSED FROM Q2 TO THIS POINT//
/PROGRAMMING FOR Q6.1-Q6.10, First time answer 01 yes or 99 refused move past/skip Q6.10. If answer “77 don’t know” to any of Q6.1-Q6.9 go to next category, but do not progress beyond 1 don’t know response—that is if 2 77/don’t know responses IN A ROW are collected within Q6.1-Q6.9, move past/skip Q6.10.
/DATA Processing, Deliver like income (only the final yes, don’t know or rEFUSed respose)/
6. Was the last time you smoked a cigarette, even one or two puffs…?
Q6.1. Within the past 24 hours Go to Q8 SMOKDAYS30
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.2/
77 DON”T KNOW/NOT SURE /GO TO Q6.2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.1= 02 or 77)/
Q6.2. Within the past 7 days
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.3/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.1 and Q6.2= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF Q6.2=2 or 77/
Q.63. Within the past 30 days
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.4/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.2 and Q6.3= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.3=02 or 77) /
Q6.4. Within the past 3 months
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.5/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.3 and Q6.4= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.4=02 or 77) /
Q6.5. Within the past 6 months
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.6/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.4 and Q6.5= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.5=02 or 77) /
Q6.6. Within the past year
01 YES /Go to Q8 SMOKDAYS30/
02 NO /GO TO Q6.7/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.5 and Q6.6= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.6=02 or 77) /
Q6.7. Within the past 5 years
01 YES / Go to q12 SMOKWHOLCIG /
02 NO /GO TO Q6.8/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.6 and Q6.7= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.7=02 or 77) /
Q6.8. Within the past 10 years
01 YES / Go to q12 SMOKWHOLCIG /
02 NO /GO TO Q6.8/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.7 and Q6.8= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.8=02 or 77) /
Q6.9. Within the past 15 years
01 YES / Go to q12 SMOKWHOLCIG /
02 NO /GO TO Q6.9/
77 DON”T KNOW/NOT SURE /IF BOTH Q6.8 and Q6.9= 77 Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
/ASK IF (Q6.9=02 or 77) /
Q.6.10. More than 15 years ago
01 YES / Go to q12 SMOKWHOLCIG /
02 NO
77 DON”T KNOW/NOT SURE /Go to q18 FUTURSMOK2/
99 REFUSED /GO TO Q30 SLTEVER2/
//PROGRAMMING, PLEASE BACK FILL Q6.1-Q6.10 BASED ON RESPONSE FROM Q6.10ver//
Q6_10ver
/ASK IF IF Q.6.10=02/
When was the last time you smoked a cigarette, even one or two puffs…?
[INTERVIEWER, IF RESPONDENT PROVIDES A RANGE THAT DOESN’T QUITE FIT A CATEGORY, PLEASE CODE TO UPPER RANGE OF ANSWER. EG—“6 MONTHS TO A YEAR AGO” WOULD BE CODED AS 06 WITHIN THE PAST YEAR]
[READ LIST IF NECESSARY]
01 Within the past 24 hours
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 year
07 Within the past 5 years /
08 Within the past 10 years /
09 Within the past 15 years /
10 More than 15 years ago
77. DON’T KNOW/NOT SURE
99. REFUSED
smokorquit
/ASK IF SMOKLAST(Q6) EQ (02-06) AND NOT REFUSED FROM Q2 TO THIS POINT//
7. You last smoked more than [Last two words of (Q6 SMOKLAST response category – 1)] ago. Is that because you are trying to quit smoking for good?
//PROGRAMMING NOTE: Last two words of (Q6 SMOKLAST response category – 1)] means fill in with the last two words of the last category that the respondent said "No" to. (This is relevant only to responses 02-06 in Q6.) For example, if the respondent says they last smoked within the past 6 months (resp cat 05), the first sentence of Q7 would be "You last smoked more than 3 months ago."//
1. yes, RESPONDENT is trying TO QUIT SMOKING for good /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 (04 OR 05 OR 06) AND SMOKEORQUIT (Q7) EQ (2 OR 7 OR 9), GO TO Q10 SMOKPASTYR/
smokdays30
/ASK IF SMOKNOW (Q3) EQ 2 OR SMOKLAST (Q6) EQ 01 OR [SMOKLAST (Q6) EQ (02-03) AND SMOKORQUIT (Q7) EQ 2] AND NOT REFUSED FROM Q2 TO THIS POINT//
[interviewer: if respondent is unsure or states a range, read:
“You said you smoked cigarettes on [STATE RANGE: “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?”]
/RANGE: 1-30/
8. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke cigarettes?
_ _. Number of Days
88. NONE Go to q12 SMOKWHOLCIG
77. DON’T KNOW/NOT SURE Go to q12 SMOKWHOLCIG
99. REFUSED Go to Q30 SLTEVER2
smoksomeday
/ASK IF SMOKDAYS30 (Q8) EQ (01-30) AND NOT REFUSED FROM Q2 TO THIS POINT//
[interviewer: if respondent is unsure or states a range, read:
“You said you smoke about [STATE RANGE: “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].
/RANGE: 1-180/
/Q9veri if number of cigarettes >= 061/
_ _ _. Number of cigarettes
666. Less than one cigarette a day
888. NONE
777. DON’T KNOW/NOT SURE
999. REFUSED Go to Q30 SLTEVER2
Q9VERi
/ASK IF Q9 >= 061/
I am sorry. I just want to make sure I recorded this correctly. You said that on average you smoked about \\:Q9: cigarettes a day during the past 30 days. Is that correct?
01 Yes - /Continue/
02 No –/ skip back to Q9/
if
q2
smok100 = (2 or 7), go to q12
smokwholecig;
else if q2 smok100
= 1, go to q13
smokwholage
smokpastyr
/ASK IF SMOKLAST (Q6) EQ (04-06) AND SMOKORQUIT (Q7) EQ (2, 7, OR 9)/
[interviewer: if respondent is unsure or states a range, read:
[You said you smoked cigarettes on [STATE RANGE: “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?
/RANGE 1-365/
_ _. Number of Days
888. NONE
777. DON’T KNOW/NOT SURE
999. REFUSED
smokYRNUM
/ASK IF SMOKPASTYR (Q10 EQ (001-365) AND NOT REFUSED FROM Q2 TO THIS POINT//
[interviewer: if respondent is unsure or states a range, read:
“You said you smoke about [STATE RANGE: “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?
/RANGE: 1-180/
/Q11VERI if number of cigarettes >= 061/
[HELP: 1 pack=20 cigarettes]
_ _ _. Number of cigarettes IF SMOK100 EQ 1 Go to Q13 SMOKWHOLAGE
666. Less than one cigarette a day IF SMOK100 EQ 1 Go to Q13 SMOKWHOLAGE
888. NONE IF SMOK100 EQ 1 Go to Q13 SMOKWHOLAGE
777. DON’T KNOW/NOT SURE IF SMOK100 EQ 1 Go to Q13 SMOKWHOLAGE
999. REFUSED Go to Q30 SLTEVER2
Q11VERI
/ASK IF Q11 >= 061/
I am sorry. I just want to make sure I recorded this correctly. You said that you smoked \\:Q11: cigarettes per day. Is that correct?
01 YES - /CONTINUE/
02 NO – /SKIP BACK TO Q11/
smokwholcig
/ASK IF [SMOK100 (Q2) EQ (2 OR 7) AND SMOKEVER (Q5) EQ 1] OR SMOKORQUIT (Q7) EQ 1 OR SMOKDAYS30 (Q8) EQ (77 OR 88) [AND NOT REFUSED FROM Q2 TO THIS POINT]/ /
12. Have you ever smoked a whole cigarette?
1. YES
2. NO
/IF q6
smoklast <= 6 go to q17
SMOKYRago,
else if q6
smoklast( >= 7 AND <= 10) go to q18 futursmok2/
7. DON’T
KNOW/NOT SURE
/IF q6
smoklast <= 6 go to q17 SMOKYRago,
else
if q6
smoklast (>= 7 AND <= 10) go to q18 futursmok2/
9. REFUSED /Go to Q30 SLTEVER2/
smokwholage
/[ASK IF SMOK100 (Q2) EQ 1 OR SMOKWHOLCIG (Q12) EQ 1] AND [NOT REFUSED FROM Q2 TO THIS POINT/]/
13. How old were you when you smoked a whole cigarette for the first time?
/RANGE: 001-130/
/Q13 VERI IF AGE IN Q13 (<=009 OR >=018/
_ _. age in years
888. RESPONDENT
HAS NEVER SMOKED A WHOLE CIGARETTE
IF q6
smoklast <= 6 go to q17
SMOKYRago,
else if q6
smoklast (>= 7 AND <= 10) go to q18 futursmok2
777. DON’T KNOW/NOT SURE if q3 smoknow = 1, go to q15 smok30dage
999. REFUSED Go to Q30 SLTEVER2
Q13VERI
/ASK IF Q13 (<=9 OR >=18)/
I am sorry. I just want to make sure I recorded this correctly. You said that you were \:Q13: years old when you first smoked a whole cigarette. Is that correct?
01 YES - /CONTINUE/
02 NO – /SKIP BACK TO Q13/
smok30dever
/ASK
IF {SMOK100 (Q2) EQ (2 OR 7) AND [SMOKWHOLCIG (Q12) EQ 1 OR
SMOKWHOLAGE (Q13) EQ (1-76)} OR [SMOK100 (Q2) EQ 1 AND SMOKNOW
(Q3) EQ (2 OR 3)]/
/ASK IF {SMOK100 (Q2) EQ (2 OR 7) AND [SMOKWHOLCIG (Q12) EQ 1 OR SMOKWHOLAGE (Q13) EQ (1-76)} OR [SMOK100 (Q2) EQ 1 AND SMOKNOW (Q3) EQ (2 OR 3) AND NOT SMOKLAST (Q6) EQ (77 OR 99)] AND NOT REFUSED FROM Q2 TO THIS POINT//
14. Have you ever smoked at least one cigarette every day for 30 days in a row?
1. YES
2. NO
IF q6
smoklast( >= 7 AND
<= 10), GO TO Q18
FUTURSMOK2;
ELSE IF q6
smoklast <= 6 GO TO Q17 SMOKYRAGO
7. DON’T
KNOW/NOT SURE
IF q6
smoklast (>= 7 AND
<= 10), GO TO Q18 FUTURSMOK2;
ELSE
IF q6
smoklast <= 6 GO TO Q17 SMOKYRAGO
9. REFUSED Go to Q30 SLTEVER2
smok30dage
/ASK IF SMOK30DEVER (Q14) EQ 1 OR [SMOKNOW (Q3) EQ 1 AND SMOKWHOLAGE (Q13) EQ (001-130) AND NOT REFUSED FROM Q2 TO THIS POINT/]/
15. How old were you when you first smoked at least one cigarette every day for 30 days in a row?
/RANGE: 001-130/
/IF NUMBER OF YEARS (<=009 OR >=018), ASK Q15VERI/
_ _. age in years
777. DON’T KNOW/NOT SURE
999. REFUSED Go to Q30 SLTEVER2
/IF Q3 SMOKNOW = 1, GO TO Q17 SMOKYRAGO/
Q15VERI
/ASK IF Q15 (<=9 OR >=18) OR IF Q15< Q13 RESPONSE/
I am sorry. I just want to make sure I recorded this correctly. You said that you were \:Q15: years old. Is that correct?
01 Yes - /Continue/
02 No – /skip back to Q15/
smok30dlast
/ASK IF SMOK30DAGE (Q15) EQ (01-130)(AND NOT REFUSED FROM Q2 TO THIS POINT)/
/PROGRAMMING FOR Q16.1-Q16.8, First time answer 01 yes or 99 refused move past/skip Q16.8. If answer “77 don’t know” to any of Q16.1-Q16.7 go to next category, but do not progress beyond 1 don’t know response—that is if 2 77/don’t know responses IN A ROW are collected within Q16.1-Q16.7, move past/skip Q16.8.
/DATA Processing, Deliver like income (only the final yes, don’t know or rEFUSed respoNse)/
16. 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…?
Q16.1. Today or yesterday
01 YES
02 NO
77 DON’T KNOW
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF Q16.1=02 or 77/
Q16.2. In the past 7 days
01 YES
02 NO
77 DON’T KNOW /IF BOTH Q16.1 and Q16.2= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.2=02 or 77) /
Q16.3. In the past 30 days
01 YES
02 NO
77 DON’T KNOW /IF BOTH Q16.2 and Q16.3= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.3=02 or 77) /
Q16.4. In the past 1 year
01 YES
02 NO
77 DON’T KNOW /IF BOTH Q16.3 and Q16.4= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.4=02 or 77) /
Q16.5. In the past 5 years
01 YES /Go to q18 futursmok20
02 NO
77 DON’T KNOW /IF BOTH Q16.4 and Q16.5= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.5=02 or 77) /
Q16.6. In the past 10 years
01 YES /Go to q18 futursmok20
02 NO
77 DON’T KNOW /IF BOTH Q16.5 and Q16.6= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.6=02 or 77) /
Q16.7. In the past 15 years
01 YES /Go to q18 futursmok20
02 NO
77 DON’T KNOW /IF BOTH Q16.6 and Q16.7= 77 Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
/ASK IF (Q16.7=02 or 77) /
Q16.8 More than 15 years ago
01 YES /Go to q18 futursmok20
02 NO
77 DON’T KNOW /Go to q18 FUTURSMOK2/
99 REFUSED /Go to Q30 SLTEVER2/
smokyrago
/ASK IF [SMOKLAST (Q6) EQ (1-6) OR SMOKNOW (Q3) EQ (1 OR 2)] AND [NOT REFUSED FROM Q2 TO THIS POINT] AND [SMOKD30DLAST (Q16) LE 4]/
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 Go to Q30 SLTEVER2
[IF Q3 SMOKNOW = 1 OR 2 GO TO Q19 SMOKEWAKE]
futursmok2
/ASK IF [SMOKNOW (Q3) EQ (3 OR 7) OR SMOKEVER (Q5) EQ (1 OR 2)] AND [NOT REFUSED FROM Q2 TO THIS POINT]
ASK
IF [SMOKNOW (Q3) EQ (3 OR 7) AND SMOKEVER (Q5) EQ (1 OR 2)] AND
[AND NOT REFUSED FROM Q2 TO THIS POINT]//.
/
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]
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for Q18 FUTURESMOK2/
Q18like /Programmer: store randomly selected order in variable name: Q18like /
Values:
Flag “1” means question was presented as such:
1 – Very likely
2 – Somewhat likely
3 – Not at all likely
Flag “2” means question was presented as such:
3-Not at all likely
2-Somewhat likely
1-Very likely
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]/
smokwake
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) AND NOT REFUSED FROM Q2 TO THIS POINT//
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 Go to preQ30 SLTEVER2
mentholcigs2
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) AND NOT REFUSED FROM Q2 TO THIS POINT/ /
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 Go to PREQ30 SLTEVER2
cigflavor
/ASK IF MENTHOLCIGS2 (Q20) EQ (1, 2, OR 7) AND NOT REFUSED FROM Q2 TO THIS POINT/ /
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 Go to Q30 SLTEVER2
brand2
/ASK IF CIGFLAVOR (Q21) EQ (1, 2, OR 7) AND NOT REFUSED FROM Q2 TO THIS POINT//
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
96. Other (specify) /GO TO Q22oth/
66. DID NOT SMOKE A USUAL BRAND DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED Go to PreQ30 SLTEVER2
22oth ____ENTER OTHER SPECIFY
/GO TO Q25 BUYQUANT2/
bghtpast30d
/ASK IF [SMOK100 (Q2) EQ (2 OR 7) AND SMOKLAST (Q6) EQ (01-03)] OR [SMOK100 (Q2) EQ 1 AND SMOKNOW (Q3) EQ 3 AND SMOKLAST (Q6) EQ (01-03)] AND [AND NOT REFUSED FROM Q2 TO THIS POINT/]
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 Go to Q30 SLTEVER2
9. REFUSED Go to Q30 SLTEVER2
brandpast30d
/ASK IF BGHTPAST30D (Q23) EQ (1) (AND NOT REFUSED FROM Q2 TO THIS POINT/)/
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
96. Other (specify) /GO TO Q24oth/
66. DID NOT BUY ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED Go to Q30 SLTEVER2
24oth ENTER SPECIFY
buyquant2
/ASK IF BRAND2 (Q22) EQ (01-77 OR 96) OR BRANDPAST30D (Q24) EQ (01-77 OR 96) (AND NOT REFUSED FROM Q2 TO THIS POINT)//
25. The last time you bought cigarettes for yourself, did you buy them by the pack or by the carton?
01. By the pack
02. By the carton Go to q27 COSTCARTON2
96. OTHER (SPECIFY) Go to Q25othSLTEVER2
77. DON’T KNOW/NOT SURE Go to PreQ30 SLTEVER2
99. REFUSED Go to PreQ30 SLTEVER2
25oth ENTER SPECIFY Go to PreQ30 SLTEVER2
costpack2
/ASK IF BUYQUANT2 (Q25) EQ 1 (AND NOT REFUSED FROM Q2 TO THIS POINT)//
26. What price did you pay for the last pack of cigarettes you bought?
/RANGE: 0001-2000/
/ASK Q26VERI IF AMOUNT PAID <=0300 OR >=0700/
[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)
IF Q3 SMOKNOW = (1 OR 2) GO TO Q28
SPECOFFERS, ELSE Go to
preQ30 SLTEVER2
7777. DON’T KNOW/NOT SURE IF Q3 SMOKNOW = (1 OR 2) GO TO Q28 SPECOFFERS, ELSE Go to preQ30 SLTEVER2
9999. REFUSED Go to preQ30 SLTEVER2
Q26VERI
/ASK IF Q26 <=0300 OR >=0700/
I am sorry. I just want to make sure I recorded this correctly. You said that you last paid \:Q26: for the last pack of cigarettes you bought. Is that correct?
01 YES - /CONTINUE/
02 NO – /SKIP BACK TO Q26/
costcarton2
/ASK IF BUYQUANT2 (Q25) EQ 2 (AND NOT REFUSED FROM Q2 TO THIS POINT/)/
27. What price did you pay for the last carton of cigarettes you bought?
/RANGE: $10.00-$90.00/
/ASK Q27VERI IF amount paid <= $30.00 OR >= $70.00/
[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) IF Q3 SMOKNOW EQ (3 OR 9), GO TO Q30 SLTEVER2
777.77. DON’T KNOW/NOT SURE IF Q3 SMOKNOW EQ (3 OR 9), GO TO Q30 SLTEVER2
999.99. REFUSED Go to Q30 SLTEVER2
Q27VERI
/ASK Q27VERI IF amount paid <= $30.00 OR >= $70.00/
I am sorry. I just want to make sure I recorded this correctly. You said that you paid \:Q27:. Is that correct?
01 Yes - /Continue/
02 No – /skip back to Q27/
Specoffers
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) AND [COSTPACK2 (Q26) EQ (0001-2000 OR 7777) OR COSTCARTON2 (Q27) EQ (10.00-90.00) AND (NOT REFUSED FROM Q2 TO THIS POINT)/]/
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 Go to PREQ30 SLTEVER2
buynet2
/ASK IF SPECOFFERS (Q28) EQ (1, 2, OR 7) AND (AND NOT REFUSED FROM Q2 TO THIS POINT)//
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
Pre30
Now I would like to ask you some questions about your use of other tobacco products.
sltever2
/ASK ALL/
[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 Go to Q33 SNUSEVER
7. DON’T KNOW/NOT SURE Go to Q33 SNUSEVER
9. REFUSED Go to Q33 SNUSEVER
sltnodays
/ASK IF SLTEVER2 (Q30) EQ 1/
31. During the past 30 days, that is, since [DATE FILL], on how many days did you use chewing tobacco, snuff, or dip?
/RANGE: 1-30/
_ _ NUMBER OF DAYS
88. NONE Go to Q33 SNUSEVER
77. DON’T KNOW/NOT SURE Go to Q33 SNUSEVER
99. REFUSED Go to Q33 SNUSEVER
sltbrand
/ASK IF SLTNODAYS (Q31) EQ (01-30)/
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
96. Other (specify) /GO TO Q32oth sltbrandoth /
66. DID NOT USE ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
77. DON’T KNOW/NOT SURE
99. REFUSED
sltbrandoth
Q32oth ENTER OTHER/SPECIFY
snusever
/ASK ALL/
[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 /Go to q36 CIGAREVER/
7. DON’T KNOW/NOT SURE /Go to q36 CIGAREVER/
9. REFUSED /Go to q36 CIGAREVER/
snusnodays
/ASK IF SNUSEVER (Q33) EQ 1/
34. During the past 30 days, that is, since [DATE FILL], on how many days did you use snus?
/RANGE: 1-30/
_ _ NUMBER OF DAYS
88. NONE /Go to q36 CIGAREVER/
77. DON’T KNOW/NOT SURE /Go to q36 CIGAREVER/
99. REFUSED /Go to q36 CIGAREVER/
sltsub
/ASK IF SNUSNODAYS (Q34) EQ (01-30)/
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
/ASK ALL/
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 Go to q39 PIPEwtrEVER
7. DON’T KNOW/NOT SURE Go to q39 PIPEwtrEVER
9. REFUSED Go to q39 PIPEwtrEVER
cigarnodays
/ASK IF CIGAREVER (Q36) EQ 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?
/RANGE: 1-30/
_ _ NUMBER OF DAYS
88. NONE Go to q39 PIPEwtrEVER
77. DON’T KNOW/NOT SURE Go to q39 PIPEwtrEVER
99. REFUSED Go to q39 PIPEwtrEVER
cigarflavr
/ASK IF CIGARNODAYS (Q37) EQ (01-30)/
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
/ASK ALL/
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 Go to q41 PIPEOTHEVER
7. DON’T KNOW/NOT SURE Go to q41 PIPEOTHEVER
9. REFUSED Go to q41 PIPEOTHEVER
pipewtrdays
/ASK IF PIPEWTREVER (Q39) EQ 1/
40. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke tobacco in a water pipe?
/RANGE: 1-30/
_ _ NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
pipeothever
/ASK ALL/
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 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 SURE 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 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
/ASK IF PIPEOTHEVER (Q41) EQ 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?
/RANGE: 1-30/
_ _ NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5 SMOKEVER = 2 OR q6 smoklast >= 4] AND SLTNODAYS (Q31) EQ (88 OR 77 OR 99) AND SNUSNODAYS (Q34) EQ (88 OR 77 OR 99) AND CIGARNODAYS (Q37) EQ (88 OR 77 OR 99) AND PIPEWTRDAYS (Q40) EQ (88 OR 77 OR 99) AND PIPEOTHDAYS(Q42) EQ (88 OR 77 OR 99), Go to q43 qtlineawrnt; else go to q44 qtlineawrt
qtlineawrnt
/ASK IF
[(SMOK100 (Q2) EQ 2 OR 7 OR 9) )OR SMOKNOW (Q3) EQ 3] AND [SMOKEVER
(Q5) EQ 2 OR SMOKLAST (Q6) >= 4]
AND SLTNODAYS (Q31) EQ (88 OR
77 OR 99) AND SNUSNODAYS (Q34) EQ (88 OR 77 OR 99) AND CIGARNODAYS
(Q37) EQ (88 OR 77 OR 99) AND PIPEWTRDAYS (Q40) EQ (88 OR 77 OR 99)
AND PIPEOTHDAYS(Q42) EQ (88 OR 77 OR 99)/
/ASK IF NOT (SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-03) OR SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS(Q42) EQ (1-30)) /
43. A telephone quitline is a free telephone-based service that connects people who smoke cigarettes or use other tobacco products with someone who can help them quit. Are you aware of any telephone quitline services that are available to help people quit using tobacco?
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
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-03) OR SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS(Q42) EQ (1-30)/
44. A telephone quitline is a free telephone-based service that connects people who smoke cigarettes or use other tobacco products with someone who can help them quit. Are you aware of any telephone quitline services that are available to help you quit using tobacco?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
qtasstawr
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-03)/
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
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-03)/
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
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-03)/
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]/
qtatt2
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-06)/
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?
/INTERVIEWER
USE 76 FOR 76 OR MORE/
[interviewer: if respondent is unsure or states a range, read:
“You said you have tried to quit smoking cigarettes about [STATE RANGE: “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?]
/RANGE: 01-76/
/Q48VERI IF NUMBER OF TIMES >= 10/
_ _. Number of times
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
Q48VERi
/ASK IF Q48 >= 10/
I am sorry. I just want to make sure I recorded this correctly. You said you have stopped smoking \\:Q48: times for one day of longer. Is that correct?
01 YES - /CONTINUE/
02 NO –/ SKIP BACK TO Q48/
/[IF Q48 QTATT2 = (88 OR 77 OR 99) AND q6 smoklast <= 5 GO TO Q53 QTWANT, ELSE IF Q48 QTATT2 = (88 OR 77 OR 99) GO TO q58 HCWCARE2/
qt12mos
/ASK IF QTATT2 EQ (01-76)/
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?
/INTERVIEWER USE 76
FOR 76 OR MORE/
/RANGE: 01-76/
[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?”]
_ _. Number of times
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
[IF [Q49 QT12MOS = (88 OR 77 OR 99) GO TO Q53 QTWANT]
Q49veri
/ASK IF Q49 >= 7/
I am sorry. I just want to make sure I recorded this correctly. You said you have stopped smoking \\:Q49: times for one day or longer in the past 12 months. Is that correct?
01 YES - /CONTINUE/
02 NO –/ SKIP BACK TO Q49/
qtline
/ASK IF QT12MOS (Q49) EQ (01-76)/
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 to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
QTCLASSPGM
/ASK IF QT12MOS EQ (01-76)/
51A. [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, to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
qtcounsl
/ASK IF QT12MOS EQ (01-76)/
51B. [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 one-on-one counseling from a health professional to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
qtmed2
/ASK IF QT12MOS EQ (01-76)/
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
IF Q6 SMOKLAST =6 GO TO Q58 HCWCARE2
qtwant
/ASK IF SMOKNOW (Q3) EQ (1 OR 2) OR [SMOKLAST (Q6) EQ (01-05) AND SMOKORQUIT (Q7) EQ 2]/.
53. Do you want to quit smoking cigarettes for good?
1. YES
2. NO Go to q58 HCWCARE2
7. DON’T KNOW/NOT SURE Go to q58 HCWCARE2
9. REFUSED Go to q58 HCWCARE2
qtframe
/ASK IF QTWANT (Q53) EQ 1/
54. Do you have a time frame in mind for quitting?
1. YES
2. NO Go to q58 HCWCARE2
7. DON’T KNOW/NOT SURE Go to q58 HCWCARE2
9. REFUSED Go to q58 HCWCARE2
qtwhen
/ASK IF QTFRAME (Q54) EQ 1/
/PROGRAMMING FOR Q55.1-Q55.4, First time answer 01 yes or 99 refused move past/skip Q55.5. If answer “77 don’t know” to any of Q55.1-Q55.4 go to next category, but do not progress beyond 1 don’t know response—that is if 2 77/don’t know responses IN A ROW are collected within Q55.1-Q55.4, move past/skip Q55.5.
/DATA Processing, Deliver like income (only the final yes, don’t know or rEFUSed respoNse)/
55. Do you plan to quit smoking cigarettes for good …
/ASK IF QTFRAME (Q54) EQ 1/
Q55.1. in the next 7 days
1 YES
2 NO
7 DON’T KNOW/ NOT SURE
9 REFUSED GO TO Q58 HCWCARE2
/ASK IF Q55.1=2 OR 7/
Q55.2 in the next 30 days
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /IF BOTH Q55.1 and Q55.2= 7 Go to Q58 HCWCARE2/
9 REFUSED GO TO Q58 HCWCARE2
/ASK IF (Q55.2=02 OR 7) /
Q55. 3. in the next 6 months
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /IF BOTH Q55.2 and Q55.3= 7 Go to Q58 HCWCARE2/
9 REFUSED GO TO Q58 HCWCARE2
/ASK IF (Q55.3=02 OR 7) /
Q55. 4. in the next 1 year,
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /IF BOTH Q55.3 and Q55.4= 7 Go to Q58 HCWCARE2/
9 REFUSED GO TO Q58 HCWCARE2
/ASK IF (Q55.3=02 OR 7) /
Q55.5. more than 1 year from now?
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /GO TO Q58 HCWCARE2/
9 REFUSED /GO TO Q58 HCWCARE2/
qtfutasst
/ASK IF QTWHEN (Q55.1 , Q55.2, Q55.3, Q55.4, or Q55.5=01)
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 health professional to help you quit?
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
qtfutmed
/ASK IF QTWHEN (Q55.1 , Q55.2, Q55.3, Q55.4, or Q55.5=01)/
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?
[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.]
1. YES
2. NO
7. DON’T KNOW/NOT SURE
9. REFUSED
hcwcare2
/ASK ALL/
58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?
1. YES IF NOT [SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-06) OR SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS(Q42) EQ (1-30)] GO TO HCWASK (Q68)
2. NO Go to q69 hccoverage
7. DON’T KNOW/NOT SURE Go to q69 hccoverage
9. REFUSED Go to q69 hccoverage
hcwadvise2
/ASK IF HCWCARE2 (Q58) EQ 1 AND NOT [SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-06) OR SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS(Q42) EQ (1-30)]/
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 Go to q68 HCWASK
7. DON’T KNOW/NOT SURE Go to q68 HCWASK
9. REFUSED Go to q68 HCWASK
hcwqtask
/ASK IF HCWADVISE2 (Q59) EQ 1/
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 Go to q62 hcwmoradvice
7. DON’T KNOW/NOT SURE Go to q62 hcwmoradvice
9. REFUSED Go to q62 hcwmoradvice
hcwqtresp
/ASK IF HCWQTASK (Q60) EQ 1/
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
/ASK IF HCWADVISE2 (Q59) EQ 1/
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 Go to q69 HCcoverage
7. DON’T KNOW/NOT SURE Go to q69 HCcoverage
9. REFUSED Go to q69 HCcoverage
hcwmaterials2
/ASK IF hcwmoradvice (Q62) EQ 1/
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
/ASK IF hcwmoradvice (Q62) EQ 1/
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
/ASK IF hcwmoradvice (Q62) EQ 1/
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
/ASK IF hcwmoradvice (Q62) EQ 1/
[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
/ASK IF hcwmoradvice (Q62) EQ 1/
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
/ASK IF {HCWCARE2 (Q58) EQ 1 AND NOT [SMOKNOW (Q3) EQ (1 OR 2) OR SMOKLAST (Q6) EQ (01-06) OR SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS(Q42) EQ (1-30)]} OR (hcwmoradvice (Q62) EQ 1) OR (HCWADVISE2 (Q59) EQ (2, 7, OR 9))/
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
hccoverage
/ASK ALL/
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 IF Q5 SMOKEVER >= 2 OR Q6 SMOKLAST >= 04, GO TO Q71 HCCPAYQO
2. NO Go to q72 SMOKHOME7D2
7. DON’T KNOW/NOT SURE Go to q72 SMOKHOME7D2
9. REFUSED Go to q72 SMOKHOME7D2
hccpayqs
/ASK IF HCCOVERAGE (Q69) EQ 1 UNLESS [SMOKEVER (Q5) >= 2 OR SMOKLAST (Q6) >= 04]/
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 OR Q31 SLTNODAYS >=77) AND (Q33 SNUSEVER >= 2 OR Q34 SNUSNODAYS>=77) AND (Q36 CIGAREVER >= 2 OR Q37 CIGARNODAYS >=77) AND (Q39 PIPEWTREVER >= 2 OR Q40 PIPEWTRDAYS>=77) AND (Q41 PIPEOTHEVER >=2 OR Q42 PIPOTHDAYS>=77), GO TO Q72 SMOKHOME7D2]/
hccpayqo
/ASK IF HCCOVERAGE (Q69) EQ 1 AND (SLTNODAYS (Q31) EQ (1-30) OR SNUSNODAYS (Q34) EQ (1-30) OR CIGARNODAYS (Q37) EQ (1-30) OR PIPEWTRDAYS (Q40) EQ (1-30) OR PIPEOTHDAYS (Q42) EQ (1-30))/
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
/ASK ALL/
PREHOME
Now I’m going to ask you some questions about smoking inside the home.
smokhome7d2
/ASK ALL/
72. Not counting decks, porches, or garages, during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did someone other than you smoke tobacco inside your home while you were at home?
/RANGE: 01-07/
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
homerules2
/ASK ALL/
73. Not counting decks, porches, or garages, inside your home, is smoking …?
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,and 3. Response 2 will always stay the second response on the list/
/ the display order of the text read to the respondent will be randomly altered for Q73 homerules2/
Q73dsply /Programmer: store randomly selected order in variable name: Q73dsply /
Values:
USE Flag “1” value for list displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
USE Flag “2” value for list displayed as such:
3 – Never allowed
2 – Allowed only at some times or in some places
1 – Always Allowed
[INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED]
1. Always allowed Go to q75 homerulesopn
2. Allowed only at some times or in some places
3. Never allowed if q72 smokhome7d2 = (1-7) Go to q75 homerulesopn
7. DON’T KNOW/NOT SURE Go to q75 homerulesopn
9. REFUSED Go to q75 homerulesopn
homecmpl
/ASK IF [SMOKHOME7D2 (Q72) EQ 88 AND HOMERULES2 (Q73) EQ 3] OR [SMOKHOME7D2 (Q72) EQ (1-7) AND HOMERULES2 (Q73) EQ 2]/
74. Not counting decks, porches, or garages, to your knowledge, during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], 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
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for HOMERULESOPN (Q75)/
Q75dsply /Programmer: store randomly selected order in variable name: Q75dsply /
Values:
Use Flag “1” for responses displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Use Flag “2” for responses displayed as such:
3-Never Allowed
2-Allowed only at some times or in some places
1 – Always Allowed
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
[DO
NOT READ]
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
PREWORK
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
/ASK ALL/
76. Are you currently working for pay or are you self-employed, either part-time or full-time?
1. YES
2. NO GO TO Q84 workindopn2
7. Don’t know Go to Q84 workindopn2
9. REFUSED Go to Q84 workindopn2
nojobs
/ASK IF EMPLOY2 (Q76) EQ 1/
77. Do you currently have one job or more than one job?
1. ONE JOB
2. MORE THAN ONE JOB /GO TO PREQ78/
7. Don’t know Go to Q84 workindopn2
9. REFUSED Go to Q84 workindopn2
/ASK IF Q77 NOJOBS=2/
PreQ78
Please
answer the following questions for the job at which you spend the
most time.
01 CONTINUE
/[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
/ASK IF NOJOBS (Q77) EQ (1 OR 2)/
78. Most of the time, do you work…?
01. Outdoors
02. In a vehicle
03. Indoors at home
04. Indoors in a place like an office building, retail store, restaurant, or factory
96. Somewhere else (Specify) /GO TO Q78oth/
77. Don’t know/NOT SURE Go to Q84 workindopn2
99. REFUSED Go to Q84 workindopn2
[INTERVIEWER: IF RESPONDENT works in more than one, PLEASE READ:
“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, PLEASE READ:
“Of the [SAY: Number of settings], please choose the setting at which you have been working the longest.”]
[INTERVIEWER: if the RESPONDENT, PLEASE READ: “Of the [SAY: Number of settings], please choose the setting which you like the most.”]
Q78oth ENTER OTHER SPECIFY
/ASK
IF Q78=2/
PreWORK2
The
next two questions refer to smoking in indoor areas. When
answering the questions, please count your vehicle as an indoor area.
shsexpwork
/ASK IF WORKPLACE (Q78) EQ (1-4, 96)/
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 last [TODAY’S DAY OF WEEK], on how many days did you breathe the smoke at your workplace from someone other than you who was smoking tobacco?
/RANGE: 01-07/
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
/IF Q78 WORKPLACE = 1, GO TO Q81 WORKSMOKOUT/
worksmokind
/ASK IF WORKPLACE (Q78) EQ (02-04, 96)/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for worksmokind (Q79)/
Q80dsply /Programmer: store randomly selected order in variable name: Q80dsply /
Values:
Use Flag “1” for responses displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Use Flag “2” for responses displayed as such:
3 – Never allowed
2 – Allowed only at some times or in some places
1 – Always Allowed
80. At your workplace, is smoking in indoor areas…?
[INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED]
[INTERVIEWER: don’t know/not sure is an acceptable response here. You do not need to probe further if respondent says don’t know”]
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
worksmokout
/ASK IF WORKPLACE (Q78) EQ 1 OR WORKSMOKIND (Q80) EQ (1-3)/
PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for worksmokout(Q81)/
Q81dsply /Programmer: store randomly selected order in variable name: Q81dsply /
Values: Use Flag “1” for responses displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Values: Use Flag “2” for responses displayed as such:
3 – Never allowed
2 – Allowed only at some times or in some places
1 – Always Allowed
81. At your workplace, is smoking in outdoor areas…?
[INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED]
[INTERVIEWER: don’t know/not sure is an acceptable response here. You do not need to probe further if respondent says don’t know”]
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
worksmokless
/ASK IF WORKSMOKOUT (Q81) EQ (1-3)/
PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for worksmokless (Q82)/
Q82dsply /Programmer: store randomly selected order in variable name: Q82dsply /
Values: Use flag “1” for questions displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Values: Use flag “2” for questions displayed as such:
3 – Never allowed
2 – Allowed only at some times or in some places
1 – Always Allowed
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]
[INTERVIEWER: don’t know/not sure is an acceptable response here. You do not need to probe further if respondent says don’t know”]
1. Always allowed
2. Allowed only at some times or in some places
3. Never allowed
7. DON’T KNOW/NOT SURE
9. REFUSED
/[IF Q80 WORKSMOKIND = 1 AND Q81 WORKSMOKOUT = 1 AND Q82 WORKSMOKLESS = 1, GO TO Q84 WORKINDOPN2]/
TOBcompwork
/ASK IF WORKSMOKIND (Q80) EQ (2 OR 3) OR WORKSMOKOUT (Q81) EQ (2 OR 3) OR WORKSMOKLESS (Q82) EQ (2 OR 3)/
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
PRE84
"The next two questions ask for your opinion about smoking at all workplaces."
workindopn2
/ASK ALL/
PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for workindopn2 (Q84)/
Q84dsply /Programmer: store randomly selected order in variable name: Q84dsply /
Values: Use flag “1” for question text displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Values: Use flag “2” for question text displayed as such:
3 – Never allowed
2 –
Allowed only at some times or in some places
1
– Always Allowed
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
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for workoutdopn2 (Q85)/
Q85dsply /Programmer: store randomly selected order in variable name: Q85dsply /
Values: Use Flag “1” for text displayed as such:
1 – Always Allowed
2 – Allowed only at some times or in some places
3 – Never allowed
Values: Use Flag “2” for text displayed as such:
3 – Never allowed
2 – Allowed only at some times or in some places
1 – Always Allowed
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
/ASK ALL/
PREVEH
Now we have two questions about smoking in vehicles.
shsvehexp
/ASK ALL/
86. During the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did you ride in a vehicle where someone other than you was smoking tobacco?
/RANGE: 01-07/
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
shsvehpol
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for shsvehpol (Q87)/
Q87dsply /Programmer: store randomly selected order in variable name: Q87dsply /
Values: Use Flag “1” for questions displayed as such:
1. Always allowed in all vehicles
2. Sometimes allowed in at least one vehicle
3. Never allowed in any vehicle
Values: Use Flag “2” for questions displayed as such:
3. Never allowed in any vehicle
2. Sometimes allowed in at least one vehicle
1. Always allowed in all vehicles
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
[DO NOT READ]
8. RESPONDENT’S FAMILY DOES NOT OWN OR LEASE A VEHICLE
7. DON’T KNOW/NOT SURE
9. REFUSED
PREPUB
/ASK ALL/
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
/ASK ALL/
88. [IF Q76 EMPLOY2 = 1: Not counting times while you were at work,] during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did you breathe the smoke from someone else who was smoking in an indoor or outdoor public place?
/RANGE: 01-07/
0_. NUMBER OF DAYS
88. NONE
77. DON’T KNOW/NOT SURE
99. REFUSED
shscomppub
/ASK ALL/
89. [IF Q76 EMPLOY2 = 1: Not counting times while you were at work,] to your knowledge, during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], 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
PREOPIN
/ASK ALL/
Now we have three questions about your opinions on smoking in indoor and outdoor public places.
shsindropn1
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for shsindropn1 (Q90)/
Q90dsply /Programmer: store randomly selected order in variable name: Q90dsply /
Values: Use Flag “1” for questions displayed as such:
1 Always be allowed
2. Be allowed only at some times or in some places
3. Never be allowed
Values: Use Flag “2” for questions displayed as such:
3. Never be allowed
2. Be allowed only at some times or in some places
1 Always be allowed
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
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for shsindropn2 (Q91)/
Q91dsply /Programmer: store randomly selected order in variable name: Q91dsply /
Values: Use Flag “1” for questions displayed as such:
1 Always be allowed
2. Be allowed only at some times or in some places
3. Never be allowed
Values: Use Flag “2” for questions displayed as such:
3. Never be allowed
2. Be allowed only at some times or in some places
1 Always be allowed
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
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for shsoutdropn (Q92)/
Q92dsply /Programmer: store randomly selected order in variable name: Q92dsply /
Values: Use Flag “1” for questions displayed as such:
1 Always be allowed
2. Be allowed only at some times or in some places
3. Never be allowed
Values: Use Flag “2” for questions displayed as such:
3. Never be allowed
2. Be allowed only at some times or in some places
1 Always be allowed
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
PREKNOW
/ASK ALL/
Now we have some general questions about smoking and tobacco use.
shsasknot
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES order of responses so that 1 and 3 randomly reverse order. 2 should always appear as the second response/
/ the display order of the text read to the respondent will be randomly altered for shsasknot (Q93)/
Q93dsply /Programmer: store randomly selected order in variable name: Q93dsply /
Values: Use Flag “1” for questions displayed as such:
1. Very likely
2. Somewhat likely
3. Not at all likely
Values: Use Flag “2” for questions displayed as such:
3. Not at all likely
2. Somewhat likely
1. Very likely
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
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,2,and 3/
/ the display order of the text read to the respondent will be randomly altered for Q94 SHSHARMOPN /
Q94dsply /Programmer: store randomly selected order in variable name: Q94dsply /
Values: Use Flag “1” for questions displayed as such:
1. Not at all harmful to one's health
2. Somewhat harmful to one's health
3. Very harmful to one's health
Values: Use Flag “2” for questions displayed as such:
3. Very harmful to one's health
2. Somewhat harmful to one's health
1. Not at all harmful to one's health
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
/ASK ALL/
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
PREDEM
/ASK ALL/
Now I would like to ask you some questions about yourself and your family. Please remember that your answers will be private and that no one will be able to identify you from any published reports.
marital2
/ASK ALL/
[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
96. Other (specify) /GO TO Q96oth/
77. DON’T KNOW/NOT SURE
99. REFUSED
Q96oth ______ENTER OTHER SPECIFY
hispanic
/ASK ALL/
98. Are you Hispanic or Latino?
1. YES
2. NO Go to Q100 RACEMULTI
7. DON’T KNOW/NOT SURE Go to Q100 RACEMULTI
9. REFUSED Go to Q100 RACEMULTI
hispgroup
/ASK IF HISPANIC (Q98) EQ 1/
99. Which one or more of the following describe your Hispanic origin or ancestry?
/ALLOW MUTLIPLE REPONSES/
/Please deliver multiple responses as “variable name_a, variable name_b, etc” as is standard for BRFSS/
[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
96. Some other Hispanic or Latino group (SPECIFY) /GO TO Q99oth/
77. DON’T KNOW/NOT SURE
99. REFUSED
[iNTERVIEWER: IF A RESPONDENT MENTIONS A COUNTRY IN CENTRAL OR SOUTH AMERICA, CODE AS 04.]
/ASK IF Q99=96/
Q99oth ENTER OTHER/SPECIFY
[PROGRAMMER: PROVIDE A LIST OF CENTRAL AND SOUTH AMERICAN COUNTRIES FOR THE INTERVIEWER TO SEE HERE.]
/LIST OF CENTRAL AND SOUTH AMERICAN COUNTRIES/
Belize |
Bolivia |
Brazil |
Chile |
Colombia |
Costa Rica |
Ecuador |
El Salvador |
Falkland Islands |
French Guiana |
Guatemala |
Guyana |
Honduras |
Nicaragua |
Panama |
Paraguay |
Peru |
Suriname |
Uruguay |
Venezuela |
racemulti
/ASK ALL/
100. I’m going to read a list of racial categories. Which one or more of the following do you consider yourself to be?
/ALLOW MULTIPLE RESPONSES/
/Please deliver multiple responses as “variable name_a, variable name_b, etc” as is standard for BRFSS/
[INTERVIEWER: Mark all that
apply.]
[INTERVIEWER, IF respondent volunteers information
prior to your having read the response list or in the middle of you
reading the response list, ok to code without reading full list. IF
this happens, please probe with “in addition to “XXX”
are there any other racial categories that describe you” to see
if more than one category is appropriate.]
01. White
02. Black or African American
03. Asian
04. Native Hawaiian or Other Pacific Islander
05. American Indian or Alaska Native
96. OTHER (SPECIFY) /GO TO Q100oth/
09. NONE OF THE ABOVE
77. DON’T KNOW/NOT SURE
99. REFUSED
Q100oth ENTER OTHER SPECIFY
[IF Q100 RACEMULTI DOES NOT INCLUDE 03 GO TO Q102 EDUCA2
asian01
/ASK IF RACEMULTI (Q100) EQ 03/
101. Which one or more of the following describe your Asian ancestry?
/ALLOW MULTIPLE RESPONSES/
/Please deliver multiple responses as “variable name_a, variable name_b, etc” as is standard for BRFSS/
[INTERVIEWER: Mark all that apply.]
01. Asian Indian
02. Chinese
03. Filipino
04 Japanese
05. Korean
06. Vietnamese
96. Other (SPECIFY)/GO TO Q101oth/
77. DON’T KNOW/NOT SURE
99. REFUSED
Q101oth ENTER other/specify
educa2
/ASK ALL/
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
/ASK ALL/
103. What is your age?
/RANGE: 018-130/
/VERIFICATION SCREEN IF AGE >=085/
_ _ _ . Age in years
777. DON’T KNOW/NOT SURE
999. REFUSED
103VERi
/ASK IF AGE >=085 OR IF AGE=< RESPONSE IN Q13 OR Q15/
I am sorry. I just want to make sure I recorded this correctly. You said that you are \\:103: years old. Is that correct?
01 Yes - /Continue/
02 No –/ skip back to 103/
gender
/ASK ALL/
[INTERVIEWER: Ask only if necessary.]
104. Are you male or female?
01. Male
02. Female
96. other (specify) /GO TO 104oth/
77. DON’T KNOW/NOT SURE
99. REFUSED
104oth ENTER OTHER/SPECIFY
childle17
/ASK ALL/
97. How many children aged 17 or younger live in your household 6 months or more of the year?
/RANGE: 01-30/
/Q97VERI if number of children >= 08/
_ _ Number of children
88. NONE
99. REFUSED
Q97VERI
/ASK IF Q97 >= 08/
I am sorry. I just want to make sure I recorded this correctly. You said that there are \\:q97: children aged 17 or younger living in your household. Is that correct?
01 Yes - Continue
02 No – skip back to original question
telnosgt1
/Q105 telnosgt1 IS LANDLINE ONLY/
/ASK ALL/
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 Go to q107 STATERES
7. DON’T KNOW/NOT SURE Go to q107 STATERES
9. REFUSED Go to q107 STATERES
telnosres
/Q106
telnosres IS LANDLINE ONLY/
/ASK IF TELNOSGT1 (Q105) EQ 1/
106. How many of these are residential numbers?
/RANGE: 1-6/
[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
stateres
/ASK ALL/
107. What state do you live in?
01-56. State FIPS code
77. DON’T KNOW/NOT SURE
99. REFUSED
//STATE FIPS CODES FOR PROGRAMMING ARE BELOW//
01 Alabama
02 Alaska
04 Arizona
05 Arkansas
06 California
08 Colorado
09 Connecticut
10 Delaware
11 District of Columbia
12 Florida
13 Georgia
15 Hawaii
16 Idaho
17 Illinois
18 Indiana
19 Iowa
20 Kansas
21 Kentucky
22 Louisiana
23 Maine
24 Maryland
25 Massachusetts
26 Michigan
27 Minnesota
28 Mississippi
29 Missouri
30 Montana
31 Nebraska
32 Nevada
33 New Hampshire
34 New Jersey
35 New Mexico
36 New York
37 North Carolina
38 North Dakota
39 Ohio
40 Oklahoma
41 Oregon
42 Pennsylvania
44 Rhode Island
45 South Carolina
46 South Dakota
47 Tennessee
48 Texas
49 Utah
50 Vermont
51 Virginia
53 Washington
54 West Virginia
55 Wisconsin
56 Wyoming
77 DON’T KNOW
99 REFUSED
/ask Q108dc.if Q107=11/
Q108dc. What District Ward do you live in?
001 Ward 1
002 Ward 2
003 Ward 3
004 Ward 4
005 Ward 5
006 Ward 6
007 Ward 7
008 Ward 8
996 OTHER/SPECIFY /GO TO q108oth/
777 DON’T KNOW/NOT SURE
999 REFUSED
/ASK IF Q107= 1-10 OR 12-99/
PRE108
What [USE “county” UNLESS SAMPLE= DC, THEN “WARD”. IF SAMPLE=AL/ALASKA, THEN “BOROUGH”: IF SAMPLE= LA/LOUISIANA, THEN “PARISH”] do you live in?
001 GAVE COUNTY
777 DON’T KNOW/NOT SURE
999. REFUSED
countyfips
/ASK IF Q107= 1-10 OR 12-99/
//PROGRAMMING, PLEASE USE COUNTY FIPS CODES IN APPENDIX A/
_________ENTERFIPS CODE
/[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.]/
PRECHRON
/ASK ALL/
Now I want to ask you some questions about chronic conditions or diseases you might have.
heartdisease
/ASK ALL/
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
/ASK ALL/
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
/ASK ALL/
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
/ASK ALL/
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
/ASK ALL/
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
/ASK ALL/
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
/ASK ALL/
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
PRETAX
/ASK ALL/
Now I would like to ask you a few more questions about your opinions and attitudes related to tobacco.
cigtaxopn2
/ASK ALL/
116. 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 Go to Q118 SLTTAXOPN
7. DON’T KNOW/NOT SURE Go to Q118 SLTTAXOPN
9. REFUSED Go to Q118 SLTTAXOPN
cigtaxopn3
/ASK IF Q116 EQ 1.
/PROGRAMMING FOR Q117.1- Q117.3, First time answer 01 yes or 99 refused move past/skip Q117.4. If answer “77 don’t know” to any of Q117.1- Q117.3 go to next category, but do not progress beyond 1 don’t know response—that is if 2 77/don’t know responses IN A ROW are collected within Q117.1- Q117.3, move past/skip Q117.4.
/DATA Processing, Deliver like income (only the final yes, don’t know or rEFUSed respoNse)/
117. Current prices for a pack of cigarettes range from about four to eight dollars. Would you be in favor of an additional tax on a pack of cigarettes of…
Q117.1. More than two dollars a pack?
1 YES
2 NO
7 DON’T KNOW/ NOT SURE
9 REFUSED /GO TO Q118 SLTTAXOPN/
/ASK IF Q55.1=2 OR 7/
Q117.2. Up to two dollars a pack?
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /IF BOTH Q117.1 AND Q117.2 = 7 GO TO Q118 SLTTAXOPN/
9 REFUSED /GO TO Q118 SLTTAXOPN/
/ASK IF Q55.2=2 OR 7/
3. Up to one dollar a pack?
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /IF BOTH Q117.2 AND Q117.3 = 7 GO TO Q118 SLTTAXOPN/
9 REFUSED /GO TO Q118 SLTTAXOPN/
/ASK IF Q55.3=2 OR 7/
4. Up to fifty cents a pack?
1 YES
2 NO
7 DON’T KNOW/ NOT SURE /GO TO Q118 SLTTAXOPN/
9 REFUSED /GO TO Q118 SLTTAXOPN/
slttaxopn
/ASK ALL/
118. 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
rskaddictopn2
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,and 3. RESPONSE 2 SHOULD REMAIN STATIC AND ALWAYS BE THE SECOND ON THE LIST/
/ the display order of the text read to the respondent will be randomly altered for 119 rskaddictopn2 /
Q119dspl /Programmer: store randomly selected order in variable name: Q119dspl/
Values: Use Flag “1” for questions that appear as such:
1. Not at all addictive
2. Moderately addictive
3. Very addictive
Values: Use Flag “2” for questions that appear as such:
3. Very addictive
2. Moderately addictive
1. Not at all addictive
119. Overall, would you say that 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
teensellopn
/ASK ALL/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,and 3. RESPONSE 2 WILL REMAIN STATIC AND ALWAYS APPEAR AS THE SECOND RESPONSE/
/ the display order of the text read to the respondent will be randomly altered for 120 teensellopn/
Q120dspl /Programmer: store randomly selected order in variable name: Q120dspl /
Values: Use Flag “1” for questions as such:
1. Not at all important
2. Somewhat important
3. Very important
Values: Use Flag “2” for questions as such:
3. Very important
2. Somewhat important
1. Not at all important
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
/ASK ALL/
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
weartobco
/ASK IF AGE (Q103) EQ (18-29)/
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—
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,and 4
/ the display order of the text read to the respondent will be randomly altered for 122 weartobco/
Q122dspl /Programmer: store randomly selected order in variable name: Q122dspl /
Values:
1. Very likely
2. Somewhat likely
3. Somewhat unlikely
4. Very unlikely
[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
parenting
/ASK ALL/
123. Now I want to ask you about the importance of discussing tobacco use with children that you have a parental relationship with. Are you currently parenting any children aged 17 or younger?
1. Yes
2. No 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 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 IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR q6 smoklast <= 3, go to q126 HELPSMOKER, else go to q125 helpnonsmok
tobusediscuss
/ASK IF PARENTING (Q123) EQ 1/
/PROGRAMMER PLEASE RANDOMLY REVERSE RESPONSES 1,and 3. RESPONSE 2 WILL REMAIN STATIC AND ALWAYS APPEAR SECOND/
/ the display order of the text read to the respondent will be randomly altered for 124 tobusediscuss/
Q124dspl /Programmer: store randomly selected order in variable name: Q124dspl /
Values: Use Flag “1” for responses appearing as such:
1. Not at all important to you
2. Somewhat important to you
3. Very important to you
Values: Use Flag “2” for responses appearing as such:
3. Very important to you
2. Somewhat important to you
1. Not at all important to you
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/
helpnonsmok
ASK IF [SMOK100 (Q2) EQ (2 OR 7 OR 9) OR SMOKNOW (Q3) EQ (3 OR 9)] AND [SMOKEVER (Q5) EQ (2 OR 7 OR 9) OR SMOKLAST (Q6) EQ (04-10,77,99)]/
125. In order to help a someone you know stop smoking or using tobacco, would you like the 1-800 quitline telephone number or the address for a website?
1. YES /GO TO 125a QUITNO/
2. NO /GO TO Q127 INCOME2/
125A QUITNO
/ASK IF 125=1/
The quitline number is 1-800-QUIT NOW OR 1-800-7848669
A website that tells smokers about the help they can get to stop smoking is www.smokefree.gov.
01 CONTINUE
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).
/ASK [IF SMOK100 (Q2) EQ 1 AND SMOKNOW (Q3) EQ (1 OR 2)] OR [SMOKLAST (Q6) EQ (01-03]/
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 /GO TO 126A/
2. NO /GO TO PREFINAL /
126A
/ASK IF 126=1/
The quitline number is 1-800-QUIT NOW OR 1-800-784-8669.
A website that tells you about help you can get to stop smoking is www.smokefree.gov.
01 CONTINUE
PREFINAL
I have two final questions that are important to the CDC to develop effective programs. Please remember that all answers are private.
income2
/ASK ALL/
127. Is your annual household income from all sources…?
/CODES FOR DATA DELIVERY/
/IF AT ANY POINT 99/REFUSED is CODED, PLEASE CODE AS 99 FOR FINAL DELVERABLE/
04. Less
than $50,000 If "02 no," ask 05; if "01 yes," ask
03
($40,000 to less than $50,000)
03. Less
than $40,000 If "02 no," code 04; if "01 yes,"
ask 02
($30,000 to less than $40,000)
02. Less
than $30,000 If "02 no," code 03; if "01 yes,"
ask 01
($20,000 to less than $30,000)
01. Less than $20,000 If "02 no," code 02
05. Less
than $70,000 If "02 no," ask 06
($50,000 to less than
$70,000)
06. Less
than $100,000 If "02 no," ask 07
($70,000 to less than
$100,000)
07. Less
than $150,000 If "02 no," code 08
($100,000 to less
than $150,000)
08. $150,000 or more
[DO NOT READ]
77. DON’T KNOW/NOT SURE
99. REFUSED
/income04 through income08 are not part of deliverable/
/ask all/
Income2. Is your annual household income from all sources:
/ask all/
Income04.. Less than $50,000
01 YES
02 NO
77 DON’T KNOW/NOT SURE
99 REFUSED
/ask if income04.. =01/
Income03. Less than $40,000
01 YES
02 NO
77 DON’T
KNOW/NOT SURE
99 REFUSED
/Ask if income03=01/
Income02 Less than $30,000?
01 YES
02 NO
77 DON’T KNOW/NOT SURE
99 REFUSED
/Ask
if income02=1/
Income01
Less than $20,000?
01 YES
02 NO
77 DON’T KNOW/NOT SURE
99 REFUSED
/ASK IF INCOME04=2/
Income05 Less than $70,000
01 YES
02 NO
77 DON’T KNOW/NOT SURE
99 REFUSED
/ASK IF INCOME05=02/
INCOME06 Less than $100,000?
01 YES
02 NO
77 DON’T KNOW/NOT SURE
99 REFUSED
/ASK IF INCOME06=02/
Income07 Less than $150,000?
01 YES
02 NO /CODE AS INCOME 08/
77 DON’T KNOW/NOT SURE
99 REFUSED
INCOME AA
//NOT FOR DELVIERY//
INTERVIEWER:
IF INCOME EQ 1:
Your annual household income is less than $20,000. Is this correct?
[Y/N]
IF INCOME EQ (2 OR 3 OR 4 OR 5 OR 6 OR 7:
Your annual household income is between [RESPONSE CATEGORY -1] and [RESPONSE CATEGORY]. Is this correct?
[Y/N]
IF INCOME EQ 8:
Your annual household income is more than $150,000. Is this correct?
[Y/N]
IS THIS CORRECT?
01 No, re-ask question
02 Yes, correct as is
sexualorient
/ASK ALL/
[INTERVIEWER: AS THE QUESTION IS READ, READ ALOUD THE NUMBERS, that is, "1. Heterosexual or straight; 2. Gay or lesbian; 3. Bisexual, 4. Transgender." 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. Transgender
[DO NOT READ]
96. OTHER (SPECIFY) /GO TO 128oth/
6. respondent Does not understand responses
7. DON’T KNOW/NOT SURE
9. REFUSED
128oth ENTER OTHER/SPECIFY
/LANDLINE STUDY ONLY/
LCLOSE
That’s my last question. Everyone’s answers will be combined to give us information about tobacco in the U.S. The information you have provided will be used to help improve the health of people all across the US.
Thank you very much for your time and cooperation. /GO TO LANGUAGE/
/CELL PHONE STUDY ONLY/
CCLOSE
That’s my last question. Everyone’s answers will be combined to give us information about tobacco in the U.S. The information you have provided will be used to help improve the health of people all across the US. As a thank you, we would like to give you a $/ Amazon.com® gift certificate. Would you like the gift code now or later?
[INTERVIEWER IF ASKED: THE CODE IS SOMETHING YOU CAN USE ONLINE AT AMAZON.COM. IT’S LIKE A GIFT CERTIFICATE. WE JUST GIVE YOU THE UNIQUE CODE AND YOU ENTER THE CODE IN ONLINE WHEN YOU MAKE A PURCHASE AT AMAZON.COM]
01 Get it now /GO TO GETNOW/
02 Get it later /GO TO LATER AND ASSIGN SPECIAL DISP #//
99 DECLINED INCENTIVE/REFUSED /TERM/
/ASK IF (CCLOSE=01) OR If NOTEXT=01/
GETNOW
Ok. Your gift code is [XXX XXXXX]—/need to insert from gift code file THEN GO TO FINAL CLOSE/
/ASK IF CCLOSE=02
LATER
No problem. Would you like us to text message the gift certificate or would you like to call us back at your convenience?
01 Text message /GO TO TEXT/
02 Call back when convenient /GO TO CALLBACK/
99 DECLINED INCENTIVE/REFUSED /TERM/
/ASK IF LATER=01/
Text. We’ll text you the gift certificate within 24 hours. Please let us know your carrier.
Do not read:
01 Alltel
02 AT&T (Cingular)
03 CellularOne
04 Centennial
05 Leap (Cricket)
06 MetroPCS
07 Nextel
08 Quest
09 Sprint
10 Suncom
11 T-Mobile
12 Unicel (Rural Cellular)
13 US Cellular
14 Verizon
15 None of these
77 Don’t know
99 Refused
/ASK IF TEXT=15, 77, or 99/
NOTEXT. I’m sorry, we can’t text message this provider. Would you like the number of the Amazon.com® gift certificate now or would you like to call us back at your convenience?
01 Get it now /GO TO GETNOW/
02 Call back when convenient /GO TO CALLBACK/
/ASK IF (NOTEXT=02) OR IF (LATER=02)/
CALLBACK
Please call us at [1-XXX-XXX-XXXX ] to get the gift certificate. It will be available for 30 days. /GO TO FINAL CLOSE/
FCLOSE
Thank you very much for your time and cooperation. /GO TO LANGUAGE/
/FOR ALL INTERVIEWERS/
language
129. [INTERVIEWER, In what language was the interview conducted? If more than one, indicate the predominant language used.]
01. English
02. Spanish
Page
| File Type | application/msword |
| File Title | ATS Questions 2008 |
| Author | Peter Mariolis |
| Last Modified By | Naomi L. Freedner |
| File Modified | 2009-10-06 |
| File Created | 2009-10-02 |
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