Attachment B-1. Sample questionnaire to be pretested through Generic Questionnaire Clearance (TUS-CPS Tobacco Questionnaire)
OMB#0925-xxxx
EXP:xx/xxxx
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Public reporting burden for this collection of information is estimated to average 15 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form to this address.
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NCI Tobacco Use Supplement to the Current Population Survey (TUS-CPS)
DRAFT: October, 2007
--------------------------------------------------------------------------------------SECTION A. SCREENING – ALL RESPONDENTS
A1 Have you smoked at least 100 cigarettes in your entire life?
[100 CIGARETTES = APPROXIMATELY 5 PACKS]
1 YES
2 NO TERMINATE
-7 REFUSED TERMINATE
-8 DON’T KNOW TERMINATE
A2 How old were you when you first started smoking cigarettes fairly regularly?
__________________
AGE
1 NEVER SMOKED REGULARLY
-7 REFUSED
-8 DON’T KNOW
A3 Do you now smoke cigarettes every day, some days, or not at all?
1 EVERY DAY GO TO SECTION B
2 SOME DAYS GO TO SECTION C
3 NOT AT ALL GO TO SECTION H
-7 REFUSED TERMINATE
-8 DON’T KNOW TERMINATE
SECTION B. EVERY DAY SMOKER HISTORY/CONSUMPTION SERIES
B1 On the average, about how many cigarettes do you now smoke each day?
[ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.]
______________ GO TO B2
NUMBER
-7 REFUSED GO TO B1a
-8 DON’T KNOW GO TO B1a
B1a Would you say that, on average, you now smoke more or less than 20 cigarettes each day?
1 MORE
2 LESS
3 ABOUT 20 (ONE PACK)
-7 REFUSED
-8 DON’T KNOW
B2 Is your usual cigarette brand menthol or non-menthol?
1 MENTHOL
2 NON-MENTHOL
3 NO USUAL TYPE
-7 REFUSED
-8 DON’T KNOW
B3 What type of cigarette do you now smoke most often -- a regular, a light, an ultralight, or
some other type?
1 REGULAR/FULL FLAVOR GO TO B5a
2 LIGHT/MILD
3 ULTRA-LIGHT
4 NO USUAL TYPE GO TO B5a
5 SOME OTHER TYPE (SPECIFY)______________________________ GO TO B5a
-7 REFUSED GO TO B5a
-8 DON’T KNOW GO TO B5a
B4 Please tell me if each of the following is true for you.
(A) You now smoke (lights/ultralights) because you feel that they are less harmful to your
health than regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(B) You now smoke (lights/ultralights) as a way to try to quit smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(C) You now smoke (lights/ultralights) because they have a smoother flavor or lighter taste
than regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF B4(A) AND B4(B) ARE BOTH TRUE, GO TO B4d.
OTHERWISE, GO TO B5a.
B4d Which is the more important reason that you smoke (lights/ultralights) -- because you feel
they are less harmful to your health, or because you’re trying to quit?
1 LESS HARMFUL
2 TRYING TO QUIT
-7 REFUSED
-8 DON’T KNOW
B5a How soon after you wake up do you typically smoke your first cigarette of the day?
___________ 1 MINUTES GO TO B5c 2 HOURS GO TO B5c
NUMBER
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
B5b Would you say you smoke your first cigarette of the day within the first 30 minutes?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
B5c Please tell me if each of the following statements is true for you. You may answer with true
or false, or with yes or no.
(A) You have trouble going more than a few hours without smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(B) Even in a bad rainstorm, if you ran out of cigarettes, you would probably go to the
store to get some more.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(C) When you go without smoking for a few hours, you experience craving.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(D) If you were in a public place where smoking isn’t allowed, you’d probably go outside
to smoke a cigarette, even in cold or rainy weather.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
B6a Do you usually buy your cigarettes by the pack or by the carton?
1 PACK
2 CARTON GO TO B6c
3 BUY BOTH PACKS AND CARTONS
4 DON’T BUY OWN CIGARETTES GO TO B7
-7 REFUSED
-8 DON’T KNOW
B6b What price did you pay for the last pack of cigarettes you bought? Please report the cost after using discounts or coupons.
$___.___ ___ GO TO B6d
-7 REFUSED GO TO B6d
-8 DON’T KNOW GO TO B6d
B6c What price did you pay for the last carton of cigarettes you bought? Please report the cost
after using discounts or coupons.
$__ __.__ __
-7 REFUSED
-8 DON’T KNOW
B6d Did y
ou buy your last (pack/carton) of cigarettes in [RESPONDENT’S STATE OF
RESIDENCE] or in some other state?
1 IN STATE OF RESIDENCE (SPECIFY) ____________________
2 IN SOME OTHER STATE OR DC (SPECIFY) ____________________________
3 BOUGHT SOME OTHER WAY (INTERNET, OTHER COUNTRY) (SPECIFY)
_____________________________________________________________________
-7 REFUSED
-8 DON’T KNOW
B7 What is the total number of years you have smoked every day? Do not include any time
you stayed off cigarettes for 6 months or longer.
________________
YEARS
1 LESS THAN 1 YEAR
2 NONE
-7 REFUSED
-8 DON’T KNOW
B8 Around this time 12 months ago, were you smoking cigarettes every day, some days, or not at all?
1 EVERY DAY
2 SOME DAYS
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
B9 Have you ever switched from a stronger cigarette to a lighter cigarette for at least 6
months?
1 YES
2 NO GO TO B11
-7 REFUSED GO TO B11
-8 DON’T KNOW GO TO B11
B10 For each of the following statements, please tell me whether it is a reason that you switched from a stronger to a lighter cigarette.
(1) You switched because you felt that a lighter cigarette would be less harmful to your
health.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(2) You switched as a way to try to quit smoking.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(3) You switched to get a smoother or lighter flavor.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF B10(1) AND B10(2) ARE BOTH YES, GO TO B10b.
OTHERWISE, GO TO B11.
B10b Which is the main reason you switched from a stronger to a lighter cigarette -- as a way to try to quit smoking, or in order to smoke a less harmful cigarette?
1 QUIT SMOKING
2 TO SMOKE A LESS HARMFUL CIGARETTE
-7 REFUSED
-8 DON’T KNOW
B11 I’m going to read you some statements about how light cigarettes compare to regular
cigarettes. For each one, please tell me whether, in your opinion, you think it is true, false,
or you don’t know.
(1) Light cigarettes give you less tar or nicotine than regular cigarettes.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
(2) Light cigarettes are safer to smoke.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
(3) Light cigarettes feel smoother and easier on your chest.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
GO TO D1, THE SECOND QUESTION IN SECTION D
SECTION C. SOME DAY SMOKER HISTORY/CONSUMPTION SERIES
C1 On how many of the past 30 days did you smoke cigarettes?
1 NONE GO TO C2
2 30 DAYS
3 LESS THAN 30 DAYS (SPECIFY) _____________________________
-7 REFUSED GO TO C2
-8 DON’T KNOW GO TO C2
C1a On the average, on those [ANSWER FROM C1] days, how many cigarettes did you usually smoke each day?
[ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.]
______________
NUMBER
-7 REFUSED
-8 DON’T KNOW
C2 Is your usual cigarette brand menthol or non-menthol?
1 MENTHOL
2 NON-MENTHOL
3 NO USUAL TYPE
-7 REFUSED
-8 DON’T KNOW
C3 What type of cigarette do you now smoke most often -- a regular, a light, an ultralight, or some other type?
1 REGULAR/FULL FLAVOR GO TO C5a
2 LIGHT/MILD
3 ULTRA-LIGHT
4 NO USUAL TYPE GO TO C5a
5 SOME OTHER TYPE (SPECIFY) ______________________________ GO TO C5a
-7 REFUSED GO TO C5a
-8 DON’T KNOW GO TO C5a
C4 Please tell me if each of the following is true for you.
(1) You now smoke (lights/ultralights) because you feel that they are less harmful to your
health than regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(2) You now smoke (lights/ultralights) as a way to try to quit smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(3) You now smoke (lights/ultralights) because they have a smoother flavor or lighter taste
than regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF C4(1) AND C4(2) ARE BOTH TRUE, GO TO C4d.
OTHERWISE, GO TO C5a.
C4d Which is the more important reason that you smoke (lights/ultralights) -- because you feel they are less harmful to your health, or because you’re trying to quit?
1 LESS HARMFUL
2 TRYING TO QUIT
-7 REFUSED
-8 DON’T KNOW
C5a On the days that you smoke, how soon after you wake up do you typically smoke your first cigarette of the day?
___________ 1 MINUTES GO TO C6a 2 HOURS GO TO C6a
NUMBER
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
C5b On the days that you smoke, would you say you smoke your first cigarette of the day within the first 30 minutes?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
C6a Do you usually buy your cigarettes by the pack or by the carton?
1 PACK
2 CARTON GO TO C6c
3 BUY BOTH PACKS AND CARTONS
4 DON’T BUY OWN CIGARETTES GO TO C7a
-7 REFUSED
-8 DON’T KNOW
C6b What price did you pay for the last pack of cigarettes you bought? Please report the cost after using discounts or coupons.
$___. ___ ___ GO TO C6d
-7 REFUSED GO TO C6d
8 DON’T KNOW GO TO C6d
C6c What price did you pay for the last carton of cigarettes you bought? Please report the cost after using discounts or coupons.
$__ __.__ __
-7 REFUSED
-8 DON’T KNOW
C6d Did you buy your last (pack/carton) of cigarettes in [RESPONDENT’S STATE OF
RESIDENCE] or in some other state.
1 IN STATE OF RESIDENCE (SPECIFY) _________________________
2 IN SOME OTHER STATE OR DC (SPECIFY) ________________________
3 BOUGHT SOME OTHER WAY (INTERNET, OTHER COUNTRY) (SPECIFY)
_____________________________________________________________________
-7 REFUSED
-8 DON’T KNOW
C7a Have you ever smoked cigarettes every day for at least 6 months?
1 YES
2 NO GO TO C8
-7 REFUSED GO TO C8
-8 DON’T KNOW GO TO C8
C7b About how long has it been since you last smoked cigarettes every day?
_______ 1 DAYS
NUMBER 2 WEEKS
3 MONTHS
4 YEARS
-7 REFUSED
-8 DON’T KNOW
C7c When you last smoked every day, on average how many cigarettes did you smoke each day?
______________
NUMBER
-8 DON’T KNOW
-7 REFUSED
C7d What is the total number of years you smoked every day? Do not include any time you stayed off cigarettes for 6 months or longer.
__________
YEARS
1 LESS THAN 1 YEAR
2 NONE
-7 REFUSED
-8 DON’T KNOW
C8 Around this time 12 months ago, were you smoking cigarettes every day, some days, or not at all?
1 EVERY DAY
2 SOME DAYS
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
C9 Have you ever switched from a stronger cigarette to a lighter cigarette for a period of 6 months or longer?
1 YES
2 NO GO TO C11
-7 REFUSED GO TO C11
-8 DON’T KNOW GO TO C11
15
C10 For each of the following statements, please tell me whether it is a reason that you switched from a stronger to a lighter cigarette.
(A) You switched because you felt that a lighter cigarette would be less harmful to your health.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(B) You switched as a way to try to quit smoking.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(C) You switched to get a smoother or lighter flavor.
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF C10(A) AND C10(B) ARE BOTH YES, GO TO C10b.
OTHERWISE, GO TO C11.
C10b Which is the main reason you switched from a stronger to a lighter cigarette -- as a way to try to quit smoking, or in order to smoke a less harmful cigarette?
1 QUIT SMOKING
2 TO SMOKE A LESS HARMFUL CIGARETTE
-7 REFUSED
-8 DON’T KNOW
C11 I’m going to read you some statements about how light cigarettes compare to regular cigarettes. For each one, please tell me whether, in your opinion, you think it is true, false, or you don’t know.
(A) Light cigarettes give you less tar or nicotine than regular cigarettes.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
(B) Light cigarettes are safer to smoke.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
(C) Light cigarettes feel smoother and easier on your chest.
1 TRUE
2 FALSE
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF C1 IS 12 DAYS OR MORE, GO TO D.
OTHERWISE, GO TO Da.
SECTION D. PAST 12-MONTH QUIT ATTEMPTS –
EVERY DAY AND SOME DAY SMOKERS
Da During the past 12 months, have you tried to quit smoking completely?
1 YES GO TO D4
2 NO GO TO F1
-7 REFUSED
-8 DON’T KNOW
D1 Have you ever stopped smoking for one day or longer because you were trying to quit
smoking?
1 YES
2 NO GO TO D7
-7 REFUSED GO TO D7
-8 DON’T KNOW GO TO D7
D2 During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit smoking?
1 YES
2 NO GO TO D8
-7 REFUSED GO TO D8
-8 DON’T KNOW GO TO D8
D3 How many times during the past 12 months have you stopped smoking for one day or
longer because you were trying to quit smoking?
1 1 GO TO D6
2 10 OR LESS (SPECIFY) ____________ GO TO D4
3 MORE THAN 10 (SPECIFY) _________ GO TO D4
-7 REFUSED
-8 DON’T KNOW
D3b Would you say that it was more or less than 3 times?
1 MORE THAN 3 TIMES
2 LESS THAN 3 TIMES
-7 REFUSED
-8 DON’T KNOW
D4 The last time you stopped smoking during the past 12 months because you were trying to quit, how long did you stop for?
_________ 1 DAYS
NUMBER 2 WEEKS
3 MONTHS
-7 REFUSED GO TO D6
-8 DON’T KNOW GO TO D6
D5 Was [ANSWER FROM D4] the longest you went without smoking in the past 12 months?
1 YES GO TO SECTION E
2 NO
-7 REFUSED
-8 DON’T KNOW
D6 During the past 12 months, what is the longest length of time you stopped smoking because you were trying to quit smoking?
_________ 1 DAYS GO TO SECTION E
NUMBER 2 WEEKS GO TO SECTION E
3 MONTHS GO TO SECTION E
-7 REFUSED GO TO D6b
-8 DON’T KNOW GO TO D6b
D6b Was it more or less than one week?
1 MORE GO TO SECTION E
2 LESS GO TO SECTION E
3 ONE WEEK GO TO SECTION E
-7 REFUSED GO TO SECTION E
-8 DON’T KNOW GO TO SECTION E
D7 Have you ever made a serious attempt to stop smoking because you were trying to quit --
even if you stopped for less than a day?
1 YES
2 NO GO TO SECTION F
-7 REFUSED GO TO SECTION F
-8 DON’T KNOW GO TO SECTION F
D8 During the past 12 months, have you made a serious attempt to stop smoking because you were trying to quit?
1 YES
2 NO GO TO SECTION F
-7 REFUSED GO TO SECTION F
-8 DON’T KNOW GO TO SECTION F
SECTION E. METHODS USED DURING PAST (12-MONTH) QUIT
ATTEMPTS – EVERY DAY AND SOME DAY SMOKERS
INTERVIEWER INSTRUCTION
IF D3 = 1, USE “TIME” IN SECTION E.
OTHERWISE, USE “LAST TIME.”
E1 Thinking back to the (last time/time) you tried to quit smoking in the past 12 months, did you use any of the following products?
A nicotine gum 1 YES 2 NO -7 REF -8 DK
A nicotine patch 1 YES 2 NO -7 REF -8 DK
A nicotine nasal spray 1 YES 2 NO -7 REF -8 DK
A nicotine inhaler 1 YES 2 NO -7 REF -8 DK
A nicotine lozenge 1 YES 2 NO -7 REF -8 DK
A nicotine tablet 1 YES 2 NO -7 REF -8 DK
A prescription pill, such as Zyban, Buproprion,
or Wellbutrin 1 YES 2 NO -7 REF -8 DK
E1b Thinking back to the (last time/time) you tried to quit smoking in the past 12 months, did you use any of the following?
(A) A telephone help line or quit line 1 YES 2 NO -7 REF -8 DK
(B) A stop smoking clinic, class, or
support group 1 YES 2 NO -7 REF -8 DK
(C) One-on-one counseling 1 YES 2 NO -7 REF -8 DK
(D) Help or support from friends or family 1 YES 2 NO -7 REF -8 DK
(E) The Internet or World Wide Web 1 YES 2 NO -7 REF -8 DK
(F) Books, pamphlets, videos, or other materials 1 YES 2 NO -7 REF -8 DK
(G) Acupuncture 1 YES 2 NO -7 REF -8 DK
(H) Hypnosis 1 YES 2 NO -7 REF -8 DK
E1c The (last time/time) you tried to quit smoking in the past 12 months, did you do any of the following?
(A) Try to quit by gradually cutting back on
cigarettes? 1 YES 2 NO -7 REF -8 DK
(B) Try to quit by switching to chewing tobacco, snuff, cigars, or pipes? 1 YES 2 NO -7 REF -8 DK
(C) Did you switch to a lighter cigarette in order to try to quit? 1 YES 2 NO -7 REF -8 DK
(D) Did you try to give up cigarettes all at once? 1 YES 2 NO -7 REF -8 DK
[IF E1c(D) = YES, ASK] Would you say you tried to quit “cold turkey” or tried in some
other way?
1 COLD TURKEY
2 OTHER (SPECIFY) __________________________________________
-7 REFUSED
-8 DON’T KNOW
E2 The (last time/time) you tried to quit smoking in the past 12 months, did you use any other methods or products?
1 YES (SPECIFY) _________________________________________________________
2 NO
-7 REFUSED
-8 DON’T KNOW
SECTION F. DOCTOR/DENTIST ADVICE TO STOP SMOKING –
EVERY DAY AND SOME DAY SMOKERS
F1 In the past 12 months, have you seen a medical doctor, dentist, nurse, or other health
professional?
1 YES
2 NO GO TO SECTION G
-7 REFUSED
-8 DON’T KNOW
F2 During the past 12 months, did any doctor, dentist, nurse, or other health professional
advise you to quit smoking?
1 YES
2 NO GO TO SECTION G
-7 REFUSED GO TO SECTION G
-8 DON’T KNOW GO TO SECTION G
F3 In the past 12 months, when any of these health professionals advised you to quit smoking, did they also…
(A) Prescribe a nicotine nasal spray, a patch, an inhaler, a lozenge or pills such as Zyban?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(B) Recommend nicotine gum, a patch, or other non-prescription product containing nicotine?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(C) Suggest that you set a specific date to stop smoking?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(D) Suggest that you use a smoking cessation class, program, quit line or counseling?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(E) Provide you with booklets, videos, or other materials to help you quit smoking on your
own?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF ANY OF F3(A) THROUGH F3(E) ARE YES, GO TO F5.
OTHERWISE, GO TO F4.
F4 During the past 12 months, did any doctor, dentist, nurse, or other health professional
spend any time talking to you about how you should try to quit smoking?
1 YES
2 NO GO TO SECTION G
-7 REFUSED GO TO SECTION G
-8 DON’T KNOW GO TO SECTION G
F5. Which health professional that you saw in the past 12 months spent the most time advising you about quitting smoking?
1 MEDICAL DOCTOR
2 NURSE
3 DENTIST
4 DENTAL HYGIENIST
5 OTHER HEALTH PROFESSIONAL (SPECIFY)
___________________________________
-7 REFUSED
-8 DON’T KNOW
SECTION G. STAGES OF CHANGE –
EVERY DAY AND SOME DAY SMOKERS
G1 Are you seriously considering quitting smoking within the next 6 months?
1 YES
2 NO GO TO G3
-7 REFUSED
-8 DON’T KNOW
G2 Are you planning to quit within the next 30 days?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
G3 Overall, on a scale from 1 to 10 where 1 is not at all interested and 10 is extremely
interested, how interested are you in quitting smoking?
_______
NUMBER
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF G3=1, GO TO SECTION J. OTHERWISE, CONTINUE.
G4 If you did try to quit smoking altogether in the next 6 months, how likely do you think you would be to succeed -- not at all, a little likely, somewhat likely or very likely?
1 NOT AT ALL
2 A LITTLE LIKELY
3 SOMEWHAT LIKELY
4 VERY LIKELY
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
GO TO SECTION J.
SECTION H. FORMER SMOKER SERIES – HISTORY/CONSUMPTION
QUIT METHODS, DOCTOR/DENTIST ADVICE
H1 About how long has it been since you completely quit smoking cigarettes?
_________ 1 DAYS
NUMBER 2 WEEKS
3 MONTHS
4 YEARS
-7 REFUSED
-8 DON’T KNOW
H2 Have you ever smoked cigarettes every day for at least 6 months?
1 YES
2 NO GO TO THE BOX BEFORE H6
-7 REFUSED GO TO THE BOX BEFORE H6
-8 DON’T KNOW GO TO THE BOX BEFORE H6
H3 About how long has it been since you last smoked cigarettes every day?
_________ 1 DAYS
NUMBER 2 WEEKS
3 MONTHS
4 YEARS
-7 REFUSED
-8 DON’T KNOW
H4 When you last smoked every day, on average how many cigarettes did you smoke each day?
[ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.]
________
NUMBER
-7 REFUSED
-8 DON’T KNOW
H5 Altogether, about how many years did you smoke every day? Do not include any time you
stayed off cigarettes for 6 months or longer.
_________
YEARS
1 LESS THAN 1 YEAR
2 NONE
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF H1 IS 1 YEAR OR LESS, GO TO H6.
IF H1 IS 5 YEARS OR MORE, GO TO SECTION J.
IF H1 IS MORE THAN 1 YEAR BUT LESS THAN 5 YEARS, DON’T KNOW
OR REFUSED, GO TO H7a.
H6 Around this time 12 months ago, were you smoking cigarettes every day, some days, or not at all?
1 EVERY DAY
2 SOME DAYS
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
H6a In the past 12 months, have you seen a doctor, dentist, or other health professional?
1 YES
2 NO GO TO H7a
-7 REFUSED
-8 DON’T KNOW
H6b During the past 12 months, did any doctor, dentist, or other health professional advise you to stop smoking?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
H7a Think back to the year before you quit smoking. During that time, was your usual cigarette brand menthol or non-menthol?
1 MENTHOL
2 NON-MENTHOL
3 NO USUAL TYPE
-7 REFUSED
-8 DON’T KNOW
H7b Again, in the year before you quit smoking, what type of cigarette did you smoke most often -- a regular, a light, an ultralight, or some other type?
1 REGULAR/FULL FLAVOR GO TO H8a
2 LIGHT/MILD
3 ULTRA-LIGHT
4 NO USUAL TYPE GO TO H8a
5 SOME OTHER TYPE (SPECIFY) _____________________________ GO TO H8a
-7 REFUSED GO TO H8a
-8 DON’T KNOW GO TO H8a
H7c In the year before you quit smoking, please tell me if each of the following was true for you.
(1) You smoked (lights/ultralights) because you felt that they were less harmful to your health than regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(2) You smoked (lights/ultralights) as a way to try to quit smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(3) You smoked (lights/ultralights) because they had a smoother flavor or lighter taste than
regular cigarettes.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF H7c(1) AND H7c(2) ARE BOTH TRUE, GO TO H7d.
OTHERWISE, GO TO H8a.
H7d Which was the more important reason that you smoked (lights/ultralights) in the year before you quit smoking - because you felt they were less harmful to your health, or because you were trying to quit?
1 LESS HARMFUL
2 TRYING TO QUIT
-7 REFUSED
-8 DON’T KNOW
H8a During the year before you quit smoking, how soon after you woke up did you typically
smoke your first cigarette of the day?
___________ 1 MINUTES GO TO H9 2 HOURS GO TO H9
NUMBER
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
H8b During the year before you quit smoking, would you say you smoked your first cigarette of the day within the first 30 minutes of awakening?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
H9 During the year before you quit smoking, please tell me if each of the following statements was true for you. You may answer with true or false, or with yes or no.
(A) You had trouble going more than a few hours without smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(B) Even in a bad rainstorm, if you ran out of cigarettes, you would probably go to the store to get some more.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(C) When you went without smoking for a few hours, you experienced craving.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(D) If you were in a public place where smoking wasn’t allowed, you would probably go
outside to smoke a cigarette, even in cold or rainy weather.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
H10a Now I would like to ask about how you went about completely quitting smoking. When you quit smoking completely, did you use any of the following products?
A nicotine gum 1 YES 2 NO -7 REF -8 DK
A nicotine patch 1 YES 2 NO -7 REF -8 DK
A nicotine nasal spray 1 YES 2 NO -7 REF -8 DK
A nicotine inhaler 1 YES 2 NO -7 REF -8 DK
A nicotine lozenge 1 YES 2 NO -7 REF -8 DK
A nicotine tablet 1 YES 2 NO -7 REF -8 DK
A prescription pill, such as Zyban, Buproprion, or Wellbutrin 1 YES 2 NO -7 REF -8 DK
H10b When you quit smoking completely did you use any of the following?
(A) A telephone help line or quit line 1 YES 2 NO -7 REF -8 DK
(B) A stop smoking clinic, class, or support group 1 YES 2 NO -7 REF -8 DK
(C) One-on-one counseling 1 YES 2 NO -7 REF -8 DK
(D) Help or support from friends or family 1 YES 2 NO -7 REF -8 DK
(E) The Internet or World Wide Web 1 YES 2 NO -7 REF -8 DK
(F) Books, pamphlets, videos, or other materials 1 YES 2 NO -7 REF -8 DK
(G) Acupuncture 1 YES 2 NO -7 REF -8 DK
(H) Hypnosis 1 YES 2 NO -7 REF -8 DK
H10c When you quit smoking completely did you do any of the following? Please mention all methods, whether or not you think they were effective.
(A) Try to quit by gradually cutting back on cigarettes? 1 YES 2 NO -7 REF -8 DK
(B) Try to quit by switching to chewing tobacco,
snuff cigars, or pipes? 1 YES 2 NO -7 REF -8 DK
(C) Did you switch to a lighter cigarette in order
to try to quit? 1 YES 2 NO -7 REF -8 DK
(D) Did you try to give up cigarettes all at once? 1 YES 2 NO -7 REF -8 DK
[IF H10c(D)=YES, ASK] Would you say you tried to quit “cold turkey” or tried in
some other way?
1 COLD TURKEY
2 OTHER (SPECIFY) __________________________________________
-7 REFUSED
-8 DON’T KNOW
H11a When you quit smoking completely -- Did you use any other methods or products?
1 YES (SPECIFY) _________________________________________________________
2 NO
-7 REFUSED
-8 DON’T KNOW
H12 During the time that you did smoke, have you ever switched from a stronger cigarette to a lighter cigarette for at least 6 months?
1 YES
2 NO GO TO SECTION J
-7 REFUSED GO TO SECTION J
-8 DON’T KNOW GO TO SECTION J
H13 For each of the following statements, please tell me whether it is a reason that you switched from a stronger to a lighter cigarette.
(A) You switched because you felt that a lighter cigarette would be less harmful to your health.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(B) You switched as a way to try to quit smoking.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
(C) You switched to get a smoother or lighter flavor.
1 TRUE/YES
2 FALSE/NO
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF H13(A) AND H13(B) ARE BOTH TRUE, GO TO H13d.
OTHERWISE, GO TO SECTION J.
H13d Which is the main reason you switched from a stronger to a lighter type of cigarette - as a way to try to quit smoking, or to smoke a less harmful cigarette?
1 QUIT SMOKING
2 TO SMOKE A LESS HARMFUL CIGARETTE
-7 REFUSED
-8 DON’T KNOW
SECTION J. OTHER TOBACCO USE – ALL RESPONDENTS
The next questions are about the use of tobacco other than in cigarettes.
PIPE SERIES
J1a Have you ever used a pipe, even one time?
1 YES
2 NO GO TO J1b
-7 REFUSED
-8 DON’T KNOW
J2a Do you now smoke a pipe every day, some days or not at all?
1 EVERY DAY
2 SOME DAYS
(A) On how many of the past 30 days did you smoke a pipe?
1 LESS THAN 30 (SPECIFY) _________
2 30
3 NONE
-7 REFUSED
-8 DON’T KNOW
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF R IS NOT A CURRENT CIGARETTE SMOKER (A3 ≠ “EVERY DAY” OR
“SOME DAYS”), AND J2a = “EVERY DAY,” CONTINUE.
OTHERWISE, GO TO J1b (CIGAR SERIES).
J3a_1 How soon after you wake up do you typically first smoke a pipe?
_______ 1 MinutesGO TO J1b
NUMBER 2 Hours GO TO J1b
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
J3a_2 Would you say you smoke your first pipe of the day within the first 30 minutes of
awakening?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
CIGAR SERIES
J1b. Have you ever used a cigar, even one time?
1 YES
2 NO GO TO J1c
-7 REFUSED
-8 DON’T KNOW
J2b Do you now smoke cigars every day, some days or not at all?
1 EVERY DAY
2 SOME DAYS
(A) On how many of the past 30 days did you smoke a cigar?
1 LESS THAN 30 (SPECIFY) _________
2 30
3 NONE
-7 REFUSED
-8 DON’T KNOW
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF R IS NOT A CURRENT CIGARETTE SMOKER (A3 ≠ “EVERY DAY OR
“SOME DAYS), AND J2b = “EVERY DAY,” CONTINUE.
OTHERWISE, GO TO J1c (CHEWING TOBACCO SERIES).
J3b_1 How soon after you wake up do you typically smoke your first cigar?
_______ 1 MinutesGO TO J1c
NUMBER 2 Hours GO TO J1c
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
J3b_2 Would you say you smoke your first cigar of the day within the first 30 minutes of
awakening?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
CHEWING TOBACCO SERIES
J1c. Have you ever used chewing tobacco, even one time?
[“USED CHEWING TOBACCO” INCLUDES PRODUCTS SUCH AS REDMAN, LEVI GARRETT, OR BEECHNUT AS WELL AS OTHER PRODUCTS.]
1 YES
2 NO GO TO J1d
-7 REFUSED
-8 DON’T KNOW
J2c Do you now use chewing tobacco every day, some days or not at all?
1 EVERY DAY
2 SOME DAYS
(A) On how many of the past 30 days did you use chewing tobacco?
1 LESS THAN 30 (SPECIFY) _________
2 30
3 NONE
-7 REFUSED
-8 DON’T KNOW
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF R IS NOT A CURRENT CIGARETTE SMOKER (A3 ≠ “EVERY DAY” OR
“SOME DAYS”), AND J2c = “EVERY DAY,” CONTINUE.
OTHERWISE, GO TO J1d (SNUFF SERIES).
J3c_1 How soon after you wake up do you typically first use chewing tobacco?
_______ 1 MinutesGO TO J1d
NUMBER 2 Hours GO TO J1d
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
J3c_2 Would you say you first use chewing tobacco within the first 30 minutes of awakening?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
SNUFF SERIES
J1d. Have you ever used snuff, even one time?
[“USED SNUFF” INCLUDES PRODUCTS SUCH AS SKOAL, SKOAL BANDITS, OR
COPENHAGEN AS WELL AS OTHER PRODUCTS.]
[SNUFF, A FINELY GROUND OR SHREDDED TOBACCO, IS PACKAGED AS DRY, MOIST, OR IN SACHETS, WHICH ARE TEA-BAG LIKE POUCHES. TYPICALLY, THE USER PLACES A PINCH OR DIP BETWEEN THE CHEEK AND GUM.]
1 YES
2 NO GO TO BOX BEFORE J4
-7 REFUSED
-8 DON’T KNOW
J2d Do you now use snuff every day, some days or not at all?
1 EVERY DAY
2 SOME DAYS
(A) On how many of the past 30 days did you use snuff?
1 LESS THAN 30 (SPECIFY) _________
2 30
3 NONE
-7 REFUSED
-8 DON’T KNOW
3 NOT AT ALL
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
IF R IS A CURRENT CIGARETTE SMOKER (A3 =“EVERY DAY” OR
“SOME DAYS”), GO TO SECTION JJ.
OTHERWISE, CONTINUE.
J3d_1 How soon after you wake up do you typically first use snuff?
_______ 1 MinutesGO TO BOX BEFORE J4
NUMBER 2 Hours GO TO BOX BEFORE J4
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
J3d_2 Would you say you first use snuff within the first 30 minutes of awakening?
1 YES
2 NO
3 IT VARIES
-7 REFUSED
-8 DON’T KNOW
INTERVIEWER INSTRUCTION
FOR J4 THROUGH J7d@1, ASK ABOUT THE TOBACCO PRODUCT
MENTIONED IN J2a, J2b, J2c, or J2d THAT IS USED EVERY DAY OR
SOME DAYS FOR 12 OR MORE OF THE PAST 30 DAYS.
IF MORE THAN ONE TOBACCO PRODUCT IS USED FOR THAT
AMOUNT OF TIME, USE THE FOLLOWING HIERARCHY TO SELECT
ONE PRODUCT TO ASK ABOUT:
CIGAR
SNUFF
CHEWING TOBACCO
PIPE
IF NONE OF THE TOBACCO PRODUCTS IS USED FOR THAT AMOUNT
OF TIME, GO TO SECTION JJ.
J4 During the past 12 months, have you stopped (smoking a pipe/smoking cigars/using chewing tobacco/using snuff) for one day or longer because you were trying to quit?
1 YES
2 NO GO TO SECTION JJ
-7 REFUSED
-8 DON’T KNOW
J5 The last time you stopped (smoking a pipe/smoking cigars/using chewing tobacco/using snuff) in the past 12 months because you were trying to quit, how long did you stop for?
_________ 1 DAYS GO TO J6a
NUMBER 2 WEEKS GO TO J6a
3 MONTHS GO TO J6a
-7 REFUSED GO TO J7a
-8 DON’T KNOW GO TO J7a
J6a Was [ANSWER FROM J5] the longest you went without (smoking a pipe/smoking
cigars/using chewing tobacco/using snuff) in the past 12 months?
1 YES GO TO J7a
2 NO
-7 REFUSED
-8 DON’T KNOW
J6b During the past 12 MONTHS, what is the longest length of time you stopped (smoking a
pipe/smoking cigars/using chewing tobacco/using snuff) because you were trying to quit?
_________ 1 DAYS
NUMBER 2 WEEKS
3 MONTHS
-7 REFUSED
-8 DON’T KNOW
J7a Thinking back about the last time you tried to quit (smoking a pipe/smoking cigars/using chewing tobacco/using snuff) in the past 12 months, did you use any of the following products?
A nicotine gum 1 YES 2 NO -7 REF -8 DK
A nicotine patch 1 YES 2 NO -7 REF -8 DK
A nicotine nasal spray 1 YES 2 NO -7 REF -8 DK
A nicotine inhaler 1 YES 2 NO -7 REF -8 DK
A nicotine lozenge 1 YES 2 NO -7 REF -8 DK
A nicotine tablet 1 YES 2 NO -7 REF -8 DK
A prescription pill, such as Zyban, Buproprion, or Wellbutrin 1 YES 2 NO -7 REF -8 DK
J7b The last time you tried to quit (smoking a pipe/smoking cigars/using chewing tobacco/using snuff), did you use any of the following?
(A) A telephone help line or quit line 1 YES 2 NO -7 REF -8 DK
(B) A stop smoking clinic, class, or support group 1 YES 2 NO -7 REF -8 DK
(C) One-on-one counseling 1 YES 2 NO -7 REF -8 DK
(D) Help or support from friends or family 1 YES 2 NO -7 REF -8 DK
(E) The Internet or World Wide Web 1 YES 2 NO -7 REF -8 DK
(F) Books, pamphlets, videos, or other materials 1 YES 2 NO -7 REF -8 DK
(G) Advice from a medical doctor, dentist or other health professional 1 YES 2 NO -7 REF -8 DK
[IF J7b(G)=YES, ASK] Which?
1 DOCTOR
2 DENTIST
3 HEALTH PROFESSIONAL
4 MORE THAN ONE OF THE PREVIOUS CHOICES
-7 REFUSED
-8 DON’T KNOW
(H) Acupuncture 1 YES 2 NO -7 REF -8 DK
(I) Hypnosis 1 YES 2 NO -7 REF -8 DK
J7c The last time you tried to quit (smoking a pipe/smoking cigars/using chewing tobacco/using snuff) in the past 12 months, did you do any of the following?
(A) Stopping by gradually cutting back on (smoking a pipe/smoking cigars/using chewing
tobacco/using snuff) in order to try to quit?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
(B) Did you try giving it up all at once?
1 YES
2 NO GO TO J7d@1
-7 REFUSED GO TO J7d@1
-8 DON’T KNOW GO TO J7d@1
[IF J7c(B)=YES, ASK] Would you say you tried to quit "cold turkey" or tried in some other
way?
1 COLD TURKEY
2 OTHER (SPECIFY) __________________________________________
-7 REFUSED
-8 DON’T KNOW
J7d@1 The last time you tried to quit (smoking a pipe/smoking cigars/using chewing tobacco/using snuff) in the past 12 months, did you use any other methods or products?
1 YES (SPECIFY) _____________________________________________________
2 NO
-7 REFUSED
-8 DON’T KNOW
SECTION JJ. PENDING HARM-REDUCTION PRODUCTS –
CURRENT AND RECENT FORMER SMOKERS
INTERVIEWER INSTRUCTION
IF A3 = “EVERY DAY” OR “SOME DAYS”, ASK JJ1.
IF A3 = “NOT AT ALL” AND H1 IS 5 YEARS OR LESS, ASK JJ1.
OTHERWISE, GO TO SECTION K .
JJ1 Now I'm going to ask about your use of new tobacco products that are sometimes claimed to have fewer harmful chemicals. Have you ever tried a product called...
(A) Eclipse? 1 YES 2 NO -7 REF -8 DK
(B) Accord? 1 YES 2 NO -7 REF -8 DK
(C) Arriva? 1 YES 2 NO -7 REF -8 DK
(D) Exalt? 1 YES 2 NO -7 REF -8 DK
(E) Revel? 1 YES 2 NO -7 REF -8 DK
(F) Omni? 1 YES 2 NO -7 REF -8 DK
(G) Advance? 1 YES 2 NO -7 REF -8 DK
SECTION K. WORK PLACE AND HOME BAN – ALL RESPONDENTS
My next questions are about the smoking rules at your job and home.
KSCR Do you currently work for pay?
1 YES
2 NO GO TO K4
-7 REFUSED GO TO K4
-8 DON’T KNOW GO TO K4
K1 Which of these best describes the area in which you work most of the time?
1 Mainly work indoors
2 Mainly work outdoors GO TO K4
3 Travel to different buildings or sites GO TO K4
4 In a motor vehicle GO TO K4
5 Somewhere else GO TO K4
6 IT VARIES (SPECIFY) _____________________________ GO TO K1c
-7 REFUSED GO TO K4
-8 DON’T KNOW GO TO K4
K1b Do you mainly work in an office building, in your own home, in someone else’s home, or in another indoor place? [IF NEEDED: You said that you now work indoors.]
1 OFFICE BUILDING
2 OWN HOME GO TO K4
3 SOMEONE ELSE’S HOME GO TO K4
4 ANOTHER INDOOR PLACE
-7 REFUSED GO TO K4
-8 DON’T KNOW GO TO K4
K1c In which state do you work on your main job or business? [IF NEEDED: This includes the District of Columbia.]
_____________________
STATE
-7 REFUSED
-8 DON’T KNOW
K2a Does your place of work have an official policy that restricts smoking in any way?
[“PLACE OF WORK” RESTRICTIONS INCLUDE POLICIES OF THE EMPLOYER,
BUILDING OWNER OR ANY GOVERNMENTAL LAWS, INCLUDING ANY POLICY AT
THE PLACE OF WORK REGARDLESS OF WHO IS RESPONSIBLE FOR IT.]
1 YES
2 NO GO TO K4
-7 REFUSED GO TO K4
-8 DON’T KNOW GO TO K4
K3a Which of these best describes your place of work's smoking policy for indoor public or
common areas, such as lobbies, rest rooms, and lunch rooms?
1 Not allowed in any public areas
2 Allowed in some public areas
3 Allowed in all public areas
4 NOT APPLICABLE
-7 REFUSED
-8 DON’T KNOW
K3b Which of these best describes your place of work's smoking policy for work areas?
1 Not allowed in any work areas
2 Allowed in some work areas
3 Allowed in all work areas
4 NOT APPLICABLE
-7 REFUSED
-8 DON’T KNOW
K4 Does anyone smoke cigarettes, cigars, or pipes anywhere inside your home?
1 YES
2 NO
-7 REFUSED
-8 DON’T KNOW
K5 On the average, about how many days per week is there smoking anywhere inside your
home?
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 RARELY OR NONE
-7 REFUSED
-8 DON’T KNOW
K6 Which statement best describes the rules about smoking inside your home?
[A “HOME” IS WHERE YOU LIVE. “RULES” INCLUDE ANY UNWRITTEN “RULES”
AND PERTAIN TO ALL PEOPLE WHETHER OR NOT THEY RESIDE IN THE HOME OR
ARE VISITORS, WORKMEN, ETC.]
1 No one is allowed to smoke anywhere inside your home
2 Smoking is allowed in some places or at some times inside your home
3 Smoking is permitted anywhere inside your home
-7 REFUSED
-8 DON’T KNOW
K7 In your opinion, how easy is it for minors to buy cigarettes and other tobacco products in your community?
1 Very easy,
2 Somewhat easy,
3 Somewhat difficult, or
4 Very difficult?
-7 REFUSED
-8 DON’T KNOW
K8 Do you think advertising of tobacco products should be always allowed, allowed under some conditions, or not allowed at all?
1 ALWAYS ALLOWED
2 ALLOWED UNDER SOME CONDITIONS
3 NOT ALLOWED AT ALL
-7 REFUSED
-8 DON’T KNOW
K9 In bars and cocktail lounges, do you think that smoking should be allowed in all areas,
allowed in some areas, or not allowed at all?
1 ALLOWED IN ALL AREAS
2 ALLOWED IN SOME AREAS
3 NOT ALLOWED AT ALL
-7 REFUSED
-8 DON’T KNOW
| File Type | application/msword |
| File Title | English TUS-CPS-Trans |
| Last Modified By | Vivian Horovitch-Kelley |
| File Modified | 2007-10-15 |
| File Created | 2007-10-01 |