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
“Top 3 attention-grabbing statements” Worksheet

Adults – List B

Please put an X in the boxes next to the 3 statements that grabbed your attention the most. On the line under each of those three statements, please write a brief reason why that statement got your attention.

	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
	Smoking during pregnancy can harm your baby
	Smoking during pregnancy can stunt your baby's growth
	Smoking during pregnancy can lead to deformities in your baby
	Smoking can kill you
	Smoking causes gangrene, Buerger’s disease, and diabetes, which can lead to amputation of limbs

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].