Form Approved
OMB No. 0920-0910
Exp. Date 01/31/2015
National Tobacco Prevention and Control Public Education Campaign:
Copy
testing of television ads
for current smokers
who are
active military or veterans,
have anxiety or depression, or
are lesbian, gay, bisexual,
or transgender
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 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 health and smoking-specific advertising. We will not report your answers individually and will only report the results from this survey for all participants combined. Thank you for taking the time to help us!
Your participation in this survey is voluntary.
Excellent
Very Good
Good
Fair
Poor
{PREAMBLE}
The next questions are about traditional tobacco cigarettes which are any roll of tobacco wrapped in paper. Below is an image of a traditional tobacco cigarette.
{Base = all qualified smokers}
[1 PACK = 20 TRADITIONAL TOBACCO 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 = current smokers}
_ _ _ age in years
{Base = current smokers}
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 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
It helps me when I’m depressed
It helps me when I’m anxious
Other specify
{Base = current smokers}
I know everything/almost everything there is to know about the physical effects of smoking traditional tobacco cigarettes
I wish I knew more about the physical effects of smoking traditional tobacco cigarettes
I think that smoking traditional tobacco cigarettes is addictive
Nicotine Replacement Therapy, such as nicotine gum or patch, makes it easier to quit smoking traditional tobacco cigarettes
There’s nothing wrong with smoking traditional tobacco cigarettes
Smoking traditional tobacco cigarettes is not such a big deal, it’s just a lot of negative hype
I would consider quitting smoking traditional tobacco cigarettes because I don’t want to harm my family or friends with second-hand smoke
Smoking traditional tobacco cigarettes seems acceptable because I see it all the time in movies and/or on TV shows
When someone quits smoking traditional tobacco cigarettes, the risk of getting a tobacco-related illness goes down a lot or goes away
Smoking traditional tobacco cigarettes is a reward
I have more respect for people who have quit smoking traditional tobacco cigarettes than for people who have never smoked
Non-smokers don’t want to date someone who smokes traditional tobacco cigarettes
People who smoke traditional tobacco 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 = current smokers}
Extremely stress-relieving
Very stress-relieving
Somewhat stress-relieving
Slightly stress-relieving
Not at all stress-relieving
{Base=current smokers}
It would positively impact my relationship with family or friends
It would positively impact some relationships with some family or friends, and negatively impact some relationships with other family or friends
It would neither positively nor negatively impact my relationship with family or friends
It would negatively impact my relationship with family or friends
{Base = current smokers}
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 vapor products, which include e-cigarettes or electronic cigarettes. For the purposes of this study, we will use the words “electronic cigarette/e-cigarette.” An electronic vapor product can looks like a traditional tobacco cigarette, but it runs on a battery and produces vapor instead of smoke. There are several hundred brands of electronic vapor products, which come in a variety of different sizes, shapes, and flavors.
Yes
No
Every day
Some days
Rarely
Not at all
{Base = uses e-cigarettes every day or some days}
_ _ _ age in years
{Base = Answers E2.01 or E2.02}
Disposable electronic cigarettes/e-cigarettes
Electronic cigarette/e-cigarette that uses cartridges
Electronic cigarette/e-cigarette that uses tanks
{Base = Answers E2.01 or E2.02 or E2.03}
Yes
No
{Base = current smokers}
Yes
No
{Base
= current smokers & those who do not use e-cigs every day, some
day or rarely}
Very Likely
Likely
Neither Likely nor Unlikely
Unlikely
Very Unlikely
Yes
No
{Base = current smokers}
Yes
No
_ _ _ age in years
{Base = uses snus}
_ _ _ age in years
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
Yes
No
{BASE = used chewing tobacco}
Yes
No
{BASE = used snus}
Yes
No
{Base = current smokers}
Issues related to job/work
Taking care of other family members (children, parents, etc.)
Expectations of family and friends
Technology
Your weight / physical appearance
Your health
Money / Paying Bills
Saving for the future
Societal expectations
Your relationship with your spouse or significant other
Your relationships with other family members (children, parents, etc.)
You relationships with friends
Other specify
Scale for each of the items in PA11:
Not Stressed At All
Somewhat Stressed
Very Stressed
Extremely
Stressed
Does Not Apply
{Base = answers 02-04 to PA11}
{Show the answers selected in PA11 where respondent answered 03, 04 or 05}
Scale for each of the selected items in PA12:
I use traditional tobacco cigarette smoking to relieve stress
I do not use traditional tobacco cigarette smoking to relieve stress
{Base = current traditional tobacco cigarette smokers}
_____ Number of times
{Base = current smokers}
Yes
No
DON’T KNOW/NOT SURE
REFUSED
{Answered 01 to QA20 yet are current (relapsed) smokers}
QA26. What was the date you last stopped smoking traditional tobacco cigarettes for more than 30 days?
{CALENDAR PICKER + Data Entry for Month, Day, and Year}
{Answered 01 to QA20 yet are current (relapsed) smokers}
QA6. Did you use electronic cigarettes/e-cigarettes to help you stop smoking?
Yes
No
{Answered 01 to QA20 yet are current (relapsed) smokers}
QA7. Did you use [TEXT FILL BASED ON CATEGORY: (“chewing tobacco, snuff or dip” if chewing tobacco user), (“snus” if snus user) or (“chewing tobacco, snuff, dip, or snus” if both chewing tobacco and snus user)] to help you stop smoking traditional tobacco cigarettes?
Yes
No
{Answered 01 to QA20 yet are current (relapsed) smokers}
Yes
No
{Answered 01 to QA20 yet
are current (relapsed) smokers}
Online resource
1-800-QUIT NOW
Family or friends
Doctor or clinic
Other specify
{Answered 01 to QA20 yet are current (relapsed) smokers}
Friend or family asked you to quit
Current health problem
Concerns over future health problem
Social pressure from people other than family and friends
Smoking traditional tobacco cigarettes became too expensive
Lack of places that allow smoking
Impact of my smoking on friend or family
Other specify
{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 traditional tobacco cigarette smokers}
Yes
No
{Base = current traditional tobacco cigarette smokers and answered 01 to QA3}
Not at all
A little
Somewhat
A lot
{Base = current traditional tobacco cigarette smokers and answered 01 to QA3}
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 = Current smokers}
Online resource
1-800-QUIT NOW
Family or friends
Doctor or clinic
Other specify
{Base = current smokers}
Friends or family
Your doctor or healthcare professional
Internet
Pharmacy
Mobile App
Other specify
{Base = current smokers}
Extremely important
Very important
Somewhat important
Slightly important
Not at all important
I have performed poorly during a fitness evaluation due to the health impact of smoking traditional tobacco cigarettes
I have not performed poorly during a fitness evaluation due to the health impact of smoking traditional tobacco cigarettes
I have not had a fitness evaluation since I starting smoking traditional tobacco cigarettes
{Base = current smokers}
Friends
Family
Co-workers
Doctor or other health professional
Website
Someone or something else? (SPECIFY)
{Base=current smokers}
Yes
No
{Base=current smokers}
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
Response Items:
P6a_1. I get upset when I think about my smoking.
P6a_2. I am disappointed in myself because I smoke.
P6a_3. I get upset when I hear or read about illnesses caused by smoking.
P6a_4. Warnings about the health risks of smoking upset me.
P6a_5. Smoking will severely lower my quality of life in the future.
P6a_6. Smokers should take warnings about traditional tobacco cigarette smoking and lung cancer seriously.
{Base=current smokers}
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
P6b_3. I need more hours in the day to do all the things that are expected from me.
P6b_4. I can’t ever seem to get caught up.
P6b_5. I don’t ever seem to have any time for myself.
P6b_6. There are times when I cannot meet everyone’s expectations.
P6b_7. Sometimes I feel as if there are not enough hours in the day.
P6b_8. Many times I have to cancel my commitments.
P6b_9. I seem to have to overextend myself in order to be able to finish everything I have to do.
P6b_10. I seem to have more commitments to overcome than some of my friends do.
P6b_12. I feel I have to do things hastily and maybe less carefully in order to get everything done.
P6b_13. I just cannot find the energy in me to do all the things expected of me.
QK5. Please tell us how much you agree or disagree with the following statements.
{Base = electronic cigarettes/e-cigarette smokers}
I feel healthier when I smoke electronic cigarettes/e-cigarettes instead of traditional tobacco cigarettes.
Electronic cigarettes/e-cigarettes have helped me quit smoking traditional tobacco cigarettes completely.
Electronic cigarettes/e-cigarettes have helped me reduce the number of traditional tobacco cigarettes I smoke, but not to quit completely.
{Base = snus}
I feel healthier when I use snus instead of smoking traditional tobacco cigarettes.
Using snus has helped me quit smoking traditional tobacco cigarettes completely.
Snus has helped me reduce the number of traditional tobacco cigarettes I smoke, but not to quit completely.
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
{Base = chewing tobacco/snuff/dip}
I feel healthier when I use chewing tobacco, snuff, or dip instead of smoking traditional tobacco cigarettes.
Using chewing tobacco, snuff, or dip has helped me quit smoking traditional tobacco cigarettes completely.
Using chewing tobacco, snuff, or dip has helped me reduce the number of traditional tobacco cigarettes I smoke, but not to quit completely.
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
{Base for this question is MILITARY only}
October 2010 to the present
September 2001 to September 2010
August 1990 to August 2001 (including Persian Gulf war)
September 1980 to July 1990
May 1975 to August 1980
Vietnam era (August 1964 to April 1975)
{Base for this question is MILITARY only}
Yes, in the past 24 months
Yes, but not in the past 24 months
No
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
{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
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
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}
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}
Yes,
No
Not sure
{BASE = answers T3_01 & Current Smoker}
Yes
No
Don’t Know/Not Sure
{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
Every day
A few times a week
A few times
Once
Not at all
{Open-End}
Every day
A few times a week
A few times
Once
Not at all
Every day
A few times a week
A few times
Once
Not at all
Every day
A few times a week
A few times
Once
Not at all
Every day
A few times a week
A few times
Once
Not at all
Every day
A few times a week
A few times
Once
Not at all
{Base = current smokers}
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 smokers}
Yes
No
{Base = recall anti-smoking advertising (OAS1/1)}
[OPEN END]
{If OAS1.01}
Yes
No
{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
Believable
Neither believable nor unbelievable
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
This ad speaks to me
Scale for items RC4.A-N:
Strongly disagree
Somewhat disagree
Neither agree nor 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}
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 or other health professionals 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
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 |