CDC National Media Campaign Evaluation--Revised Non-Smok

D R A F T

Form Approved

OMB No. 0920-0923

Exp. Date 04/30/2014

- CDC National Media Campaign Evaluation

Revised Non-Smoker 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 A: PREVIOUS TOBACCO USE

[IF A2=1, ASK A4]

A4. Have you smoked cigarettes at all, even one puff, in the past 12 months?

1. Yes

2. No

[IF A4=1, ASK A5]

A5. Have you quit smoking cigarettes completely in the past ______ [FILL # MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013?

1. Yes

2. No

SECTION B: TOBACCO USE QUESTIONS

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

[IF A5=1, ASK B1]

The next few questions ask about your attempts to quit smoking at different times over the past year. In answering, please think specifically about the timeframe for each question.

B1. 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?

_____ Number of times

[IF B1 > 0, ASK B1a]

B1a. During the past [FILL MONTHS SINCE MARCH 4, 2013], that is since March 4, 2013, have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

1. Yes

2. No

[IF B1a=1, ASK B2]

B2. Thinking about your more recent past, during the past 3 months, how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

_____ Number of times

[IF A5=1, ASK B3]

B3. How long has it been since you last smoked a cigarette?

B3a. _____________[ENTER NUMBER]

B3b. [DROP BOX FOR UNITS]

1. Hours (0 – 24)

2. Days (0 – 10)

3. Weeks (0 – 26)

4. Months (0 – 6)

[IF B1a > 0 ASK B4a]

B4a. When you last tried to quit smoking, did you do any of the following?

[PRESENT IN RANDOM ORDER] Yes No

[ANSWER ALL]

B4a_1. Give up cigarettes all at once

B4a_2. Gradually cut back on cigarettes

B4a_3. Switch completely to electronic cigarettes or e-cigarettes such as Blu or

NJOY

B4a_4. Substituted some of your regular cigarettes with e-cigarettes

B4a_5. Switch to mild or some other brand of cigarettes

B4a_6. Use nicotine replacements like the nicotine patch or nicotine gum

B4a_7. Use medications like Zyban or Chantix

B4a_8. Get help from a telephone quit line

B4a_9. Get help from a website such as Smokefree.gov

B4a_10. Get help from a doctor or other health professional

[IF B1a > 0 ASK B5]

B5. When you last tried to quit smoking, did any of the following motivate you to try to quit?

[PRESENT IN RANDOM ORDER] Yes No

[ANSWER ALL]

B5_1. A family member or friend encouraged me to try to quit

B5_2. Television commercials, radio ads, or other types of advertisements that

focus on the health consequences of smoking

B5_3. My doctor or other health professional advised me to quit smoking

B5_4. Workplace restrictions on smoking

B5_4. Other, specify ________________

[IF A4 = 1, ASK B6 & B7]

B6. During the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, did any doctor, nurse or health professional ask if you smoke?

1. Yes

2. No

B6a. During the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, have you talked with your doctor or health care professional about quitting smoking?

1. Yes

2. No

B7. During the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, has a doctor, nurse or health professional advised you to quit smoking?

1. Yes

2. No

SECTION C: ATTITUDES AND BELIEFS

Social Norms of Smoking and SHS

C1. Do you believe cigarette smoking is related to:

[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

C2.How likely do you think a smoker is to develop a smoking-related disease as a result of smoking?

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 by diabetics will make their medical complications from diabetes such as blindness, renal failure, or amputations worse?

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 …?

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?

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?

1. Extremely Likely

2. Very Likely

3. Somewhat Likely

4. Very Unlikely

5. Extremely Unlikely

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?

1. Yes

2. No

D4a. During the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, have you talked to any family members or friends about the dangers of smoking?

1. Yes

2. No

[IF D4a MONTH FILL = “3 MONTHS” AND D4a=1, FILL D5=1 AND GO TO D5aa]

[ELSE IF D4a=1, ASK D5]

D5. Thinking about your more recent past, during the past 3 months, have you talked to any family members or friends about the dangers of smoking?

1. Yes

2. No

D5aa. During the past [FILL MONTHS SINCE MARCH 4, 2013] months , that is since March 4, 2013, did you encourage a friend or family member to quit smoking?

1. Yes

2. No

[IF D5aa MONTH FILL = “3 MONTHS” AND D5aa=1, FILL D5a=1 AND GO TO D6]

[ELSE IF D5aa=1, ASK D5a]

D5a. Thinking about your more recent past, during the past 3 months, did you encourage a friend or family member to quit smoking? Yes

1. 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?

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

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

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?

1. Yes

2. No

[IF E9=1, ASK E9aa]

E9aa. In the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, have you recommended any family members or friends that smoke to call a telephone quitline?

1. Yes

2. No

[IF E9aa MONTH FILL = “3 MONTHS” AND E9aa=1, FILL E9a=1 AND GO TO E10]

[ELSE IF E9aa=1, ASK E9a]

E9a. Thinking about your more recent past, in the past 3 months, have you recommended any family members or friends that smoke to call a telephone quitline?

1. Yes

2. No

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

1. Yes

2. No

[IF E10=1 ASK E10aa]

E10aa. In the past [FILL MONTHS SINCE MARCH 4, 2013], that is since March 4, 2013, have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

1. Yes

2. No

[IF E10aa MONTH FILL = “3 MONTHS” AND E10aa=1, FILL E10a=1 AND GO TO E10b]

[ELSE IF E10aa=1, ASK E10a]

E10a. Thinking about your more recent past, in the past 3 months, have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

1. Yes

2. No

E10b. In the past [FILL MONTHS SINCE MARCH 4, 2013] MONTHS, that is since March 4, 2013, have you recommended any family members or friends that smoke to talk with their doctor or health care professional about quitting smoking?

1. Yes

2. No

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

1. Yes

2. No

[IF E11 = 1, ASK E12]

E12. Have you visited any quit smoking websites online in the past [FILL MONTHS SINCE MARCH 4, 2013] months, since March 4, 2013?

1. Yes

2. No

[IF E12 MONTH FILL = “3 MONTHS” AND E12=1, FILL E13=1 AND GO TO E13]

[ELSE IF E12=1, ASK E13]

E13. Thinking about your more recent past, have you visited any quit smoking websites online in the past 3 months?

1. Yes

2. No

E16c. Have you heard of the Website www.cdc.gov/Tips?

1. Yes

2. No

[IF E16c=1 ASK E16d]

E16d. Have you visited www.cdc.gov/Tips in the past [FILL MONTHS SINCE MARCH 4, 2013] months, since March 4, 2013?

1. Yes

2. No

[IF E16d MONTH FILL = “3 MONTHS” AND E16d=1, FILL E16e=1 AND GO TO E16f]

[ELSE IF E16d=1, ASK E16e]

E16e. Thinking about your more recent past, have you visited www.cdc.gov/Tips in the past 3 months?

1. Yes

2. No

[IF E16d=1 ASK E16f]

E16f. In the past [FILL MONTHS SINCE MARCH 4, 2013] months, that is since March 4, 2013, have you recommended any family members or friends that smoke to visit www.cdc.gov/Tips?

1. Yes

2. No

[IF E16f MONTH FILL = “3 MONTHS” AND E16f = 1, FILL E16g=1 AND GO TO E17a]

[ELSE IF E16f=1, ASK E16g]

E16g. Thinking about your more recent past, in the past 3 months, have you recommended any family members or friends that smoke to visit www.cdc.gov/Tips?

1. Yes

2. No

E18. In the past [FILL MONTHS], since March 4, 2013, have you seen or heard of any ads on television or radio with the following themes or slogans?

[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?

1 2

Yes No

[RANDOMIZE]

E19_1. On TV

E19_2. On the radio

E19_3. In newspapers or magazines

E19_4. On the Internet

E19_5. Billboards or other outdoor ads

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

1. Yes

2. No

EXPOSURE AND REACTIONS TO TV ADS

Now, we would like you to view a series of anti-tobacco television 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?

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.

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. Have you seen this ad on television in the past [FILL MONTHS], since March 4, 2013?

1. Yes

2. No

[if E25=1, ask E26]

E26. In the past [FILL MONTHS SINCE March 4, 2013], how frequently have you seen this ad on television?

1. Rarely

2. Sometimes

3. Often

4. Very Often

E26a. Have you seen this ad online in the past [FILL MONTHS], since March 4, 2013?

1. Yes

2. No

E26b. In the past [FILL MONTHS SINCE March 4, 2013], how frequently have you seen this ad online?

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.

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?

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 [FILL MONTHS SINCE MARCH 4, 2013].

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

1. Yes

2. No

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

1. Yes

2. No

[IF F31=1, ASK F32:]

F32. When you talked about the ads, did you talk about any of the following topics? Please select all that apply.

1 2

Yes No

[RANDOMIZE]

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?

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?

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. Have you heard this ad on the radio in the past [FILL MONTHS], since March 4, 2013?

1. Yes

2. No

[if E36=1, ask E37]

E37. In the past [FILL MONTHS SINCE March 4, 2013], how frequently have you heard this ad on the radio?

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. In the past [FILL MONTHS], since March 4, 2013, 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

[RANDOMIZE]

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

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

__ Number of Children

[ASK G2 – G11 OF ALL RESPONDENTS]

[ASK G11 OF ALL RESPONDENTS]

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

1. Yes

2. No

[ASK G15 OF ALL RESPONDENTS]

G15. Have you been diagnosed by a physician or other qualified medical professional with any of the following medical conditions?

1 2

Yes No

G15_1. Acid reflux disease

G15_2. ADHD or ADD

G15_3. Anxiety disorder

G15_4. Asthma, chronic bronchitis, or COPD

G15_5. Cancer (any type except skin cancer)

G15_6. Chronic pain (such as low back pain, neck pain, or Fibromyalgia)

G15_7. Depression

G15_8. Diabetes

G15_9. Heart attack

G15_10. Heart disease

G15_11. High blood pressure

G15_12. High cholesterol

G15_13. HIV/AIDS

G15_14. Kidney disease

G15_15. Mental health condition

G15_16. Multiple sclerosis

G15_17. Osteoarthritis, joint pain or inflammation

G15_18. Osteoporosis or osteopenia

G15_19. Rheumatoid arthritis

G15_20. Seasonal allergies

G15_21. Skin cancer

G15_22. Sleep disorders such as sleep apnea or insomnia

G15_23. Stroke

G15_24. Something else

[ASK G16-G22 IF NEW ABS]

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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