Form Approved
OMB No. 0920-0910
Exp. Date 01/31/2015
National Tobacco Prevention and Control Public Education Campaign:
Copy
testing of television ads
Main
Questionnaire for current or former cigarette smokers
who use
or are open to using electronic cigarettes or e-cigarettes
Public reporting burden of this collection of information is estimated to average 21 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0910).
{PREAMBLE SHOWN DURING SCREENER}
On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking-specific advertising that you see in the media. Your opinions are very important to us! Please be assured that the purpose of this survey is to gather feedback regarding specific health-related advertising. We do not plan to report your answers individually. We plan to report results from this survey for the group as a whole. Thank you for taking the time to help us!
Your participation in this survey is voluntary.
Qualified Respondent Category |
|||
Current Smoker |
AND |
USED |
Electronic cigarettes |
Current Smoker |
AND |
MAY USE |
Electronic cigarettes |
Former Smoker |
AND |
USED |
Electronic cigarettes |
Former Smoker |
AND |
MAY USE |
Electronic cigarettes |
Excellent
Very Good
Good
Fair
Poor
{Base = all qualified smokers}
[1 PACK = 20 CIGARETTES]
[RANGE 1-100]
{Numeric response}
{Base = Respondents who SMOKE EVERY DAY (IF TS2 = 1)}
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
{Base = all respondents}
{Numeric response; mask 0-125}
{Base = all respondents}
At home
At work
Friend’s or family’s house
In my car or other type of vehicle
Someone else’s car or other type of vehicle
At a party
At a restaurant
At a bar
Outdoors
Somewhere else (other specify)
{Base = Current smokers}
{RANDOMIZE}
Smoking cigarettes is a social thing to do when I’m out with friends
Smoking cigarettes is something to do at parties
I just feel like smoking cigarettes
Smoking cigarettes goes well with/after meals
I like the taste of cigarettes
Smoking cigarettes helps me relax
Smoking cigarettes goes well when I’m drinking alcohol
Smoking cigarettes helps me stay awake
Smoking cigarettes helps when I’m stressed
Smoking cigarettes excites me
Smoking cigarettes is something to do when I’m bored
Smoking cigarettes helps me lose weight / not gain weight
I have tried to quit smoking cigarettes and cannot
Smoking cigarettes is something I can do with others while working
Other specify
{Base = Former smokers}
{RANDOMIZE}
Smoking cigarettes is a social thing to do when I’m out with friends
Smoking cigarettes is something to do at parties
I just feel like smoking cigarettes
Smoking cigarettes goes well with/after meals
I like the taste of cigarettes
Smoking cigarettes helps me relax
Smoking cigarettes goes well when I’m drinking alcohol
Smoking cigarettes helps me stay awake
Smoking cigarettes helps when I’m stressed
Smoking cigarettes excites me
Smoking cigarettes is something to do when I’m bored
Smoking cigarettes helps me lose weight / not gain weight
I have tried to quit smoking cigarettes and cannot
Smoking cigarettes is something I can do with others while working
Other
specify
{Base = All respondents}
I know everything there is to know about the physical effects of smoking cigarettes
I wish I knew more about the physical effects of smoking cigarettes
I think that smoking cigarettes is addictive
Nicotine Replacement Therapy, such as nicotine gum or patch, makes it easier to quit
There’s nothing wrong with smoking cigarettes
Smoking cigarettes is not such a big deal, it’s just a lot of negative hype
I would consider quitting smoking cigarettes because I don’t want to harm my family or friends with second-hand smoke
Smoking cigarettes seems acceptable because I see it all the time in movies
When someone quits smoking cigarettes, the risk of getting a tobacco-related illness goes away
Smoking cigarettes is a reward
I have more respect for people who have quit smoking cigarettes than for people who have never smoked
Non-smokers don’t want to date someone who smokes
People who smoke cigarettes have more friends
There is nothing wrong with using electronic cigarettes/e-cigarettes
Scale for each of the items in PA10b:
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
{Base = All respondents}
Extremely stress-relieving
Very stress-relieving
Somewhat stress-relieving
Slightly stress-relieving
Not at all stress-relieving
{Base=current smokers}
Yes, it would positively impact my relationship with family or friends
It would neither positively or negatively impact my relationship
It would negative impact my relationship with family or friends
{Base = All respondents}
Very dangerous
Dangerous
Neither dangerous nor safe
Safe
Very safe
{Base = All Smokers}
Definitely not
Probably not
Probably yes
Definitely yes
Not Sure
{PREAMBLE}
The next questions are about electronic cigarettes, often called e-cigarettes. An e-cigarette looks like a regular cigarette, but it runs on a battery and produces vapor instead of smoke. There are many types of e-cigarettes.
{Base = All respondents}
Please indicate your answer on a
scale of 1 to 5, where one is much less harmful, 3 is the same as
regular cigarettes, and 5 is much more harmful.
1 (much less harmful than smoking only regular cigarettes)
2
3 (equally as harmful as smoking only regular cigarettes)
4
5 (much more harmful than smoking only regular cigarettes)
{Base = used e-cigarettes and answers 02-07 to EU1b}
Every day
Some days
Not at all
{Base = used e-cigarettes}
Please indicate the type of e-cigarette that you use the most.
Disposable electronic cigarettes/e-cigarettes
Electronic cigarette/e-cigarette that uses cartridges
Electronic cigarette/e-cigarette that uses tanks
{Base = responded to EU1c)
________________ [ENTER NUMBER]
{Base = used e-cigarettes}
Yes
No
{Base = used e-cigarettes and is current smoker}
I enjoy using electronic cigarettes/e-cigarettes more than smoking cigarettes
I enjoy smoking cigarettes more than using electronic cigarettes/e-cigarettes
I don’t enjoy using electronic cigarettes/e-cigarettes and I don’t enjoy smoking cigarettes
I enjoy both equally
{Base = used e-cigarettes and is current smoker}
The number of cigarettes I smoke has increased since I started using electronic cigarettes/e-cigarettes
The number of cigarettes I smoke has decreased since I started using electronic cigarettes/e-cigarettes
The number of cigarettes I smoke has stayed about the same since I started using electronic cigarettes/e-cigarettes
{Base = used e-cigarettes and is former smoker}
I used electronic cigarettes/e-cigarettes when I smoked cigarettes
I did not use electronic cigarettes/e-cigarettes until after I quit smoking cigarettes
{Base = used e-cigarettes and is former smoker and answered 01 to EU7}
Yes, I used electronic cigarettes/e-cigarettes to quit smoking regular cigarettes
I did not use electronic cigarettes/e-cigarettes to quit smoking regular cigarettes
{Base = used e-cigarettes and is former smoker and answered 01 to EU7b}
Yes, I will continue to use e-cigarettes as a replacement for regular cigarettes
I plan to stop using e-cigarettes
I have stopped using e-cigarettes
{Base = used e-cigarettes}
B12a. Do you use electronic/e-cigarettes in any of the following places?
Yes
No
[ANSWER ALL, RANDOMIZE ORDER]
B12a_1. Restaurants or bars
B12a_2. Stores or shopping malls
B12a_3. Airplanes
B12a_4. Beaches, parks, or other outdoor places
B12a_5. In your car or other type of vehicle
B12a_6. In your home
B12a_7. Somewhere else, specify
{Base = used e-cigarettes}
Restaurants or bars
Stores or shopping malls
Airplanes
Beaches, parks, or other outdoor places
In your car or other type of vehicle
In your home
Somewhere else, specify _______________
I have not thought about using electronic cigarettes/e-cigarettes in any of the above locations {Exclusive; ANCHOR}
{Base = used e-cigarettes}
Outdoors
Indoors
About the same
{Base = used e-cigarettes}
I usually use electronic cigarettes/e-cigarettes when I am alone
I usually use electronic cigarettes/e-cigarettes when I am with other people
I usually use electronic cigarettes/e-cigarettes about the same when I am alone and when I am with other people
{Base = used e-cigarettes}
Yes, using electronic cigarettes/e-cigarettes is more socially acceptable
No, using electronic cigarettes/e-cigarettes is equally as socially acceptable as smoking cigarettes
No, using electronic cigarettes/e-cigarettes is less socially acceptable than smoking cigarettes
{Base = used e-cigarettes and is current smoker}
Yes, I am embarrassed to use electronic cigarettes/e-cigarettes in front of other people
No I am not embarrassed to use electronic cigarettes/e-cigarettes in front of other people
{Base = used e-cigarettes}
Yes
No
EC13_1. They cost less than other forms of tobacco
EC13_2. They can be used in places where smoking cigarettes isn’t allowed
EC13_3. They might be less harmful to me than regular cigarettes
EC13_4. They might be less harmful to people around me than regular cigarettes
EC13_5. Electronic cigarettes/e-cigarettes come in flavors I like
EC13_6. Electronic cigarettes/e-cigarettes can help me quit smoking regular cigarettes
EC13_7. Electronic cigarettes/e-cigarettes can help me reduce the number of regular cigarettes I smoke.
EC13_8. Electronic cigarettes/e-cigarettes don’t smell
EC13_9. Using an electronic cigarette/e-cigarette feels like smoking a regular cigarette
EC13_10. Electronic cigarettes/e-cigarettes don’t bother people who don’t use tobacco
EC13_11. The advertising for electronic cigarettes/e-cigarettes appeals to me.
EC13_12. They help me deal with cravings to smoke.
EC13_13. I have a friend or family member who suggested I use electronic cigarettes/e-cigarettes as a way to quit smoking.
EC13_14. I was curious about electronic cigarettes/e-cigarettes
EC13_15. Other, specify________________________
{IF MORE THAN ONE ITEM SELECTED IN EC13, DISPLAY LIST OF ALL REASONS SELECTED IN EC13. IF ONLY ONE ITEM SELECTED IN EC13, FILL FOR EC21}
[BASE = IF EU1A = 3, ASK EC21a]
OPEN-ENDED________________________
[BASE = IF EU1A = 1 or 2, ASK EC21b]
OPEN-ENDED________________________
{Base = used e-cigarettes}
Over the Internet
Convenience stores
Drug stores or pharmacies
Gas stations
Specialty e-cigarette shops (sometimes called vape shops)
Shopping malls
Other specify
{Base = open to using e-cigarettes}
within the next 30 days
within the next 6 months
within the year
longer than a year
{Base = open to using e-cigarettes and is current smoker}
Yes
No
{Base = open to using e-cigarettes and is current smoker}
The number of cigarettes I smoke will probably decrease if I use electronic cigarettes/e-cigarettes
The number of cigarettes I smoke will probably increase if I use electronic cigarettes/e-cigarettes
The number of cigarettes I smoke will probably stay the same if I use electronic cigarettes/e-cigarettes
{Base = open to using e-cigarettes}
In an airplane
At home
At work
Friend’s or family’s house
In my car or other type of vehicle
Someone else’s car or other type of vehicle
At a party
At a restaurant
At a bar
Outdoors
Somewhere else (other specify) {ANCHOR}
{Base = open to using e-cigarettes}
Yes, using electronic cigarettes/e-cigarettes is more socially acceptable than smoking cigarettes
No, using electronic cigarettes/e-cigarettes is equally as socially acceptable as smoking cigarettes
No, using electronic cigarettes/e-cigarettes is less socially acceptable than smoking cigarettes
{Base = open to using e-cigarettes}
Yes
No
EO13_1. They cost less than other forms of tobacco
EO13_2. They can be used in places where smoking cigarettes isn’t allowed
EO13_3. They might be less harmful to me than regular cigarettes
EO13_4. They might be less harmful to people around me than regular cigarettes
EO13_5. Electronic cigarettes/e-cigarettes come in flavors I like
EO13_6. Electronic cigarettes/e-cigarettes can help me quit smoking regular cigarettes
EO13_7. Electronic cigarettes/e-cigarettes can help me reduce the number of regular cigarettes I smoke.
EO13_8. Electronic cigarettes/e-cigarettes don’t smell
EO13_9. Using an electronic cigarette/e-cigarette feels like smoking a regular cigarette
EO13_10. Electronic cigarettes/e-cigarettes don’t bother people who don’t use tobacco
EO13_11. The advertising for electronic cigarettes/e-cigarettes appeals to me.
EO13_12. They help me deal with cravings to smoke.
EO13_13. I have a friend or family member who suggested I use electronic cigarettes/e-cigarettes as a way to quit smoking.
EO13_14. I was curious about electronic cigarettes/e-cigarettes
EO13_15. Other, specify________________________
{IF MORE THAN ONE ITEM SELECTED IN EO13, DISPLAY LIST OF ALL REASONS SELECTED IN EO13. IF ONLY ONE ITEM SELECTED IN EO13, FILL FOR EO21}
{Base = All respondents}
A lot less harmful
A little less harmful
About the same
A little more harmful
A lot more harmful
Yes
No
{Base = all respondents}
Yes
No
{Base = all respondents}
Yes
No
There are definitely health risks associated with using smokeless tobacco products
There are probably health risks associated with using smokeless tobacco products
There are probably some non-serious health risks associated with using smokeless tobacco products
There are probably no health risks associated with using smokeless tobacco products
There are definitely no health risks associated with using smokeless tobacco products
{Base = Current smokers}
_____ Number of times
{Base = Current smokers}
_____ Number of times
{Base = Current smokers}
[PRESENT IN RANDOM ORDER]
YES
NO
QA3_A. Give up cigarettes all at once
QA3_B. Gradually cut back on cigarettes
QA3_C. Switch completely to electronic cigarettes or e-cigarettes such as Blu or NJOY
QA3_D. Substitute some of your regular cigarettes with electronic cigarettes or e-cigarettes
QA3_E. Switch to mild or some other brand of cigarettes
QA3_F. Use nicotine replacements like the nicotine patch or nicotine gum
QA3_G. Use medications like Zyban or Chantix
QA3_H. Get help from a telephone quit line
QA3_I. Get help from a website such as Smokefree.gov
QA3_J. Get help from a doctor or other health professional
{Base = Current smokers}
Yes
No
{Base = QA4_01}
Not at all
A little
Somewhat
A lot
{Base = QA4_01}
QA6. Do you plan to quit smoking for good….
In the next 7 days,
In the next 30 days,
In the next 6 months,
In the next 1 year, or
More than 1 year from now
Not sure/Uncertain
{Base = All respondents}
Friends or family
Your doctor or healthcare professional
Internet
Pharmacy
Mobile App
Other specify
{Base = All respondents}
I hope good things happen in my life, but I often feel that I don’t have much control
I make things happen in my life
I set goals for my future
I believe a person should take life as it comes – whatever happens, happens
Life has been good to me so far
I believe in my ability to make important changes in the world
Spirituality and/or religion play a big part in my life
I am confident that I have the ability to achieve my dreams
Scale for each of the items in PA10a:
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
{Base = used e-cigarettes}
Extremely social
Very social
Somewhat social
Slightly social
Not at all social
{Base = used e-cigarettes}
I feel comfortable using my e-cigarettes in all locations or places
There are
some locations or places where I feel uncomfortable using
e-cigarettes
{Base = used e-cigarettes and answers PA14a_01}
{OPEN-END}
{Base = used e-cigarettes and answers PA14a_01}
{OPEN-END}
{Base = All respondents}
Yes
No
{Base = All respondents}
Yes
No
{Base = All respondents}
Yes
No
{Base = open to using e-cigarettes}
{OPEN-END}
{Base=all respondents}
Yes
No
{Base for this section is all respondents}
Male
Female
None
1-2 children
3-4 children
5 or more children
Now married
Living with my partner
Widowed
Divorced
Separated
Never married
Prefer not to answer
01 Heterosexual / Straight
02 Lesbian
03 Gay (male)
04 Bisexual
05 Transgender
06 Something else – please specify ______________
07 Prefer not to answer
01 Yes, now on active duty
02 Yes, on active duty during the past 12 months, but not now
03 Yes, was on active duty but not during the past 12 months
04 Am now training for Reserves or National Guard
05 No, never served in the military
{PREAMBLE}
Please indicate your race or ethnic background. Are you….?
SELECT ONE
Hispanic or Latino
Not Hispanic or Latino
SELECT ONE OR MORE
White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
Less than high school
Completed high school or equivalent
Job-specific training program(s) after high school
Some college, but no degree
Associate Degree
College (such as B.A., B.S.)
Some graduate school, but no degree
Graduate degree (such as MBA, MS, M.D., Ph.D.)
Prefer not to answer
Less than $15,000
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 or more
Prefer not to answer
01 Working – as a paid employee
02 Working – self-employed
03 Not working – on temporary layoff from a job
04 Not working – looking for work
05 Not working – retired
06 Not working – disabled
07 Not working – other
08 Prefer not to answer
{BASE for this section is all respondents}
Did you start at a search engine such as Google, Bing or Yahoo, at a site that specializes in topical information, like WebMD, at a more general site like Wikipedia, that contains information on all kinds of topics, or at a social network site like Facebook?
01 At a search engine such as Google, Bing or Yahoo
02 At a site that specializes in information, like WebMD
03 At a more general site like Wikipedia, that contains information on all kinds of topics
04 At a social network site like Facebook
05 Other specify
Yes
No
Don’t Know/Not Sure
{BASE = answers T2_01}
Yes, I own a smartphone
I do not own a smartphone
{BASE = answers T3_01}
An iPhone
An Android device (e.g. Motorola Droid, Samsung Galaxy, etc.)
A Blackberry
A Windows Phone
Something else
{BASE = answers T2_01}
More than once per day
Once per day
A few times per week
Once per week
Less than once per week
Rarely
Never
Basically every day
A few times a week
A few times a month
Once a month
Not at all
Basically every day
A few times a week
A few times a month
Once a month
Not at all
Basically every day
A few times a week
A few times a month
Once a month
Not at all
Basically every day
A few times a week
A few times a month
Once a month
Not at all
{Base = All respondents}
Yes
No
{Base = EAD1_01}
On the Internet
In newspapers or magazines
Convenience stores, supermarkets, gas stations, or shopping malls
On TV or at the movies
On the radio
On billboards or other outdoor ads
Other specify
None of the above
{Base = EAD2=01}
I do not use the Internet
Never
Rarely
Sometimes
Most of the time
Always
{Base = EAD2_02}
I do not read newspapers or magazines
Never
Rarely
Sometimes
Most of the time
Always
{Base = EAD2=03}
I do not go to convenience stores, supermarkets, gas stations, or shopping malls
Never
Rarely
Sometimes
Most of the time
Always
{Base = EAD2_04}
I do not watch TV or go to the movies
Never
Rarely
Sometimes
Most of the time
Always
Yes
No
{Base = All respondents}
Yes
No
{Base = recall anti-smoking advertising (OAS1/1)}
[OPEN END]
{Base in this section = all respondents or as indicated}
We would now like to show you a television ad and then gather your reactions to that ad. Please make sure the volume on your computer is turned up, so that you can both see and hear the video. Please click “Next” to continue.
[Respondent will review one of three ads}
{Image
of ad should be at top of page when the rest of the questions are
asked}
[OPEN END]
Extremely believable
Moderately believable
Slightly believable
Neither believable nor unbelievable
Slightly unbelievable
Moderately unbelievable
Extremely unbelievable
On a scale from 1 to 5, where 1 indicates not feeling any emotion, and 5 indicates feeling emotion with extreme intensity, please indicate how much this advertisement made you feel:
Angry
Afraid
Ashamed
Sad
Hopeful
Understood
Surprised
Trusting
Motivated
Regretful
Scale for items RC3.A-J:
I did not feel this emotion
Slight emotion
Moderate emotion
Very intense emotion
Extreme and intense emotion
This ad is convincing
This ad grabbed my attention
This ad was easy to understand
I learned something new by viewing or hearing this ad
I trust the information in this ad
This ad is believable
I would talk to someone else about this ad
This ad is annoying
The people in this ad are believable
This ad is worth remembering
This ad is powerful
This ad is informative
This ad is meaningful
I can identify with what the ad says
Scale for items RC4.A-N:
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
Confusing
Unclear
Hard to understand
None of the above
[Base = IF RC5 is any of 1, 2, or 3]
{Open End}
Yes
No
{Base = answered Rc7.01}
{Open End}
Yes
No
{Base = ask only if Rc9.01}
{Open End}
{Base = Current smokers}
Yes
No
{Base = ask only if Rc11.02}
{Open End}
{Base = ask only if Rc11.01}
{Open End}
{Base = All respondents}
Call 1-800-QUIT-NOW for assistance in quitting smoking
Visit an informational government website, such as www.cdc.gov/tips for information on quitting
Talk with my doctor about quitting smoking
Not smoke around others
Visit the Twitter site for the campaign.
Try to quit on my own
Use an electronic cigarette/ e-cigarette to help quit smoking
Support smoke-free laws in my community
Do nothing
Scale for items RC14.A-H:
Very Unlikely
Unlikely
Neither Likely Nor Unlikely
Likely
Very Likely
{Base = All respondents}
[OPEN END]
{Base = All respondents}
{OPEN-END – make the open-end box look like Google’s Search Engine}
Page
File Type | application/msword |
File Title | OSH Media Rough Cut Survey |
Author | Carol Haney |
Last Modified By | Macaluso, Renita (CDC/ONDIEH/NCCDPHP) |
File Modified | 2014-01-29 |
File Created | 2014-01-29 |