Quanitative Study of Youth Reactions to Rough-Cut Advertising to Prevent Youth Tobacco Use Among Multicultural Youth

OMB# 0910-0674

Exp. 3/31/2016

Quantitative Study of Youth Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use among Multicultural Youth

Electronic Screener

WELCOME PAGE

[TEXT TO PRESENT TO PARTICIPANT]: “We are looking for students to take a survey after school. If you are selected and agree to take part in the research activities, you will receive a $20 gift card that can be used anywhere. Please answer the questions on the following pages to see if you qualify. You will find out right away at the end of the survey if you have been selected. If so, you will be asked to stay after school for about 10 minutes on [DATE] to take the main survey.

Only the researchers will know how you answer. We will not share the answers you give with anyone outside of the research study. There are no right or wrong answers to these questions.”

[Each item on the Copy Testing Questionnaire will be presented in a separate page, separated by a “NEXT” button.]

DEMOGRAPHICS AND TOBACCO USE

B1. How old are you?

1. 11 years old or younger

2. 12 years old

3. 13 years old

4. 14 years old

5. 15 years old

6. 16 years old

7. 17 years old

8. 18 years old or older

B2. Out of the last 30 days, on how many days did you exercise for at least 30 minutes?

1. 0 days

2. 1-10 days

3. 11-20 days

4. 20-29 days

5. All 30 days

B3. About how many cigarettes have you smoked in your entire life (e.g., Newport, Salem, Kool, Camel)? Your best guess is fine.

1. I have never smoked cigarettes, not even one or two puffs

2. 1 or more puffs but never a whole cigarette

3. 1 to 99 cigarettes (less than 5 packs)

4. 100 or more cigarettes (5 or more packs)

B4. Do you think that you will smoke a cigarette soon?

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not

5. Don’t know

6. Do not want to answer

B5. Out of the past 7 days, on how many days did you eat breakfast?

1. 0 days

2. 1-2 days

3. 3-4 days

4. 5-6 days

5. Every day

B6. Do you think you will smoke a cigarette in the next year?

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not

5. Don’t know

6. Do not want to answer

B7. If one of your best friends were to offer you a cigarette, would you smoke it?

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not

5. Don’t know

6. Do not want to answer

B8. What is your sex?

1. Female

2. Male

B9. What is your race or ethnicity? Select all that apply

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Hispanic or Latino

5. Native Hawaiian or Other Pacific Islander

6. White

7. Other

8. Not Applicable or Do Not Know

[SCREEN OUT DISQUALIFYING YOUTH BEFORE PROCEEDING TO NEXT PAGE.]

[IF B1 = A OR H, DISQUALIFY]

[IF B3 = A AND B4 = D-F AND B6 = D-F AND B7 = D-F, DISQUALIFY]

[IF B3 = D, DISQUALIFY]

[ELSE, PROCEED TO NEXT PAGE]

[TEXT PRESENTED TO DISQUALIFIED PARTICIPANTS]: “Thank you for answering our questions! Unfortunately, you will not be invited to take part in the after school survey. Please return the tablet to a research assistant. Have a great day!”

MARKETING AND RESEARCH

C1. Do you or any member of your immediate family or a close friend work for...?

A. A market research company

B. An advertising agency or public relations firm

C. The media (TV/radio/newspapers/magazines)

D. A healthcare professional (doctor, nurse, pharmacist, dietician, etc.)

E. None of these

C2. When was the last time you participated in a research study?

1. Within the past 6 months [SCREEN OUT]

2. More than 6 months ago

[IF C1 = A-D, DISQUALIFY]

[IF C2 = A, DISQUALIFY]

[ELSE, PROCEED TO NEXT PAGE]

[TEXT PRESENTED TO DISQUALIFIED PARTICIPANTS]: “Thank you for answering our questions! Unfortunately, you will not be invited to take part in the after school survey. Please return the tablet to a research assistant. Have a great day!”

PICTURE SELECTION EXERCISE

[IF HIP HOP I-BASE SCORE < 4, DISQUALIFY.]

[ELSE, QUALIFY]

[TEXT PRESENTED TO DISQUALIFIED PARTICIPANTS]: “Thank you for answering our questions! Unfortunately, you will not be invited to take part in the after school survey. Please return the tablet to a research assistant. Have a great day!”

[TEXT PRESENTED TO QUALIFIED PARTICIPANTS]: “Congrats! You qualify to complete the survey! Please provide the following information so that we can send you a reminder about the survey!”

CONTACT INFO PAGE

A1. First Name: ________________________

A2. Last Name: ________________________

A3. Last Classroom #/Teacher Today: ____________________________

A4. Last Classroom #/Teacher on [DATE]: ____________________________

A5. Phone: ______________________

A6. Select One: Cell or Home

[TEXT PRESENTED TO QUALIFIED PARTICIPANTS]: “Thank you! Please return the tablet to a research assistant so that they can give you the information you need to complete the survey and receive a $20 gift card!”

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 2 minutes per response to complete the Screener (the time estimated to read, review and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to [email protected].

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