Qualitative Study on Cigarettes and Smoking: Knowledge, Beliefs, and Misperceptions about cigarettes and cigarette smoking

OMB No. 0910-0674

Exp: 3/31/16

Qualitative Study on Cigarettes and Smoking
“New Information” Worksheet

Adolescents – List B

Please place a check mark in the box next to the statements that taught you something new about cigarettes or smoking.

	Cigarettes cause cancer
	Smoking causes many forms of cancer such as lung, liver, stomach, oral, cervical, pancreatic, kidney, colorectal, bone marrow, blood, and bladder cancer
	Smoking causes bladder cancer which can lead to painful and frequent urination
	Cigarettes cause strokes and heart disease
	Smoking causes heart attacks and strokes by clogging your arteries
	Smoking causes gangrene, Buerger’s disease, and diabetes which can lead to amputation of limbs
	Smoking causes blindness
	Secondhand smoke causes death in nonsmokers

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 1 minute per response to complete the worksheet (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].