ATTACHMENT A: Over-inclusive instrument for HINTS FDA cycle: working draft
STATEMENT OF PRIVACY: Collection of this information is authorized by The Public Health Service Act, Sections 411 (42 USC 285 a) and 412 (42 USC 285a-1.a and 285a1.3). The purpose of this data collection is to evaluate whether the survey questions are easy to understand. The results of the data collection will be used to improve the survey instrument. Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private under the Privacy Act and will only be seen by people authorized to work on this project. The report summarizing the findings will not contain any names or identifying information. Identifying information will be destroyed when the project ends.
NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN: Public reporting burden for this collection of information is estimated to average 90 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 (0925-0589-XX). Do not return the completed form to this address.
Communication/Information seeking
Health info seeking sources (From HINTS 4 Cycle 3)
A1. Have you ever looked for information about health or medical topics from any source?
Yes
No GO TO A7
A2. The most recent time you looked for information about health or medical topics, where did you go first?
Mark only one.
Books
Brochures, pamphlets, etc.
Cancer organization
Family
Friend/Co-worker
Doctor or health care provider
Internet
Library
Magazines
Newspapers
Telephone information number
Complementary, alternative, or unconventional practitioner
Other-Specify
A3. Did you look or go anywhere else that time?
Yes
No
A4. The most recent time you looked for information about health or medical topics, who was it for?
Myself
Someone else
Both myself and someone else
A5. Do family members and friends ask you for information or advice on health topics?
Yes
No
A6. Based on the results of your most recent search for information about health or medical topics, how much do you agree or disagree with each of the following statements? (Strongly agree, Somewhat agree, Somewhat disagree, Strongly disagree)
It took a lot of effort to get the information you needed
You felt frustrated during your search for the information
You were concerned about the quality of the information
The information you found was hard to understand
A7. Overall, how confident are you that you could get advice or information about health or medical topics if you needed it?
Completely confident
Very confident
Somewhat confident
A little confident
Not confident at all
A8. In general, how much would you trust information about health or medical topics from each of the following? (Not at all, A little, Some, A lot)
A doctor
Family or friends
Newspapers or magazines
Radio
Internet
Television
Government health agencies
Charitable organizations
Religious organizations and leaders
A9. Imagine that you had a strong need to get information about health or medical topics. Where would you go first?
Mark only one
Books
Brochures, pamphlets, etc.
Cancer organization
Family
Friend/Co-worker
Doctor or health care provider
Internet
Library
Magazines
Newspapers
Telephone information number
Complementary, alternative, or unconventional practitioner
Other-Specify
A10. Have you ever looked for information about cancer from any source?
Yes
No
A11. How much attention do you pay to information about health or medical topics from each of the following sources? (None, A little, Some, A lot)
In online newspapers
In print newspapers
In special health or medical magazines or newsletters
On the Internet
On the radio
On local television news programs
On national or cable television news programs
On social networking sites such as Facebook or Twitter
Have you ever looked for information about tobacco any source?
Yes
No
What kinds of information on tobacco products have you ever looked for from any source? (maybe also ask to indicate which one was the most recent search for)
Health effects
Reduced exposure products
Quitting help/information
List of chemicals in tobacco products
Cost/Coupons
Instructions/tutorials
Where to buy
Information about new kinds of tobacco products (or could ask a question first about what type of product they search for info about –cigarettes, cigars, snus, smokeless etc…)
(need to add others here)
Something else (specify)
Overall, how confident are you that you could get advice or information about tobacco products if you needed it?
Completely confident
Very confident
Somewhat confident
A little confident
Not confident at all
In general, how much would you trust information about tobacco from each of the following?
A doctor/medical professional
Family or friends
Newspapers or magazines
Radio
Community center/Gym
Internet (can we break this out to be more specific, blogs, internet news sites, social media etc…)
Television (can we break this out to be more specific, tv ads, tv news, tv shows etc…)
Government health agencies (give examples ?)
Charitable organizations / Advocacy organizations (not sure people will know what that means)
Religious organizations and leaders
Tobacco companies
Internet Access/Use
B1. Do you ever go on-line to access the Internet or World Wide Web, or to send and receive e-mail?
Yes
No GO TO C1
B2. When you use the Internet, do you access it through... (Yes/No)
A regular dial-up telephone line
Broadband such as DSL, cable or FiOS
A cellular network (i.e., telephone, 3G/4G)
A wireless network (Wi-Fi)
B3. Do you access the Internet any other way?
Yes- Specify
No
B4. In the past 12 months, have you used the Internet to look for health or medical information for yourself?
Yes
No
B5. Is there a specific Internet site you like to go to for health or medical information?
Yes
No GO TO B7
B6. Specify which Internet site you especially like as a source of health or medical information:
B7. In the last 12 months, have you used the Internet for any of the following reasons? (Yes/No)
Looked for information about quitting smoking
Bought medicine or vitamins on-line
Participated in an on-line support group for people with a similar health or medical issue
Used e-mail or the Internet to communicate with a doctor or doctor’s office
Used a website to help you with your diet, weight, or physical activity
Looked for a health care provider
Downloaded health-related information to a mobile device, such as an MP3 player, cell phone, tablet computer or electronic book device
Visited a “social networking” site, such as “Facebook” or “LinkedIn” to read and share about medical topics
Wrote in an on-line diary or “blog” (i.e., Web log) about any type of health topic
Kept track of personal health information such as care received, test results, or upcoming medical appointments
Looked for health or medical information for someone else
B8. Have you done anything else health-related on the Internet?
Yes - Specify
No
Tobacco use phenotypes
Cigarettes
Have you smoked at least 100 cigarettes in your entire life?
Do you now smoke cigarettes every day, some days or not at all?
If you now smoke every day or some days, on the days that you smoke, how many cigarettes did you smoke on average?
Smokeless
Have you used chewing tobacco, snuff or dip, such as Redman, Levi Garrett, Beechnut, Skoal or Copenhagen, at least 20 times in your entire life?
Do you now use chewing tobacco, snuff, or dip , such as Redman, Levi Garrett, Beechnut, Skoal or Copenhagen, every day, some days or not at all?
Cigars/Cigarillos/Little Cigars
Have you smoked cigars, cigarillos or little filtered cigars, such as Black and Milds, Swisher Sweets, Dutch Masters and Phillies Blunts at least 50 times in your entire life?
Do you now smoke cigars, cigarillos, or little cigars, such as Black and Milds, Swisher Sweets, Dutch Masters and Phillies Blunts every day, some days or not at all?
Is the size of the cigars, cigarillos, or little filtered cigars that you usually smoke…?
Hookah or water pipe; Electronic Cigarettes; Dissolvables; Pipe; Roll your own cigarettes; Snus
[see NYTS 2012- one question with checkboxes for each product type]
Which of the following tobacco products have you ever heard of?
Which of the following tobacco products have you ever tried?"
Menthol/flavoring
Were any of the tobacco products you used in the past 30 days flavored to taste like menthol (mint), clove, spice, alcohol (wine, cognac), candy, fruit, chocolate, or other sweets?
Quit Intentions (HINTS III)
H4. Are you seriously considering quitting smoking within the next 6 months?
Yes Go to Question H6
No Go to Question H6
H5. About how long has it been since you completely quit smoking cigarettes?
Write a number in one box below
H6. Do you believe that some cigarettes are less harmful than others?
Yes
No
H7. Do you believe that some smokeless tobacco products, such as chewing tobacco and snuff, are less harmful than cigarettes?
Yes
No
H8. There are a number of resources that people use to help them stop smoking. Before being contacted for this survey (and regardless of whether or not you smoke), had you ever heard of telephone quit lines such as a toll-free number to call for help in quitting smoking?
Yes
No Go to Question H9
H8a. Have you ever called a telephone quitline?
Yes
No
H8b. In the past 12 months, did any doctor, dentist, nurse, or other health professional suggest that you call or use a telephone helpline or quit line to help you quit smoking?
I have not smoked in the past 12 months
Yes
No
H8c. How likely would you be to call a smoking cessation telephone quit line in the future, for any reason?
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
H9. Before being contacted for this survey, had you ever heard of 1-800-QUIT-NOW?
Yes
No
Social Influence
PATH ITEM AX0072. Of the five closest friends or acquaintances that you spend time with on a regular basis, how many of them use any kind of tobacco?
Addiction
Addiction measure
Heaviness of smoking index (HSI) - maybe modified for smokeless - measures time to first cigarette and number of cigarettes per day.
How many containers of smokeless tobacco (including containers of snus) per week do you use?
Half of a container or less
1 container
2 containers
3 containers
More than 3 containers
On the days that you use smokeless tobacco, how soon after you wake up do you first use it? (Select one.)
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
NYTS 2012: How soon after you wake up do you want to use a tobacco product?
I do no use a tobacco product
Within 5 minutes,
From 6 to 30 minutes,
From more than 30 minutes to 1 hour,
After more than 1 hour but less than 24 hours,
I rarely want to use a tobacco product.
PATH: On the days that you smoke how/How soon after you wake up do you typically smoke your first cigarette of the day?
PATH: On the days that you smoke, would/ Would you say you smoke your first cigarette of the day within the first 30 minutes after you wake up?
Yes
No
It varies
PATH: The following statement about the use of tobacco and nicotine in general. Please rate your level of agreement for each statement using the following scale: 1= not true of me at all and 5=extremely true of me. I usually want to (use a tobacco product) right after I wake up . (1-5, 6= don't know; 7=refused). From PATH but prior to cognitive testing.
NYTS 2012: 1. During the past 30 days, have you had a strong craving or felt like you really needed to use a tobacco product of any kind (such as smoking a cigarette or using chewing tobacco, snuff, dip, or snus)?
or PATH: 2. Do you ever have strong cravings to X? (from PATH, but prior to cognitive testing)
or PATH 3. The following statement about the use of tobacco and nicotine in general. Please rate your level of agreement for each statement using the following scale: 1= not true of me at all and 5=extremely true of me. I frequently crave X(tobacco products- in PATH this X is filled in by products participant has previously endorsed) . (1-5, 6= don't know; 7=refused). From PATH but prior to cognitive testing.
How true is this statement for you? I feel restless and irritable when I don't use tobacco for a while.
Do you sometimes wake up at night in order to have a cigarette or other tobacco product?
During the past 30 days, have you had a strong craving to use a tobacco product of any kind?
During the past 30 days, did you ever feel like you really needed to use a tobacco product?
During the past 30 days, was there a time when you wanted to use a tobacco product so much that you found it difficult to think of anything else?
Beliefs about nicotine
Are each of the following statements true or false? Nicotine is the main substance in tobacco that makes people smoke.
Are each of the following statements true or false? The nicotine in cigarettes is the chemical that causes most of the cancer.
Are each of the following statements true or false? The nicotine in cigarettes is the chemical that causes most of the cancer.
From PATH: To what extent do you believe nicotine to be the main substance in tobacco that makes people want to smoke? 1=not at all, 2=a little, 3=somewhat, 4=very much, 5 don't know, 6 refused.
Include item on myth of nicotine as the cancer/disease causing agent in tobacco
Beliefs about addiction
How likely is someone to become addicted to X (for all products)
Do you consider yourself addicted to X?
Overall, how addictive is each of the following? (Not at all addictive, Moderately addictive, Very Addictive)
Cigarette smoking
Cigar smoking
Smokeless tobacco use
Tobacco Message Exposure Source/Frequency/Reaction
Heavily modified/reduced TeRMMS items
Perceptions of different themes of (mock) tobacco ads (lifestyle vs. product vs. health vs. other)—would also work for implied claims items
NATS 2012/13:
Have you noticed promotions for free samples of cigarettes in the past 30 days?
Have you noticed promotions for free samples of smokeless tobacco products in stores and venues where children are allowed, in the past 30 days?
Have you noticed promotions for events being sponsored by a cigarette or smokeless tobacco brand name or logo in the past 30 days?
Have you noticed promotions for cigarettes sold singly in stores, otherwise known as ""loosies"" in the past 30 days?"
NATS 2012/13:
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions in the mail for any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions from the internet for any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions in an email sent by a tobacco company for any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions with the purchase of any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions with the purchase of a non-tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions at an event, bar, or nightclub for any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions from friends or family for any tobacco product in the past 30 days?
Did you receive coupons, rebates, buy 1 get 1 free, 2 for 1 or any other special promotions from some other source in the past 30 days?
NYTS 2012:
When you are using the internet, how often do you see any ads or promotions for cigarettes or other tobacco products?
When you read newspapers or magazines, how often do you see any ads or promotions for cigarettes or other tobacco products?
During the past 30 days, did you [your household] receive coupons from a tobacco company through...
During the past 30 days, did a tobacco company send you information (other than coupons) through...
When you go to a convenience store, supermarket, or gas station, how often do you see any ads or promotions for cigarettes or other tobacco products?
During the past 30 days, how often did you see any ads or promotions for cigarettes or other tobacco products that were outdoors on a billboard or could be seen from outside a store?"
Social Media/Social Networks
Traditional Media Use
HPHC
Awareness of HPHC list & list by brand / Use of list / Perceptions of communication objectives of HPHC list / Source of exposure to list and info from list
In the past year, how often have you seen a list of the chemicals contained in tobacco products?
Never
Rarely
Sometimes
Often
In the past year, how often have you thought about the chemicals contained in tobacco products?
Never
Rarely
Sometimes
Often
If you heard about a list of potentially harmful chemicals in tobacco products listed by each brand would you look for it?
Yes
No
What information would you want to find on that list?
Mark all that apply
General Info on health effects for me
Info on health effects for someone else
Info on the levels of a specific chemical(s) in the brand I use
Info on the levels of a specific chemical(s) in the brand someone else uses
To find a brand to switch to lower my risk of health problems
To find a brand to switch to lower the risk of health problems for someone else
Curiosity/just to see what chemicals in are a brand
To verify claims made about health effects of a specific brand/type
To figure out what brand is the most cost-effective (note: most/least chemical for lowest price = good?)
Scared to know what’s on the list (similar to ‘don’t want to be reminded’, but slightly different perspective)
I already know about the risk I am taking by using tobacco products
To compare brands (more of an ‘in general’ comparison vs. for a specific reason)
Even if it will upset me, I want to know about chemicals in tobacco products
It is important to know about chemicals in tobacco products
For research/educational purposes
My health care provider/family member told me to
Advised to by friend, teacher, physician, etc.
Use as motivation to quit for self or someone else
Use as motivation to not initiate for self or someone else
Why wouldn’t you look for this list?
Mark all that apply
I don’t use tobacco products
I already know everything about the chemicals in them
I don’t care about the chemicals in tobacco products
I don’t trust that such a list would be accurate/unbiased
Nobody close to me uses tobacco products
Too much effort to find the list
Wouldn’t know where to find it
I have already seen the list (probe for where!)
I don’t want to be reminded about the chemicals in tobacco/ Don’t want to be reminded about the health effects of tobacco (asking for feedback on this “Information Avoidance” item from someone)
When it comes to information about tobacco, sometimes ignorance is bliss.
I would rather not know about the chemicals in tobacco[DBP3]
To determine whether to switch to lower risk tobacco type (e.g., combusted to smokeless)
I wouldn’t understand the list
I don’t have time
I don’t smoke (or use tobacco products) that much …social smoker
I’m not addicted to tobacco products (I can quit anytime)
I don’t have a computer
Haven’t heard of the list
Don’t have access (if it’s online only)
If there were a public list of the chemicals in tobacco products, where do you think you would be able to find that list?
Mark all that apply
Government website
Industry
Doctor’s office
Newspapers
Magazines
Radio
TV ads
Smartphone App
Other internet (specify)
Charitable organizations / Advocacy organizations
Other source (specify)
HPHC Study items:
A1. [TX ONLY According to this information,] Do chemicals in cigarettes come from…? (Select one for each item.) [RANDOMIZE LIST.] Yes No
The tobacco leaf
Tobacco smoke
The cigarette carton
Glues, inks, and paper
The filter
Additives
[CONTROL & TX=CIG & RYO.]
A2. [TX ONLY According to this information,] How many of the chemicals in cigarettes come from the tobacco leaf and the smoke? (Select one.)
None of the chemicals
A few of the chemicals
Many of the chemicals
All of the chemicals
[CONTROL & TX=SMK.]
A3. [TX ONLY According to this information,] How many of the chemicals in smokeless tobacco products come from the tobacco leaf? (Select one.)
None of the chemicals
A few of the chemicals
Many of the chemicals
All of the chemicals
A4. [TX ONLY According to this information,] Who tests tobacco products for harmful chemicals and reports the amounts to FDA? (Select one.)
Tobacco farmers
Federal government
State and local health departments
Tobacco companies
No one
None of the above
A5. For each question, please answer YES or NO. (Select one for each question.) [RANDOMIZE LIST.]
Imagine one tobacco product has a greater number of chemicals than another tobacco product. [TX ONLY According to the information,] Can you tell which of these products is more likely to cause a tobacco-related health problem?
Formaldehyde has been linked to cancer. Now imagine one brand of tobacco product has more formaldehyde in it than another brand. [TX ONLY According to the information,] Can you tell which of these brands is more likely to cause cancer?
A6. For each of the following statements, please select True or False. (Select one for each statement.) [RANDOMIZE LIST.]
[TX ONLY According to this information,] Researchers have linked some of the chemicals from tobacco products to health problems.
[TX ONLY According to this information,] Researchers have discovered all of the health problems that may be caused by harmful chemicals from tobacco products.
[TX ONLY According to this information,] Researchers have discovered all of the harmful chemicals that come from using tobacco products.
[TX ONLY According to this information,] All tobacco products contain chemicals that may cause harm.
[TX ONLY According to this information,] Research is ongoing to find out which chemicals cause harm.
[TX ONLY According to this information,] Nicotine causes cancer.
[TX ONLY According to this information,] Nicotine is one reason why people have trouble quitting tobacco products.
A7. For each question, please answer YES or NO. (Select one for each question.) [RANDOMIZE LIST.]
Yes
No
[TX ONLY According to this information,] Can you tell a tobacco user’s chance of developing a tobacco-related health problem by counting the total number of chemicals in his/her tobacco product?
[TX ONLY According to this information,] Can you tell a tobacco user’s chance of developing a health problem by looking at the amount of a harmful chemical in his/her tobacco product?
[IF TX GROUP]
A8. For each of the following statements, please select True or False. (Select one for each statement.) [RANDOMIZE LIST.]
According to this information, when a chemical is listed without an amount it may mean the chemical was not detected.
According to this information, when a chemical is listed without an amount it may mean the information is not currently available.
D1. On a scale of 1 to 5 with 1 being not harmful at all and 5 being extremely harmful, how harmful to someone’s health is…? (Select one for each statement.) [RANDOMIZE 1-3.]
Smoking cigarettes
Smoking roll-your-own tobacco
Using smokeless tobacco
[TX = CIG. SHOW STIMULI.] Smoking this brand of cigarettes
[TX = RYO. SHOW STIMULI.] Smoking this brand of roll-your-own tobacco
[TX = SMK. SHOW STIMULI.] Using this brand of smokeless tobacco
D2. How much do you agree or disagree with the following statement? There is no safe tobacco product. (Select one.)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
NATS 2012/3:
How often have you seen a list of the chemicals contained in tobacco products in the past twelve months?
How often have you thought about the chemicals contained in tobacco products in the past twelve months? Would you say…
NYTS 2012:
In the past 30 days, how often have you thought about the harmful chemicals in tobacco products?
Attitudes and beliefs about product regulation
Implied claims
Implied claims
3 areas of focus:
Natural/organic/additive-free
Lower addiction potential
Health claim—lower exposure to a chemical / less health risk
Either ask about hypothetical products advertised with these terms or show 2 fake brands that use these terms, and have them assess each on:
Believability of statement / if such a statement has to be approved (and by who)
Health/addiction risk (as appropriate)
Credibility of FDA for tobacco control messaging/information
When it comes to the Food and Drug Administration’s (FDA) ability to regulate cigarettes, this agency is:
Not at all qualified
A little qualified
Somewhat qualified
Very qualified
Risk perceptions
new vs. conventional products
NATS 2012/3 ITEMS:
How harmful do you think each of the following is to a person’s health? (Not at all harmful, Moderately harmful, Very harmful)
Cigarette smoking
Cigar smoking
Smokeless tobacco use
Dissolvable tobacco
How long do you think someone has to smoke before it harms their health? Would you say...
Less than a year
1 year
5 years
10 years
20 years or more
How much do you think your risk of developing a smoking-related disease would decrease if you cut the amount that you smoke in half? Would you say...
Not at all
A little
Somewhat
A lot
How much do you think people harm themselves when they smoke cigarettes some days but not every day? Would you say...
Not at all
A little
Somewhat
A lot
How much do you think your risk of developing a smoking-related disease would decrease if you cut your smokeless tobacco use by half? Would you say...
Not at all
A little
Somewhat
A lot
How concerned are you that your smoking could affect the health of someone else? Would you say...
Not at all
A little
Somewhat
A lot
If you had to do it over again, would you have started using tobacco? Would you say...
Definitely not
Probably not
Probably yes
Definitely yes
NYTS 2012 ITEMS:
How much do you think people harm themselves when they smoke a few cigarettes every day?
No harm
Little harm
Some harm
A lot of harm
How much do you think people harm themselves when they smoke 10 or more cigarettes every day?
No harm
Little harm
Some harm
A lot of harm
Do you believe that electronic cigarettes or e-cigarettes, such as Ruyan or NJOY are (LESS HARMFUL, EQUALLY HARMFUL, or MORE HARMFUL) than regular cigarettes?
Less harmful
Equally harmful
More harmful
I have never heard of electronic cigarettes or e-cigarettes
I don’t know enough about these products
How much do you think people harm themselves when they use smokeless tobacco, such as chewing tobacco, snuff, dip, or snus, every day?
No harm
Little harm
Some harm
A lot of harm
How much do you think people harm themselves when they use smokeless tobacco, such as chewing tobacco, snuff, dip, or snus, some days but not every day?
No harm
Little harm
Some harm
A lot of harm
Do you believe that dissolvable tobacco products, such as Ariva, Stonewall, Camel orbs, Camel sticks, Marlboro sticks, or Camel strips are (LESS HARMFUL, EQUALLY HARMFUL, or MORE HARMFUL) than other smokeless tobacco products, such as chewing tobacco, snuff, dip or snus?
Less harmful
Equally harmful
More harmful
I have never heard of dissolvable tobacco products
I don’t know enough about these products
How strongly do you agree with the statement 'All tobacco products are dangerous'?"
Strongly agree
Agree
Disagree
Strongly disagree
FDA Center for Food Safety and Applied Nutrition
Proposed Questions for the HINTS
October 18, 2012
(Q1-Q3 may be inserted as a separate section after Section K)
These next questions ask about dietary supplements such as vitamins, minerals, herbs, and other supplements that you may take in addition to your regular diet.
1. If you hear or read that a dietary supplement product "may produce anticarcinogenic effects in the body," does this mean that the product may do any of the following things: (Yes/No)
reduce the risk of cancer(s)
treat cancer(s)
completely prevent cancer(s)
cure cancer(s)
[GO TO Q2 ONLY WHEN “REDUCTION”=YES. ALL OTHER RESPONSES, SKIP TO Q3]
2. If a dietary supplement product says on its package that it "may produce anticarcinogenic effects in the body," does this mean the product may reduce the risk of:
a single type of cancer
a few or some types of cancer
all cancers
3. If a dietary supplement product says on its package that it "may reduce the risk of certain cancers," does this mean the product may reduce the risk of:
a single type of cancer
a few or some types of cancer
all cancers
(The following questions may be inserted as additional items in Question L4)
4. How much do you agree or disagree with each of the following statements?
Cancer is most often caused by a person's behavior or lifestyle
Getting checked regularly for cancer helps find cancer when it's easy to treat
People can tell they might have cancer before being diagnosed
Cancer is an illness that when detected early can typically be cured
It seems like everything causes cancer
There's not much you can do to lower your chances of getting cancer
There are so many different recommendations about preventing cancer, it's hard to know which ones to follow
All cancers have the same causes
All cancers can be prevented in the same ways
All cancers can be treated in the same ways
All cancers can be cured in the same ways
All cancers can be avoided through what one eats and drinks
All cancers can be avoided by using dietary supplements
All cancers can be treated by using dietary supplements instead of drugs or surgery
Dietary supplement use and adverse event questions for HINTS—
adapted from the 2002 Health and Diet Survey
Use
Please think about dietary supplements such as vitamins, minerals, herbs, and other supplements that you may take in addition to your regular diet.
1. Please indicate whether or not you have taken one or more of the following types of dietary supplement(s) in the past 12 months: (Yes/No)
Vitamin or Mineral supplements, such as Vitamin C, Vitamin E, iron, or calcium
Supplements for enhancing athletic performance
Supplements for inducing weight loss
Supplements for enhancing sexual or reproductive function
Supplements for improving mood or mental health
Supplements for pain relief
Other supplements to address a health problem or enhance health,including herbs or botanicals
2. Have you given any dietary supplements to any infant(s), child(ren), or adolescent(s) in your family:
Yes
No
2a. If yes, what was the reason for using the supplement:
2b. If yes, please provide the name(s) of the supplement(s):
Adverse Events Associated with Dietary Supplements
3. In the past 12 months, have you experienced any health problem that you thought might be related to any dietary supplements you took?
Yes
No
4. The last time you had such a problem, what were the major symptoms of the problem?
Mark all that apply
Heart problems/chest pain
Abdominal pain
Headache
Rashes
Allergy/reaction
Nausea
Blood pressure problems
Diarrhea
Cramping/muscle aches
Sleep problems
Dizziness/fainting
Itching
Anxiety/nervousness
Drowsiness
Vomiting
Other symptoms, please specify
5. What supplement(s) did you think was(were) related to your problem?
Mark all that apply
Multi-vitamins
“Xenadrine”
Unspecified vitamins/minerals
Iron
Ginko Biloba
Vitamin C
Calcium
“Metabolife”
Vitamin E
Ginseng
“Phen Phen”
St. John’s wort
Vitamin B
Other supplement(s), please specify
6. Did you report your problem to any of the following institutions or professional: (Yes/No)
The Food and Drug Administration
The CDC, Centers for Disease Control and Prevention
A health department or poison control center
The manufacturer of the dietary supplement
Your doctor
FDA OC/RCS Proposed Questions
Let’s think about news reports you hear on medical-product and food safety, the Food and Drug Administration’s (FDA) activities, and how these affect your choices.
1. What do you think are FDA’s main purposes for requiring product information on medical products?
Mark all that apply
Legal requirement
Describing how to use the product safely
Manufacturer advertising
Explaining the potential negative effects of using the product
Explaining the benefits from using the product
2. If the FDA reports that it is investigating an approved drug, does it mean ... (Yes/No/Not sure/Don’t know)
The drug is not safe to use.
It is unclear whether the drug is safe to use.
The drug is safe to use as directed.
I need to ask my doctor whether it’s safe to use the drug.
3. If a drug you need to take is recalled, would you… (Yes/No/Not sure/Don’t know)
Examine the lot number on my pill bottle
Stop taking the drug immediately
Call my doctor to help me understand what to do
Be careful taking the drug by paying attention to side-effects
Continue taking the drug as directed
4. Under what conditions would you pay attention to reports of an FDA investigation? (Yes/No/Not sure/Don’t know)
If it’s a product you use
If it’s a product that a loved one or a friend uses
You follow all FDA investigations that you hear about
You pay little or no attention to FDA investigations
5. The FDA uses many sources to share information from investigations into medical products and food that directly affect you. Where would you prefer that FDA present this information?
Mark all that apply
FDA website (http://www.FDA.gov)
MedWatch (http://www.fda.gov/Safety/MedWatch)
Other health or medical-related websites (e.g., webMD, healthfinder)
Televised interview with FDA physician
Printed interview with FDA physician in newspaper
YouTube video
6. If a food you had bought were recalled, would you… (Yes/No/Not sure/Don’t know)
Throw it out
Call your doctor to help you understand what to do with the food
Be careful using the food washing it well and cooking it thoroughly)
Continue to eat the food as usual
7. How much do you trust the FDA to keep your medical products and foods safe?
Not at all
Somewhat
A lot
8. How much do you believe those listed below will give you a clear recommendation about how to manage a problem with medical products? (Not at all, Somewhat , A lot)
Food and Drug Administration (FDA)
The manufacturer
My doctor
The industry’s professional association
9. How much do you believe those listed below will give you a clear recommendation about how to manage a food safety problem? (Not at all, Somewhat, A lot)
Food and Drug Administration (FDA)
Centers for Disease Prevention & Control (CDC)
My doctor
USDA (Department of Agriculture)
10. Do you AGREE or DISAGREE with each of the following statements. (Agree, Disagree, Neither agree nor disagree)
The food I buy is safe to eat.
The medications I buy are safe to use.
The medications I buy are effective.
Vaccines that I get are safe.
Vaccines that I get are effective.
Cosmetics are tested and proved safe before they are sold.
Pet food is safe for animals to consume.
My medical equipment is safe to use.
My medical equipment works well.
Demographics
Standard HINTS demographics
O1.What is your age?
O2. What is your current occupational status?
Mark only one.
Employed
Unemployed
Homemaker
Student
Retired
Disabled
Other-Specify
O3. Have you ever served on active duty in the U.S. Armed Forces, military Reserves or National Guard? Active duty does not include training in the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.
Yes, now on active duty
Yes, on active duty in the last 12 months but not now
Yes, on active duty in the past, but not in the last 12 months
No, training for Reserves or National Guard only
No, never served in the military
O4. In the past 12 months, have you received some or all of your health care from a VA hospital or clinic?
Yes, all of my health care
Yes, some of my health care
No, no VA health care received
O5. What is your marital status?
Married
Living as married
Divorced
Widowed
Separated
Single, never been married
O6. What is the highest grade or level of schooling you completed?
Less than 8 years
8 through 11 years
12 years or completed high school
Post high school training other than college (vocational or technical)
Some college
College graduate
Postgraduate
O7. Were you born in the United States?
Yes GO TO O10
No
O8. In what year did you come to live in the United States?
O9. How well do you speak English?
Very well
Well
Not well
Not at all
O10. Are you of Hispanic, Latino/a, or Spanish origin? One or more categories may be selected.
Mark one or more.
No, not of Hispanic, Latino/a, or Spanish origin
Yes, Mexican, Mexican American, Chicano/a
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino/a, or Spanish origin
O11. What is your race? One or more categories may be selected.
Mark one or more.
White
Black or African American
American Indian or Alaska Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
O12. Including yourself, how many people live in your household?
O13. Starting with yourself, please mark the sex, and write in the age and month of birth for each adult 18 years of age or older living at this address.
O14. How many children under the age of 18 live in your household?
O15. Do you currently rent or own your home?
Own
Rent
Occupied without paying monetary rent
O16. Does anyone in your family have a working cell phone?
Yes
No
O17. Is there at least one telephone inside your home that is currently working and is not a cell phone?
Yes
No
O18. 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?
$0 to $9,999
$10,000 to $14,999
$15,000 to $19,999
$20,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $199,999
$200,000 or more
Sexual Orientation
NHIS: Do you think of yourself as:
[Gay | Lesbian or gay]
[Straight, that is not gay | Straight, that is, not Lesbian or gay]
Bisexual
Something else
NHIS: By something else, do you mean that…
You are not straight, but identify with another label such as queer, trisexual, omnisexual or pan-sexual
You are transgender, transsexual, or gender variant
You have not figured out your sexuality or are in the process of figuring it out
You do not think of yourself as having a sexuality
You do not use labels to identify yourself
You made a mistake and did not mean to pick this answer
You mean something else
NHIS: You did not enter an answer for the question. Is that because:
You don’t understand the words
You understand the words, but you have not figured out your sexuality or are in the process of figuring it out
You mean something else
YRBS Sexual identity: Which of the following best describes you?
Heterosexual (straight)
Gay or lesbian
Bisexual
Not sure
NSFG 2006-2008: Do you think of yourself as…
Heterosexual or straight
Homosexual, gay or lesbian
Bisexual
Or something else?
Tobacco users in household
Does anyone who lives with you now use tobacco products?
Do you live in the same household with someone who smokes tobacco products?
[If yes to Q2] Q3. How many people in your household smoke?
[If Q1 = 2 or 3 and Q2 = yes] Q4. Has anyone smoked tobacco in your home in the past seven days?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Aaron Maitland |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |