MAY 2011 FOLLOW-UP QUESTIONNAIRE
Version OMB2_PB_3-3-11_2-11-11_1-27-11 OMB _9-4-10
(2010-2011 Tobacco Use Supplement to the CPS series)
OMB #: 0925-0368 Expires: March 31, 2013
Public reporting burden for this collection of information is estimated to average 6 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 (0925-0368). Do not return the completed form to this address.
SECTIONS Page
SECTION A. SCREENING FOR EVER/EVERY DAY/SOMEDAY SMOKING 5
SECTION B. EVERY-DAY SMOKER HISTORY/CONSUMPTION SERIES 7
SECTION C. SOME-DAY SMOKER SERIES 17
SECTION D. PAST 12-MONTH QUIT ATTEMPTS FOR CURRENT EVERY-DAY
AND SOME-DAY SMOKERS 28
SECTION E. METHODS USED DURING PAST (12-MONTH) QUIT ATTEMPTS
(EVERY-DAY AND SOME-DAY SMOKERS) 32
SECTION F. DOCTOR/DENTIST ADVICE TO STOP SMOKING --- CURRENT AND
SOME-DAY SMOKERS 35
SECTION G. STAGES OF CHANGE – EVERY DAY/SOME-DAY SMOKERS 37
SECTION H. FORMER SMOKER SECTION 38
SECTION J. OTHER TOBACCO USE – ALL RESPONDENTS 51
SECTION JJ. NEW TOBACCO RELATED PRODUCTS 66
SECTION K. WORKPLACE POLICY, HOME RULES, PUBLIC OPINION ABOUT 67
CLEAN INDOOR AIR POLICIES
MAY 2011 Follow – Up Tobacco Use Supplement to the CPS
All skip paths should go to the next item unless otherwise instructed. All item questions accept don’t know and refused as response. All <D> and <R> pre-codes are to be blind coded. Use blind coded <L> to go to END.
Allow Proxy interviews on the 4th callback.
PRESUP This month we would also like to ask a few questions about your thoughts and experiences concerning tobacco use. I need to ask each individual, age 18 years old and older, these questions.
ENTER (1) TO PROCEED
ENTER (I) FOR IMPORTANCE OF RESPONDING
|
H_SUPP_I If Respondent says “I answered these last year — why are you asking again?” FR REPLY:
We want to be able to see if anything has changed. Also, the new set of questions is much shorter.
If Respondent asks more generally why we are asking about tobacco, or who will use the data, or how the data will be used, FR REPLY with the more general statement:
Your answers to the tobacco questions are very important. The National Institutes of Health, CDC, and other researchers will use this information to measure changes in tobacco use and to help with services and policy-making.
PRESS ENTER TO CONTINUE
NXTPR |
ENTER LINE NO: |__|__| FOR [fill name]
I (also) need to talk with [fill name/READ LIST OF NEEDED PERSONS]. Is he/she at home now/Are either of them at home now/Are any of them at home now)?
GET SELF RESPONSE ONLY. WHEN DONE GETTING ALL ELIGIBLE PERSONS AT THAT VISIT, F10 FOR CALLBACKS CALLBACK #: [fill number]
(CNTRL-R) Respondent Refused for someone else
ENTER LINE NUMBER FOR INTERVIEW: |__|__| |
HOUSEHOLD ROSTER LN Q NEED NAME M AGE 01 (Person 1) 02 (Person 2) 03 (Person 3) |
NXTPR3 DO NOT ASK, INTERVIEWER CHECK ITEM
(ONLY TAKE A PROXY IF THIS IS THE 4TH CALLBACK, THE PERSON WILL NOT RETURN BEFORE CLOSEOUT OR THE HOUSEHOLD IS GETTING IRRITATED.)
Is this a Self or Proxy response?
(1) Self [GO TO A1]
(2) Proxy
|__|
EPROXY DO NOT ASK
POSSIBLE ERROR
You have picked PROXY for [fill name] even though [fill name] is the current respondent.
Are you currently talking to [fill name]?
(1) Yes, SELF interview [GO TO A1]
(2) No
|__|
NXTPER5 |
DO NOT ASK ENTER LINE NUMBER OF CURRENT RESPONDENT |__|__|
|
HOUSEHOLD ROSTER LN NAME 01 (Person 1) 02 (Person 2) 03 (Person 3) |
SECTION A. SCREENING FOR EVER/EVERY DAY/SOMEDAY SMOKING
A1 (Have/Has) (you/name) smoked at least 100 cigarettes in (your/his/her) entire life?
[FR NOTE: 100 CIGARETTES = APPROXIMATELY 5 PACKS]
(1) YES [GO TO A3]
(2) NO [GO TO SECTION J]
[DON’T KNOW OR REFUSED: GO TO SECTION J]
A2 How
old (were/was) (you/name) when (you/he/she) first started smoking
cigarettes FAIRLY REGULARLY?
ENTER
(0) IF NEVER SMOKED REGULARLY: [GO
TO A2a]
ENTER
AGE (01 – AGE):
[GO TO A2b]
|__|__|
[Age
>5: GO TO A2b ]
[AGE
Less Than OR Equal 5: GO TO A2v]
[DON’T
KNOW OR REFUSED: GO TO A2b]
A2v
I have recorded that (you/name) (were/was) [fill entry A2] years old
when (you/he/she) started smoking cigarettes fairly regularly. Is
that correct?
Yes [GO TO A2b]
No [GO TO A2]
A2a You
said that (you/name) never smoked regularly. How old (were/was)
(you/name) the first time (you/he/she) smoked part or all of a
cigarette?
ENTER
AGE (01 – AGE):
[SKIP
TO A2c]
|__|__|
[[Age
>5: GO TO A2c ]
[AGE
Less Than OR Equal 5: GO TO A2av]
DON’T
KNOW OR REFUSED: GO
TO A2c]
A2av I
have recorded that (you/name) (were/was) [fill entry A2a years old)
when your first smoked part or all of a cigarette. Is that correct?
Yes [GO TO A2c]
No [GO TO A2a]
|__|
A2b In
what state or country did (you/name) live when (you/he/she) started
to smoke cigarettes fairly regularly?
FR:
Spell out the
state or country name entering a text of at most 40 characters
__________
ENTER STATE/COUNTRY NAME GO TO A3
[DON’T
KNOW OR REFUSED: GO
TO A3]
A2c In
what state or country did (you/name) live when (you/he/she) FIRST
smoked part or all of a cigarette?
FR:
Spell out the
state or country name entering a text of at most 40 characters
__________
ENTER STATE/COUNTRY NAME GO TO A3
[DON’T
KNOW OR REFUSED: GO
TO A3]
A3 (Do/Does) (you/name) now smoke cigarettes every day, some days, or not at all?
(1) Every day
(2) Some days
(3) Not at all
|__|
BOX 1
IF SELF RESPONDENT AND:
A3 = (1) EVERY DAY SMOKERS GO TO SECTION B
A3 = (2) SOME-DAY SMOKERS GO TO SECTION C
A3 = (3) NOT-AT-ALL SMOKERS GO TO SECTION H
A3 = D, R GO TO SECTION J
IF PROXY RESPONDENT GO TO SECTION J
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.)
ENTER NUMBER OF CIGARETTES PER DAY
(1-99)
|__||__|
BOX 2
IF B1 = D, R GO TO B1a
IF B1 > 40 GO TO B1v
ELSE GO TO B2
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)
|__|
[1, 2, OR 3: GO TO B2]
[Don’t Know OR Refused: GO TO B2]
B1v I have recorded that on the average, you now smoke [fill entry B1] cigarettes a day. Is that correct?
(1) Yes [GO TO B2]
(2) No [GO TO B1]
|__|
[Don’t Know OR Refused: GO TO B2]
B2 Do you usually smoke menthol or non-menthol cigarettes?
(1) Menthol
(2) Non-menthol
(3) NO USUAL TYPE
|__|
ALL GO TO B5a
B2a
For each of the following, please tell me whether it’s a
reason you usually smoke menthol/non-menthol { fill menthol if
B2 = 1; fill non-menthol if B2 = 2 } cigarettes? ----Please
answer “yes” or “no” for each.
(1)
Yes
(2)
No
B2a1
|__| They are less harmful than non-menthol /menthol
{fill
non-menthol if B2 = 1; fill menthol if B2 = 2—NOTE:
Opposite of the fill in the question stem B2a}
cigarettes
B2a2
|__| They have a better flavor than non-menthol /menthol
{fill
non-menthol if B2 = 1; fill menthol if B2 = 2—NOTE:
Opposite of the fill in the question stem B2a}
cigarettes
B2a3
|__| They are less harsh on your THROAT than non-menthol
/menthol
{fill non-menthol if B2 = 1; fill menthol if B2 = 2—NOTE:
Opposite of the fill in the question stem B2a}
cigarettes
B2a4
|__| They are
less harsh on your CHEST than
non-menthol/menthol {
fill non-menthol if B2 = 1; fill menthol if B2 = 2 ---
NOTE:
Opposite of the fill in the question stem B2a}
cigarettes
B5a How soon after you wake up do you typically smoke your first cigarette of the day?
(IF NECESSARY, FR ASK FOR BEST ANSWER IN MINUTES OR HOURS)
ENTER (0) IF RESPONDENT INSISTS IT VARIES
B5anum ENTER NUMBER (0 – 90)
|__|__|
B5aunt ENTER UNIT REPORTED
|__| (1) Minutes (2) Hours
BOX 5
IF B5a = 0, D, R GO TO B5b
ELSE GO TO BA6a
B5b Would you say you smoke your first cigarette of the day within the first 30 minutes?
(1) Yes
(2) No
(3) Varies— DO NOT READ
|__|
[1, 2, OR 3: GO TO BA6a]
[Don’t know OR Refused: GO TO BA6a]
B5c Do
you sometimes awaken during the night to have a cigarette?
Yes
No
DO
NOT READ
DON’T
SLEEP AT NIGHT
USE
SOME OTHER TOBACCO PRODUCT WHEN I AWAKEN DURING THE NIGHT
|__|
BA6a Do you USUALLY BUY your own cigarettes?
(1) Yes [GO TO B6a]
(2) No [GO TO B6e1]
|__|
[Don’t Know OR Refused: GO TO B6e1]
B6a Do you USUALLY buy your cigarettes by the pack or by the carton? [FR: A CARTON HAS 10 PACKS]
(1) Pack
(2) Carton
(3) Buy both packs and cartons
|__|
GO TO B6d
BOX
6
IF
B6a = (1) OR
(3) OR
D,
R GO
TO B6b
IF
B6a = (2) GO
TO B6c
B6b/B6b2
What price did you pay for the LAST PACK of cigarettes you bought?
Please report the cost after using discounts or coupons.
[FR:
Enter
“dollars” per pack on the first screen (B6b) and enter
“cents” per pack on the next screen (B6b2)]
B6b $___ __ ( 0-99 )
B6b2 .
___ ___ (0-99)
[GO
TO B6d]
[Don’t
know OR Refused: GO TO B6d]
B6c/B6c2 What
price did you pay for the LAST CARTON of cigarettes you bought?
Please report the cost after using discounts or coupons.
[FR:
Enter
“dollars” per pack on the first screen (B6c) and enter
“cents” per pack on the next screen (B6c2)]
B6c
$___ __ ( 0-99 )
B6c2 .
___ ___ (0-99)
[GO
TO B6d]
[Don’t
know OR Refused: GO TO B6d]
B6d/ Did you buy your LAST (fill appropriate term here from B6a responses (=1 or 3 or DK or R fill “pack”; =2 fill “carton”) of cigarettes in (fill respondent’s state of residence) or in some other state?
(1) In respondent’s state of residence
(2) In some other state (including DC)
(3) BOUGHT SOME OTHER WAY (Internet, other country, ...)
|
BOX 7
IF B6d =1 ENTER AUTOMATICALLY RESPONDENT’S STATE OF RESIDENCE IN B6d2 GO TO B6d3
ELSE IF B6d = 2 GO TO B6d2
ELSE IF B6d = 3 GO TO B6d3
ELSE GO TO B6e1
B6d2 In what other state did you buy your LAST (fill appropriate term here from B6a responses (=1, 3, DK or R fill “pack”; =2 fill “carton”) of cigarettes?
|__|__| ENTER STATE ABBREVIATION –TEXT OF AT MOST 2 CHARACTERS -
GO TO B6d3
B6d3 Did you buy your LAST (fill appropriate term here from B6a responses (=1,
3, DK or R fill “pack”; =2 fill “carton”) of cigarettes from an Indian
reservation?
YES- GO TO B6e1
NO GO TO B6e1
[DON’T KNOW OR REFUSED, GO TO B6e1]
B6dOTH
Was
the “Other Way” in which you purchased your LAST (fill
appropriate term here from B6a responses (=1, 3, DK or R fill
“pack”; =2 fill “carton”) of cigarettes:
READ
the FIRST THREE CHOICES
(1)
In
a foreign country or a duty-free shop
(2)
From an Indian
reservation OR
(3)
By mail-order, phone or internet
(4)
Some other way (NOT READ)
|__|
If
B6dOTH = (4)--some other way, GO TO B6dSPC; ELSE GO TO B6e1
B6dSPC:
Please specify the “Other Way”
_______________________________________________[
FR: ENTER
A TEXT OF AT MOST 60 CHARACTERS]
B6e1 In the LAST 2 months, have you bought or traded for any SINGLE or INDIVIDUAL cigarettes?
[FR: RESPONDENT MAY REFER TO IT AS A “LOOSIE” OR “LOOSE OUT OF THE PACK;” “TRADED” INCLUDES BARTER OR EXCHANGE OF SOMETHING OTHER THAN MONEY FOR CIGARETTES.]
( 1 ) Yes, bought
( 2 ) No , did not buy
( 3 ) Traded
|__|[Don’t
Know OR Refused: GO
TO B7a
IF B2 = 1, GO TO B8; ELSE IF B2 =2, 3, R, OR DK, GO TO B7c2MD
B6e2/B6e2a What
price did you pay for the LAST “single or individual”
cigarette you bought?
[
FR: PRICE
PER INDIVIDUAL CIGARETTE; ENTER THE DOLLARS IN THIS SCREEN (B6e2)
AND ENTER THE CENTS PORTION OF COST OF A “LOOSIE”
CIGARETTE IN THE NEXT SCREEN (B6e2a)]
$
__
(0-9)
B6e2
.
____ (0-99)
B6e2a
GO
TO B6e3
B6e2sp
Please Specify what you exchanged for cigarettes.
[FR:
ENTER
A TEXT OF AT MOST 60 CHARACTERS]
___________________________________________
GO
TO B7a
B6e31 Did
you buy your LAST “single
or individual” cigarette
in (fill
respondent’s state of residence)
or in some
other state or
other country?
(1)
In respondent’s state of residence
(2)
In some other state (including DC)
(3) In
another country
(4)
BOUGHT SOME OTHER WAY (Internet, etc.)
|__|
BOX 7B
IF B6e31 = 1, ENTER AUTOMATICALLY
RESPONDENT’S STATE OF RESIDENCE IN B6e32 GO
TO B7a
ELSE IF B6e31= 2, 3
GO TO B6e32
ELSE IF B6e31 = 4
GO TO B6e3SPC
ELSE GO
TO B7a
B6e32
In what OTHER state or country did you buy your LAST SINGLE OR
INDIVIDUAL cigarette?
_______________________
[FR:
SPELL OUT THE STATE OR COUNTRY NAME. ENTER A TEXT OF AT MOST 40
CHARACTERS. ]
GO
TO B7a
B6e3SPC Specify
other way in which last single cigarette was purchased
____________________________________
GO TO B7a
B7a At
what age did you first start to smoke cigarettes EVERY DAY?
ENTER
AGE (01 – AGE)
|__|__|
[Age
>5: GO TO B7b]
[AGE
Less Than OR Equal 5: GO TO B7av]
[DON’T
KNOW OR REFUSED: GO TO B7c]
B7av
I have recorded that you were [fill entry B7a] years old when you
started smoking cigarettes EVERY DAY. Is that correct?
Yes [GO TO B7b]
No [GO TO B7a]
|__|
B7b When
you first started to smoke EVERY DAY, were you living in [fill
state/country from A2b] or somewhere else?
in
state/country from A2b
somewhere
else
B7bspc
Specifically, which other state or country were you living in
when you started to smoke every day?
_________________ [FR:
SPELL OUT THE STATE OR COUNTRY NAME. ENTER A TEXT OF AT MOST 40
CHARACTERS.]
B7c
For how long have you smoked EVERY DAY?
READ CHOICES 1-4
All
or nearly all the years you have smoked
Most
of the years you have smoked
Half
of the years you have smoked, OR -
Less
than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
B7c2 MD During the PAST 12 months have you smoked MENTHOL cigarettes for 6 months or more?
(1) Yes
(2) No
|__|
GO TO B8
B7c3
For how long have you smoked MENTHOL cigarettes?
READ CHOICES 1-4
All
or nearly all the years you have smoked
Most
of the years you have smoked
Half
of the years you have smoked, OR -
Less
than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
B7d Think
of the time during your life when you SMOKED THE MOST. During that
time, how many cigarettes did you smoke each day?
[
ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.]
ENTER
NUMBER OF CIGARETTES PER DAY
(1-99)
|__|__|
IF
40: GO TO B8
[If
>40: GO TO B7dv]
[Don’t
Know OR Refused: GO TO B8]
B7dv
I have recorded that the time during your life when you SMOKED THE
MOST, you smoked [fill entry B7d] cigarettes each day. Is that
correct?
(1)
Yes [GO TO B8]
(2)
No [GO TO B7d]
|__|__|
[Don’t
Know OR Refused: GO TO B8]
B8 Around this time 12 MONTHS AGO, were you smoking cigarettes every day, some days, or not at all?
(1) Every day IF B8=1 GO TO B9
(2) Some days IF B8=2 GO TO B10a
(3) Not at all IF B8 =3 GO TO D1R (2nd QUESTION IN SECTION D)
|__|
IF B8=DK, R GO TO B11
B9 Around this time 12 MONTHS AGO, on the average, about how many cigarettes did you smoke each day?
(ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.)
ENTER NUMBER OF CIGARETTES PER DAY
(1-99)
|__||__|
BOX 7C
IF B9 = D, R, GO TO B11
IF B9 > 40, GO TO B9v
ELSE GO TO B11
B9v I have recorded that on the average, you smoked [fill entry B9] cigarettes a day 12 months ago. Is that correct?
(1) Yes
(2) No GO TO B9
|__| IF B9v =1 OR B9v = D, R GO TO B11
B10a Around this time 12 MONTHS AGO, on how many of the 30 days in the month did you smoke cigarettes?
ENTER (0) FOR NONE
|__|__| Range 0-30
BOX 7D
IF B10a = 0 OR 30 GO TO B10av
ELSE GO TO B10b
B10av You said that you smoked cigarettes some days. Is that correct?
(1) Yes
(2) No
|__|
BOX 7E
IF (B10av = 1 AND B10a= 30 ), OR B10av = DK, R GO TO B10b
IF B10av = 1 AND B10a= 0 GO TO D1R
IF B10av = 2 GO TO B8
B10b On the average, on those [If B10a = 1-30 (Fill entry B10a days) If B10a=D, R (Fill days you smoked)], how many cigarettes did you usually smoke each day?
WE ARE STILL TALKING ABOUT “AROUND THIS TIME 12 MONTHS AGO”
|__|__| ( 1-99 ) IF 40 GO TO B11; ELSE IF B10b = D, RB11
B10bv I have recorded that on the average, when you smoked on those [fill entry B10a] days, you smoked [fill entry B10b] cigarettes a day. Is that correct?
(1) Yes
(2) No GO TO B10b
|__|
B11 Around this time 12 MONTHS AGO, were you usually smoking menthol or non-menthol cigarettes?
(1) Menthol
(2) Non-menthol
(3) NO USUAL TYPE
|__|
EVERY-DAY SMOKERS (A3=1) GO TO D1R (2nd QUESTION IN SECTION D)
SECTION C. SOME-DAY SMOKER SERIES
C1 On how many of the past 30 days did you smoke cigarettes?
ENTER (0) FOR NONE
|__|__| (0-30)
BOX 9
IF C1 = 0 OR 30 GO TO C1v
ELSE IF C1=DK, R GO TO C1i
ELSE GO TO C1a
C1v You said that you smoked cigarettes some days. Is that correct?
(1) Yes
(2) No
|__|
BOX 10
IF C1v = 1 AND C1 = 30 GO TO C1a
IF C1v = 1 AND C1 = 0 GO TO C2
IF C1v = 2 GO TO A3
IF C1v = DK, R GO TO C1a
C1i Would you say you smoked on AT LEAST 12 DAYS in the past 30 days?
Yes
(2) No
|__|
C1a On the average, on those [C1 days IF entry for C1 NE D/R. OR “AT LEAST 12 days” IF C1i = 1 YES] days, how many cigarettes did you usually smoke each day?
|__|__| IF 40 GO TO C2
[IF >40, GO TO C1av]
[Don’t Know OR Refused: GO TO C2]
C1av I have recorded that on the average, when you smoked on those [C1 / AT LEAST 12] days, you smoked [C1a] cigarettes a day. Is that correct?
(1) Yes [GO TO C2]
(2) No [GO TO C1a]
|__|
[Don’t Know OR Refused: GO TO C2]
C2 Do you usually smoke menthol or non-menthol cigarettes?
(1) Menthol
(2) Non-menthol
(3) NO USUAL TYPE
|__|
ALL GO TO C5anum/unt
C2a
For each of the following, please tell me whether it’s a
reason you usually smoke menthol/non-menthol { fill
menthol if C2 = 1; fill non-menthol if C2 = 2
} cigarettes ? ----Please answer “yes” or “no”
for each.
(1)
Yes
(2)
No
C2a1
|__| They are less harmful than non-menthol /menthol
{{fill
non-menthol if C2 = 1; fill menthol if C2 = 2—NOTE:
Opposite of the fill in the question stem C2a}
cigarettes
C2a2
|__| They have a better flavor than non-menthol /menthol
{{fill
non-menthol if C2 = 1; fill menthol if C2 = 2—NOTE:
Opposite
of the fill in the question stem C2a}
cigarettes
C2a3
|__| They are less harsh on your
THROAT
than
non-menthol
/menthol
{{fill
non-menthol if C2 = 1; fill menthol if C2 = 2—NOTE:
Opposite
of the fill in the question stem C2a}
cigarettes
C2a4
|__| They are less harsh on your
CHEST
than
non-menthol/menthol { fill
non-menthol if C2 = 1; fill menthol if C2 = 2 —
NOTE:
Opposite
of the fill in the question stem C2a}
cigarettes
C5anum/unt On the days that you smoke, how soon after you wake up do you typically smoke your first cigarette of the day?
(IF NECESSARY, FR ASK FOR BEST ANSWER IN MINUTES OR HOURS)
ENTER (0) IF RESPONDENT INSISTS IT VARIES
C5anum ENTER NUMBER (0 – 90)
|__|__|
C5aunt ENTER UNIT REPORTED
|__| (1) Minutes (2) Hours
BOX 13
IF C5a = 0, D, R GO TO C5b
ELSE GO TO CA6a
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) Varies— DO NOT READ
|__|
[GO TO CA6a]
C5c Do
you sometimes awaken during the night to have a cigarette?
(1)
Yes
(2)
No
DO
NOT READ
DON’T
SLEEP AT NIGHT
USE
SOME OTHER TOBACCO PRODUCT WHEN I AWAKEN DURING THE NIGHT
|__|
CA6a Do you USUALLY BUY your own cigarettes?
(1) Yes (GO TO C6a)
No (GO TO C6e1)
|__|
[Don’t Know OR Refused: GO TO C6e1]
C6a Do you USUALLY buy your cigarettes by the pack or by the carton? [FR: A CARTON HAS 10 PACKS]
(1) Pack
(2) Carton
(3) Buy both packs and cartons
|__| GO TO C6d1
BOX
14
IF
C6a = (1) OR
(3) OR
DK,
R GO
TO C6b
IF
C6a = (2) GO
TO C6c
C6b/C6b2 What
price did you pay for the LAST PACK of cigarettes you bought?
Please report the cost after using discounts or coupons. [FR:
PRICE PER PACK]
$___
___ C6b (0-99) ENTER DOLLARS PORTION OF THE PRICE PER PACK
.___
___ C6b2 (0-99) ENTER THE CENTS PORTION OF THE PRICE PER PACK
GO
TO C6d
[Don’t
Know OR Refused: GO TO C6d]
C6c/C6c2 What
price did you pay for the LAST carton of cigarettes you bought?
Please report the cost after using discounts or coupons. [FR:
PRICE PER CARTON]
$__
__ __ C6c (0-999) ENTER THE DOLLARS PORTION OF THE PRICE PER CARTON
.__
__ C6c (0-99) ENTER THE CENTS PORTION OF THE PRICE PER CARTON
GO
TO C6d
[Don’t
Know OR Refused: GO TO C6d]
C6d1 Did you buy your LAST (fill appropriate term here from C6a responses (=1, 3, DK or R fill “pack”; =2 fill “carton”) of cigarettes in [fill respondent’s state of residence] or in some other state?
(1) In respondent’s state of residence
(2) In some other state (including DC)
(3) BOUGHT SOME OTHER WAY (Internet, other country, ...)
|__|
BOX 15
IF C6d1 =1, ENTER AUTOMATICALLY RESPONDENT’S STATE OF RESIDENCE IN C6d2 AND GO TO C6d3
ELSE IF C6d1 = 2, GO TO C6d2
ELSE IF C6d1 = 3, GO TO C6d3
ELSE GO TO C6e1
C6d2 In what other state did you buy your LAST (fill appropriate term here: pack/carton from C6a responses (=1, 3, DK or R fill “pack”; =2 fill “carton”) of cigarettes?
|__|__| ENTER 2 CHARACTER STATE ABBREVIATION GO TO C6d3
C6d3 Did you buy your LAST (fill appropriate term here from C6a responses (=1,
3, DK or R fill “pack”; = 2 fill “carton”) of cigarettes from an Indian reservation?
(1)YES
(2)NO
|
ALL GO TO C6e1
C6dOTH
Was
the “Other Way” in which you purchased your LAST (fill
appropriate term here from C6a responses (=1, 3, DK or R fill
“pack”;
=2 fill “carton”)
of cigarettes:
READ
THE FIRST THREE CHOICES
(1)
In
a foreign country or a duty-free shop
(2)
From an Indian reservation OR
(3)
By mail-order, phone or internet
(4)
Some other way
(NOT READ)
|__|
If
C6dOTH = (4)--Some other way GO TO C6dSPC; ELSE GO TO C6e1
C6dSPC
- Please specify the “Other Way” in which your LAST
cigarettes were purchased
______________________________________
ENTER
A TEXT OF AT MOST 60 CHARACTERS
C6e1 In the LAST 2 months, have you bought or traded for any SINGLE or INDIVIDUAL cigarettes?
[FR: RESPONDENT MAY REFER TO IT AS A “LOOSIE” OR “LOOSE OUT OF THE PACK.” TRADED INCLUDES BARTER OR EXCHANGE OF SOMETHING OTHER THAN MONEY FOR CIGARETTES.]
Yes, bought
(2) No, did not buy
(3) Traded
ALL GO TO C7amod
C6e2/C6e2b What price did you pay
for the LAST “single or individual” cigarette
you bought?
[FR: ENTER
THE DOLLAR PORTION OF THE PRICE ON THIS SCREEN (C6e2).;
ENTER THE CENTS PORTION OF THE PRICE
PER LOOSIE ON THE NEXT
SCREEN (C6e2b)]
$__ C6e2 (0-9)
.__ __ C6e2b (0-99)
GO
TO C6e31
C6e31 Did
you buy your LAST SINGLE or INDIVIDUAL cigarette in [fill
respondent’s state of residence] or in some other state or
other country?
(1)
In respondent’s state of residence
In
some other state (including DC)
In
another country
(4)
BOUGHT SOME OTHER WAY (Internet, etc..)
|__|
BOX
15B
IF
C6e31 =1, ENTER AUTOMATICALLY RESPONDENT’S STATE OF
RESIDENCE IN C6e32 GO
TO C7a
ELSE
IF C6e31 = 2, 3
GO
TO C6e32
ELSE
IF C6e31 = 4
GO TO C6e3SPC
ELSE
GO
TO C7a
C6e32
In what OTHER state or other country did you buy your LAST SINGLE OR
INDIVIDUAL cigarette?
-------------------------------------
[FR:
SPELL OUT THE STATE OR COUNTRY NAME. ENTER A TEXT OF AT MOST 40
CHARACTERS]
GO
TO C7a
C6e3SPC
SPECIFY
other way in which last single cigarette was purchased:
_______________________
[FR:
ENTER A TEXT OF AT MOST 60 CHARACTERS]
GO
TO C7a
C6e2a1
Please Specify what you exchanged for a cigarette.
_________________________________
[FR: ENTER
A TEXT OF AT MOST 60 CHARACTERS].
Past Smoking Behavior for Some-Day Smokers
C7amod During the PAST 12 months have you smoked cigarettes EVERY DAY for at least 6 months?
(1) Yes
(2) No
GO TO IF statement ahead of C7d2md
IF C2 =1 GO TO C8; ELSE IF C2=2, 3, D, R, GO TO C7d2md
C7a2 At
what age did you first start to smoke cigarettes EVERY DAY?
ENTER
AGE (01 – AGE)
|__|__|
[Age
>5: GO TO C7a3]
[AGE
Less Than OR Equal 5: GO TO C7a2v]
[DON’T
KNOW OR REFUSED: GO TO C7d]
C7a2v
I have recorded that you were [fill entry C7a2] years old when you
started smoking cigarettes EVERY DAY. Is that correct?
(1)Yes [GO TO C7a3]
(2)No [GO TO C7a2]
|__|
C7a3 When
you first started to smoke EVERY DAY, were you living in [fill
state/country from A2b] or somewhere else?
in
state/country from A2b GO
TO C7d
somewhere
else GO
TO C7a3SP
C7a3SP
Please specify the other state or country you were living in when
you started to smoke EVERY DAY
-------------
[FR:
SPELL OUT THE FULL NAME. ENTER A TEXT OF AT MOST 40
CHARACTERS]
C7d
For how long have you smoked EVERY DAY
READ CHOICES 1-4
All
or nearly all the years you have smoked
Most
of the years you have smoked
Half
of the years you have smoked, OR -
Less
than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
IF
C2 = 1, GO TO C7d3; ELSE IF C2 =2, 3, R, OR DK, GO TO C7d2
C7d2mod During the PAST 12 months, have you smoked MENTHOL cigarettes for 6 months or more?
(1) Yes
(2) No
IF
C7d2 = 1, THEN GO TO C7d3; ELSE if C7a =2, R, or DK, GO TO C8; ELSE
GO TO C7e
ALL GO TO C8
C7d3
For how long have you smoked MENTHOL cigarettes
READ CHOICES 1-4
All
or nearly all the years you have smoked
Most
of the years you have smoked
Half
of the years you have smoked, OR -
Less
than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
IF
C7a = 2, R, or DK, Go to C8; ELSE Go To C7e
C7e When
you last smoked every day, on average how many cigarettes did you
smoke each day?
ENTER
NUMBER OF CIGARETTES EACH DAY (1‑99)
|__|__|
IF
40: GO TO C7f
[If
>40: GO TO C7ev]
[Don’t
Know OR Refused: GO TO C7f]
C7ev
I have recorded that when you last smoked every day, on the
average you smoked [fill entry
C7e]
cigarettes each day. Is that correct?
(1)
Yes [GO TO C7f]
(2)
No [GO TO C7e]
|__|__|
[Don’t
Know OR Refused: GO TO C7f]
C7f Think
of the time during your life when you SMOKED THE MOST. During that
time, how many cigarettes did you smoke each day?
[
ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.]
ENTER
NUMBER OF CIGARETTES PER DAY
(1-99)
|__|__|
IF
40: GO TO C8
[If
>40: GO TO C7fv]
[Don’t
Know OR Refused: GO TO C8]
C7fv
I have recorded that the time during your life when you SMOKED THE
MOST, you
smoked
[fill entry C7f] cigarettes each day. Is that correct?
(1)
Yes [GO TO C8]
(2)
No [GO TO C7f]
|__|__|
[Don’t
Know OR Refused: GO TO C8]
C8 Around this time 12 MONTHS AGO, were you smoking cigarettes every day, some days, or not at all?
(1) Every day IF C8 = 1 GO TO C9
(2) Some days IF C8 = 2 GO TO C10a
(3) Not at all IF C8 =3 GO TO BOX 18
|__|
IF C8 = DK, R GO TO C11
C9 Around this time 12 MONTHS AGO, on the average, about how many cigarettes did you smoke each day?
(ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.)
ENTER NUMBER OF CIGARETTES PER DAY
(1-99)
|__||__|
BOX16B
IF C9 = D, R, GO TO C11
IF C9 > 40, GO TO C9v
ELSE GO TO C11
C9v I have recorded that on the average, you smoked [fill entry C9] cigarettes a day 12 months ago. Is that correct?
(1) Yes GO TO C11
(2) No GO TO C9
|__|
DK, R GO TO C11
C10a Around this time 12 MONTHS AGO, on how many of the 30 days in the month did you smoke cigarettes?
ENTER (0) FOR NONE
|__|__| (0 – 30)
BOX 16C
IF C10a = 0 OR 30 GO TO C10av
If C10a=D, R, GO TO C10b
ELSE GO TO C10b
C10av You said that you smoked cigarettes some days. Is that correct?
(1) Yes
(2) No
|__|
BOX 16D
IF (C10av = 1 AND C10a= 30), OR C10av = DK, R, GO TO C10b
ELSE IF C10av = 1 AND C10a= 0, GO TO C11
ELSE IF C10av = 2, GO TO C8 AND CORRECT
ELSE GO TO C10b
C10b On the average, on those [fill entry C10a days; If C10a=D, R, then fill with “days you smoked”], how many cigarettes did you usually smoke each day?
We are still talking about “around this time 12 months ago.”
|__|__| (1-99)
IF C10b than or = 40, GO TO C11; ELSE IF C10b = D, R GO TO C11; IF C10b > 40, GO TO C10bv
C10bv I have recorded that on the average, when you smoked on those [fill entry C10a days; If C10a=D, R, then fill with “days you smoked”], you smoked [fill entry C10b] cigarettes a day. Is that correct?
(1) Yes
(2) No GO TO C10b AND CORRECT
|__|
C11 Around this time 12 MONTHS AGO, were you usually smoking menthol or non-menthol cigarettes?
(1) Menthol
(2) Non-menthol
(3) NO USUAL TYPE
|__|
BOX 18
IF ENTRY IN C1than or 12 DAYS IN THE PAST 30 DAYS, D1R (2nd question in Section D)
ELSE IF C1i = 1 (Yes) D1R (2nd question in Section D)
ELSE IF C1i = 2 (NO), OR C1i = DK, R Da
ELSE IF C1 < 12 Da
SECTION D. PAST 12-MONTH QUIT ATTEMPTS FOR CURRENT EVERY-DAY
AND SOME-DAY SMOKERS
PAST 12-MONTH QUIT ATTEMPTS FOR SOME-DAY SMOKERS SMOKING <12 DAYS IN THE PAST 30 DAYS
Da During the PAST 12 MONTHS, have you TRIED to QUIT smoking COMPLETELY?
(1) Yes [GO TO D3]
(2) No [GO TO F1a]
|__|
[Don’t Know OR Refused: GO TO F1a]
Db Have
you EVER TRIED to QUIT smoking COMPLETELY?
(1)
Yes
(2)
No
|__|
All responses GO TO F1a
PAST 12-MONTH QUIT ATTEMPTS FOR EVERY-DAY AND SOME-DAY SMOKERS (some day smokers smoking >=12 days during the past 30 days)
Quit attempts of 1 day or longer:
D1R During the PAST 12 MONTHS, have you stopped smoking for ONE DAY or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?
(1) Yes [GO TO D3]
(2) No [GO TO D7R]
|__|
[Don’t Know OR Refused: GO TO D7R]
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?
FR READ CHOICES
Once (1 time)
2-3 times
4 or more times
|__|
BOX 19
IF D3 = DK/REF, GO TO D3b
ELSE GO TO D4
D3b Would you say that during the past 12 months it was MORE THAN 3 TIMES that you have stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?
(1) Yes
(2) No
|__|
[GO TO D4]
D4 The LAST TIME you stopped smoking during the PAST 12 months because you were TRYING to quit, how long did you stop for?
D4num ENTER NUMBER
(1 – 365)
|__|__|__|
D4unt ENTER UNIT REPORTED
(1) Days
(2) Weeks
(3) Months
(4) Years
|__|
IF D4num AND/OR D4unt = DK/REF GO TO D4b
IF D4num >18 AND D4unt = 2 GO TO D4v
IF D4num > 12 AND D4unt =3GO TO D4v
IF D4num >2 AND D4unt = 4 GO TO D4v
ELSE GO TO D4c
D4v I have recorded that the LAST TIME you stopped smoking in the past 12 months BECAUSE YOU WERE TRYING TO QUIT SMOKING was for a duration of [fill entry D4num AND D4unt]? Is that correct?
(1) Yes GO TO D4cmon/day/yr
(2) No GO TO D4 and correct
|
D4b Was it more or less than one week?
(1) More
(2) Less
(3) One week
|
D4cmon/day/yr When was the approximate END date of this LAST QUIT ATTEMPT that lasted [fill response to D4num, D4unt OR fill response to D4b—(more than/less than equal to) 1 week]?
D4cmon FR: ENTER THE MONTH FROM THE LIST 1-12
D4cday FR: ENTER THE 2 DIGIT DAY (PRECEDE BY ZERO IF NECESSARY) (1-31)
D4cyr FR: ENTER 4 DIGITS OF THE YEAR (2010-2011)
IF D4b= DK, R, GO TO SECTION E BOX 21; ELSE GO TO D5
D5 Was [fill entry D4num AND D4unt / OR D4b] the LONGEST you went without smoking in the past 12 months?
(1) Yes GO TO SECTION E
(2) No
|__|
D6 During the PAST 12 MONTHS, what is the [LENGTH / LONGEST length: If D3 = 1, fill with “LENGTH;” ELSE fill with “LONGEST Length”] of time you stopped smoking because you were TRYING to quit smoking?
[FR NOTE: IF QUIT ATTEMPT BEGAN MORE THAN 12 MONTHS AGO BUT ENDED WITHIN THE PAST 12 MONTHS, COUNT ALL OF IT.]
D6num ENTER NUMBER (1 - 365)
|__|__|__|
D6unt ENTER UNIT REPORTED
(1) Days
(2) Weeks
(3) Months
(4) Years
|
BOX 20
IF D6num AND/OR D6unt = DK/REF, GO TO D6b
IF D6num >18 AND D6unt = 2, GO TO D6v
IF D6num > 12 AND D6unt=3, GO TO D6v
IF D6num >2 AND D6unt = 4, GO TO D6v
ELSE GO TO SECTION E
D6v I have recorded that the LONGEST length of time you stopped smoking in the past 12 months because you were TRYING to quit smoking was [fill entry D6num and
D6unt]? Is that correct?
(1) Yes [GO TO SECTION E, Box 21]
(2) No [GO TO D6/D6num/unt]
|__|
[Don’t Know OR Refused: GO TO D6b]
D6b Was it more or less than one week?
(1) More
(2) Less
(3) One week
|__| [GO TO SECTION E, Box 21]
Quit attempts of less than a day (if no quit attempts lasting for one DAY or more):
D7R DURING THE PAST 12 MONTHS, have you made a serious attempt to stop smoking because you were TRYING to quit – even if you stopped for less than a day?
(1) Yes [GO TO SECTION E, Box 21]
(2) No [GO TO F1a]]
|__|
[Don’t Know OR Refused: GO TO F1a]
D8R 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
[GO TO F1a]
(2) No
[GO TO
F1a]
|__| [Don’t
Know OR Refused
SECTION E. METHODS USED DURING PAST (12-MONTH) QUIT ATTEMPTS (EVERY-DAY AND SOME-DAY SMOKERS)
BOX 21
IF D3 = 1, THEN FILL E1a, E1b, E1c AND E2 WITH “The TIME”
ELSE FILL E1a, E1b, E1c AND E2 WITH “The LAST TIME”
E1a 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:
[FR: REPEAT THE STEM OF THE QUESTION AS NECESSARY]
(1) Yes
(2) No
E1a1 A nicotine patch |__|
E1a2 A nicotine gum or nicotine lozenge |__|
E1a3 A nicotine nasal spray or nicotine inhaler |__|
E1abn1/u1 In total, during the LAST TIME/time you tried to QUIT smoking, how long did you use [fill with EACH E1a 1, 2, 3 = 1 (YES) OR IF all three are =1- YES, then fill with “ANY of these” ]
|__|__|number- n1[1-99]
|__| |units-u1 [1= Days, 2= Weeks, 3= Months]
E1a7a 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:
(1) Yes
(2) No
E1a7a A prescription pill, called Chantix or Varenicline ? |__|
E1a7b A prescription pill, called Zyban, Bupropion, or Wellbutrin? |__|
E1a7c Another prescription pill |__|
IF E1a7c = YES, GO TO E1a7cs; ELSE GO TO E1acn1/u1.
E1a7cs Please specify the other type of prescription pill: __________________________ [FR: ENTER THE OTHER TYPE OF PRESCRIPTION PILL USING TEXT OF AT MOST 20 CHARACTERS]
E1acn1/u1 In total, during the LAST TIME/time you tried to QUIT smoking, how long did you use [fill with EACH E1a7a,b,c =1 (YES) OR IF ALL E17a ,7b , AND 7c are =1- YES, then fill with “ANY of these prescription PILLS?” ]
|__|__| number--n1 [1-99]
|__| unit-- u1 [1= Days, 2= Weeks, 3= Months]
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: [FR NOTE: FOR THIS QUESTION, RE-READ STEM PERIODICALLY]
(1) Yes
(2) No
E1b1 |__| A telephone help line or quit line
E1b2 |__| One-on-one counseling
E1b3 |__| A stop smoking clinic, class, or support group
E1b4 |__| Help or support from friends or family
E1b5 |__| Internet or web-based program
E1b6 |__| Books, pamphlets, videos, or other materials
E1b7 |__| Acupuncture or hypnosis IF E1b7 = 1 (YES), THEN GO TO E1b7a; ELSE GO
TO E1c
E1b7a |__| Which: acupuncture or hypnosis or both?
(1) Acupuncture
(2) Hypnosis
(3) Both
E1c The (LAST TIME / time) you tried to QUIT smoking in the past 12 months: Did you do ANY of the following: [FR NOTE: FOR THIS QUESTION, RE-READ STEM PERIODICALLY]
(1) Yes
(2) No
E1c1 |__| Try to quit by GRADUALLY cutting back on cigarettes?
E1c2 |__| Try to quit by SWITCHING to smokeless tobacco such as chewing
tobacco, snuff, or snus?
E1c2b |__| Try to quit by SWITCHING to regular cigars, cigarillos, little filtered
cigars or pipes filled with tobacco?
E1c3 |__| Did you SWITCH to a “lighter” cigarette in order to TRY TO QUIT?
IF B2 OR C2=2 (NON-MENTHOL), 3, DK, OR R, GO TO E1c3b; ELSE IF B2 OR C2=1, GO TO E1c3c
E1c3b |__| Did you SWITCH to menthol cigarettes in order to TRY TO QUIT?----
[IF RESPONDENT SAYS THEY WERE ALREADY SMOKING 'MENTHOL CIGARETTES WHEN THEY TRIED TO QUIT-- THEN THE ANSWER IS "NO" THEY DIDN'T SWITCH TO TRY TO QUIT]
IF B2 OR C2=2 (NON-MENTHOL), THEN GO TO E1c4; ELSE GO TO E1c3c
E1c3c |__| Did you switch to non-menthol cigarettes in order to TRY TO QUIT?
[IF RESPONDENT SAYS THEY WERE ALREADY SMOKING ”NON-MENTHOL” CIGARETTES WHEN THEY TRIED TO QUIT-- THEN THE ANSWER IS "NO" THEY DIDN'T SWITCH TO TRY TO QUIT]
E1c4 |__| Did you try to give up cigarettes ALL at ONCE
IF E1c4 = 1 (YES), GO TO E1d; ELSE GO TO F1a
E1d Please tell me which one statement is true about this most recent quit attempt where you
tried to give up cigarettes all at once: [IF NEEDED, We are still talking about the past 12 months.]
READ THE 4 RESPONSE CATEGORIES
(1) I tried to quit as soon as I made the decision.
(2) I planned the quit for later the same day.
(3) I planned the quit for a date in the future.
(4) I decided to quit after having NOT smoked for some other reason
|__|
E1e When you tried to quit all at once, would you say you TRIED TO QUIT “cold turkey?
YES
NO
IF NEEDED: “COLD TURKEY” IS STOPPING ALL AT ONCE WITHOUT ANY AIDS
|__|
(All responses GO TO F1a)
SECTION F. DOCTOR/DENTIST ADVICE TO STOP SMOKING --- CURRENT AND SOME-DAY SMOKERS
F1a In the PAST 12 MONTHS have you SEEN a medical doctor?
(1) Yes GO TO F1b
(2) No GO TO F2a
|__|
[Don’t Know OR Refused: GO TO F2a]
F1b During the PAST 12 MONTHS, did any medical doctor ADVISE you to stop smoking?
(1) Yes GO TO F1c
(2) No GO TO F2a
|__|
[Don’t Know OR Refused: GO TO F2a]
F1c In the PAST 12 MONTHS, when a medical doctor advised you to quit smoking, did
the doctor also: [REPEAT THE STEM OF THE QUESTION AS NEEDED.]
Yes
No
F1c1 |__| Suggest that you call or use a telephone help line or quit line?
F1c2 |__| Suggest that you use a smoking cessation class, program, or counseling?
F1c3 |__| Recommend or Prescribe a nicotine product such as patch, gum, lozenge, nasal
spray or inhaler?
F1c4 |__| Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, or Wellbutrin
F1c5 |__| Suggest that you set a specific date to stop smoking?
GO TO F2a
F2a In the PAST 12 MONTHS have you SEEN a dentist?
(1) Yes GO TO F2b
(2) No GO TO G1
|__|
[Don’t Know OR Refused: GO TO G1]
F2b
During the PAST 12 MONTHS,
did any dentist ADVISE you to stop smoking?
(1) Yes GO TO F2c
(2) No GO TO G1
|__|
[Don’t Know OR Refused: GO TO G1]
F2c1 In the PAST 12 MONTHS, when a dentist advised you to quit smoking, did
the dentist also:
Yes
No
F2c1 |__| Suggest that you call or use a telephone help line or quit line?
F2c2 |__| Suggest that you use a smoking cessation class, program, or counseling?
F2c3 |__| Recommend or Prescribe a nicotine product such as a patch, gum, lozenge,
nasal spray or inhaler
F2c4 |__| Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, or Wellbutrin
F2c5 |__| Suggest that you set a specific date to stop smoking?
All responses GO TO G1
SECTION G. STAGES OF CHANGE – EVERY DAY/SOME-DAY SMOKERS
G1 Are you seriously considering quitting smoking within the next 6 months?
(1) Yes [GO TO G2]
(2) No [GO TO G3]
|__|
[Don’t Know OR Refused: GO TO G3]
G2 Are you planning to quit within the next 30 days?
(1) Yes
(2) No
|__| All responses GO TO G3
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?
|__| IF G3 = 1, GO TO SECTION J; ELSE GO TO G4
(1) Not at all
(2) A little likely
(3) Somewhat likely
(4) Very likely
|__|
ALL EVERY DAY/SOME DAY SMOKERS (A3=1, 2) GO TO SECTION J
SECTION H. FORMER SMOKER SECTION
H1NUM/UNT About how long has it been since you COMPLETELY quit smoking cigarettes?
H1NUM ENTER NUMBER
(1‑99)
|__|__|
H1UNT ENTER UNIT REPORTED
(1) Days
(2) Weeks
(3) Months
(4) Years
|__|
BOX 24
IF H1NUM> 18 AND H1UNT= 2, GO TO H1v
IF H1NUM > 30 AND H1UNT = 3, GO TO H1v
IF H1NUM > = AGE AND H1UNT= 4, GO TO H1ERR
ELSE GO TO BOX H2 UNIVERSE
H1ERR *** DO NOT READ ***
It was reported that this person is (fill AGE). Response of [fill entry H1NUM/UNT] is inconsistent with person’s age.
(B) Back to correct
|__| GO TO H1NUM
H1v I have recorded that it has been about [fill entry H1NUM and H1UNT] since you completely quit smoking cigarettes? Is that correct?
(1) Yes [GO TO Box H2 Universe]
(2) No [GO TO H1NUM]
|__|
[Don’t Know OR Refused: GO TO Box H2 Universe]
BOX H2 UNIVERSE: IF H1NUM/H1UNT < 7 MONTHS/ 28 WEEKS, < than or = 99 DAYS, GO TO H2Mod; ELSE GO TO BOX 26.
H2Mod During the PAST 12 months, have you smoked cigarettes EVERY DAY for at least 6 months?
(1) Yes [GO TO BOX 26]
(2) No [GO TO BOX 26]
|__|
[Don’t Know OR Refused: GO TO BOX 26]
H2a At
what age did you first start to smoke cigarettes EVERY DAY?
ENTER
AGE (01 – AGE)
|__|__|
[Age
>5: GO TO H2b]
[AGE
Less Than OR Equal 5: GO TO H2av]
[DON’T
KNOW OR REFUSED: GO TO H5]
H2av
I have recorded that you were [fill entry H2a] years old when you
started smoking cigarettes EVERY DAY. Is that correct?
(1)Yes
[GO TO H2b]
(2)No
[GO TO H2a]
|__|
H2b When
you first started to smoke EVERY DAY, were you living in [fill
state/country from A2b] or somewhere else?
in
state/country from A2b
GO TO H5
somewhere
else
H2bSPC
Please
specify the other state or country you were living in when you first
started to smoke EVERY DAY.
__________________ SPELL
OUT THE STATE /COUNTRY NAME. ENTER A TEXT OF AT
MOST
40 CHARACTERS
H5
For how long did you smoke EVERY DAY?
READ
CHOICES 1-4
(1)
All or nearly all the years you have smoked
(2)Most
of the years you have smoked
(3)Half
of the years you have smoked, OR -
(4)Less
than half the years you have smoked
(5)IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
H5a When
you last smoked every day, on average how many cigarettes did you
smoke each day?
ENTER
NUMBER OF CIGARETTES EACH DAY
(1‑99)
|__|__|
IF
40: GO
TO H5b
[If
>40: GO
TO H5av]
[Don’t
Know OR Refused: H5b]
H5av
I have recorded that when you last smoked every day, on the
average you smoked [fill entry H5a] cigarettes each day. Is that
correct?
(1)
Yes [GO
TO H5b]
(2)
No [GO
TO H5a]
|__|__|
[Don’t
Know OR Refused: H5b]
H5b Think
of the time during your life when you SMOKED THE MOST. During that
time, how many cigarettes did you smoke each day?
[
ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO
CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.)]
ENTER
NUMBER OF CIGARETTES PER DAY
(1-99)
|__|__|
IF
40: GO TO BOX 26
[If
>40: GO TO H5bv]
[Don’t
Know OR Refused: GO TO BOX 26]
H5bv
I have recorded that the time during your life when you SMOKED THE
MOST, you smoked [fill entry H5b] cigarettes each day. Is that
correct?
(1)
Yes [GO TO BOX 26]
(2)
No [GO TO H5b]
|__|__|
[Don’t
Know OR Refused: GO TO BOX 26]
BOX 26
IF H1NUM/UNT < than or =1 YEAR (12 MONTHS, 52 WEEKS, 99 DAYS), GO TO H6
IF
H1 >
3YEARS
(36
MONTHS, EQUIVALENT in WEEKS and in DAYS) GO
TO H11
ELSE
GO
TO H6C2
ELSE SECTION J
H6 Around this time 12 MONTHS AGO, were you smoking cigarettes every day, some days, or not at all?
(1) Every day IF H6 = 1 GO TO H6A
(2) Some days IF H6 =2 GO TO H6B
(3) Not at all
|__|
[IF H6 = 3, GO TO H6c4md UNIVERSE; ELSE IF H6 = DK, R GO TO H6Ci]]
H6A Around this time 12 MONTHS AGO, on the average, about how many cigarettes did you smoke each day?
(ONE PACK USUALLY EQUALS 20 CIGARETTES. IF CONVERTING PACKS TO CIGARETTES, ALWAYS VERIFY CALCULATION WITH RESPONDENT.)
ENTER NUMBER OF CIGARETTES PER DAY
(1-99)
|__||__|
BOX26A
IF H6A = D, R, GO TO H6Ci
IF H6A > 40, GO TO H6Av
ELSE GO TO H6Ci
H6Av I have recorded that on the average, you smoked [fill entry H6A] cigarettes a day 12 months ago. Is that correct?
(1) Yes GO TO H6Ci
(2) No GO TO H6A to CORRECT
|__|
H6B Around this time 12 MONTHS AGO, on how many of 30 days in the month did you smoke cigarettes?
ENTER (0) FOR NONE
|__|__| (0-30)
BOX 26B
IF H6B = 0 OR 30, GO TO H6Bv
ELSE GO TO H6C
H6Bv You said that you smoked cigarettes some days. Is that correct?
(1) Yes
(2) No
|__|
BOX 26C
IF (H6Bv = 1 AND H6B = 30 ), OR H6Bv = DK, R, GO TO H6C
ELSE IF H6Bv = 1 AND H6B =0, GO TO BOX H6c4md UNIVERSE
ELSE IF H6Bv = 2, GO TO H6
H6C On the average, on those [fill entry H6B] days, how many cigarettes did you usually smoke each day?
WE ARE STILL TALKING ABOUT “AROUND THIS TIME 12 MONTHS AGO”
|__|__| IF < = 40, GO TO H6Ci; ELSE IF H6C = D, R GO TO H6Ci
H6Cv I have recorded that on the average, when you smoked on those [fill entry H6B] days, you smoked [fill entry H6C] cigarettes a day. Is that correct?
(1) Yes
(2) No GO TO H6C
|__|
(Don’t Know or Refused GO TO H6Ci)
H6Ci Around this time 12 MONTHS AGO, were you usually smoking menthol or non-menthol cigarettes?
(1) Menthol
(2) Non-menthol
(3) NO USUAL TYPE
|__|
[IF H6Ci = 1, GO TO H6d1;]
[ ELSE IF H6Ci = 2, 3, DK, R, GO TO BOX H6c4md UNIVERSE ]
H6C2
Thinking back to the 12 MONTHS BEFORE YOU QUIT SMOKING CIGARETTES,
During
that time, did you usually smoke menthol or non-menthol cigarettes?
(1)
Menthol
(2)
Non-menthol
(3)
NO USUAL TYPE
|__|
[1
or 2: GO TO H6C3;]
[
3, Don’t Know OR Refused: GO TO H6C4]
H6C31
For each of the following, please tell me whether it’s a
reason you usually smoked menthol/non-menthol { fill
menthol
if H6Ci or H6C2 = 1; fill non-menthol
if H6Ci or H6C2 = 2
} cigarettes ? ----Please answer “yes” or “no”
for each.
(1)
Yes
(2)
No
H6C31
|__| They
were less harmful than non-menthol /menthol
{fill non-menthol
if H6C2 = 1 or H6Ci = 1;
fill
menthol
if H6C2 = 2 or H6Ci = 2—NOTE:
Opposite
of the fill in the question stem H6C31}
cigarettes
H6C32 |__|
They
had a better flavor than non-menthol /menthol
{fill non-menthol
if H6Ci =1 or H6C2 = 1; fill menthol
if H6Ci = 2 or H6C2 = 2—NOTE:
Opposite
of the fill in the question stem H6C31}
cigarettes
H6C33
|__| They were less harsh on your THROAT
than non-menthol /menthol
{fill non-menthol
if H6Ci = 1 or H6C2 = 1; fill menthol
if
H6Ci = 2 or H6C2 = 2—NOTE:
Opposite
of the fill in the question stem H6C31}
cigarettes
H6C34
|__| They were less harsh on your CHEST than
non-menthol/menthol {fill
non-menthol if H6Ci
= 1 or H6C2 = 1; fill
menthol if
H6Ci = 2 or H6C2 = 2—NOTE:
Opposite of the fill in the question stem H6C31}
cigarettes
IF
H6Ci or
H6C2
= 1, GO TO H6d1 ELSE IF H6Ci
or H6C2
=2, 3, R, or DK, GO TO BOX H6C4MOD UNIVERSE.
BOX H6c4md UNIVERSE: IF H1NUM/H1UNT < 7 MONTHS/ 28 WEEKS / < than or = 99 DAYS, ASK H6C4MD; ELSE GO TO H6d1
H6c4md During the PAST 12 MONTHS, have you smoked MENTHOL cigarettes for 6 months or more?
(1) Yes
(2) No
ALL GO TO H6d1
H6C5
For how long have you smoked MENTHOL cigarettes?
READ
CHOICES 1-4
(1)
All or nearly all the years you have smoked
(2)
Most of the years you have smoked
Half
of the years you have smoked, OR -
Less
than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
H6d1 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:
(1) Yes
(2) No
H6d1 A nicotine patch |__|
H6d2 A nicotine gum or nicotine lozenge |__|
H6d3 A nicotine nasal spray or nicotine inhaler |__|
H6dnum/unt In total, how long did you use [fill with EACH H6d 1, 2, 3 = 1 (YES) OR IF all three are =1- YES, then fill with “ANY of these” ] during your last quit attempt when you stopped smoking completely
|__|__|num [1-99]
|__|| unt [1= Days, 2= Weeks, 3= Months
H6d7a When you quit smoking completely, did you use ANY of the following PRODUCTS:
(1) Yes
(2) No
H6d7a A prescription pill, called Chantix or Varenicline ? |__|
H6d7b A prescription pill, called Zyban, Bupropion, or Wellbutrin? |__|
H6d7c Another prescription pill |__|
IF H6d7c = YES, GO TO H6d7sp
H6d7sp --- Please specify the other prescription used: __________________________
FR: ENTER A TEXT OF AT MOST 20 CHARACTERS
H6d7dnum/unt In total, how long did you use [fill with EACH H6d7a,b,c =1 (YES) OR IF ALL7a and 7b and 7c are =1- YES, then fill with “ANY of these prescription PILLS” ] during your last quit attempt when you stopped smoking completely?
|__|__| num [1-99]
|__| unt [1= Days, 2= Weeks, 3= Months
H6e1 When you quit smoking completely, did you use ANY of the following: [FR: FOR THIS QUESTION, RE-READ STEM PERIODICALLY]
(1) Yes
(2) No
H6e1 |__| A telephone help line or quit line
H6e2 |__| One-on-one counseling
H6e3 |__| A stop smoking clinic, class, or support group
H6e4 |__| Help or support from friends or family
H6e5 |__| The Internet or a web-based program
H6e6 |__| Books, pamphlets, videos, or other materials
H6e7 |__| Acupuncture or hypnosis
[IF YES to H6e7, GO TO H6e7a; ELSE GO TO H6Fa1
H6e7a |__| ] Which: acupuncture or hypnosis or both?
(1) Acupuncture (2) Hypnosis (3) Both
H6Fa1 When you quit smoking completely, did you do ANY of the following: Please mention ALL methods, whether or not you think they were effective: [FR: FOR THIS QUESTION, RE-READ STEM PERIODICALLY]
(1) Yes
(2) No
H6Fa1 |__| Try to quit by GRADUALLY cutting back on cigarettes?
H6Fa2 |__| Try to quit by SWITCHING to smokeless tobacco such as chewing
tobacco, snuff, or snus?
H6Fa2b |__| Try to quit by SWITCHING to regular cigars, cigarillos, little filtered
cigars or pipes filled with tobacco?
H6Fa3 |__| Did you SWITCH to a “lighter” cigarette in order to TRY TO QUIT?
IF H6Ci = 2 (NON-MENTHOL), 3, DK, R, OR
H6C2 =2 (NON-MENTHOL), 3, DK, R
GO TO H6Fa3b; ELSE IF H6c4md =
2, DK, R, GO TO H6Fa3b; ELSE GO
TO H6Fa3c.
H6Fa3b |__| Did you SWITCH to menthol cigarettes in order to TRY TO QUIT?
FR: IF RESPONDENT SAYS THEY WERE ALREADY SMOKING MENTHOL CIGARETTES WHEN THEY TRIED TO QUIT-- THEN THE ANSWER IS "NO, THEY DIDN'T SWITCH TO TRY TO QUIT.”
IF
H2Ci = 2 (NON-MENTHOL)
OR H6C2 = 2 (NON-MENTHOL,
THEN GO TO H6Fa4; ELSE GO TO H6Fa3c.
H6Fa3c |__| Did you SWITCH to non-menthol cigarettes in order to TRY TO QUIT?
FR: IF RESPONDENT SAYS THEY WERE ALREADY SMOKING NON-MENTHOL CIGARETTES WHEN THEY TRIED TO QUIT-- THEN THE ANSWER IS "NO, THEY DIDN'T SWITCH TO TRY TO QUIT.”
H6Fa4 |__| Did you try to give up cigarettes all at once?
IF H6Fa4 = 1 (YES), GO TO H6f1; ELSE GO TO H61a
H6f1 Please tell me which is true about when you completely quit smoking by giving up
cigarettes all at once:
READ THE 4 RESPONSE OPTIONS
(1) I tried to quit as soon as I made the decision.
(2) I planned the quit for later the same day.
(3) I planned the quit for a date in the future.
(4) I decided to quit after having NOT smoked for some other reason
|__|
H6f2 When you completely stopped smoking by quitting ALL AT ONCE, would you say
you QUIT “COLD TURKEY”?
Yes
No
FR: “COLD TURKEY” IS STOPPING ALL AT ONCE WITHOUT ANY AIDS
|__|
H61a DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , did you SEE a medical doctor?
Yes GO TO H61b
NO GO TO H62a
don’t know or refused --- GO TO H62a
|__|
H61b DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , did any medical doctor ADVISE you to stop smoking?
YES GO TO H61c
NO GO TO H62a
don’t know or refused GO TO H62a
|__|
H61c1 DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , when a medical doctor advised you to quit smoking, did the doctor also:
H61c1 Suggest that you call or use a telephone help line or quit line?
H61c2 Suggest that you use a smoking cessation class, program, or counseling?
H61c3 Recommend or prescribe a nicotine product such as patch, gum, lozenge,
nasal spray or inhaler?
H61c4 Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, or
Wellbutrin?
H61c5 Suggest that you set a specific date to stop smoking?
GO TO H62a
H62a DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , did you SEE a dentist?
YES GO TO H62b
NO GO TO H8a
[don’t know or refused GO TO H8a ]
H62b DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking, did any dentist ADVISE you to stop smoking?
YES GO TO H62c
NO GO TO H8a
[don’t know OR refused GO TO H8a]
H62c1 DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , when a dentist advised you to quit smoking, did the dentist also:
H62c1 |__| Suggest that you call or use a telephone help line or quit line?
H62c2 |__| Suggest that you use a smoking cessation class, program, or counseling?
H62c3 |__| Recommend or Prescribe a nicotine product such as patch, gum, lozenge, nasal spray or inhaler?
H62c4 |__| Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, Wellbutrin?
H62c5 |__| Suggest that you set a specific date to stop smoking?
GO TO H8aNUM/UNT
H8aNUM/UNT DURING the 12 MONTHS BEFORE you COMPLETELY quit smoking , how soon after you woke up did you typically smoke your first cigarette of the day?
(IF NECESSARY, ASK FOR BEST ANSWER IN MINUTES OR HOURS)
ENTER (0) IF RESPONDENT INSISTS IT VARIES
H8aNUM ENTER NUMBER (0 – 90)
|__|__|
H8aUNT ENTER UNIT REPORTED
|__| (1) Minutes (2) Hours
BOX 29
IF H8aNUM = 0, D, R, GO TO H8b
ELSE GO TO Section J
H8b DURING the 12 MONTHS BEFORE you COMPLETELY 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) Varies— DO NOT READ
|__|
H8c DURING
the12 MONTHS BEFORE you COMPLETELY quit smoking , did
you sometimes awaken at night to have a cigarette?
Yes
No
DO
NOT READ
DON’T
SLEEP AT NIGHT
USE
SOME OTHER TOBACCO PRODUCT WHEN I AWAKEN DURING THE NIGHT
|__|
[GO TO Section J]
[The
menthol questions are repeated again below for those who stopped
smoking greater than 3 years ago from Box 26. ]
H11a Thinking
back to the 12 MONTHS BEFORE YOU COMPLETELY QUIT
SMOKING
CIGARETTES, During that time, DID YOU USUALLY SMOKE menthol or
non-menthol cigarettes?
Menthol
NON-MENTHOL
NO
USUAL TYPE
|__|
[1,
2: GO TO H11b1]
[3,
Don’t Know OR Refused: GO TO H11c]
H11b1 For
each of the following, please tell me whether it’s a reason
you usually smoked menthol/non-menthol {
fill menthol if H11 = 1; fill non-menthol if H11 = 2 }
cigarettes ? ----Please answer “yes “or “no”
for each.
(1)
Yes
(2)
No
H11b1
|__| They
were
less harmful than non-menthol /menthol
{ fill
non-menthol if
H11 = 1 ; fill
menthol if
H11 = 2 —NOTE:
Opposite
of the fill in the question stem H11b1}
cigarettes.
H11b2 |__|
They
had a better flavor than non-menthol /menthol
{
fill
non-menthol if
H11= 1; fill
menthol if
H11 = 2—NOTE:
Opposite
of the fill in the question stem H11b1}
cigarettes.
H11b3
|__| They
were
less
harsh on your THROAT
than
non-menthol /menthol
{
fill
non-menthol if
H11 = 1; fill
menthol if
H11 = 2—NOTE:
Opposite
of the fill in the question stem H11b1}
cigarettes.
H11b4
|__| They were less harsh on your CHEST than
non-menthol/menthol {
fill
non-menthol if
H11 = 1; fill
menthol if
H11 = 2 }—NOTE:
Opposite
of the fill in the question stem H11b}
cigarettes.
IF
H11a
= 1, GO TO H11D; ELSE IF H11a
=2, 3, R, or DK, GO TO H11c
H11c
Have you EVER smoked MENTHOL cigarettes for 6 months or more?
(1)
Yes
(2)
No
|
IF
H11c= 1, THEN GO TO H11D; ELSE GO TO SECTION J
H11d
For how long have you smoked MENTHOL cigarettes?
READ CHOICES 1-4
(1)
All or nearly all the years you have smoked
(2)
Most of the years you have smoked
(3)
Half of the years you have smoked, OR –
(4)
Less than half the years you have smoked
IF
VOLUNTEERED: LESS THAN ONE YEAR
|__|
SECTION J. OTHER TOBACCO USE – ALL RESPONDENTS
J The next questions are about the use of tobacco other than in cigarettes.
PRESS 1 TO CONTINUE
J1a (Have/Has) (you/name) EVER used any of the following EVEN ONE TIME?
(1) Yes
(2) No
J1a1 A regular cigar or cigarillo (in Spanish use “medium size cigar” instead of the word “cigarillo”) OR a little filtered cigar? |__|
FR: Regular cigars are different from little filtered cigars. They can be large cigars, or smaller in size such as cigarillos (in Spanish use “medium size cigars” instead of the word “cigarillos” here.) They are usually sold individually or in packs of 5 or 8. Some common brands are Black and Mild’s, Swisher Sweets cigarillos, and Phillies Blunts, but there are others.
FR: Little filtered cigars are different from regular cigars and cigarillos (in Spanish use “medium size cigars” instead of word “cigarillos” here). They resemble cigarettes in size, and are often sold in packs of 20. They are usually brown in color and have a spongy filter like a cigarette. Some common brands are Prime Time little filtered cigars and Winchester little filtered cigars, but there are others.
J1a2 A regular pipe filled with tobacco |__|
FR: IF ASKED, “pipe smoking” ONLY INCLUDES PIPE TOBACCO. IT DOES NOT INCLUDE SMOKING HASHISH, MARIJUANA, CRACK, OR OTHER SUBSTANCES IN A PIPE. DO NOT INCLUDE WATER PIPES/HOOKAHS {who - kahs OR OTHER NAMES: SHISHA/NARGHILE/ARGILEH, OR HUBBLE-BUBBLE}
J1a3 A water pipe or hookah {pronounced: who-kah} pipe filled with tobacco?
FR: IF ASKED, “water pipe or hookah {who -kah} pipe smoking” ONLY INCLUDES PIPE TOBACCO. IT DOES NOT INCLUDE SMOKING HASHISH, MARIJUANA, CRACK, OR OTHER SUBSTANCES IN A PIPE. A WATER PIPE OR HOOKAH {who -kah} PIPE IS ALSO REFERRED TO AS A SHISHA, NARGHILE, ARGILEH OR HUBBLE-BUBBLE.
The next question is about smokeless tobacco products which are used in the mouth --
J1a4 (Have/Has) (you/name) EVER used any of the following EVEN ONE TIME?
(1) Yes
(2) No
J1a4 SMOKELESS tobacco, such as moist snuff, dip, spit, chew tobacco or snus?
FR: Snuff or dip is commonly placed between the gum and lip and sold in round cans in --a loose form or a pouch that looks like a small tea-bag; common brands are Skoal, Copenhagen and Grizzley but there are others.
Chewing or spit tobacco (also twist, plug or scrap) is usually placed in the side of your mouth and chewed and often sold in wallet-sized pouches;
common brands are Redman, Levi- Garret, and Beech-nut, but there are others.
Snus is a spitless tobacco product that may be sold in a tin or slidepak in a loose form or in small teabag-like pouches; common brands are Camel Snus, Marlboro Snus, and Skoal Snus.
BOX 31
IF ((J1a1 THROUGH J1a4 = NO, DK or R) AND:
IF PROXY RESPONDENT GO TO S78
IF SELF RESPONDENT GO TO BOX 34)
ELSE IF ANY J1a1, 2, 3, 4 = YES (1) GO TO J2a1-4 FOR THOSE PRODUCTS
BOX 32
ASK J2a FOR EACH YES ENTRY IN J1a1 THROUGH J1a4
J2a/J2a1-4 (Do you/Does [name]) NOW (smoke/use) [fill entry in J1a] every day, some days or not at all? [J1a1-4 entries: smoke regular cigars, or cigarillos or little filtered cigars…./ smoke a regular pipe…/ use a water pipe or hookah pipe filled with tobacco…./use smokeless tobacco…. ]
(1) Every day
(2) Some days
(3) Not at all
|__|
FR NOTE: IF RESPONDENT MENTIONS THAT HE/SHE ONLY USED A GIVEN NON-CIGARETTE TOBACCO PRODUCT ONE OR TWO TIMES, STILL ASK THE CORRESPONDING QUESTION FOR THE J2A1-4 SERIES AND INDICATE THEIR RESPONSE TO THAT QUESTION AS APPROPRIATE .
IF (J2a2 = 1 OR 2) AND (J2a3 = 1 OR 2), THEN ASK J2a3v; ELSE GO TO BOX 33.
J2a3v Do you currently smoke BOTH regular pipes AND water pipes or hookah {who-kah} pipes?
YES
NO- GO TO J2a2 and J2a3 to correct and then proceed to BOX 33
|__|
GO TO BOX 33
BOX 33
IF J2a = 1 OR 3:
IF PROXY: IF LAST ENTRY FROM J1a GO TO S78
ELSE REPEAT J2a FOR NEXT YES ENTRY IN J1a1 – 4
IF J2a=1:
IF SELF: IF J2a4 (SMOKELESS) IS 1 (EVERY DAY) AND LAST ENTRY FROM J1a GO TO Ja
ELSE IF J2a1 (CIGARS) IS 1 (EVERY DAY) AND LAST ENTRY FROM J1a GO TO Jb
ELSE LAST YES ENTRY FROM J1a1-4, GO TO Jda
ELSE REPEAT J2a FOR NEXT YES ENTRY IN J1a1-4
IF J2a=3;
IF SELF: IF LAST ENTRY FROM J1a, GO TO Jda
ELSE REPEAT J2a FOR NEXT YES ENTRY IN J1a1 – 4
FOR EACH ENTRY J2a1-4 =3 (NOT AT ALL), ASK THE APPROPRIATE
QUESTIONS IN THE Jd SERIES (HOW MANY TIMES/ HOW LONG
HAS IT BEEN SINCE YOU COMPLETELY STOPPED SMOKING//USING ………
CIGARS/PIPES//SMOKELESS TOBACCOQ Jda
IF J2a = 2: (Someday Smokers)
IF PROXY: IF LAST YES ENTRY FROM J1a 1-4, GO TO S78
ELSE REPEAT J2a FOR NEXT YES ENTRY IN J1a1 -4
IF SELF: GO TO J2b
IF J2a= DK/REF (-2 or -3), GO BACK TO J2a for next item (ie. cigars, etc.)
IF J2a= DK/REF (-2 or -3) AND IF LAST ENTRY FROM J1a1-4, GO TO BOX 34
J2b/J2b1-4 On how many of the past 30 days did you (smoke/use) [fill entry J1a1-4]?
[ASK SEPARATELY FOR EACH “YES” ENTRY IN J1a WITH J2a = 2]
ENTER NUMBER OF DAYS
ENTER (0) FOR NONE
(0-30)
|__||__| IF [entry in J2b = 0 OR 30] GO TO J2b1-4v; ELSE AFTER OBTAINING ALL RELEVANT RESPONSES TO THIS QUESTION, IF SMOKELESS CURRENT USE, GO TO Ja; ELSE IF CIGAR CURRENT USE, GO TO Jb; ELSE GO TO Jda.,
J2b1-4v You said that you (smoked/used) [fill entry J1a] some days. Is that correct?
[ASK SEPARATELY FOR EACH “YES” ENTRY IN J1a WITH J2b = (0) OR 30]
(1) Yes
(2) No [GO TO RELEVANT J2a1-4 AND CORRECT]
|__|
NOTE: THE J2a, J2b, and J2bv (as needed) SERIES IS REPEATED FOR EACH YES ENTRY IN J1a1-4 AS APPROPRIATE
AFTER OBTAINING ALL RELEVANT RESPONSES TO THIS QUESTION, IF SMOKELESS CURRENT USE, GO TO Ja; ELSE IF CIGAR CURRENT USE, GO TO Jb; ELSE GO TO Jda.
Ja During the PAST 30 days, what BRAND of smokeless tobacco [IF necessary: moist snuff, dip, spit, chew or snus] did you use MOST OFTEN?
Allow for filling in code number OR ENTER Brand NAME by clicking on it—
Ja |__|__| (1-22)
IF BRAND IS NOT ON THE LIST, ENTER “22” for OTHER in Ja.
THE UNREAD CODES FOR INTERVIEWER ENTRY ARE:
1
BEECH-NUT
2 CAMEL SNUS
3 COPE
4
COPENHAGEN
5 COUGAR
6
GRIZZLY
7 HAWKEN
8 HUSKY
9
KAYAK
10 KODIAK
11 LEVI GARRETT
12
LONGHORN
13 MARLBORO SNUS
14 RED
MAN
15 RED SEAL
16 ROOSTER
17 SILVER CREEK
18 SKOAL
19
SKOAL SNUS
20 TAYLOR'S PRIDE
21 TIMBER
WOLF
22 OTHER
[NOTE: THESE brands are 96% of the market share]
IF Ja = 22, GO TO Jaspc; ELSE IF J2a1 = 1 or 2 GO TO Jb--- [ If ‘cigars” is NOW smoked every day or some days, ask Jb and Jc ]—ELSE GO TO Jda.
Jaspc Please specify the other brand: ___________________ FR: ENTER A TEXT OF AT MOST 20 CHARACTERS.
IF J2a1 = 1 or 2 GO TO Jb--- [ If ‘cigars” is NOW smoked every day or some days, ask Jb and Jc ]—ELSE GO TO Jda.
Jb During the PAST 30 days, what type of CIGAR did you use MOST OFTEN?
READ the 3 CHOICES
(1) Regular/large cigars
“Cigarillos” ( in Spanish use “medium size cigars” instead of the word “cigarillos here”)
Little, filtered cigars
Jc During the PAST 30 days, what BRAND of CIGAR did you smoke MOST OFTEN?
____ ENTER CODE FOR BRAND (1-15). ENTER 15 for OTHER BRAND NOT ON THE LIST
NOTE: List of major brands for Coding SEE BELOW. IF indicates “ need to prompt with F/U question”, ask FU question Jcpro after asking main question Jc. It does this for certain brands that produce regular and little cigars.
THE UNREAD CODES FOR INTERVIEWER ENTRY ARE:
1 Al Capone (makes regular and little/small cigars== prompt)
2 Backwoods (regular only)
3 Black & Milds (makes regular and cigarillo-medium size cigars (in Spanish use “medium size cigars “ instead of the word “cigarillo” here) with plastic hard filters) ===prompt)
4 Captain Black (little only)
5 Dutch Masters (regular/large cigar)
6 Dutch Treats (little cigar)
7 Erik (little only)
8 Hav-a-tampa (makes regular and little/small cigars== prompt)
9 King Edward(makes regular and little/small cigars== prompt)
10 Muriel (makes regular and little/small cigars== prompt)
11 Phillies (makes regular and little/small cigars== prompt)
12 Prime Time (little only)
13 Smoker's Choice (little only)
14 Swisher Sweet* (makes regular and little/small cigars== prompt)
15 Other (prompt )
Jcpro—Is that a regular or little cigar? Little cigars are cigarette size with a filter.
(1) Regular cigar
(2)Little/small cigars
UNREAD codes:
(3) None of the above;
(4) More than one of the above;
DK; R
|__|
Jcflavr—During the past 30 days, did you USUALLY smoke flavored cigars? By flavored we mean fruit, candy, alcohol, clove or any other flavorings
(1) Yes
(2) No
|__|
ASK Jda SEPARATELY FOR EACH OF THE 4 NON-CIGARETTE OTHER TOBACCO PRODUCTS WITH A J2a 1-4=1, 2, OR 3
Jda1-4 About how many times in your life have you smoked/used [fill entry J1a1-4]?
[ASK SEPARATELY FOR EACH “YES” ENTRY IN J1a WITH J2a = 1, 2 OR 3]
1-9 times
10-19 times
20-49 times
50 or more times ---
FOR ANY Jda 1-4 =4 (50 OR MORE TIMES) IMMEDIATELY ASK CORRESPONDING Jdb1-4. THEN RETURN TO ASKING Jda1-4 FOR THE NEXT APPROPRIATE PRODUCT. WHEN HAVE COMPLETED ASKING Jda1-4 AND Jdb 1-4 AS APPROPRIATE, GO TO Box Jd.
Jdb1-4 Was the number as many as 100 or more times!
Yes
No
Box Jd
FOR EACH ENTRY J2a1 OR 4 = 3 (NOT AT ALL) AND CORRESPONDING Jda = 2, 3, OR 4, GO TO Jdc; ELSE GO TO BOX 34.
Jdc1,
4 Thinking about how long it has been since you COMPLETELY quit ….
smoking cigars, cigarillos, or little filtered cigars //
a
regular pipe filled with tobacco / a water pipe or hookah
{who- kah}
pipe filled with tobacco
smokeless
tobacco, WAS it within the PAST 12 months, that is since May 2010?
(1) Yes (2) No
[FR NOTE: IF RESPONDENT ASKS IF COUNT QUITTING IN MAY 2010, SAY YES.]
IF Jdc 1 OR 4 = 1 (YES), GO TO CORRESPONDING Jd1/2_1, 4; ELSE GO TO BOX 34.
Jd1/2_1,
4 About how long has it been since you COMPLETELY quit smoking
cigars, cigarillos, or little filtered cigars ///a
regular pipe filled with tobacco / a water pipe or hookah {who-kah}
pipe filled with tobacco //
using smokeless tobacco?
Jd11/2/3
4 |__|__|| NUMBER (1-99)
Jd2
1/2/3
4 |__| UNITS
(1) Days
(2) Weeks
(3) Months
(4)
Years
FR
NOTE:
IF
GIVEN PRODUCT WAS ONLY USED ONE OR TWO TIMES EVER, AND CURRENTLY
USED “NOT AT ALL,” ENTER “Ctrl-R” ( OR
“Once or twice EVER”)AND DO NOT ASK Jd1/2 FOR THAT GIVEN
PRODUCT
Jd3
ASK Jd3 SEPARATELY FOR EACH J1a1-4 = 1 (YES):
Jd3 In
total, how many years did you smoke //use –
cigars or cigarillos or little filtered cigars / a regular pipe / a
water pipe or hookah pipe filled with tobacco / smokeless tobacco
(fill as appropriate from J1a1-4)?
ENTER
0 FOR LESS THAN ONE YEAR
FR
NOTE:
IF
GIVEN PRODUCT WAS ONLY USED ONE OR TWO TIMES EVER, AND CURRENTLY
USED “NOT AT ALL,” ENTER 0 FOR LESS THAN ONE YEAR ( OR
“Once or twice EVER”)
Jd31,
2,3 ,4 |__|__| (0-99) years
BOX 34
FOR PROXY RESPONDENT: GO TO S78
FOR SELF RESPONDENT:
IF CURRENT SMOKER OF CIGARETTES (A3=1 OR 2) GO TO SECTION JJ
ELSE IF J1a1-4 = NO OR J2a = DK/Refused OR ANY COMBINATION OF THESE THREE STIPULATIONS FOR ALL FOUR “OTHER” TOBACCO PRODUCTS FOR ALL ENTRIES, GO TO SECTION JJ
ELSE IF ONLY ONE PRODUCT IS SMOKED NOW EVERY DAY OR SOME DAYS AND THAT PRODUCT IS A WATER PIPE (HOOKAH)], THEN GO TO SECTION JJ
ELSE GO TO BOX 39
Other tobacco time to first use
BOX 39
IF ONLY ONE PRODUCT MENTIONED IN J2a IS NOW USED “EVERY DAY” OR “SOME DAYS [J2a =1 OR J2a =2* ( * means > = 12 days used product within the last 30 days) ] AND THAT PRODUCT IS J2a1, 2 OR 4 (CIGARS, REGULAR PIPES, OR SMOKELESS) FILL J3a AS “smoke your first cigar” // “ smoke your first pipe” // “use smokeless tobacco”;
ELSE IF > 1 PRODUCT MENTIONED IN J2a, AND IF J2a=1,2* INDICATES NOW SMOKES CIGARS AND ONE OR BOTH PIPE PRODUCTS (J2a1 =1, 2* AND J2a2 OR 3 = 1,2*) FILL J3a AS “smoke your first cigar or pipe”; OR IF SMOKES ONLY BOTH TYPES OF PIPES FILL J3a AS “smoke your first pipe”;
ELSE IF ASK
J3c J2a1-4
indicates NOW USES any
other THESE
COMBINATIONS of two or more non-cigarette tobacco products -- (e.g.,
cigars AND smokeless; pipes (regular or hookah) AND smokeless; OR
cigars, pipes (regular or hookah) AND smokeless) FILL J3a AS “use
any
of your non-cigarette
tobacco products for the first time”;
IF respondent insists it VARIES in
response to ANY
J3a1 -J3c,
record a "0" for VARIES and ask J3d.
ELSE IF [(J2a=3 OR J1a = 2) FOR ALL J1a1-
4] AND [Jd1/2 LESS THAN OR
EQUALTO 1 YEAR EQUIVALENCE, 12 MONTHS, 52 WEEKS, 99 DAYS Or use
instead Jdc =1) FOR ONLY ONE
“OTHER TOBACCO PRODUCT” J1a1,2,OR
4] AND [(IF A3 =3 AND H1NUM/UNT > 1 YEAR, 12 MOS., 52 WEEKS, OR
EQUIVALENCE) OR (IF A1=2) ] THEN GO TO J3f.
_________________________________________________________
J3a How soon after you wake up do you typically [fill with appropriate stem and ending based on responses to J2a1-4 as directed in Box39]…… “smoke your first cigar” // “smoke your first pipe”; “first use smokeless tobacco”; “smoke your first cigar or pipe”; “ use any of your non-cigarette tobacco products for the first time”?
(IF NECESSARY, FR ASK FOR BEST ANSWER IN MINUTES OR HOURS)
ENTER (0) in J3a1 IF RESPONDENT INSISTS IT VARIES
J3a1 ENTER NUMBER (0 - 90)
|__|__|
J3a2 ENTER UNIT REPORTED
|__| (1) Minutes (2) Hours
IF ANY
J3a1/2, c
= 0, D, or R, THEN GO TO J3d_a-c;
ELSE GO TO J3e
BOX 39A.
J3b How soon after you wake up do
you typically [fill with appropriate stem and ending based on
responses to J2a1,2]
smoke your first --cigar or pipe
(IF NECESSARY, FR ASK FOR BEST
ANSWER IN MINUTES OR HOURS)
ENTER (0) in J3b IF RESPONDENT
INSISTS IT VARIES
J3b1 ENTER
NUMBER (0 - 90)
|__|__|
J3b2 ENTER
UNIT REPORTED
|__| (1) Minutes (2) Hours
J3c
How soon after you wake up do you typically [fill with appropriate
ending based on multiple responses to J2a1-4]
use any
of your non-cigarette
tobacco products -- for the first time?
(IF NECESSARY, FR ASK FOR BEST
ANSWER IN MINUTES OR HOURS)
ENTER (0) in J3c IF RESPONDENT
INSISTS IT VARIES
J3c
1 ENTER
NUMBER (0 - 90)
|__|__|
J3c2 ENTER
UNIT REPORTED
|__| (1) Minutes (2) Hours
J3d Would you say you first smoke a cigar/ pipe// use smokeless tobacco// smoke a cigar or pipe //( other combination of ) non-cigarette tobacco products--- within the first 30 minutes of awakening?
(1) Yes
(2) No
(3) Varies— DO NOT READ
|__|
J3e Do
you sometimes awaken during the night to use tobacco?
(1)Yes
(2)No
(3)Don’t
sleep at night
(UNREAD)
GO TO BOX 39A
J3f1/2 In
the 12 months BEFORE YOU COMPLETELY QUIT smoking (…cigars//
pipes. using smokeless
tobacco), how soon after you
woke up did you typically [fill with appropriate stem and ending
based on responses to J2a1,
2 OR 4]
smoke your first cigar
-//
pipe - use smokeless
tobacco?
(IF NECESSARY, FR ASK FOR BEST ANSWER IN MINUTES OR HOURS)
ENTER (0) in J3f1 IF RESPONDENT INSISTS IT VARIES
J3f1 ENTER NUMBER (0 - 90)
|__|__|
J3f2 ENTER UNIT REPORTED
|__| (1) Minutes (2) Hours
IF J3f1/2 = 0, D or R, THEN GO TO J3g; ELSE GO TO BOX 39A
J3g
Would you say you first used cigars/
pipes/
smokeless tobacco// within the first 30 minutes of awakening?
(1) Yes
(2) No
(3) Varies— DO NOT READ
|__|
J3h During
the 12
months BEFORE YOU COMPLETELY QUIT smoking …cigars/pipes..//
using smokeless tobacco, DID
you sometimes awaken at night to use tobacco?
(1)Yes
(2)No
DO
NOT READ
(3)DON’T
SLEEP AT NIGHT
---
(4) USE SOME OTHER TOBACCO PRODUCT WHEN I AWAKEN DURING THE NGHT]
]--
|__|
BOX 39A
IF A3 = 1 OR 2 (CURRENT CIGARETTE SMOKER) GO TO SECTION JJ- DO NOT ASK J4-J7
ELSE IF J2a3 = 1 OR 2, THEN GO TO SECTION JJ (DO NOT ASK J4 – J7 FOR WATER PIPES (HOOKAHS)
ELSE IF ONLY ONE PRODUCT MENTIONED IN J2a (J2a 1, 2, 4) IS NOW USED “EVERY DAY” OR “SOME DAYS [J2a =1 OR J2a =2*)]THAT PRODUCT IS USED FOR J4-J7—GO TO J4
ELSE IF > 1 PRODUCT MENTIONED IN J2a [J2a =1 OR J2a =2*], GO TO SECTION JJ
ELSE IF [(J2a=3 OR J1a = 2) FOR ALL J1a1, 2
,4] AND [Jd1/2 LESS THAN OR
EQUAL TO 1 YEAR EQUIVALENCE, 12 MONTHS, 52 WEEKS, 99 DAYS Or
use instead Jdc =1)
FOR ONLY ONE “OTHER TOBACCO PRODUCT” J1a1,
2OR 4] AND [ (IF A3 =3
AND H1NUM/UNT > 1 YEAR, 12 MOS., 52 WEEKS, OR EQUIVALENCE) OR (IF
A1=2) ] THEN GO TO Box J7a.
ELSE GO TO SECTION JJ
J4 During the PAST 12 MONTHS, have you stopped smoking/using [fill entry BOX 39A—cigars/pipes/ smokeless tobacco] for one day or longer BECAUSE YOU WERE TRYING TO QUIT?
(1) Yes è GO TO J5
(2) No GO TO SECTION JJ
IF J4 = D, R è GO TO SECTION JJ
J5num/unt The LAST TIME you stopped smoking/using [fill entry Box 39A] in the Past 12 Months BECAUSE YOU WERE TRYING TO QUIT, how long did you stop for?
J5num ENTER NUMBER (1 - 99)
|__|__|
J5unt ENTER UNIT REPORTED
(1) Days
(2) Weeks
(3) Months
|__| IF (J5unt = 2 AND J5num >18) OR (J5num >12 AND J5unt = 3), GO TO J5v; ELSE IF J5num/unt = D or R, GO TO QUESTION J7a1; ELSE GO TO J6a.
J5v I have recorded that the LAST TIME you stopped smoking/using [fill entry Box 39 A cigars/ pipes/ used smokeless] in the past 12 months because you were TRYING to quit was [fill entry J5num/J5unt]? Is that correct?
(1) Yes
(2) No GO TO J5num/Junt TO CORRECT
|__|
J6a Was [fill entry J5num/unt] the LONGEST you went without smoking/using [fill entry Box 39A- cigars/ pipes/ using smokeless tobacco] in the past 12 months?
(1) Yes GO TO Question J7a1
(2) No
|__|
J 6b During the past 12 MONTHS, what is the LONGEST length of time you stopped smoking/using [fill entry Box 39-- cigars/ pipes/ used smokeless] because you were TRYING to quit?
J6bnum ENTER NUMBER (1 -99)
|__|__|
J6bunt ENTER UNIT REPORTED
(1) Days
(2) Weeks
(3) Months
|__| IF (J6num >18 AND J6bunt = 2) OR (J6bnum >12 AND J6bunt = 3) ºGO TO J6bv; ELSE ºGO TO QUESTION J7a1
J6bv I have recorded that the LONGEST length of time you stopped smoking/using [fill entry Box 39—cigars/ pipes/ using smokeless tobacco] in the past 12 months because you were TRYING to quit was [fill entry J6bnum/J6bunt]? Is that correct?
(1) Yes GO TO QUESTION J7a1
(2) No GO TO J6bnum/unt TO CORRECT
|__|
BOX J7a--
For J7a –
J7c-- Use alternative wording for those who met criteria in BOX 39A
for recent former users of one “other tobacco product” :
ELSE IF [(J2a=3 OR J1a =
2) FOR ALL J1a1- 4] AND [Jd1/2
LESS THAN OR EQUAL TO 1 YEAR EQUIVALENCE , 12 MONTHS, 52 WEEKS,
99DAYS Or use
instead Jdc =1)
(i.e., 1 YEAR FOR ONLY
ONE “OTHER TOBACCO PRODUCT”J1a1, 2
OR 4] AND [ ( IF A3 =3
AND H1NUM/UNT > 1 YEAR, 12 MOS., 52 WEEKS, OR EQUIVALENCE) OR (IF
A1=2) ] THEN GO TO QUESTION J7a1 USING ALTERNATIVE WORDING AS
DIRECTED in this BOX BELOW.)
J7a-c “Now I would like to ask about
HOW you went about completely quitting smoking…cigars//
pipes/using smokeless
tobacco. When you COMPLETELY quit smoking cigars/ pipes/using
smokeless tobacco, did you use ANY of the following PRODUCTS?—For
J7b and J7c alternative wording is: “When you COMPLETELY quit
smoking cigars// pipes/using
smokeless tobacco, did..............?
J 7a1 Thinking back about the last time you tried to quit [fill entry Box 39A—smoking cigars/ smoking pipes/ using smokeless tobacco] in the past 12 months …..// SUBSTITUTE ALTERNATIVE WORDING FOR RECENT FORMER USER OF OTHER TOBACCO PRODUCT-- CRITERIA FROM BOX 39A/ BOX J7a-- above//……:
Did you use any of the following PRODUCTS:
(1) Yes
(2) No
J7a1 A nicotine patch |__|
J7a2 A nicotine gum or lozenge |__|
J7a3 A nicotine nasal spray or inhaler |__|
J7a7a A prescription pill called Chantix or Varenicline? |__|
J7a7b A prescription pill, called Zyban, Bupropion, or Wellbutrin? |__|
J7a7c Another prescription pill ? |__|
IF YES TO J7a7c (J7a7c=1) GO TO J7aspc; ELSE GO TO J7b1
J7aspc -- Specify other pill: ____________________ FR: ENTER TEXT OF AT
MOST 40 CHARACTERS
J7b1 The LAST TIME you tried to quit [fill entry Box 39A/Box J7a—smoking cigars/ smoking
pipes/using smokeless tobacco], did you use ANY of the following: //USE ALTERNTAIVE WORDING FOR RECENT FORMER USER OF OTHER TOBACCO PRODUCT//:
[FR NOTE: FOR THIS QUESTION, RE-READ STEM PERIODICALLY]
(1) Yes
(2) No
J7b1 |__| A telephone help line or quit line?
J7b2 |__| One-on-one counseling?
J7b3 |__| A stop smoking clinic, class, or support group?
J7b4 |__| Help or support from friends or family?
J7b5 |__| The Internet or web-based program?
J7b6 |__| Books, pamphlets, videos, or other materials?
J7b6b |__| Acupuncture or hypnosis?
IF J7b6b = 1 (YES), THEN GO TO J7b6c; ELSE GO TO Jb7.
J7b6c |__| Which one? (1) Acupuncture (2) Hypnosis (3) Both
J7b7 |__| Advice from a medical doctor, dentist or other health professional?
IF J7b7 = 1 (YES), THEN GO TO J7b7a; ELSE GO TO J7c.
J7b7a |__| Which ?- (1) Doctor (2) Dentist (3) Other health professional (4) More than one of the previous choices
FR: SPECIFY DOCTOR, DENTIST, OTHER BY ENTERING THE APPROPRIATE CHOICES (1-4)
J7c The LAST TIME you tried to QUIT (fill entry Box 39A/ BOX J7a—smoking cigars /smoking pipes/using smokeless tobacco) in the past 12 months//, did you do ANY of the following: // USE ALTERNTAIVE WORDING FOR RECENT FORMER USER OF OTHER TOBACCO PRODUCT//:
(1) Yes
(2) No
J7c1 |__| Stop by gradually cutting back on (fill entry Box 39A/J7a) … smoking
cigars/smoking pipes/using smokeless tobacco…. in order to TRY TO QUIT?
J7c2 |__| Did you TRY GIVING IT UP ALL AT ONCE?
IF YES TO J7c2, ask J7c2a; ELSE GO TO SECTION JJ
J7c2a|__| Would you say you TRIED TO QUIT “cold turkey?
FR: “COLD TURKEY” IS STOPPING ALL AT ONCE WITHOUT ANY AIDS
(1) Yes
(2) No
|__|
SECTION JJ. New Tobacco Related Products
(ASK ALL CURRENT CIGARETTE SMOKERS, OR
CURRENT USERS OF OTHER TOBACCO PRODUCTS, OR--- RECENT FORMER USERS
OF ANY TOBACCO PRODUCT (CIGARETTES OR OTHER TOBACCO PRODUCTS)-- WHO
STOPPED USING THAT PRODUCT WITHIN THE LAST THREE YEARS (H1NUM/UNT
OR
Jd1/2_1-4
<equal 3 years, 36 months, 99 weeks, or 99 days OR
Jdc1, or 4 = 1 (YES- stopped within the PAST 12 months)
–
JJ1a Have you EVER TRIED a product called an electronic cigarette or e-cigarette, such as “Smoking Everywhere,” “NJOY,” or other brands?”
[FR: IF FURTHER INFO IS NEEDED: These battery powered products don’t contain tobacco but deliver nicotine through a vapor.]
Yes
(2) No
|__|
IF JJ1a = 1 (YES), GO TO JJ2a1; ELSE GO TO Section K
JJ2a1 Have you ever used e-cigarettes to help you QUIT (CAPS) smoking cigarettes or quit using other tobacco products?
(1) Yes
(2) No
|__|
ALL GO TO JJ2a2
JJ2a2 Have you ever used e-cigarettes to
help you when you WEREN’T
ALLOWED to smoke
cigarettes, cigars or pipes?
Yes
No
ALL GO TO SECTION K
JJ1
Tobacco companies are developing new smokeless tobacco products, in
various shapes, such as a pellet, a toothpick size stick, and a film
strip, made from finely ground flavored tobacco that dissolves.
Some common brands are Camel Orbs, Strips and Sticks.
JJ1
Have you tried any new smokeless tobacco products?
(1) Yes
(2) No
|__|
IF YES TO JJ1, ASK JJ2; ELSE GO TO
Section K
JJ2
What did you try?
ENTER ALL PRODUCTS MENTIONED SEPARATED
BY COMMAS . ENTER A TEXT OF AT MOST 60 CHARACTERS
______________________________
GO
TO SECTION K
SECTION K. WORKPLACE POLICY, HOME RULES, PUBLIC OPINION ABOUT CLEAN
INDOOR AIR POLICIES
– ALL RESPONDENTS
BOX 41 -- CONTEXT FOR K1 same as always been:
IF NOT RETIRED AND HAVE BEEN WORKING FOR PAY OR EMPLOYED IN PAST WEEK AND ARE NOT SELF-EMPLOYED:
K1a The next questions are about your place of work.
[FR NOTE: IF RESPONDENT HAS MORE THAN 1 JOB, HAVE HIM/HER ANSWER FOR HIS/HER MAIN JOB.]
K1a. Do you mainly work indoors or outdoors?
[FR NOTE: DO NOT READ THE FIRST 2 CATEGORIES UNLESS NECESSARY. NEVER READ THE REMAINING CATEGORIES.]
(1) Indoors [GO TO K1b]
(2) Outdoors [GO TO K4]
(3) About equally indoors and outdoors [GO TO K1b2]
(4) Works mainly indoors in a non-traditional environment such as warehouse or other similar large semi-structured area --[GO TO K1b1]
(5) Mainly travel around to different clients or sites or mainly in a motor vehicle /bus /train /boat /airplane /underground /in a mine, etc. [GO TO K4]
(6) Varies [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?
(1) Office building [GO TO K1b1]
(2) Own home [GO TO K4]
(3) Someone else’s home [GO TO K4]
(4) Another indoor place [GO TO K1b1]
don’t know or refused [SKIP TO K1b1]
K1b1 In which State (including DC), do you work?
|__|__| FR: ENTER 2 LETTER ABBREVIATION FOR THE STATE.
GO TO K2a
K1b2. When you work INDOORS: Do you mainly work in an office building, in your own home, in someone else’s home, or in another indoor place?
(1)Office building [GO TO K1c]
(2) Own home [GO TO K4]
(3) Someone else’s home [GO TO K4]
(4) Another indoor place [GO TO K1c]
don’t know OR refused [GO TO K1c]
K1c In which State (including DC), do you work on your main indoor job or business?
|__|__| ENTER 2 LETTER STATE ABBREVIATION
K2a. Is smoking restricted in ANY WAY at your place of work?
[READ IF NECESSARY]: “By ‘restricted’, we mean any limitation on smoking , regardless of who is responsible for that restriction (including owner, employer, gov’t , union, etc.).
Yes
NO [GO TO K4 ]
Don’t KNOW OR refused [GO TO K4]
|___|
K3a Which of these best describes the smoking policy at your place of work for INDOOR
PUBLIC OR COMMON AREAS, such as lobbies, rest rooms, and lunch rooms?
READ THE FIRST 3 ANSWER CATEGIES ONLY
(1) Not allowed in ANY public areas
(2) Allowed in SOME public areas
(3) Allowed in ALL public areas
ENTER (4) IF NOT APPLICABLE
K3b Which of these best describes the smoking policy at your place of work for INDOOR WORK AREAS?
READ THE FIRST 3 ANSWER CATEGIES ONLY
(1) Not allowed in ANY work areas
(2) Allowed in SOME work areas
(3) Allowed in ALL work areas
ENTER (4) IF NOT APPLICABLE
|__|
K3c During
the PAST TWO WEEKS, has anyone smoked in the area in which you work?
(1)Yes
(2)NO
|__|
K3d Within
the PAST 12 MONTHS, has your employer offered any stop smoking
program or any other help to employees who want to quit smoking?
(1)YES
(2)NO
K4 The final set of questions are about your home and other places.
K4 Which statement best describes the rules about smoking INSIDE YOUR HOME?
[READ IF NECESSARY]: “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
|__|
K6c In
bars, cocktail lounges, and clubs, 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
Not
allowed at all
|__|
K6f On
outdoor children’s playgrounds and outdoor children’s
sports fields, 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
|__|
K6g Inside casinos, 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
|__|
K6h Inside a car, when there are other people present, do you THINK that smoking
SHOULD…
Always
be allowed, GO
TO K6h2
Be
allowed under some conditions, or GO
TO K6h2
Never be allowed?
GO
TO K7 IF B2=1 OR C2=1 (MENTHOL SMOKER); ELSE GO TO KStresh
SINTTP
DON’T
KNOW OR REFUSED GO TO K6h2
K6h2
IF
children are present inside the car, do you think that smoking
SHOULD…
Always
be allowed,
Be
allowed under some conditions, or
Never
be allowed?
K7 If menthol cigarettes were no longer sold, which of the following would you MOST
LIKELY do:
(1) Switch to non-menthol cigarettes
(2) Switch to some other tobacco product; or
(3) Quit smoking and not use any other tobacco product
DO NOT READ CATEGORY #4.
(4) NONE OF THE ABOVE
|__|
IF K7 = 4 (NONE OF THE ABOVE), GO TO K7SPC; ELSE GO TO SINTTP
K7SPC Please specify what you would MOST LIKELY DO if menthol cigarettes were no longer sold _________________________ (60 characters)
KStresh—STATE
of Residence When Born for ALL Respondents
KStresh:
In what state or country were you born?
IF THE PERSON WAS BORN IN ONE OF THE
50 STATES OF THE UNITED
STATES
(OR DC) ENTER WHICH STATE, IF THE PERSON WAS NOT BORN IN THE UNITED
STATES ENTER A COUNTRY.
FR:
SPELL OUT THE STATE
OR COUNTRY NAME. ENTER A TEXT OF AT
MOST
40 CHARACTERS
________________________________
(GO
TO SINTTP)
STATE
of Residence When Born-- for ALL PROXY Respondents
KStresh: -
In what state or country was ______ (Respondent’s name for
which the
PROXY
is responding)
born?
FR:
IF THE
RESPONDENT WAS BORN IN ONE OF THE 50 STATES OF THE UNITED
STATES
(OR DC) ENTER WHICH STATE, IF THE PERSON WAS NOT BORN IN THE UNITED
STATES ENTER A COUNTRY.
SPELL
OUT THE STATE OR COUNTRY NAME. ENTER A TEXT OF AT MOST 40
CHARACTERS.
________________________________
SINTTP *** DO NOT READ ***
In what language was the interview conducted for this person?
(1) English
(2) Spanish
(3) Chinese
(4) Korean
(5) Vietnamese
(6) Khmer
(7) Other Asian or Asian unspecified
(8) Other
|__|
| File Type | application/msword |
| File Title | revised2003Cessation_0709.wpd |
| Author | Sonja |
| Last Modified By | OMB_OIRAJW |
| File Modified | 2011-03-10 |
| File Created | 2011-03-10 |