Smoker Baseline Questionnaire

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

CDC National Media Campaign

- Smoker Baseline Questionnaire -

Public reporting burden of this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).

SUBJECTS FOR QUESTIONNAIRE

SECTION B: TOBACCO USE QUESTIONS

SECTION C: SMOKING CESSATION

SECTION D: ATTITUDES AND BELIEFS RELATED TO CESSATION

SECTION E: SECONDHAND SMOKE

SECTION F: MEDIA USE AND AWARENESS

SECTION G: CLOSING QUESTIONS

SECTION B: TOBACCO USE QUESTIONS

The next few questions are about tobacco use and smoking cessation.

B1. On the average, about how many cigarettes a day do you now smoke?

__________________ number of cigarettes

I smoke less than 1 cigarette a day

B2. On the days that you smoke, how soon after you wake up do you usually have your first cigarette? Would you say…

Rationale: Provides an indicator of addiction; NATS Q19

1. Within 5 minutes

2. 6-30 minutes

3. From more than 30 minutes to 1 hour

4. After more than 1 hour

B3. How old were you when you smoked a whole cigarette for the first time?

Rationale: Key Outcome Indicator 1.13.1; NATS Q13

_____ Years

SECTION C: SMOKING CESSATION

C1. In your whole life, how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

Rationale: To identify lifetime prevalence of quit attempts; NATS Q48

_____ Number of times

C2. During the past 3 months, that is, since [DATE FILL], how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

Rationale: Key Outcome Indicator 3.11.1; Revised from NATS Q49 with “3 months” instead of “12 months” since follow-up survey will occur 3-4 months after baseline survey.

_____ Number of times

C3. During the past 12 months, that is, since [DATE FILL], how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

Rationale: Key Outcome Indicator 3.11.1; NATS Q49

_____ Number of times

C4. During the past 3 months, that is, since [DATE FILL], how many times have you tried to quit smoking cigarettes for good, but stopped for less than a day?

Rationale: Key Outcome Indicator 3.11.1; Revised from NATS Q49 with “3 months” instead of “12 months” to allow for more sensitivity.

_____ Number of times

C5. Have you stopped smoking for one day or longer since January 1, 2012 because of a New Year’s resolution to stop smoking?

Rationale: Key Outcome Indicator 3.11.1; Revised from NATS Q49 to include “since January 1, 2012.”

1. Yes

2. No

C6. Do you want to quit smoking cigarettes for good?

Rationale: Key Outcome Indicator 3.08.3; Q54

1. Yes

2. No

C7. How much do you want to quit smoking? Would you say…

1. Not at all

2. A little

3. Somewhat

4. A lot

C8. Do you have a time frame in mind for quitting?

Rationale: Key Outcome Indicator 3.08.3; NATS Q55

1. Yes

2. No

C9. Do you plan to quit smoking for good….

1. In the next 7 days,

2. In the next 30 days,

3. In the next 6 months,

4. In the next 1 year, or

5. More than 1 year from now?

C10. If you decided to give up smoking altogether in the next 12 months, how likely do you think you would be to succeed? Would you say…

Rationale: Increased Awareness, Knowledge, and Intention to Quit;

Change in Beliefs about Perceived Ability to Quit Smoking. Source: NY ATS; FL Online Adult Longitudinal Media Survey

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

C11. How much do you think your health would improve if you were to quit smoking?

Rationale: Increased Awareness Knowledge and Intention to Quit - Increased belief that smoking is harmful to health. Source:FL Online Adult Longitudinal Media Survey

1. Not at all

2. A little

3. Somewhat

4. A lot

C12. How worried are you that smoking will damage your health in the future?

Rationale: Increased Awareness Knowledge and Intention to Quit, Increased belief that smoking is harmful to health. Source: FL Online Adult Longitudinal Media Survey

1. Not at all worried

2. A little worried

3. Somewhat worried

4. Very worried

C13. How do you think most people who are important to you would feel about you quitting tobacco use during the next 12 months? Would they…

Rationale: Increased Awareness Knowledge and Intention to Quit; Change in beliefs about referent’s attitudes about smoking. Source:FL Online Adult Longitudinal Media Survey

1. Strongly disapprove

2. Disapprove

3. Neither disapprove nor approve

4. Approve

5. Strongly approve

C14. Among close friends, do

Rationale: Normative behaviors about smoking and smoking cessation

1. All of them smoke?

2. Most of them smoke?

3. Most of them not smoke?

4. None of them smoke?

C15. Among close relatives, do

Rationale: Normative behaviors about smoking and smoking cessation

1. All of them smoke?

2. Most of them smoke?

3. Most of them not smoke?

4. None of them smoke?

C16. How many of your family members have quit smoking or are currently quitting smoking?

Rationale: Normative behaviors about smoking and smoking cessation

1. None

2. Only a few

3. Some

4. Most

5. All

C17. How many of your friends have quit smoking or are currently quitting smoking?

Rationale: Normative behaviors about smoking and smoking cessation

1. None

2. Only a few

3. Some

4. Most

5. All

QUITLINE USE AND AWARENESS

C18. A telephone quitline is a free telephone-based service that connects people who smoke cigarettes with someone who can help them quit. Are you aware of any telephone quitline services that are available to help you quit smoking?

Rationale: Key Outcome Indicator 3.08.6; NATS Q44

1. Yes

2. No

C19. If you decided to quit smoking in the future, would gather information or support for quitting from…

1. Yes 2. No

C19_1. A telephone quitline

C19_2. An Internet website

C19_3. A class, program, or one-on-one counseling from a healthcare provider

C19_4. Your doctor or other health care professional

C20. Have you heard of 1-800-QUIT-NOW?

Rationale: Awareness of quit line as smoking cessation resource

1. Yes

2. No

[If C20=1, ASK C21]

C21. Have you ever called 1-800 QUIT-NOW or any other telephone quitline?

1. Yes

2. No

[IF C21=1, ASK C22]

C22. Have you called 1-800 QUIT-NOW or any other telephone quitline in the past 3 months?

Rationale: Awareness of quit line as smoking cessation resource

1. Yes

2. No

SECTION D: ATTITUDES AND BELIEFS RELATED TO CESSATION

The next few questions will ask about your opinions related to smoking, tobacco use, and cessation.

Please tell us if you strongly agree, agree, disagree, or strongly disagree with the following statements.

1 2 3 4

Strongly Strongly

disagree Disagree Agree agree

Rationale: Helps assess attitudes about smoking cigarettes. Source: Adolescent Decisional Balance Scale from Velicer et al. J. Pers. Soc.Psych., 48(5); 1279-89.

[RANDOMIZE ORDER]

D1. Smoking cigarettes is pleasurable.

D2. Smoking cigarettes relieves tension.

D3. Smoking helps me concentrate and do better work.

D4. I would be more energetic right now if I didn’t smoke.

D5. I’m embarrassed that I have to smoke.

D6. Smoking is hazardous to my health.

Thoughts About Quitting

Rationale: helps assess intentions to quit smoking. Source: American Legacy surveys, FL Online Adult Longitudinal Media Survey

[RANDOMIZE ORDER]

D7. I have been thinking a lot about quitting smoking recently.

D8. I am eager for a life without smoking.

D9. I am not prepared to make changes in my life in order to quit smoking.

Worries About Health

Rationale: Assesses attitudes about smoking and D14 addresses belief about harm from smoking. Source: Adapted from FL Online Adult Longitudinal Media Survey

D10. I get upset when I think about my smoking.

D11. I am disappointed in myself because I smoke.

D12. I get upset when I hear or read about illnesses caused by smoking.

D13. Warnings about the health risks of smoking upset me.

D14. Smoking will severely lower my quality of life in the future.

D15. I will not become a burden to others in the future because of my smoking.

General Attitudes Related to Smoking and Cessation

Rationale: intention to quit smoking and beliefs about harmful effects of smoking. Source: FL Online Adult Longitudinal Media Survey (and for D18 American Legacy surveys).

[RANDOMIZE ORDER]

D16. Smokers should take warnings about cigarette smoking and lung cancer seriously.

D17. On a scale from 1 to 5 with 1 being the “lowest” and 5 being the “highest,” how would you rate quitting smoking as a priority in your life?

1. Lowest

5. Highest

Risk Perception

D18. Smoking can cause immediate damage to your body.

1. Strongly Disagree

2. Disagree

3. Agree

4. Strongly Agree

D19. How likely do you think a smoker is to develop a smoking-related disease as a result of smoking?

Rationale: beliefs about cigarette smoking and harm to health. Source: FL Online Adult Longitudinal Media Survey.

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

D20. How likely do you think you are to develop a smoking-related disease as a result of smoking?

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

D21. Do you believe cigarette smoking is related to:

Rationale: Beliefs about cigarette smoking and health effects related to smoking. Source: NHIS.

[RANDOMIZE ORDER] 1 2

Yes No

D21_1. Lung Cancer

D21_2. Cancer of the mouth or throat

D21_3. Heart Disease

D21_4. Diabetes

D21_5. Emphysema

D21_6. Stroke

D21_7. Hole in throat (stoma or tracheotomy)

D21_8. Buerger’s Disease

D21_9. Amputations (removal of limbs);

D21_10. Asthma

D21_11. Gallstones

Social Norms of Smoking and SHS

D22. Thinking about all the health problems in your community, how important is addressing the problem of tobacco use? Would you say it is…

Rationale: norms about tobacco use.

1. Among the most important health problems

2. Equally as important as other health problems

3. Among the least important health problems

D23. In general, how do the adults you spend time with feel about cigarette smoking by adults?  Do they feel it is…

1. Totally acceptable

2. Somewhat acceptable

3. Neither acceptable nor unacceptable

4. Somewhat unacceptable

5. Totally unacceptable

               

D24. How do the adults you spend time with feel about someone smoking if children are present?  Do they feel it is…

1. Totally acceptable

2. Somewhat acceptable

3. Neither acceptable nor unacceptable

4. Somewhat unacceptable

5. Totally unacceptable

SECTION E: SECONDHAND SMOKE

E1. Other than yourself, does anyone who lives in your home smoke cigarettes now?

Rationale: Perceived social norms about smoking. Source: NY ATS; FL Online Adult Longitudinal Media Survey.

1. Yes

2. No

E2. About how often do you smoke when you are in the company of children?

Rationale: Perceived social norms about smoking. Source: FL Online Adult Longitudinal Media Survey.

1. Always

2. Sometimes

3. Rarely

4. Never

E3. Not counting decks, porches, or garages, during the past 7 days, that is, since last [today’s day of week], on how many days did someone other than you smoke tobacco inside your home while you were at home?

Rationale: Key Outcome Indicator 2.04.4; NATS Q73

Number of days____________

E4. Not counting decks, porches, or garages, inside your home, is smoking …?

Rationale: Key Outcome Indicator 2.04.4; NATS Q74

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed

E5. Not counting motorcycles, in the vehicles that you and your family members who live with you own or lease, is smoking …

Rationale: Key Outcome Indicator 2.04.4; NATS Q88

1. Always allowed in all vehicles

2. Sometimes allowed in at least one vehicle

3. Never allowed in any vehicle

4. My family does not own or lease a vehicle

E6. The next few questions will ask about your opinions related to smoking, tobacco use, and cessation.

Rationale: belief that cigarette smoking and secondhand smoke are harmful to health.

Please tell us if you strongly agree, agree, disagree, or strongly disagree with the following statements.

1 2 3 4

Strongly Strongly

disagree Disagree Agree agree

E6_1. Cigarette smoking has no serious effects on non-smokers.

E6_2. Parents who live with their children should not be allowed to smoke in their homes.

E6_3. Adults should not smoke around other people in their home.

E6_4. I protect all other household members from any harm related to smoking.

E7. Do you think that breathing smoke from other people’s cigarettes or from other tobacco products is …?

Rationale: Key Outcome Indicator 2.03.5; NATS Q95

1. Not at all harmful to one’s health

2. Somewhat harmful to one’s health

3. Very harmful to one’s health

E8. How likely do you think it is that regularly breathing secondhand smoke from cigarettes would cause children to have asthma or breathing problems?

Rationale: Increased belief that cigarette smoking and secondhand smoke are harmful to health.

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

E9. Are you seriously considering increasing restrictions on smoking in your household?

1. Definitely Yes

2. Probably Yes

3. Probably Not

4. Definitely Not

SECTION F: MEDIA USE AND AWARENESS

F1. On an average day, how much television do you watch?

Rationale: use of television. Source: FL Online Adult Longitudinal Media Survey.

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

F2. On an average day, how many hours do you listen to the radio?

Rationale: use of radio. Source: FL Online Adult Longitudinal Media Survey.

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

F3. On an average day, how many hours do you use the Internet for personal reasons?

Rationale: use of internet. Source: FL Online Adult Longitudinal Media Survey.

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

F4. What type of Internet connection do you have for your home computer or other primary computer?

Rationale: ability to view ads online. Source: NY Media Tracking Survey Online.

1. Cable/DSL/Broadband/High-Speed

2. Dial-Up

3. Not sure

F5. In the past 3 months, about how often have you seen ads against smoking on television?

Rationale: exposure to tv ads. Source: MTS (replaced “anti smoking” with “ads against smoking”).

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

F6. In the past 3 months, how often have you heard ads against smoking on the radio?

Rationale: exposure to radio ads. Source: FL Online Adult Longitudinal Media Survey (replaced “anti smoking” with “ads against smoking”).

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

F7. In the past 3 months, how often have you seen ads against smoking in newspapers or magazines?

Rationale: exposure to print ads.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

F8. In the past 3 months, how often have you seen ads against smoking in videos, or websites online?

Rationale: exposure to web ads and/or videos. Source: MTS (replaced “anti smoking” with “ads against smoking”).

1. Almost every time I was online

2. Frequently when I was online

3. Occasionally when I am online

4. Never/Not that I remember

5. I rarely or never go online or use the internet

F9. Have you ever heard of any quit smoking websites online?

Rationale: awareness of internet smoking cessation resources.

1. Yes

2. No

[IF F9 = 1, ASK F10]

F10. Have you ever visited any quit smoking websites online?

Rationale: use of internet smoking cessation resources.

1. Yes

2. No

[IF F10 = 1, ASK F10a]

F10A. Have you visited any quit smoking websites online in the past 3 months?

Rationale: use of internet smoking cessation resources.

1. Yes

2. No

F11. Have you heard of the Website www.smokefree.gov?

Rationale: awareness of smoking cessation resources.

1. Yes

2. No

[IF F11 = 1, ASK F12]

F12. Have you ever visited www.smokefree.gov?

Rationale: use of internet smoking cessation resources.

1. Yes

2. No

[IF F12 = 1, ASK F12A]

F12A. Have you visited www.smokefree.gov in the past 3 months?

Rationale: use of internet smoking cessation resources.

1. Yes

2. No

F13. In the past 3 months, have you seen or heard advertisements for products to help people quit smoking, such as nicotine patches or gums?

Rationale: awareness of smoking cessation resources.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

F14. Have you ever seen or heard of any ads against tobacco on television or radio with the following themes or slogans?

Rationale: Ad awareness. Source: adapted from FL Online Adult Longitudinal Media Survey.

[RANDOMIZE ORDER] 1 2

Yes No

F14_1. TIPS FROM A FORMER SMOKER

F14_2. TRUTH

F14_3. BECOME AN EX

F14_4. EVERY CIGARETTE IS DOING YOU DAMAGE

F14_5. TOBACCO FREE LIVING

F15. In the past 3 months, how often have you noticed cigarettes or tobacco products being advertised or promoted in shop windows or inside shops where tobacco is sold?

Rationale: awareness of cigarettes or other tobacco product ads and promotions. Source: NY ATS

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

F16. In the past 3 months, have you received things like coupons, special price offers or discounts on cigarettes, or other promotional items in the mail from tobacco companies?

Rationale: awareness of cigarettes or other tobacco product ads and promotions. Source: NY ATS

1. Yes

2. No

SECTION G: CLOSING QUESTIONS

G1. How many children aged 17 or younger live in your household 6 months or more of the year?

Rationale. Demographics. Source: US DHHS Standards. Dorsey and Graham. 2011. New HHS Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. JAMA 306(21):2378-2379.

__ Number of Children

G2. What is your sex?

Rationale: demographics. Source: US DHHS Standards. Dorsey and Graham. 2011. New HHS Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. JAMA 306(21):2378-2379.

1. Male

2. Female

G3. Are you Hispanic, Latino/a, or of Spanish origin (1 or more categories may be selected)?

Rationale: demographics. Source: US DHHS Standards. Dorsey and Graham. 2011. New HHS Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. JAMA 306(21):2378-2379.

1. No, not of Hispanic, Latino/a, or Spanish origin

2. Yes, Mexican American, Chicano/a

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, Another Hispanic, Latino/a, or Spanish origin

G4. What is your race? (1 or more categories may be selected)

Rationale: demographics. Source: US DHHS Standards. Dorsey and Graham. 2011. New HHS Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. JAMA 306(21):2378-2379.

1. White

2. Black or African American

3. American Indian or Alaska Native

4. Asian Indian

5. Chinese

6. Filipino

7. Japanese

8. Korean

9. Vietnamese

10. Other Asian

11. Native Hawaiian

12. Guamanian or Chamorro

13. Samoan

14. Other Pacific Islander

G5. What is the highest level of school you have completed or the highest degree you have received?

Rationale: demographics. Source: NATS.

1. 5th grade or less

2. 6th grade

3. 7th grade

4. 8th grade

5. 9th grade

6. 10th grade

7. 11th grade

8. 12th grade, no diploma

9. Ged or equivalent

10. High school diploma

11. Some college, no degree

12. Certificate, diploma, or associate degree: occupational, technical, or vocational program

13. Associate degree: academic program

14. Bachelor’s degree

15. Master’s degree

16. Professional school degree (examples: md, dds, dvm, llb, jd)

17. Doctoral degree (examples: phd, edd)

The next question is about the total income of YOUR HOUSEHOLD for the PAST 12 MONTHS. Please include your income PLUS the income of all members living in your household (including cohabiting partners and armed forces members living at home). Please count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net income from a business, interest, dividends, child support, alimony, and Social Security, public assistance, pensions, or retirement benefits).

G6. Thinking about members of your family living in this household, what is your combined annual income, meaning the total pre-tax income from all sources earned in the past year?

Rationale: demographics. Source: HINTS.

1. $0 to $9,999

2. $10,000 to $14,999

3. $15,000 to $19,999

4. $20,000 to $34,999

5. $35,000 to $49,999

6. $50,000 to $74,999

7. $75,000 to $99,999

8. $100,000 to $199,999

9. $200,000 or more

G7. Are you now …?

Rationale: demographics. Source: NATS response options

1. Married

2. Living with a partner

3. Divorced

4. Widowed

5. Separated

6. Single, that is, never married and not now living with a partner

96. Other (Specify)

G8. Which statement best describes your current employment status?

Rationale: demographics. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

1. Working full time as a paid employee

2. Working full time, self-employed

3. Not working, on temporary layoff from a job

4. Not working, looking for work

5. Not working, retired

6. Not working, disabled

7. Not working, other

G9. How many smoking or tobacco related web surveys like this have you completed with Knowledge Networks during the past year?

Rationale: potential exposure to similar surveys. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

1. None

2. 1 survey

3. 2 surveys

4. 3 surveys

5. 4 surveys

6. 5 or more surveys

[IF G9> 2, ASK G10]

G10. Did you view or listen to any videos or other advertisements about quitting smoking in any of these surveys?

Rationale: potential exposure to similar ads/surveys. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

1. Yes

2. No

G11. Do you currently participate in any other online web panels besides Knowledge Networks?

Rationale: potential exposure to similar surveys. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

1. Yes

2. No

G12. In what state do you currently reside?

Rationale: demographics. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

_________Pull Down List of States

G13. What county do you live in?

Rationale: demographics. Source: Knowledge Networks panel questions.

NOTE: This is a standard question that Knowledge Networks asks its panel members.

_________Pull Down List of Counties

G14. In what zip code do you live?

Rationale: demographics.

G15. Have you been diagnosed by a physician or other qualified medical professional with any of the following medical conditions?

Rationale: Possible influencers for smoking cessation. Source: Knowledge Networks standard questionnaire

NOTE: This is a standard question that Knowledge Networks asks its panel members.

1 2

Yes No

G15_1. Acid reflux disease

G15_2. ADHD or ADD

G15_3. Anxiety disorder

G15_4. Asthma, chronic bronchitis, or COPD

G15_5. Cancer (any type except skin cancer)

G15_6. Chronic pain (such as low back pain, neck pain, or Fibromyalgia)

G15_7. Depression

G15_8. Diabetes

G15_9. Heart attack

G15_10. Heart disease

G15_11. High blood pressure

G15_12. High cholesterol

G15_13. HIV/AIDS

G15_14. Kidney disease

G15_15. Mental health condition

G15_16. Multiple sclerosis

G15_17. Osteoarthritis, joint pain or inflammation

G15_18. Osteoporosis or osteopenia

G15_19. Rheumatoid arthritis

G15_20. Seasonal allergies

G15_21. Skin cancer

G15_22. Sleep disorders such as sleep apnea or insomnia

G15_23. Stroke

G15_24. Something else

G15_25. None of these [Single select]

[ASK G16-G17 IF OFF-PANEL]

G16. Would you say you can carry on a conversation in Spanish, both understanding and speaking – very well, pretty well, just a little, or not at all?

1. Very well

2. Pretty well

3. Just a little

4. Not at all

G17. Would you say you can read a newspaper or book in Spanish – very well, pretty well, just a little, or not at all?

1. Very well

2. Pretty well

3. Just a little

4. Not at all

G18. Would you say you can carry on a conversation in English, both understanding and speaking – very well, pretty well, just a little, or not at all?

1. Very well

2. Pretty well

3. Just a little

4. Not at all

G19. Would you say you can read a newspaper or book in English – very well, pretty well, just a little, or not at all?

1. Very well

2. Pretty well

3. Just a little

4. Not at all

[ASK G20-G22 IF OFF-PANEL]

G20. Do you or anyone in this household connect to the Internet from home?

1. Yes

2. No

G21. Do you live in a metro or non-metro area?

1. Non-Metro (Rural)

2. Suburban

3. Urban

G22. Using the scale below, please tell us how much you agree or disagree with the following statements.

1 2 3 4 5

Strongly Somewhat Neither Somewhat Strongly

Agree Agree Agree nor Disagree Disagree

Disagree

G22A. I usually try new products before other people do.

G22B. I often try new brands because I like variety and get bored with the same

old thing.

G22C. When I shop I look for what is new.

G22D. I like to be the first among my friends and family to try something new.

G22E. I like to tell others about new brands or technology.

Thank you for completing today’s survey. Your input will greatly help researchers assess the impact of television ads about quitting smoking.

You will be awarded [FILL IF KN: “5,000 KN points”] [FILL IF OFF-PANEL: “$1”] for completing this survey. A follow-up survey will be sent to you in about 3 to 4 months and you will be awarded [FILL IF KN: “15,000 KN points”] [FILL IF OFF-PANEL: “$3”] for completing that survey.

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