Smartphone Web Survey Follow-up

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

First Web Survey Follow-up for Smartphone Users

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

• ask of all

INTRO Welcome to the Smartphone Survey! You have [POP IN] points. Today’s survey is worth three points.

• ask of all

• not required

ALC1 Alcoholic beverages include beer, wine, wine coolers, liquor such as whiskey or gin, and any other type of alcoholic beverage.

Last week, did you drink any type of alcoholic beverage?

Note: Last week means between Last Monday and Sunday

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

• ask if alc1=1

ALC2 Last week, how many alcoholic beverages did you drink?

enter numeric response /range=1-996/

• ask of all

• not required

SMK1 Last week, did you smoke any cigarettes at all?

Note: Last week means between Last Monday and Sunday

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

• ask if SMK1 =1

SMK2 Last week, how many cigarettes did you smoke?

enter numeric response /range=1-996/

• Ask if smk1=1

CIGWARN During the past 7 days, have warning labels on cigarette packages led you to think about quitting?

1. YES

2. NO

3. I did not see warning labels on packages

97. DON’T KNOW/NOT SURE

99. REFUSED

• ASK OF ALL

OTHTOB In the past 7 days, have you used any of the following products at least once?

OTHTOB_A Cigars, cigarillos, or little cigars

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_B Chewing tobacco, snuff, or dip

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_C Snus, such as Camel or Marlboro snus

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_D Dissolvable tobacco products like Ariva, Stonewall, Camel orbs, Camel sticks, or Camel strips

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_E Electronic Cigarettes or E-cigarettes, such as Ruyan or NJOY

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_F Flavored little cigars

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_G Water pipes, also known as hookahs

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_H Clove cigarettes or clove cigars

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_I Roll your own cigarettes

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

OTHTOB_J Flavored cigarettes like Camel Crush

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

• ask of all

• from nats

HISP Are you Hispanic or Latino?

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED

• ASK OF ALL

RACE I’m going to read a list of racial categories. Which one or more of the following do you consider yourself to be?

• /ALLOW MULTIPLE RESPONSES/

/Please deliver multiple responses as “variable name_a, variable name_b, etc” as is standard for BRFSS/

[INTERVIEWER: Mark all that apply.]

[INTERVIEWER, IF respondent volunteers information prior to your having read the response list or in the middle of you reading the response list, ok to code without reading full list. IF this happens, please probe with “in addition to “XXX” are there any other racial categories that describe you” to see if more than one category is appropriate.]

01. White

02. Black or African American

03. Asian

04. Native Hawaiian or Other Pacific Islander

05. American Indian or Alaska Native

DO NOT READ:

09. NONE OF THE ABOVE

97. DON’T KNOW/NOT SURE

99. REFUSED

• read to all

CLOSE1

This week’s survey is complete, thanks! You currently have [POP IN] survey points.