Form Approved
OMB No. 0920-0910
Exp. Date 01/31/2015
National Tobacco Prevention and Control Public Education Campaign:
Message Testing for Dual Use
Main Questionnaire
Public reporting burden of this collection of information is estimated to average 20 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 and smoking-specific diseases. 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 Categories – Complete Set |
|||
Current Cigarette Smoker |
AND CURRENTLY USES |
Uses e-cigarettes or chewing tobacco or snus or a combination of these three
|
Current Cigarette Smoker AND (Current E-Cig User AND/OR Current Chewing Tobacco User AND/OR Current Snus User) |
Former Cigarette Smoker |
AND CURRENTLY USES |
Uses e-cigarettes or chewing tobacco or snus or a combination of these three |
Former Cigarette Smoker AND (Current E-Cig User AND/OR Current Chewing Tobacco User AND/OR Current Snus User) |
Screening logic for following categories defined above as part of Categories Set #1 |
|||
Current user of cigars, cigarillos or little cigars exclusively |
|||
Current tobacco cigarette smoker and currently uses cigars, cigarillos or little cigars |
|||
Former tobacco cigarette smoker and currently uses cigars, cigarillos or little cigars |
{Base = all respondents}
Excellent
Very Good
Good
Fair
Poor
{Base = current smokers only}
[1 PACK = 20 TOBACCO CIGARETTES]
[RANGE 1-100]
{Numeric response}
{Base = Respondents who SMOKE EVERY DAY (IF SCREENER.TS2 = 1)}
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
{Base = all current and former smokers}
_ _ _ age in years
{Base = chewing tobacco/snus user}
{Base = e-cigarette users}
_ _ _ age in years
{Base
= e-cigarette users}
{Base = former tobacco cigarette smokers}
Yes
No
{Base = uses chew or snus}
Yes
No
{Base = e-cigarette users}
Yes
No
{Base = Smoked cigars, cigarillos, little cigars}
Every day
Some days
Not at all [GO TO Q CO10]
{Base = Smoked cigars/cigarillos/little cigars}
Cigars
Cigarillos
Little cigars
I don’t have a preference
Not sure
{Base = Smoked cigars/cigarillos/little cigars}
{Base = Smoked cigars/cigarillos/little cigars}
Yes
No
{Base = Smoked cigars/cigarillos/little cigars}
Yes
No
{Base = Smoked cigars/cigarillos/little cigars}
Yes
No
{Base = Smoked cigars/cigarillos/little cigars}
Yes
No
{IF SCREENER.CO9=1 smokes every day; GO TO CO12. IF CO9 = 2 (smokes some days), GO TO CO17. }
{Base = Smoked cigars/cigarillos/little cigars}
RANGE: 1-99
{Base = Smoked cigars/cigarillos/little cigars DAILY}
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
{Base = Smoked cigars/cigarillos/little cigars}
{Base = Smoked cigars/cigarillos/little cigars and smoked cigars/cigarillos/little cigars in past 30 days}
{Base = Smoked cigars/cigarillos/little cigars and smoked cigars/cigarillos/little cigars in past 30 days}
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
{Base = Smoked cigars/cigarillos/little cigars and former or current smoker }
Yes
No
{Base = Smoked cigars/cigarillos/little cigars and former or current smoker}
Yes
No
{Base = cigars/cigarillos/little cigars users and former or current smoker}
Yes
No
{Base = all respondents}
Yes
No
{Base = c40.01}
{Base = E-Cigarette user & former or current smoker}
Yes
No
{Base = All respondents}
Yes
No
{Base = All respondents}
Much less harmful than smoking only traditional tobacco cigarettes
Somewhat less harmful than smoking traditional tobacco cigarettes
Equally harmful as smoking only traditional tobacco cigarettes
Somewhat more harmful than smoking traditional tobacco cigarettes
Much more harmful than smoking only traditional tobacco cigarettes
{Base = uses chew}
{Base = uses snus}
{Base = all respondents}
Yes
No
{Base = all respondents}
Yes
No
{Base = all respondents}
There are definitely health risks associated with using smokeless tobacco products
There are probably some 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 = uses chew}
Yes
No
{Base = uses snus}
Yes
No
{Base = current tobacco cigarette smokers}
_____ Number of times
{Base = current smokers}
Yes
No
DON’T KNOW/NOT SURE
REFUSED
{Answered 01 to QA20}
QA26. What was the date you stopped smoking traditional tobacco cigarettes for more than 30 days? (Please give month, day and year)
{CALENDAR PICKER + Data Entry for Month, Day, and Year}
{Base = current smokers who answered 1 or more to QA1}
[PRESENT IN RANDOM ORDER]
YES
NO
QA3_A. Give up traditional tobacco cigarettes all at once
QA3_B. Gradually cut back on traditional tobacco cigarettes
QA3_C. Substitute some of your traditional tobacco cigarettes with electronic cigarettes/e-cigarettes
QA3_D. Switch completely to electronic cigarettes/e-cigarettes
QA3_E. Switch to mild or some other brand of traditional tobacco cigarettes
QA3_F. Use nicotine replacement products such as a 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 tobacco cigarette smokers}
Yes
No
{Base = current tobacco cigarette smokers}
Not at all
A little
Somewhat
A lot
{Base = current cigarette smokers}
QA5. 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
I don’t plan to quit smoking traditional tobacco cigarettes
Not sure/Uncertain
{Base = Former Cigarette Smokers}
QA6. Did you use electronic cigarettes/e-cigarettes to help you stop smoking?
Yes
No
{Base = Former Cigarette Smokers AND uses Chewing tobacco or Snus}
QA7. Did you use [TEXT FILL BASED ON CATEGORY: (“chewing tobacco” if chewing tobacco user), (“snus” if snus user) or (“chewing tobacco or snus” if both chewing tobacco and snus user)] to help you stop smoking traditional tobacco cigarettes?
Yes
No
{Base = Current Cigarette Smokers}
Online resource
1-800-QUIT NOW
Family or Friends
Doctor or Clinic
Other specify
{Base = Former Cigarette Smokers}
Yes
No
{Base
= answered Yes to QA8b}
Online resource
1-800-QUIT NOW
Family or Friends
Doctor or Clinic
Other specify
{Former Smokers Only}
Current significant health problem
Future health problem
Social pressure
Expense
Lack of places open to smoking
Impact on friend or family
{Former Smokers Only}
{CALENDAR PICKER + Data Entry for Month, Day, and Year}
{Base = Current smokers}
{RANDOMIZE}
Smoking traditional tobacco cigarettes is a social thing to do when I’m out with friends
Smoking traditional tobacco cigarettes is something to do at parties
I’m addicted to smoking
Smoking traditional tobacco cigarettes goes well with/after meals
I like the taste of tobacco cigarettes
Smoking traditional tobacco cigarettes helps me relax
Smoking traditional tobacco cigarettes goes well when I’m drinking alcohol
Smoking traditional tobacco cigarettes helps me stay awake
Smoking traditional tobacco cigarettes helps when I’m stressed
Smoking traditional tobacco cigarettes excites me
Smoking traditional tobacco cigarettes is something to do when I’m bored
Smoking traditional tobacco cigarettes helps me lose weight / not gain weight
I have tried to quit smoking traditional tobacco cigarettes and cannot
Smoking traditional tobacco cigarettes is something I can do with others while working
Other specify
{Base = all respondents}
Friends
Family
Co-workers
Doctor
Website
Someone or something else? (SPECIFY)
Yes
No
{Base=all respondents}
Yes
No
{Base=current smokers}
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
Response Items:
P6_10. I get upset when I think about my smoking.
P6_11. I am disappointed in myself because I smoke.
P6_12. I get upset when I hear or read about illnesses caused by smoking.
P6_13. Warnings about the health risks of smoking upset me.
P6_14. Smoking will severely lower my quality of life in the future.
P6_16. Smokers should take warnings about traditional tobacco cigarette smoking and lung cancer seriously.
{Base=all respondents}
1. Yes
2. No
Response Items:
D21_1. Lung Cancer
D21_2. Cancer of the mouth or throat
D21_3. Heart Disease
D21_4. Diabetes
D21_5. Emphysema
D21_6. Stroke
D21_7. Hole in throat (stoma or tracheotomy)
D21_8. Buerger’s Disease
D21_9. Amputations (removal of limbs);
D21_10. Asthma
D21_11. Gallstones
D21_12.Chronic Obstructive Pulmonary Disease (COPD) or Chronic Bronchitis
D21_13. Periodontal or Gum Disease
D21_14. Premature birth
D21_15. Colorectal Cancer
{Base=all respondents}
QK9. In your opinion, smoking/using [cigarettes AND {TEXTFILL (electronic cigarettes OR chewing tobacco OR cigars, cigarillos, or little cigars)} is… Select all that apply.
Cool
Dangerous
Gross
Irresponsible
Rebellious
Rude
Sexy
Sophisticated
Stupid
Tough
Ugly
On its way in
On its way out
None of these
Other, specify _____
QK5. Please tell us how much you agree or disagree with the following statements.
{Base = cigars cigarillo/little cigar smokers}
I feel healthier when I smoke cigarillos/little cigars instead of regular cigarettes.
When I first started smoking cigarillos/little cigars, I smoked the flavored ones (e.g. menthol, mint, clove, spice, candy, fruit, etc.).
{Base = e-cigarette smokers}
I feel healthier when I smoke e-cigarettes instead of traditional tobacco cigarettes.
E-cigarettes have helped me quit smoking traditional tobacco cigarettes completely.
E-cigarettes have helped me reduce the number of traditional tobacco cigarettes I smoke, but not to quit completely.
Smoking both e-cigs and traditional tobacco cigarettes is just as harmful as smoking only traditional tobacco cigarettes.
{Base = cigars cigarillo/little cigar smokers}
I feel healthier when I use chewing tobacco/dip instead of smoking cigarettes.
Chewing tobacco and smoking cigarettes is just as harmful as only smoking cigarettes.
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
{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 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 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
10 Completed
General Education Diploma (GED)
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
01 Heterosexual / Straight
02 Lesbian
03 Gay (male)
04 Bisexual
05 Transgender
06 Something else – please specify ______________
07 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 topical 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}
T3.
Some cell phones are called "smartphones" because of
certain features they have, such as Internet access and the ability
to download apps. Is your cell phone a smartphone, such as an iPhone,
Android, Blackberry or Windows phone?
Yes, I own a smartphone
I do not own a smartphone
{BASE = answers T3_01 & Current Smoker}
Yes
No
Don’t Know/Not Sure
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
{Open-End}
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
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 for this section is all RESPONDENTS}
Yes
No
On the Internet
In newspapers or magazines
Convenience stores, supermarkets, gas stations, or shopping malls
On TV
At the movies
On the radio
On billboards or other outdoor ads
Other specify
Yes
No
{Base = current cigarette smokers recall anti-smoking advertising (OAS1/1)}
Yes
No
{Base = former cigarette smokers recall anti-smoking advertising (OAS1/1)}
Yes
No
{Programmer Instructions: Each respondent reviews 1 message from a set of 9 messages; randomize messages to respondents confirming that all 9 messages are equally viewed.}
Here is a statement about quitting smoking. Please read the following statement, we’d like to get your opinions about it. Please be sure to review the statement completely before answering the questions that follow. Note that the next questions will ask you about the message without you being able to review it.
{Programmer
instruction: Display selected statement by itself for 15 seconds
before showing the “next” button”}
[OPEN END]
[OPEN END]
{Programmer instruction: For the rest of the questions in this section, display the selected statement. Rotate the rest of the questions as indicated}
{for viewers of messages with e-cigarette respondents}
The use of electronic cigarettes/e-cigarettes is much less harmful than smoking traditional tobacco cigarettes
The use of electronic cigarettes/e-cigarettes is somewhat less harmful than smoking traditional tobacco cigarettes
The use of electronic cigarettes/e-cigarettes is equally as harmful as smoking traditional tobacco cigarettes
The use of electronic cigarettes/e-cigarettes is somewhat more harmful than smoking traditional tobacco cigarettes
The use of electronic cigarettes/e-cigarettes is much more harmful than smoking traditional tobacco cigarettes
I don’t know/Not sure
{for viewers of messages on cigars/cigarillos/little cigars}
The use of cigars, cigarillos or little cigars is much less harmful than smoking traditional tobacco cigarettes
The use of cigars, cigarillos or little cigars is somewhat less harmful than smoking traditional tobacco cigarettes
The use of cigars, cigarillos or little cigars is equally as harmful as smoking traditional tobacco cigarettes
The use of cigars, cigarillos or little cigars is somewhat more harmful than smoking traditional tobacco cigarettes
The use of cigars, cigarillos or little cigars is much more harmful than smoking traditional tobacco cigarettes
I don’t know/Not sure
{for viewers of messages on chewing tobacco}
The use of chewing tobacco is much less harmful than smoking traditional tobacco cigarettes
The use of chewing tobacco is somewhat less harmful than smoking traditional tobacco cigarettes
The use of chewing tobacco is equally as harmful as smoking traditional tobacco cigarettes
The use of chewing tobacco is somewhat more harmful than smoking traditional tobacco cigarettes
The use of chewing tobacco is much more harmful than smoking traditional tobacco cigarettes
I don’t know/Not sure
{for viewers of Messages with “Quit Smoking”}
Quit smoking traditional tobacco cigarettes
Quit smoking electronic cigarettes/e-cigarettes
Quit smoking electronic cigarettes/e-cigarettes and traditional tobacco cigarettes
Other specify
{for viewers of Messages with “Quit Smoking Cigarettes”}
Quit smoking traditional tobacco cigarettes
Quit smoking electronic cigarettes/e-cigarettes
Quit smoking electronic cigarettes/e-cigarettes and traditional tobacco cigarettes
Other specify
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 statement made you feel:
Angry
Afraid
Ashamed
Sad
Hopeful
Understood
Surprised
Motivated
Regretful
Scale for items M3.A-J:
I did not feel this emotion
Slight emotion
Moderate emotion
Very intense emotion
Extreme and intense emotion
This statement is convincing
This statement grabbed my attention
This statement was easy to understand
I learned something new by reading this statement
I trust the information in this statement
This statement is believable
I would talk to someone else about this statement
This statement is annoying
This statement is worth remembering
This statement is powerful
This statement is informative
This statement is meaningful
I can identify with what the statement says
Scale for items M4.A-N:
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
{base = for e-cigarette messages}
… motivates me to quit smoking traditional tobacco cigarettes and e-cigarettes.
… motivates me to stop smoking e-cigarettes but continue smoking traditional tobacco cigarettes
… motivates me to quit smoking traditional tobacco cigarettes but continue smoking e-cigarettes.
… makes me think that cutting down on traditional tobacco cigarettes is not enough to reduce my risk for disease.
…makes me feel like I might as well smoke more traditional tobacco cigarettes.
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
{base = for chewing tobacco messages}
… motivates me to quit all tobacco products.
… motivates me to stop chewing tobacco but continue smoking traditional tobacco cigarettes
… motivates me to quit smoking traditional tobacco cigarettes but continue chewing tobacco.
… makes me think that cutting down on traditional tobacco cigarettes is not enough to reduce my risk for disease.
…makes me feel like I might as well smoke more traditional tobacco cigarettes.
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
Confusing
Unclear
Hard to understand
None of the above
[Base = IF M5 is any of 1, 2, or 3]
{Open End}
{Base = Current smokers}
Yes
No
{Base = Current smokers}
Yes
No
{Base = e-cigarette users}
Yes
No
{Base = chew or snus}
Yes
No
{Base = ask only if M6a.02}
{Open End}
{Base = ask only if M6.01}
{Open End}
{BASE = Former Smokers}
This question is about the possibility of encouraging someone you care about to quit smoking traditional tobacco cigarettes , based on the message you just read.
{BASE = Non-Smokers and all Ad Types}
Yes
No
{BASE = Non-Smokers and all Ad Types}
I am more likely to smoke traditional tobacco cigarettes in the future after reading this message
I am less likely to smoke traditional tobacco cigarettes in the future after reading this message
I neither am more or less likely to smoke traditional tobacco cigarettes in the future after reading this message
{Base = ask only if M9.02}
{Open End}
{Base = ask only if M9.01}
{Open End}
{Base = All respondents}
Much less harmful than smoking only traditional tobacco cigarettes
Somewhat less harmful than smoking traditional tobacco cigarettes
Equally as harmful as smoking only traditional tobacco cigarettes
Somewhat more harmful than smoking traditional tobacco cigarettes
Much more harmful than smoking only traditional tobacco cigarettes
{Base=all respondents}
Yes
No
{Base = ask only if selected for IDI}
Yes
No
{If Yes, redirect to IDI system}
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | OSH Media Rough Cut Survey |
Author | Carol Haney |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |