Form 0920-0923 Att D-2a. Nonsmoker Follow-up Survey_1 9-13

Form Approved

OMB No. 0920-0923

Exp. Date 02/28/2013

Evaluation of the National Tobacco Prevention and Control Public Education Campaign

- Non-Smoker Phase 2 Follow-Up 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 (0920-0923).

SUBJECTS FOR QUESTIONNAIRE

SECTION B: TOBACCO USE QUESTIONS

SECTION C: ATTITUDES AND BELIEFS

SECTION D: SECONDHAND SMOKE

SECTION E: MEDIA USE AND AWARENESS

SECTION F: CLOSING QUESTIONS

SECTION B: TOBACCO USE QUESTIONS

NOTE: A RESPONSE OPTION OF “REFUSE TO ANSWER” IS INCLUDED FOR ALL ITEMS.

B4. For the next series of questions, please tell us if you would say definitely not, probably not, probably yes, or definitely yes.

Rationale: susceptibility to cigarette smoking and intention. Source: MTS and NYTS.

1 2 3 4

Definitely not Probably not Probably yes Definitely yes

[RANDOMIZE]

B4_1. Do you think you will try a cigarette soon?

B4_2. If you started smoking regularly, do you think you could stop smoking anytime you wanted?

B4_3. Do you think you will smoke a cigarette anytime during the next year?

SECTION C: ATTITUDES AND BELIEFS

Social Norms of Smoking and SHS

C1. Do you believe cigarette smoking is related to:

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

[RANDOMIZE ORDER] 1 2

Yes No

1. Lung Cancer

2. Cancer of the mouth or throat

3. Heart Disease

4. Diabetes

5. Emphysema

6. Stroke

7. Hole in throat (stoma or tracheotomy)

8. Buerger’s Disease

9. Amputations (removal of limbs);

10. Asthma

11. Gallstones

12. COPD or Chronic bronchitis

C1a. Do you believe cigars, cigarillos, or little cigars smoking is:

Rationale: Beliefs about cigar smoking compared to cigarettes smoking. Source: Developed from consultation with subject matter experts.

1. Healthier than smoking cigarettes

2. About the same health effects as smoking cigarettes

3. Less healthier than smoking cigarettes

C1b. Do you believe smoking brown cigarettes is:

Rationale: Beliefs about cigar smoking compared to cigarettes smoking. Source: Developed from consultation with subject matter experts.

1. Healthier than smoking cigarettes

2. About the same health effects as smoking cigarettes

3. Less healthier than smoking cigarettes

C2. 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

The next few questions ask your opinion about smoke from other people’s cigarettes.

C3. 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

C4. 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

C4a. 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?

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

C4b. How likely do you think it is that smoking worsens medical complications of diabetes such as blindness, renal failure, or amputations?

Rationale: Increased belief that cigarette smoking is harmful to health.

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

C5. How likely would you be to ask a stranger not to smoke around you if you couldn’t move away from their smoke—…?

Rationale: Key Outcome Indicator 2.03.4. Source: NATS 94

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

C6. 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

C6_1. Cigarette smoking has no serious effects on non-smokers.

C6_2 Parents who live with their children should not be allowed to smoke in their homes.

C6_3. Adults should not smoke around other people in their home.

C6_4. I protect all other household members from any harm related to smoking.

C7. Thinking about all the health problems in your community, how important is addressing the problem of tobacco use? Would you say it is…

1. Among the most important health problems

2. Equally as important as other health problems

3. Among the least important health problems

4. Don’t know

C8. 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

C9. 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 D: SECONDHAND SMOKE

D1. Other than yourself, does anyone who lives in your home smoke cigarettes now?

Rationale: Environment/Norms Source: NYATS

1. Yes

2. No

D2. 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____________

D3. 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

D4. 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

D5. Since [FILL DATE OF CAMPAIGN LAUNCH], have you talked to any family members or friends about the dangers of smoking?

1. Yes

2. No

D5a. Since [FILL DATE OF CAMPAIGN LAUNCH], did you encourage a friend or family member to quit smoking? Rationale: cessation. Source: adapted from TUS-CPS.

1. Yes

2. No

D6. Among close friends, do…

1. All of them smoke?

2. Most of them smoke?

3. Most them NOT smoke?

4. None of them smoke?

D7. Among close relatives, do…

1. All of them smoke?

2. Most of them smoke?

3. Most them NOT smoke?

4. None of them smoke?

D8. How many of your family members have quit smoking or are currently quitting smoking?

1. None

2. Only a few

3. Some

4. Most

5. All

D9. How many of your friends have quit smoking or are currently quitting smoking?

1. None

2. Only a few

3. Some

4. Most

5. All

SECTION E. MEDIA USE AND AWARENESS

E1. On an average day, how much television do you watch?

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

E2. On an average day, how many hours do you listen to the radio?

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

E3. On an average day, how many hours do you use the Internet for personal reasons?

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

E3a. 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?

Rationale: Access to Internet via computer/laptop versus mobile phones.

Source: Adapted from PEW Survey on Internet Use Q2.

1. Mostly on cell phone

2. Mostly on something else

3. Both equally

4. Depends

5. Don’t know

6. Refused

E4. What type of Internet connection do you have for your home computer or other primary computer?

1. Cable/DSL/Broadband/High-Speed

2. Dial-Up

3. Not sure

4. No internet at home

E4a. Since [FILL DATE OF CAMPAIGN LAUNCH], when you were using the Internet or your smartphone, how many times did you see information about…?

Rationale: awareness, use, sharing of tobacco related information.

1 = never

2 = 1-2 times

3 = 3-5 times

4 = 6-10 times

5 = > 10 times

99 = Don’t know

…Cigarettes and other tobacco products?

…Ways to quit smoking?

…Secondhand smoke?

…The health effects of smoking?

…Electronic cigarettes?

…Warning labels on cigarette packages?

…Banning menthol cigarettes?

…Coupons or discounts for buying cigarettes or other tobacco products online?

…Antismoking ads?

E4b. Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever seen information about any of these topics when using the following platforms?  (Mark all that apply)

	Internet search engines	Online News Sources	Twitter	Facebook	YouTube	Tumblr	Email	Some Other Social Network
Cigarettes and other tobacco products
Coupons or discounts for buying cigarettes
Ways to quit smoking
Advertisements for e-cigarettes

E4c. Since [FILL DATE OF CAMPAIGN LAUNCH], when you were using the Internet or your smartphone, how many times did you search for information about…? Rationale: Awareness, use, and sharing of tobacco related information.

1 = never

2 = 1-2 times

3 = 3-5 times

4 = 6-10 times

5 = > 10 times

99 = Don’t know…Cigarettes and other tobacco products?

…Ways to quit smoking?

…Secondhand smoke?

…The health effects of smoking?

…Electronic cigarettes?

…Warning labels on cigarette packages?

…Banning menthol cigarettes?

…Coupons or discounts for buying cigarettes or other tobacco products online?

…Antismoking ads?

E4d. Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever searched for information about any of these topics when using the following platforms?  (Mark all that apply)

	Internet search engines	Online News Sources	Twitter	Facebook	YouTube	Tumblr	Email	Some Other Social Network
Cigarettes and other tobacco products
Coupons or discounts for buying cigarettes
Ways to quit smoking
Advertisements for e-cigarettes

E4e. 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?

Rationale: Awareness, use, and sharing of tobacco related information.

1 = never

2 = 1-2 times

3 = 3-5 times

4 = 6-10 times

5 = > 10 times

99 = Don’t know

…Cigarettes and other tobacco products?

…Ways to quit smoking?

…Secondhand smoke?

…The health effects of smoking?

…Electronic cigarettes?

…Warning labels on cigarette packages?

…Banning menthol cigarettes?

…Coupons or discounts for buying cigarettes or other tobacco products online?

…Antismoking ads?

E4f. Since [FILL DATE OF CAMPAIGN LAUNCH], have you ever shared  information about any of these topics when using the following platforms?  (Mark all that apply)

	Internet search engines	Online News Sources	Twitter	Facebook	YouTube	Tumblr	Email	Some Other Social Network
Cigarettes and other tobacco products
Coupons or discounts for buying cigarettes
Ways to quit smoking
Advertisements for e-cigarettes

E5. Since [FILL DATE OF CAMPAIGN LAUNCH], 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

E6. Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you heard ads against smoking on the radio?

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

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

E7. Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you seen ads against smoking on in newspapers or magazines?

Rationale: exposure to tv ads.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

E8 Since [FILL DATE OF CAMPAIGN LAUNCH], how often have you seen ads against smoking in videosonline?

Rationale: exposure to web ads and/or online 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

E9. 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 smokers?

Rationale: Key Outcome Indicator 3.08.6; NATS Q44

1. Yes

2. No

[IF E9=1, ASK E9a]

E9a. Since [FILL DATE OF CAMPAIGN LAUNCH], have you recommended any family members or friends that smoke to call a telephone quitline?

Rationale: Awareness of and communication about quit line as smoking cessation resource.

1. Yes

2. No

E10. Have you heard of 1-800-QUIT-NOW?

Rationale: Awareness of quit line as smoking cessation resource

1. Yes

2. No

[IF E10=1, ASK E10a]

E10a. Since [FILL DATE OF CAMPAIGN LAUNCH], have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

Rationale: Awareness of and communication about quit line as smoking cessation resource

1. Yes

2. No

E10b. 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?

Rationale: Health care provider as smoking cessation resource

1. Yes

2. No

E11. Have you ever heard of any quit smoking websites online?

Rationale: awareness of internet smoking cessation resources.

1. Yes

2. No

[IF E11 = 1, ASK E13]

E13. Since [FILL DATE OF CAMPAIGN LAUNCH], ave you visited any quit smoking websites online?

Rationale: awareness of internet smoking cessation resources.

1. Yes

2. No

E14. Have you ever heard of the Website [insert final campaign url]?

Rationale: awareness of internet smoking cessation resources.

1. Yes

2. No

[IF E14 = 1, ASK E16]

E16. Since [FILL DATE OF CAMPAIGN LAUNCH], have you visited [insert final campaign url]?

Rationale: awareness of internet smoking cessation resources.

1. Yes

2. No

[IF E14=1, ASK E16a]

E16a. Since [FILL DATE OF CAMPAIGN LAUNCH], have you recommended any family members or friends that smoke to visit [insert final campaign url]?

Rationale: Awareness of and communication about web site as smoking cessation resource

1. Yes

2. No

E17. 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?

Rationale: awareness of internet smoking cessation resources.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

E18. Since [FILL DATE OF CAMPAIGN LAUNCH], , have you seen or heard of any ads 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

E14_1. TIPS FROM A FORMER SMOKER

E14_2. TRUTH

E14_3. BECOME AN EX

E14_4. EVERY CIGARETTE IS DOING YOU DAMAGE

E14_5. TOBACCO FREE LIVING

[IF E18 = YES, ASK E19]

E19. Where have you seen or heard about the TIPS Campaign?

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

1 2

Yes No

E19_1. On TV

E19_2. On the radio

E19_3. In newspapers or magazines

E19_4. On the Internet

E19a. On a mobile device

E19_5. Billboards or other outdoor ads

E19a. Have you heard of the Website [insert final campaign url]?

1. Yes

2. No

E19b. Since [FILL DATE OF CAMPAIGN LAUNCH] Have you visited [insert final campaign url]?

1. Yes

2. No

E21. The TIPS campaign is on social networking sites including Facebook, YouTube and Twitter. Have you ever seen the TIPS campaign on these sites?

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

1. Yes

2. No

EXPOSURE AND REACTIONS TO TV & ONLINE VIDEO ADS

Now, we would like you to view a series of anti-tobacco television and online advertisements that have been shown in the U.S. When you are ready, please click on the link below to view the first advertisement. There are a total of [INSERT NUMBER] ads to view. After you view each ad, there will be a few questions that ask about your opinions of the ad.

[randomize order of ads]

[record order]

SHOW AD #1

E22. Were you able to view this video?

Rationale: technical diagnostic check to ensure video streaming. Source: FL Online Adult Longitudinal Media Survey.

1. Yes

2. No

[if E22=no, skip to E23]

E23. As you viewed this ad, how was it in terms of viewing and sound quality? In answering, think about such issues as whether the images were jerky or unclear or whether the sound was clear and smooth.

Rationale: clear exposure to ad. Source: NY Media Tracking Survey Online.

1. Not at all clear and smooth

2. Somewhat clear and smooth

3. Clear and smooth

4. Very clear and smooth

5. Extremely clear and smooth

E24. Now we would like to show you some screen shots from a television advertisement against smoking that has been shown in the U.S. Once you have viewed the images displayed below, please click on the forward arrow below to continue with the survey.

[display images for ad #1]

E25. Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen this ad on television?

Rationale: exposure to ad.

1. Yes

2. No

[if E25=1, ask E26]

E26. Since [FILL DATE OF CAMPAIGN LAUNCH], how frequently have you seen this ad on television?

Rationale: exposure to ad.

1. Rarely

2. Sometimes

3. Often

4. Very Often

E26a. Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen this ad online?

Rationale: exposure to ad.

1. Yes

2. No

E26b. Since [FILL DATE OF CAMPAIGN LAUNCH], how frequently have you seen this ad online?

Rationale: exposure to ad.

1. Rarely

2. Sometimes

3. Often

4. Very Often

E27. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements.

Rationale: resonance of ad. Source: FL Online Adult Longitudinal Media Survey.

1. Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

[RANDOMIZE ORDER]

E27_1. This ad is worth remembering.

E27_2. This ad grabbed my attention.

E27_3. This ad is powerful.

E27_4. This ad is informative.

E27_5. This ad is meaningful to me.

E27_6. This ad is convincing.

E27_7. This ad is ridiculous.

E27_8. This ad is terrible.

E27_9. This ad was difficult to watch.

E28. 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…

1 2 3 4 5

[RANDOMIZE ORDER] Not at all Very

E28_1. Sad

E28_2. Afraid

E28_3. Irritated

E28_4. Ashamed

E28_5. Discouraged

E28_6. Hopeful

E28_7. Motivated

E28_8. Understood

E28_9. Angry

E29. Would this ad make you want to encourage someone you care about to quit smoking?

Rationale: ad impact. Source: CDC Health Message Testing System.

1. Yes

2. No

[REPEAT ABOVE SEQUENCE OF QUESTIONS FOR EACH AD SHOWN]

For the next few questions, think about all of the advertisements you just viewed and recalled seeing in the past three months.

E29a. Do you think these ads would be relevant for people who smoke cigars, cigarillos or very small cigars that look like cigarettes?

1. Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

E29b. Do you think these ads would be relevant for people who smoke brown cigarettes?

1. Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

E30. Did seeing these ads make you want to encourage someone you care about to quit smoking?

Rationale: ad impact. Source: CDC Health Message Testing System.

1. Yes

2. No

E31. Did you talk to anyone about any of these ads ?

Rationale: resonance of ad. Source: FL Online Adult Longitudinal Media Survey.

1. Yes

2. No

[IF F31=1, ASK F32]

E32. When you talked about the ads, did you talk about any of the following topics? Please select all that apply.

Rationale: ad impact. Source: FL Online Adult Longitudinal Media Survey.

1 2

Yes No

1. These ads were effective

2. These ads were NOT effective

3. I should stop smoking

4. The person I was talking to or someone else I know should stop smoking

5. Other, specify________________________

EXPOSURE TO RADIO ADS

Now, we would like you to listen to a series of radio advertisements that have aired in the U.S. When you are ready, please click on the link below to listen to the first advertisement. There are a total of XX ads to listen to. After you listen to each ad, there will be a few questions that ask about your recent recall of the ad.

[randomize order of ads]

[record order]

PLAY RADIO AD #1

E33. Were you able to listen to this ad?

Rationale: exposure to ad. Source: FL Online Adult Longitudinal Media Survey.

1. Yes

2. No

[if E33=no, skip to E35]

E34. As you listened to this ad, how was it in terms of sound quality?

Rationale: clear exposure to ad. Source: NY Media Tracking Survey Online.

1. Not at all clear and smooth

2. Somewhat clear and smooth

3. Clear and smooth

4. Very clear and smooth

5. Extremely clear and smooth

E35. Now we would like to show you a script from a radio advertisement that has been shown in the U.S. Once you have read the script displayed below, please click on the forward arrow below to continue with the survey.

[display SCRIPT for ad #1]

E36. Since [FILL DATE OF CAMPAIGN LAUNCH], have you heard this ad on the radio in the past 3 months?

Rationale: exposure to ad.

1. Yes

2. No

[if E36=1, ask E37]

E37. Since [FILL DATE OF CAMPAIGN LAUNCH], how frequently have you heard this ad on the radio?

Rationale: exposure to ad.

1. Rarely

2. Sometimes

3. Often

4. Very Often

[REPEAT ABOVE SEQUENCE OF QUESTIONS FOR EACH AD SHOWN]

Next, you will see some advertisements that have recently appeared in magazines, on websites, and on signs in areas such as bus shelters, bus interiors, and other public places. There are 3 sets of images to view, followed by a few questions about whether you have seen these ads before. When you are ready to view them, please click “Next.”

SHOW IMAGE #1

Please click “Next” to view the next set of images.

SHOW IMAGE #2

Please click “Next” to view the next set of images.

SHOW IMAGE #3

E38. Since [FILL DATE OF CAMPAIGN LAUNCH], have you seen any of these ads in magazines, on Websites, or in public places outside your home?

1. Yes

2. No

E39. Where did you see these advertisements?

1. Yes 2. No

E39_1. Magazines or print publications

E39_2. Websites online

E39_3. Public places such as bus shelters, bus interiors, outdoor bulletins, etc.

SECTION G: CLOSING QUESTIONS

G. In what zip code do you live?

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

__ Number of Children

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

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)

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 grade or level of schooling you completed?

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: ND, 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?

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 …?

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

G8. Which statement best describes your current employment status?

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 during the past year?

1. None

2. 1 survey

3. 2 surveys

4. 3 surveys

5. 4 surveys

6. 5 or more surveys

[IF G9 > 1, ASK G10]

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

1. Yes

2. No

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

1. Yes

2. No

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 15,000 KN points for completing the survey.

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