Attachment J. Primary and Secondary Outcomes, Survey Questions, and Expected Timeframe for Outcome Change
Type of Outcome |
Expected Timeframe for Impact |
Survey Question |
Instrument Item Numbers |
|||||||
Smokers Survey - Baseline |
Smokers Survey - Follow Up |
Nonsmokers Survey - Baseline |
Nonsmokers Survey - Follow Up |
Smokers Survey- Wave 3 |
Nonsmokers Survey- Wave 3 |
|
||||
Secondary Outcome: Campaign Awareness and Receptivity |
Within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], have you seen or heard of any ads on television or radio with the following themes or slogans? |
F14 |
F17 |
E18 |
E18 |
F17 |
|
E18 |
|
Within 3-12 months |
Where have you seen or heard about the TIPS Campaign? |
- |
F18 |
- |
E19 |
F18 |
|
E19 |
||
Within 12 months |
Have you heard of the Website [INSERT FINAL URL]? |
- |
F18A |
- |
E19A |
F18A |
|
E19A |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you visited [INSERT FINAL URL]? |
- |
F18B |
- |
E19B |
F18B |
|
E19B |
||
Within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], Have you seen this ad on television? |
- |
F24 |
- |
E25 |
F24 |
|
E25 |
||
Within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], how frequently have you seen this ad on television? |
- |
F24A |
- |
E26 |
F24A |
|
E26 |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen this ad on the online? |
- |
- |
- |
- |
F24A1 |
|
E26A |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how frequently have you seen this ad on the online? |
- |
- |
- |
- |
F24B |
|
E26B |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen this ad on a mobile device? |
- |
- |
- |
- |
F24C |
|
E26C |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how frequently have you seen this ad on a mobile device? |
- |
- |
- |
- |
F24D |
|
E26D |
||
Within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], have you heard this ad on the radio? |
- |
F35 |
- |
E36 |
F35 |
|
E36 |
||
Within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], how frequently have you heard this ad on the radio? |
- |
F35A |
- |
E37 |
F35A |
|
E37 |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen any of these ads in magazines, on Websites, or in public places outside your home? |
- |
F36 |
- |
E38 |
F36 |
|
E38 |
||
Within 3-12 months |
Where did you see these advertisements? |
- |
F37 |
- |
E39 |
F37 |
|
E39 |
||
Within 4 months |
On an average day, how much television do you watch? |
- |
- |
- |
- |
F1 |
|
E1 |
||
Within 4 months |
On an average day, how many hours do you listen to the radio? |
- |
- |
- |
- |
F2 |
|
E2 |
||
Within 4 months |
On an average day, how many hours do you use the Internet for personal reasons? |
- |
- |
- |
- |
F3 |
|
E3 |
||
Within 4 months |
Overall, when you use the Internet, are you mostly using your cell phone or mostly using some other device like a desktop, laptop, tablet or other mobile device? |
- |
- |
- |
- |
F3A |
|
E3A |
||
Within 4 months |
What type of Internet connection do you have for your home computer or other primary computer? |
- |
- |
- |
- |
F4 |
|
E4 |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you seen ads against smoking on television? |
F5 |
F5 |
E5 |
E5 |
F5 |
|
E5 |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you heard ads against smoking on the radio? |
F6 |
F6 |
E6 |
E6 |
F6 |
|
E6 |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you seen ads against smoking in newspapers or magazines? |
F7 |
F7 |
E7 |
E7 |
F7 |
|
E7 |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you seen ads against smoking in videos online? |
F8 |
F8 |
E8 |
E8 |
F8 |
|
E8 |
||
Within 4 months |
Have you ever heard of any quit smoking websites online? |
- |
- |
- |
- |
F9 |
|
E11 |
||
Within 3-12 months |
The TIPS campaign is on social networking sites including Facebook, YouTube , and Twitter. Have you ever seen the TIPS campaign on these sites? |
- |
F20 |
- |
E21 |
F20 |
|
E21 |
||
Within 3-12 months |
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements. This ad is….. |
- |
F25_1 - F25_9 |
- |
E27_1 - E28_9 |
F25_1 - F25_9 |
|
E27_1 - E27_9 |
||
Within 3-12 months |
On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this ad made you feel… |
- |
F26_1 - F26_9 |
- |
E28_1 - E28_9 |
F26_1 - F26_9 |
|
E28_1 - E28_9 |
||
Within 3-12 months |
Would this ad make you want to encourage someone you care about to quit smoking? |
- |
F27 |
- |
E29 |
F27 |
|
E29 |
||
Within 3-12 months |
Would this ad make you want to quit smoking? |
- |
F28 |
- |
- |
F28 |
|
- |
||
Within 4 months |
Do you think these ads would be relevant for people who smoke cigars, cigarillos or very small cigars that look like cigarettes. |
- |
- |
- |
- |
F28A |
|
E29A |
||
Within 4 months |
Do you think these ads would be relevant for people who smoke brown cigarettes? |
|
|
|
|
F28B |
|
E29B |
||
Within 3-12 months |
Did seeing these ads on television make you want to encourage someone you care about to quit smoking? |
- |
F29 |
- |
E30 |
F29 |
|
E30 |
||
Within 3-12 months |
Did you talk to anyone about any of these ads ? |
- |
F30 |
- |
E31 |
F30 |
|
E31 |
||
Within 3-12 months |
When you talked about the ads, did you talk about any of the following topics? Please select all that apply. |
- |
F31_1 - F31_5 |
- |
F32_1 - F32_5 |
F31_1 - F31_5 |
|
E32 (no E32_1-E32_5) |
||
Within 3-12 months |
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? |
C18 |
C18 |
- |
E9 |
C18 |
|
E9 |
||
Within 3-12 months |
Have you heard of 1-800-QUIT-NOW? |
C20 |
C20 |
E10 |
E10 |
C20 |
|
E10 |
||
Within 3-12 months |
Have you heard of the Website [insert final url] ? |
F11 |
F11 |
E14 |
E14 |
F11 |
|
E14 |
||
Secondary Outcome: Awareness of Cessation Services |
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH],have you called 1-800 QUIT-NOW or any other telephone quitline? |
C22 |
C22 |
- |
- |
C22 |
|
- |
|
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you talked with your doctor or health care professional about quitting smoking? |
- |
- |
- |
- |
C23 |
|
- |
||
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH],have you visited any quit smoking websites online? |
F10A |
F10A |
E13 |
E13 |
F10A |
|
E13 |
||
Secondary Outcome: Behavior - Cessation-Related Information-seeking |
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you visited [insert final url]? |
F12A |
F12A |
E16 |
E16 |
F12A |
|
E16 |
|
Within 3-12 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen or heard advertisements for products to help people quit smoking, such as nicotine patches or gums? |
F13 |
F13 |
E17 |
E17 |
F13 |
|
E17 |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], when you were using the Internet or your smartphone, how many times did you see information about…? |
- |
- |
- |
- |
F14 |
|
E4A |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever seen information about any of these topics when using the following platforms? |
- |
- |
- |
- |
F14A |
|
E4B |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], when you were using the Internet or your smartphone, how many times did you search for information about…? |
- |
- |
- |
- |
F14B |
|
E4C |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever searched information about any of these topics when using the following platforms? |
- |
- |
- |
- |
F15 |
|
E4D |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], , how many times have you shared information with other people, or posted information on your social network (e.g., Facebook, LinkedIn, Twitter, MySpace, or another social network) about each of the following? |
- |
- |
- |
- |
F16 |
|
E4E |
||
Within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever shared information about any of these topics when using the following platforms? |
- |
- |
- |
- |
F16B |
|
E4F |
||
Within 3-12 months |
If you decided to quit smoking in the future, would gather information or support for quitting from…a telephone quitline, etc.. |
C19_1 - C19_4 |
C19_1 - C19_4 |
- |
- |
C19_1 - C19_4 |
|
- |
||
Possibly within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH],, have you recommended any family members or friends that smoke to call a telephone quitline? |
- |
- |
E9A |
E9A |
- |
|
E9A |
||
Possibly within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH], have you recommended any family members or friends that smoke to visit[insert final url]? |
- |
- |
E16A |
E16A |
- |
|
E16A |
||
Possibly within 3-12 months |
Since [DATE OF CAMPAIGN LAUNCH],, have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW? |
- |
- |
E10A |
E10A |
- |
|
E10A |
||
Possibly within 4 months |
Since [FILL DATE OF CAMPAIGN LAUNCH], have you recommended any family members or friends that smoke to talk with their doctor or health care professional about quitting smoking? |
- |
- |
- |
- |
- |
|
E10B |
||
Possibly within 3-12 months |
During the past 3 months, have you talked to any family members or friends about the dangers of smoking? |
- |
- |
D5 |
D5 |
- |
|
D5 |
||
Secondary Outcome: Cessation-Related Communication with Smokers |
Possibly within 3-12 months |
During the past 3 months, did you encourage a friend or family member to quit smoking?
|
- |
- |
D5A |
D5A |
- |
|
D5A |
|
Possibly within 3-12 months |
Do you want to quit smoking cigarettes for good? |
C6 |
C6 |
- |
- |
C6 |
|
- |
||
Possibly within 3-12 months |
How much do you want to quit smoking? Would you say… |
C7 |
C7 |
- |
- |
C7 |
|
- |
||
Possibly within 3-12 months |
Do you have a time frame in mind for quitting? |
C8 |
C8 |
- |
- |
C8 |
|
- |
||
Possibly within 3-12 months |
Do you plan to quit smoking for good…. |
C9 |
C9 |
- |
- |
C9 |
|
- |
||
Possibly within 3-12 months |
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… |
C10 |
C10 |
- |
- |
C10 |
|
- |
||
Secondary Outcome: Smoking and Cessation-Related Knowledge, Attitudes, and Policies |
Possibly within 3-12 months |
How much do you think your health would improve if you were to quit smoking? |
C11 |
C11 |
- |
- |
C11 |
|
- |
|
Possibly within 3-12 months |
How worried are you that smoking will damage your health in the future? |
C12 |
C12 |
- |
- |
C12 |
|
- |
||
Possibly within 3-12 months |
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… |
C13 |
C13 |
- |
- |
C13 |
|
- |
||
Possibly within 3-12 months |
Among close friends, do |
C14 |
C14 |
D6 |
D6 |
C14 |
|
D6 |
||
Possibly within 4 months |
Among close relatives, do |
C15 |
C15 |
D7 |
D7 |
C15 |
|
D7 |
||
Possibly within 3-12 months |
How many of your family members have quit smoking or are currently quitting smoking? |
C16 |
C16 |
D8 |
D8 |
C16 |
|
D8 |
||
Possibly within 3-12 months |
How many of your friends have quit smoking or are currently quitting smoking? |
C17 |
C17 |
D9 |
D9 |
C17 |
|
D9 |
||
Possibly within 3-12 months |
Smoking cigarettes is pleasurable. |
D1 |
D1 |
- |
- |
D1 |
|
- |
||
Possibly within 3-12 months |
Smoking cigarettes relieves tension. |
D2 |
D2 |
- |
- |
D2 |
|
- |
||
Possibly within 3-12 months |
Smoking helps me concentrate and do better work. |
D3 |
D3 |
- |
- |
D3 |
|
- |
||
Possibly within 3-12 months |
I would be more energetic right now if I didn’t smoke. |
D4 |
D4 |
- |
- |
D4 |
|
- |
||
Possibly within 3-12 months |
I’m embarrassed that I have to smoke. |
D5 |
D5 |
- |
- |
D5 |
|
- |
||
Possibly within 3-12 months |
Smoking is hazardous to my health. |
D6 |
D6 |
- |
- |
D6 |
|
- |
||
Possibly within 3-12 months |
I have been thinking a lot about quitting smoking recently. |
D7 |
D7 |
- |
- |
D7 |
|
- |
||
Possibly within 3-12 months |
I am eager for a life without smoking. |
D8 |
D8 |
- |
- |
D8 |
|
- |
||
Possibly within 3-12 months |
I am not prepared to make changes in my life in order to quit smoking. |
D9 |
D9 |
- |
- |
D9 |
|
- |
||
Possibly within 3-12 months |
I get upset when I think about my smoking. |
D10 |
D10 |
- |
- |
D10 |
|
- |
||
Possibly within 3-12 months |
I am disappointed in myself because I smoke. |
D11 |
D11 |
- |
- |
D11 |
|
- |
||
Possibly within 3-12 months |
I get upset when I hear or read about illnesses caused by smoking. |
D12 |
D12 |
- |
- |
D12 |
|
- |
||
Possibly within 3-12 months |
Warnings about the health risks of smoking upset me. |
D13 |
D13 |
- |
C1_1 - C1_11 |
D13 |
|
- |
||
Possibly within 3-12 months |
Smoking will severely lower my quality of life in the future. |
D14 |
D14 |
- |
- |
D14 |
|
- |
||
Possibly within 3-12 months |
I will not become a burden to others in the future because of my smoking. |
D15 |
D15 |
- |
- |
D15 |
|
- |
||
Possibly within 3-12 months |
Smokers should take warnings about cigarette smoking and lung cancer seriously. |
D16 |
D16 |
- |
- |
D16 |
|
- |
||
Possibly within 3-12 months |
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? |
D17 |
D17 |
- |
- |
D17 |
|
- |
||
Possibly within 3-12 months |
Smoking can cause immediate damage to your body. |
D18 |
D18 |
- |
- |
D18 |
|
- |
||
Possibly within 3-12 months |
How likely do you think a smoker is to develop a smoking-related disease as a result of smoking? |
D19 |
D19 |
C2 |
C2 |
D19 |
|
C2 |
||
Possibly within 3-12 months |
How likely do you think you are to develop a smoking-related disease as a result of smoking? |
D20 |
D20 |
- |
- |
D20 |
|
- |
||
Possibly within 3-12 months |
Do you believe cigarette smoking is related to: |
D21_1 - D21_11 |
D21_1 - D21_11 |
C1_1 - C1_11 |
C1_1 - C1_11 |
D21_1 –D21_12 |
|
C1_1 – C1_12 |
||
Possibly within 4 months |
Do you believe cigars, cigarillos, or little cigars smoking is: |
- |
- |
- |
- |
D21A |
|
- |
||
Possibly within 4 months |
Do you believe smoking brown cigarettes is: |
- |
- |
- |
- |
D21B |
|
C1A |
||
Possibly within 4 months |
How likely do you think it is that smoking worsens medical complications of diabetes such as blindness, renal failure, or amputations? |
- |
- |
- |
- |
D21C |
|
C4B |
||
Possibly within 3-12 months |
Thinking about all the health problems in your community, how important is addressing the problem of tobacco use? Would you say it is… |
D22 |
D22 |
C7 |
C7 |
D22 |
|
C7 |
||
Possibly within 3-12 months |
In general, how do the adults you spend time with feel about cigarette smoking by adults? Do they feel it is… |
D23 |
D23 |
C8 |
C8 |
D23 |
|
C8 |
||
Possibly within 3-12 months |
How do the adults you spend time with feel about someone smoking if children are present? Do they feel it is… |
D24 |
D24 |
C9 |
C9 |
D24 |
|
C9 |
||
Possibly within 3-12 months |
How likely would you be to ask a stranger not to smoke around you if you couldn’t move away from their smoke—…? |
- |
- |
C5 |
C5 |
- |
|
C5 |
||
Possibly within 3-12 months |
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? |
E3 |
E3 |
D2 |
D2 |
E3 |
|
D2 |
||
Possibly within 3-12 months |
Not counting decks, porches, or garages, inside your home, is smoking …? |
E4 |
E4 |
D3 |
D3 |
E4 |
|
D3 |
||
Possibly within 3-12 months |
Not counting motorcycles, in the vehicles that you and your family members who live with you own or lease, is smoking … |
E5 |
E5 |
D4 |
D4 |
E5 |
|
D4 |
||
Possibly within 3-12 months |
Cigarette smoking has no serious effects on non-smokers. |
E6_1 |
E6_1 |
C6_1 |
B4_1 |
E6_1 |
|
C6_1 |
||
Possibly within 3-12 months |
Parents who live with their children should not be allowed to smoke in their homes. |
E6_2 |
E6_2 |
C6_2 |
B4_2 |
E6_2 |
|
C6_2 |
||
Possibly within 3-12 months |
Adults should not smoke around other people in their home. |
E6_3 |
E6_3 |
C6_3 |
B4_3 |
E6_3 |
|
C6_3 |
||
Possibly within 3-12 months |
I protect all other household members from any harm related to smoking. |
E6_4 |
E6_4 |
C6_4 |
- |
E6_4 |
|
C6_4 |
||
Possibly within 3-12 months |
Do you think that breathing smoke from other people’s cigarettes or from other tobacco products is …? |
E7 |
E7 |
C3 |
C3 |
E7 |
|
C3 |
||
Possibly within 3-12 months |
How likely do you think it is that regularly breathing secondhand smoke from cigarettes would cause children to have asthma or breathing problems? |
E8 |
E8 |
C4 |
C4 |
E8 |
|
C4 |
||
Possibly within 4 months |
How likely do you think it is that regularly breathing secondhand smoke from cigarettes would cause non-smokers to have asthma, infections, or lung damage? |
- |
- |
- |
- |
E8A |
|
C4A |
||
Possibly within 3-12 months |
Are you seriously considering increasing restrictions on smoking in your household? |
E9 |
E9 |
- |
- |
E9 |
|
- |
||
Unknown likelihood within 4 months |
About how long has it been since you last smoked cigarettes -- even a puff? |
- |
- |
B3 |
- |
- |
|
- |
||
Unknown likelihood within 4 months |
Do you think you will try a cigarette soon? |
- |
- |
B4_1 |
B4_1 |
- |
|
B4_1 |
||
Unknown likelihood within 4 months |
If you started smoking regularly, do you think you could stop smoking anytime you wanted? |
- |
- |
B4_2 |
B4_2 |
- |
|
B4_2 |
||
Unknown likelihood within 4 months |
Do you think you will smoke a cigarette anytime during the next year? |
- |
- |
B4_3 |
B4_3 |
- |
|
B4_3 |
||
Unknown likelihood within 3-12 months |
Since [DATE FILL OF CAMPAIGN LAUNCH], how many times have you tried to quit smoking cigarettes for good, but stopped for less than a day? |
C4 |
C4 |
- |
- |
- |
|
- |
||
Unknown likelihood within 4 months |
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? |
- |
- |
- |
- |
C1 |
|
- |
||
Primary Outcome: Cessation-related Intentions and Behaviors |
Unknown likelihood within 4 months |
Since [DATE FILL OF CAMPAIGN LAUNCH] how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good? |
- |
- |
- |
- |
C2 |
|
- |
|
Unknown likelihood within 4 months |
During the past 12 months (365 days), what is the longest period of time you stopped smoking cigarettes because you were trying to quit smoking for good? |
- |
- |
- |
- |
C4A1 |
|
- |
||
Unknown likelihood within 4 months |
Since [DATE FILL OF CAMPAIGN LAUNCH], what is the longest period of time you stopped smoking cigarettes because you were trying to quit smoking for good? |
- |
- |
- |
- |
C4A2 |
|
- |
||
Unknown likelihood within 4 months |
During the past 12 months (365 days), how many days did you NOT smoke (not even a puff)? |
- |
- |
- |
- |
C4A3 |
|
- |
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Unknown likelihood within 4 months |
Since [DATE FILL OF CAMPAIGN LAUNCH], how many days did you NOT smoke (not even a puff)? |
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C4B |
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Unknown likelihood within 3-12 months |
Have you stopped smoking for one day or longer since January 1, 2013 because of a New Year’s resolution to stop smoking? |
C5 |
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C5 |
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Unknown likelihood within 3-12 months |
Other than yourself, does anyone who lives in your home smoke cigarettes now? |
E1 |
E1 |
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E1 |
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D1 |
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Unknown likelihood within 3-12 months |
About how often do you smoke when you are in the company of children? |
E2 |
E2 |
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E2 |
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File Type | application/msword |
Author | kcdavis |
Last Modified By | Fraze, Jami (CDC/ONDIEH/NCCDPHP) |
File Modified | 2013-01-09 |
File Created | 2013-01-09 |