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The
Population
Assessment
of
Tobacco
and
Health
(PATH)
Study
Screener
for
E-‐Cigarette
and
Hookah
Focus
Groups
The Population Assessment of Tobacco and Health or PATH Study Westat is a
longitudinal data collection by the National Institutes of Health (NIH), through the
National Institute on Drug Abuse (NIDA), in partnership with the Food and Drug
Administration (FDA). NIDA is conducting the PATH Study through Westat, the prime
contractor.
As part of the PATH Study, Westat is partnering with the American Legacy Foundation
to conduct focus groups on e-cigarette and hookah use. If you are eligible to participate
in a focus group and agree to participate, the PATH Study will provide you $40.00 at its
completion to thank you for your participation. First though, I need to determine your
eligibility to participate by asking a few questions.
1. May I go ahead?
o
YES
o
NO à TERMINATE
2. How old are you?
o
UNDER 18à INELIGIBLE
o
_________
3. How many individual interviews or focus groups have you participated in at survey
research companies in the past year?
o
0
o
ONE OR MORE à INELIGIBLE
4. Are you currently employed by Westat, a tobacco company, a market research firm,
or the Federal government?
o
YES
AGENCY ___________________
IF HHS (NIH, FDA, CDC)à INELIGIBLE
ANOTHER AGENCY OK
o
NO
5. Do you now smoke cigarettes every day, some days or not at all?
o
EVERY DAY à GO TO QUESTION 7
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o
SOME DAYS à GO TO QUESTION 6
o
NOT AT ALL à GO TO QUESTION 8
6. About how often do you smoke cigarettes?
_______________________________
7. For how long have you been smoking cigarettes this often?
o
LESS THAN 3 MONTHSà INELIGIBLE
o
3 MONTHS OR MORE
8. Do you have access to a computer?
o
YES
o
NO
9. Do you have an email address?
o
YES
o
NO
E-CIGARETTE SCREENING
10. Have you ever used an electronic cigarette, also known as an e-cigarette?
o
YES
o
NOà GO TO HOOKAH SECTION
11. Do you now use e-cigarettes every day, some days or not at all?
o
EVERY DAY à GO TO QUESTION 13
o
SOME DAYS
o
NOT AT ALL à TERMINATE
12. About how often do you use e-cigarettes?
_______________________________
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13. For how long have you been using e-cigarettes this often?
o
LESS THAN 3 MONTHS à GO TO HOOKAH SECTION
o
3 MONTHS OR MORE
14. What was the brand of the last e-cigarette you purchased?
_______________________________
[IF UNABLE TO NAME A BRAND, à INELIGIBLE]
E-CIGARETTE GROUP ELIGIBILITY
DUAL USE GROUPS
o
AT LEAST WEEKLY CIGARETTE SMOKING FOR AT LEAST 3 MONTHS
o
AT LEAST WEEKLY E-CIGARETTE USE FOR AT LEAST 3 MONTHS
o
CAN REPORT AN E-CIGARETTE BRAND
o
HAS ACCESS TO COMPUTER
o
HAS EMAIL ADDRESS
E-CIGARETTE EXCLUSIVE GROUPS
o
EVERY DAY OR SOME DAY E-CIGARETTE USE FOR AT LEAST 3-6
MONTHS
o
MONTHLY CIGARETTE SMOKING OK
o
CAN REPORT AN E-CIGARETTE BRAND
o
HAS ACCESS TO COMPUTER
o
HAS EMAIL ADDRESS
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HOOKAH SCREENING
15. Have you ever used a hookah?
o
YES
o
NOà TERMINATE
16. Have you used hookah in the past 3 months?
o
YES
o
NO à TERMINATE
17. Do you now use hookah every day, weekly, monthly, or less than monthly?
o
EVERY DAY
o
WEEKLY
o
MONTHLY
o
LESS THAN MONTHLY
18. Do you live in the Washington, D.C. area?
o
YES
o
NO à DETERMINE ELIGIBILITY
19. Are you willing to travel to the Dupont Circle area to participate in a focus group?
o
YES
o
NO
HOOKAH GROUP ELIGIBILITY
HOOKAH GROUPS – ONLINE
o
USED HOOKAH IN PAST THREE MONTHS
o
HAS ACCESS TO COMPUTER
o
HAS EMAIL ADDRESS
HOOKAH GROUPS – IN PERSON
o
USED HOOKAH IN PAST THREE MONTHS
o
WILLING TO TRAVEL TO DUPONT
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20. Are you male or female?
o
MALE
o
FEMALE
21. What is your race/ethnicity?
o
BLACK OR AFRICAN AMERICAN
o
HISPANIC OR LATINO
o
WHITE
o
AMERICAN INDIAN OR ALASKA NATIVE
o
ASIAN
o
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
o
OTHER _______________________________
22. What is your age?
_______________________ years
23. What is the highest level of education you have completed?
o
LESS THAN HIGH SCHOOL
o
COMPLETED 12TH GRADE/HIGH SCHOOL GRADUATE
o
SOME COLLEGE/2-YEAR COLLEGE/TECHNICAL SCHOOL
o
COLLEGE DEGREE
o
GRADUATE OR PROFESSIONAL SCHOOL
IF INELIGIBLE
Thank you for your interest, but you are not eligible for this study. We will destroy the
information you have provided.
IF ELIGIBLE
Thank you for answering all the questions. We will contact you if you are selected to participate.
May I please have your name, phone number and/or email to contact you?
COLLECT RESPONDENT NAME, ADDRESS, AND PHONE NUMBER.
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Name: _____________________________________________________________
Address: _____________________________________________________________
City: _________________________________ State: ______ Zip Code: __________
Phone: _________________________________
Email: _________________________________
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| File Type | application/pdf |
| File Title | Microsoft Word - B. E-cigarette hookah focus group screener 021414.docx |
| File Modified | 2014-02-19 |
| File Created | 2014-02-14 |