Non-Smoker Survey Wave 1 - word

NONSMOKER WAVE 1 SURVEY

[DISPLAY]

Form Approved

OMB No. 0920-0923

Exp. Date XX/XX/XXXX

Evaluation of the National Tobacco Prevention and Control Public Education Campaign Nonsmoker Questionnaire

Public reporting burden of this collection of information is estimated to average 30 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 NA4]

NA4. Have you smoked cigarettes at all, even one puff, in the past 12 months?

1. Yes

2. No

[IF NA4=1, ASK NA5]

NA5. Have you quit smoking cigarettes completely in the past 6 months?

1. Yes

2. No

SECTION B: TOBACCO USE QUESTIONS

[IF NA5=1, ASK NB2]

NB2. 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 NA4=1, ASK NB1]

NB1. 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

NC1a. During the past 4 months, on which days did you try to quit smoking? Using your cursor, click on each day that you did not smoke cigarettes because you were trying to quit smoking. Your best guess is fine.

Please click on each date you did not smoke due to quitting. If you did not try to quit smoking on any day in the past four months, select the 'Did not' response below.

NC1b. In the past 4 months, during any of the weeks listed below did you quit smoking entirely for at least one day because you were trying to quit smoking?

Please click on each week that you did not smoke due to quitting for at least one day. If you did not try to quit smoking for at least one day during the following weeks in the past four months, select the 'Did not' response below.

NC1c. On which days did you try to quit smoking during these weeks over the past 4 months? Using your cursor, click on each day that you did not smoke cigarettes because you were trying to quit smoking. Your best guess is fine.

If you did not try to quit smoking on any day during the following weeks in the past four months, select the 'Did not' response below.

NC1d_1. Did you use electronic cigarettes/e-cigarettes on at least one day during any of the following weeks in the past 4 months?

If you did not use e-cigarettes during any of the following weeks, select the 'Did not' response below.

NC1d_2. Did you use any tobacco product other than cigarettes or electronic cigarettes/e-cigarettes on at least one day during any of the following weeks in the past 4 months?

If you did not use any tobacco product other than cigarettes or electronic cigarettes/e-cigarettes during any of the following weeks, select the 'Did not' response below.

NC1e. For each week listed below, we have 3 questions:

1) did you quit smoking during the week for at least one day because you were trying to quit smoking?

2) did you use an electronic cigarette/e-cigarette on at least one day during the week?

3) did you use any tobacco product other than cigarettes or electronic cigarettes/e-cigarettes (such as cigar, hookahs or smokeless tobacco products) on at least one day during the week?

Select all weeks that apply within each column. If you did NOT do a particular behavior for all the weeks, select the appropriate 'Did not' response at the bottom.

[IF NA4=1, ASK NB3]

NB3. How long has it been since you last smoked a cigarette?

NB3a. _____________[ENTER NUMBER]

NB3b. [DROP BOX FOR UNITS]

1. Hours (0 – 24)

2. Days (0 – 10)

3. Weeks (0 – 26)

4. Months (0 – 6)

[IF NB1>0 or NB1a =1 ASK NB4]

NB4. When you last tried to quit smoking, did you do any of the following?

[PRESENT IN RANDOM ORDER] Select

[ANSWER ALL]

1. Yes

2. No

NB4_1. Give up cigarettes all at once

NB4_2. Gradually cut back on cigarettes

NB4_3. Switch completely to electronic cigarettes or e-cigarettes such as Blu or NJOY

NB4_4. Substituted some of your regular cigarettes with e-cigarettes

NB4_5. Switch to mild or some other brand of cigarettes

NB4_6. Use nicotine replacements like the nicotine patch or nicotine gum

NB4_7. Use medications like Zyban or Chantix

NB4_8. Get help from a telephone quit line

NB4_9. Get help from a website such as Smokefree.gov

NB4_10. Get help from a doctor or other health professional

[IF NB1>0 or NB1a =1 ASK NB5]

NB5. When you last tried to quit smoking, did any of the following motivate you to try to quit?

[PRESENT AS GRID IN RANDOM ORDER, ASK ALL]

1. Yes

2. No

NB5_1. A family member or friend encouraged me to try to quit

NB5_2. Television commercials, radio ads, or other types of advertisements that

focus on the health consequences of smoking

NB5_3. My doctor or other health professional advised me to quit smoking

NB5_4. Workplace restrictions on smoking

NB5_5. Other, specify____________

[IF NA4=1, ASK NB6 & NB7]

NB6. Since [FILL START DATE] between [START DATE] and [END DATE], did you see or talk to any type of dental care provider (dentist, dental hygienist, orthodontist, oral surgeon, any other dental specialist) for dental care or a dental check-up?

1. Yes

2. No

NB6a. During the past [FILL # MONTHS PLANNED CAMPAIGN DURATION] months, that is since [FILL DATE], have you talked with your dental care provider (dentist, dental hygienist, orthodontist, oral surgeon, any other dental specialist) about your smoking or about quitting smoking?

1. Yes

2. No

NB7. During the past [FILL # MONTHS PLANNED CAMPAIGN DURATION] months, that is since [ FILL DATE], has a dental care provider (dentist, dental hygienist, orthodontist, oral surgeon, any other dental specialist) advised you to quit smoking?

1. Yes

2. No

E-CIGARETTE QUESTIONS

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.

NB8. Have you ever used electronic cigarettes or e-cigarettes, such as Smoking Everywhere, NJOY, Blu or Vapor King, even one time?

1. Yes

2. No

[IF NB8=1 ASK NB9]

NB9. Do you now use electronic cigarettes or e-cigarettes….

1. Every day

2. Some days

3. Not at all

[IF NB9=1 ASK Nb9a and Nb9b]

NB9a. Do you usually use disposable electronic cigarettes/e-cigarettes or do you use an electronic cigarette/e-cigarette that uses cartridges or tanks?

Please indicate the type of e-cigarette that you use the most.

1. Disposable electronic cigarettes/e-cigarettes

2. Electronic cigarette/e-cigarette that uses cartridges

3. Electronic cigarette/e-cigarette that uses tanks

NB9b. On average, about how many [FILL “disposable e-cigarettes” IF NB9a=1]; [FILL “e-cigarette cartridges” if NB9a=2]; [FILL “e-cigarette tanks” if NB9a=3] do you now use each week?

________________ [ENTER NUMBER]

[IF NB8=1 ASK NB10 & NB11]

NB10. Are any of the following a reason why you [IF NB9=3, FILL: first tried; IF NB9=1 or 2, FILL: currently use] electronic cigarettes/e-cigarettes?

[SELECT ALL THAT APPLY, PRESENT RANDOMLY]

Yes No

B10_1. They cost less than other forms of tobacco [PATH]

B10_2. They can be used in places where smoking cigarettes isn’t allowed

B10_3. They might be less harmful to me than regular cigarettes

B10_4. They might be less harmful to people around me than regular cigarettes

B10_5. Electronic cigarettes/e-cigarettes come in flavors I like

B10_6. Electronic cigarettes/e-cigarettes can help me quit smoking regular cigarettes

B10_7. Electronic cigarettes/e-cigarettes can help me reduce the number of regular cigarettes I smoke.

B10_8. Electronic cigarettes/e-cigarettes don’t smell

B10_9. Using an electronic cigarette/e-cigarette feels like smoking a regular cigarette

B10_10. Electronic cigarettes/e-cigarettes don’t bother people who don’t use tobacco

B10_11. The advertising for electronic cigarettes/e-cigarettes appeals to me.

B10_12. They help me deal with cravings to smoke.

B10_13. I have a friend or family member who suggested I use electronic cigarettes/e-cigarettes as a way to quit smoking.

B10_14. I was curious about electronic cigarettes/e-cigarettes

B10_15. Other, specify________________________

NB11. Which of those is the main reason you [IF NB9=3, FILL: first tried; IF NB9=1 or 2, FILL: currently use] electronic cigarettes/e-cigarettes?

[IF MORE THAN ONE ITEM SELECTED IN NB10, DISPLAY LIST OF ALL REASONS SELECTED IN NB10. IF ONLY ONE ITEM SELECTED IN B10, FILL FOR NB11]

[IF NB9 = 3, ASK NB11a]

NB11a. You indicated previously that you have tried electronic cigarettes/e-cigarettes before but do not currently use them. Using the text box below, tell us in a few words why you do not use electronic cigarettes/e-cigarettes now.

OPEN-ENDED________________________

[ASK NB12 IF NB9=1 or 2]

NB12. Do you use electronic cigarettes/e-cigarettes in places where smoking regular cigarettes is not allowed?

1. Yes

2. No

NB12a. Do you use electronic/e-cigarettes in any of the following places?

1. Yes

2. No

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 _______________

NB13. As far as you know or believe are electronic cigarettes/e-cigarettes less harmful than regular cigarettes, more harmful than regular cigarettes, or are they equally harmful to health?

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 regular cigarettes)

2

3 (the same as regular cigarettes)
4

5 (much more harmful than regular cigarettes)

QUITLINE USE AND AWARENESS

NE9. 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 NE9=1, ASK NE9a]

NE9a. In the past 3 months, that is since [FILL DATE], have you recommended any family members or friends that smoke to call a telephone quitline?

1. Yes

2. No

NE10. Have you heard of 1-800-QUIT-NOW?

1. Yes

2. No

[IF NE10=1 ASK NE10a]

NE10a. In the past 3 months, that is since [FILL DATE], have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

1. Yes

2. No

SECTION C: ATTITUDES AND BELIEFS

Social Norms of Smoking and SHS

The next few questions will ask about your opinions related to smoking and tobacco use.

NC1. Do you believe cigarette smoking is related to:

[RANDOMIZE ORDER] 1 2

Yes No

NC1_1. Lung Cancer

NC1_2. Cancer of the mouth or throat

NC1_3. Heart Disease

NC1_4. Diabetes

NC1_5. Emphysema

NC1_6. Stroke

NC1_7. Hole in throat (stoma or tracheotomy)

NC1_8. Buerger’s Disease

NC1_9. Amputations (removal of limbs);

NC1_10. Asthma

NC1_11. Gallstones

NC1_12. COPD or Chronic bronchitis

NC1_13. Periodontal or Gum Disease

NC1_14. Premature birth

NC1_15. Colorectal Cancer

NC2.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

NC4b. 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.

NC3. 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

NC4. 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

NC4a. 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

SECTION D: SECONDHAND SMOKE & PEER COMMUNICATION

ND1. Other than yourself, does anyone who lives in your home smoke cigarettes now?

1. Yes

2. No

ND1a. During the past 7 days, that is, since [DATE FILL], on how many days did you breathe vapor from someone else was using an electronic cigarette/e-cigarette in an indoor or outdoor place?

______________ [# OF DAYS]

ND4. During the past 3 months, that is since [FILL DATE], have you talked to any family members or friends about the dangers of smoking?

1. Yes

2. No

ND5a. During the past 3 months, that is since [FILL DATE], did you encourage a friend or family member to quit smoking?

1. Yes

2. No

NE10c. In the past 3 months, that is since [FILL DATE], have you recommended any family members or friends that smoke to talk with their dentist or dental hygienist about quitting smoking?

1. Yes

2. No

ND6. Among close friends, do…

1. All of them smoke?

2. Most of them smoke?

3. Most of them NOT smoke?

4. None of them smoke?

ND7. Among close relatives, do…

1. All of them smoke?

2. Most of them smoke?

3. Most of them NOT smoke?

4. None of them smoke?

SECTION E. MEDIA USE AND AWARENESS

NE1. 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

NE2. 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

NE3. 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

NE4. 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

NE14. Have you heard of the Website www.cdc.gov/Tips?

1. Yes

2. No

[IF NE14=1 ASK NE14a]

NE14a. Have you visited www.cdc.gov/Tips in the past 3 months, since [FILL DATE]?

1. Yes

2. No

[IF NE14a=1, ASK NE14c]

NE14c. In the past 3 months, that is since [FILL DATE], have you recommended any family members or friends that smoke to visit www.cdc.gov/Tips?

1. Yes

2. No

NE18. In the past [FILL MONTHS PLANNED CAMPAIGN DURATION] months, since [FILL DATE], have you seen or heard of any ads on television or radio with the following themes or slogans?

[RANDOMIZE ORDER] 1 2

Yes No

NE18_1. TIPS FROM A FORMER SMOKER

NE18_2. TRUTH

NE18_3. BECOME AN EX

NE18_4. EVERY CIGARETTE IS DOING YOU DAMAGE

NE18_5. TOBACCO FREE LIVING

[IF NE18_1=1, ASK NE19]

NE19. Where have you seen or heard about the TIPS Campaign?

1 2

Yes No

[RANDOMIZE]

NE19_1. On TV

NE19_2. On the radio

NE19_3. In newspapers or magazines

NE19_4. On the Internet

NE19_5. Billboards or other outdoor ads

NE20. 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 REACTION TO TV ADS

Now, we would like you to view a series of advertisements that have been shown on television and online in the U.S. Please make sure your computer’s volume is set to an appropriate level. You may be prompted by your computer to download a program enabling video playback. If the videos do not work, you’ll still be able to see images and descriptions of the advertisements. When you are ready, please click on the link below to view the first advertisement. There is a total of [FILL # TOTAL ADS] ads to view. After you view each ad, there will be a few questions that ask about your opinions of the ad.

[SHOW AD_x]

NF21_x. Were you able to view this video?

1. Yes

2. No

[IF NF21_x=2, GO TO NF23_x]

[ASK NF23_x IF NF21_x=2]

NF23_x. Now we would like to show you some screen shots from a television advertisement 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 STORYBOARD IMAGES FOR AD_x]

NF24_x. Have you seen this ad on television or online in the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, since [CAMPAIGN LAUNCH DATE]?

1. Yes

2. No

[IF NF24_x = 1, ASK NF24a_x_TV]

NF24a_x_TV. In the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, how frequently have you seen this ad on television?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

[IF NF24_x = 1, ASK NF24a_x_COMPUTER]

NF24a_x_COMPUTER. In the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, how frequently have you seen this ad on a laptop or desktop computer?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

[IF NF24_x = 1, ASK NF24a_x_MOBILE]

NF24a_x_MOBILE. In the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, how frequently have you seen this ad on a tablet or smartphone?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

[IF NF24a_x_COMPUTER = 1, ASK NF24d_x]

NF24d_x. You previously indicated that you have seen this ad on either a laptop or desktop computer. When you saw this ad on your computer, did you…..

1. Yes

2. No

NF24d_x_1. Notice the ad on a Website that you were visiting?

NF24d_x_2. First search for the ad on YouTube, Google, or other Internet search engine?

[SHOW NF25_x – NF28_x FOR FIRST 3 ADS ONLY]

NF25_x. 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]

NF25a_x. This ad is worth remembering.

NF25b_x. This ad grabbed my attention.

NF25c_x. This ad is powerful.

NF25d_x. This ad is informative.

NF25e_x. This ad is meaningful to me.

NF25f_x. This ad is convincing.

NF25g_x. This ad is ridiculous.

NF25h_x. This ad is terrible.

NF25i_x. This ad was difficult to watch.

NF26_x. 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

NF26a_x. Sad

NF26b_x. Afraid

NF26c_x. Irritated

NF26d_x. Ashamed

NF26e_x. Discouraged

NF26f_x. Hopeful

NF26g_x. Motivated

NF26h_x. Understood

NE26i_x. Angry

NF27_x. Would this ad make you want to encourage someone you care about to quit smoking?

1. Yes

2. No

NF28_x. Would this ad make you want to quit smoking?

1. Yes

2. No

[DISPLAY: Now, we would like you to view another ad]

[REPEAT ABOVE SEQUENCE OF QUESTIONS FOR EACH OF THE NEXT 2 ADS SHOWN]

[ASK NF28a IF ANY NF24_x=1]

For the next few questions, think about all of the advertisements you just viewed and recalled seeing in the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months.

[ASK NF29 IF ANY NF24_x=1]

NF29. Did seeing these ads on television make you want to encourage someone you care about to quit smoking?

1. Yes

2. No

[ASK NF30 IF ANY NF24_x=1]

NF30. Did you talk to anyone about any of these ads?

1. Yes

2. No

[IF NF30=1, ASK NF31]

EXPOSURE TO RADIO ADS

Now, we would like you to listen to a radio advertisement that has aired in the U.S. Please make sure your computer’s volume is set to an appropriate level. You may be prompted by your computer to download a program enabling audio playback. If you cannot hear the audio, you’ll still be able to read a description of the advertisement. There is a total of [FILL # TOTAL RADIO ADS] radio ads to listen to. When you are ready, please click on the link below to listen to the ad. After you listen to the ad, there will be a few questions that ask about your recent recall of the ad.

[PLAY RADIO AD CHOSEN]

NF32_x. Were you able to listen to this ad?

1. Yes

2. No

[IF NF32_x=2, GO TO NF34]

[ASK NF34_x IF NF32_x=2]

NF34_x. 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 RADIO AD]

NF35_x. Have you heard this ad on the radio in the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, since [CAMPAIGN LAUNCH DATE]?

1. Yes

2. No

[IF NF35_x=1, ASK NF35a_x]

NF35a_x. In the past [FILL # MONTHS SINCE CAMPAIGN LAUNCH] months, how frequently have you heard this ad on the radio?

1. Rarely

2. Sometimes

3. Often

4. Very Often

EXPOSURE TO DISPLAY, PRINT, AND OUT-OF-HOME

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, billboards 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 “Online Compilation.jpg”]

Please click “Next” to view the next set of images.

[SHOW IMAGE “Print Compilation.jpg”]

Please click “Next” to view the next set of images.

[SHOW IMAGE “Out of Home Compilation.jpg”]

Please click “Next” to proceed to the next questions.

NE36. In the past [FILL MONTHS SINCE CAMPAIGN LAUNCH] months, since [CAMPAIGN LAUNCH DATE], have you seen any of these ads in magazines, on Websites, or in public places outside your home?

1. Yes

2. No

NE37. Where did you see these advertisements?

1. Yes 2. No

[RANDOMIZE]

NE37_1. Magazines or print publications

NE37_2. Websites online

NE37_3. Public places such as bus shelters, bus interiors, outdoor bulletins, etc.

AWARENESS OF E-CIGARETTE ADS

NF38_x. Now we would like to show you a series of screen shots from [FILL # ADS] television advertisements that have 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 STORYBOARD IMAGES FOR E-CIG AD_x]

NF38_x. Have you seen this ad on television or online in the past 3 months, since [FILL DATE] 6 months?

1. Yes

2. No

[IF NF38_x = 1, ASK NF38a_x_TV]

NF38_x_TV. In the past 3 months, how frequently have you seen this ad on television?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

[IF NF38_x = 1, ASK NF38a_x_COMPUTER]

NF38a_x_COMPUTER. In the past 3 months, how frequently have you seen this ad on a laptop or desktop computer?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

[IF NF38_x = 1, ASK NF38a_x_MOBILE]

NF38a_x_MOBILE. In the past 3 months, how frequently have you seen this ad on a tablet or smartphone?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

NF41_x. 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]

NF41a_x. This ad is worth remembering.

NF41b_x. This ad grabbed my attention.

NF41c_x. This ad is powerful.

NF41d_x. This ad is informative.

NF41e_x. This ad is meaningful to me.

NF41f_x. This ad is convincing.

NF42_x. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statement.

1. Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

[RANDOMIZE ORDER]

NF42a_x. [IF B8=2, EVER_ECIG=NO)] This ad makes me want to try an e-cigarette.

SECTION G: CLOSING QUESTIONS

[ASK NG1 OF ALL RESPONDENTS]

NG1. How many children aged 17 or younger live in your household 6 months or more of the year?

__ Number of Children

[IF SAMPLE = ABS, ASK NG5 – NG8]

NG5. What is the highest level of school you have completed?

1. No formal education

2. 1^st, 2^nd, 3^rd, or 4^th grade

3. 5^th or 6th grade

4. 7th grade or 8^th grade

5. 9th grade

6. 10th grade

7. 11th grade

8. 12th grade, no diploma

9. High school graduate – high school Diploma or the equivalent (GED)

10. Some college, no degree

11. Associate degree

12. Bachelor’s degree

13. Master’s degree

14. Professional or Doctorate degree

[IF SAMPLE = ABS, ASK NG6]

The next question is about the total income of YOUR HOUSEHOLD for the PAST 12 MONTHS. Please include your income PLUS the income of all members living in your household (including cohabiting partners and armed forces members living at home). Please count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net income from a business, interest, dividends, child support, alimony, and Social Security, public assistance, pensions, or retirement benefits).

NG6. Was your total HOUSEHOLD income in the past 12 months…

1. Below $35,000

2. $35,000 or more

3. Don’t Know

[IF NG6=1, ASK NG6a]

NG6a. We would like to get a better estimate of your total HOUSEHOLD income in the past 12 months before taxes. Was it…

1. Less than $5,000

2. $5,000 to $7,499

3. $7,500 to $9,999

4. $10,000 to $12,499

5. $12,500 to $14,999

6. $15,000 to $19,999

7. $20,000 to $24,999

8. $25,000 to $29,999

9. $30,000 to $34,999

[IF NG6=2, ASK NG6b]

G6b. We would like to get a better estimate of your total HOUSEHOLD income in the past 12 months before taxes. Was it…

1. $35,000 to $39,999

2. $40,000 to $49,999

3. $50,000 to $59,999

4. $60,000 to $74,999

5. $75,000 to $84,999

6. $85,000 to $99,999

7. $100,000 to $124,999

8. $125,000 to $149,999

9. $150,000 to $174,999

10. $175,000 or more

[IF SAMPLE = ABS, ASK NG7]

NG7. Are you now married, widowed, divorced, separated, never married, or living with a partner?

1. Married

2. Widowed

3. Divorced

4. Separated

5. Never married

6. Living with a partner

[IF SAMPLE = ABS, ASK G8]

NG8. Which statement best describes your current employment status?

1. Working - as a paid employee

2. Working - self-employed

3. Not working - on temporary layoff from a job

4. Not working - looking for work

5. Not working - retired

6. Not working - disabled

7. Not working - other

[ASK NG9 OF ALL RESPONDENTS]

NG9. How many smoking or tobacco related web surveys like this have you completed during the past year?

1. None

2. 1 survey

3. 2 surveys

4. 3 surveys

5. 4 surveys

6. 5 or more surveys

[ASK NG15 OF ALL RESPONDENTS]

NG15. Have you been diagnosed by a physician or other qualified medical professional with any of the following medical conditions?

1 2

Yes No

NG15_1. Acid reflux disease

NG15_2. ADHD or ADD

NG15_3. Anxiety disorder

NG15_4. Asthma, chronic bronchitis, or COPD

NG15_5. Cancer (any type except skin cancer)

NG15_6. Chronic pain (such as low back pain, neck pain, or Fibromyalgia)

NG15_7. Depression

NG15_8. Diabetes

NG15_9. Heart attack

NG15_10. Heart disease

NG15_11. High blood pressure

NG15_12. High cholesterol

NG15_13. HIV/AIDS

NG15_14. Kidney disease

NG15_15. Mental health condition

NG15_16. Multiple sclerosis

NG15_17. Osteoarthritis, joint pain or inflammation

NG15_18. Osteoporosis or osteopenia

NG15_19. Rheumatoid arthritis

NG15_20. Seasonal allergies

NG15_21. Skin cancer

NG15_22. Sleep disorders such as sleep apnea or insomnia

NG15_23. Stroke

NG15_24. Something else

NG20. Do you or anyone in this household connect to the Internet from home?

1. Yes

2. No

NG21. Do you live in a metro or non-metro area?

1. Non-Metro (Rural)

2. Suburban

3. Urban

[ASK NG22 OF ALL RESPONDENTS]

NG22. Using the scale below, please tell us how much you agree or disagree with the following statements.

1 2 3 4 5

Strongly Somewhat Neither Somewhat Strongly

Agree Agree Agree nor Disagree Disagree

Disagree

NG20a. I usually try new products before other people do.

NG20b. I often try new brands because I like variety and get bored with the same old thing.

NG20c. When I shop I look for what is new.

NG20d. I like to be the first among my friends and family to try something new.

NG20e. I like to tell others about new brands or technology.

[IF KP ACTIVE, DISPLAY]:

Thank you for completing today’s survey. Your input will greatly help researchers assess the impact of television ads about quitting smoking.

[IF KP ACTIVE, DISPLAY]:

You will be awarded [AMOUNT] bonus points credited to your KnowledgePanel account for completing the survey. A follow-up survey will be sent to you in about [FILL # MONTHS PLANNED CAMPAIGN DURATION] and you will be awarded [AMOUNT] bonus points for completing that survey.

[IF KP WITHDRAWN OR ABS, DISPLAY]:

ADD1. Those are all of our questions.  Thanks so much for your participation in our survey.  As a token of our appreciation, we would like to send you [IF SAMPLE = KP WITHDRAWN, “$15”; IF SAMPLE=ABS, “$20”].  Would you please provide your name and mailing address so that we can put the check in the mail.  This information will not be connected with your survey responses in any way.

After you have entered your information, please make sure to click “Next”.

Name (First/Last): [TEXTBOX]

Street Address (If applicable, include unit number): [TEXTBOX]

City: [TEXTBOX]

State: [TEXTBOX]

Zip Code : [TEXTBOX]

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