Focus Group Study of Youth Reactions to Creative Advertising Concepts Designed to Prevent Youth Tobacco Use among Multicultural Youth

OMB# 0910-0796
Exp. 6/30/2018

Screener
We are looking for students to take part in a focus group after
school. If you are selected and agree to take part, you will
receive a $25 VISA or American Express gift card that can be
used anywhere. Please answer the questions on the following
pages to see if you qualify. We will let you know during your last
period class if you were selected. If so, you will be asked to stay
after school for 90 minutes on [DATE].
There are no right or wrong answers, and only the researchers
will know how you answer these questions, so please be honest
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CONTINUE

First Name:

Last Name:

Last Classroom #/Teacher Today:

Phone:

Last Classroom #/Teacher on

1) How old are you?
a. 11 years old or younger

:

Last Classroom #/Teacher on

3) About how many cigarettes have you
2) Have you ever tried
cigarette smoking, even smoked in your entire life? Your best
guess is fine.
one or two puffs?

b. 12 years old
c. 13 years old

a. Yes

d. 14 years old

b. No

a. I have never smoked cigarettes, not
even one or two puffs
b. 1 or more puffs but never a whole
cigarette

e. 15 years old

c. 1 cigarette

f. 16 years old
g. 17 years old
h. 18 years old or older
6) If one of your best
friends were to offer you a
cigarette, would you
smoke it?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
10) Have you ever tried
smoking tobacco from a
hookah or waterpipe, even
one or two puffs?
a. Yes
b. No
14) What is your sex?
a. Female
b. Male

(Circle One: CELL or HOME)

7) Have you ever been
curious about smoking
a cigarette?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not

d. 2 to 5 cigarettes
e. 6 to 15 cigarettes (about 1/2 a pack
total)
f. 16 to 25 cigarettes (about 1 pack total)
g. 26 to 99 cigarettes

(more than 1 pack, but less than 5 packs)
h. 100 or more cigarettes (5 or more
packs)

8) Have you ever tried smoking cigars, cigarillos, or little cigars,
such as Black and Milds, Swisher Sweets, Dutch Masters, White
Owl, or Phillies Blunts, even one or two puffs?
a. Yes
b. No
11) If one of your best friends
were to offer you tobacco from
a hookah or waterpipe, would
you smoke it?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not

12) Have you ever tried smoking
electronic cigarettes,
e-cigarettes, vape pens, or
hookah pens, such as Fin, NJOY,
Blu, e-Go, or Vuse, even one or
two puffs?
a. Yes
b. No

16) What race or races do you consider yourself to be? (You can
choose one answer or more than one answer)
15) Are you Hispanic or
Latino?

a. American Indian or Alaska Native

:

4) Do you think that you
will smoke a cigarette
soon?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
5) Do you think you will
smoke a cigarette in the
next year?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
9) If one of your best
friends were to offer you a
cigar, cigarillo, or little
cigar, would you smoke it?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
13) If one of your best
friends were to offer you
an electronic cigarette,
e-cigarette, vape pen, or
hookah pen, would you
smoke it?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not

b. Asian
a. Yes

c. Black or African American

b. No

d. Native Hawaiian or Other Pacific Islander
e. White
g. Other

CONTINUE ON NEXT PAGE

17) RANK THE 3 PEOPLE THAT
WOULD BEST FIT IN YOUR
MAIN GROUP OF FRIENDS,
STARTING WITH THE BEST FIT.

Rank #1:

18) RANK THE 3 PEOPLE THAT
WOULD LEAST FIT IN YOUR
MAIN GROUP OF FRIENDS,
STARTING WITH THE WORST
FIT.

Rank #2:
Rank #3:

Rank #1:
Rank #2:
Rank #3:

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19) RANK THE 3 PEOPLE THAT
WOULD BEST FIT IN YOUR
MAIN GROUP OF FRIENDS,
STARTING WITH THE BEST FIT.

Rank #1:

20) RANK THE 3 PEOPLE THAT
WOULD LEAST FIT IN YOUR
MAIN GROUP OF FRIENDS,
STARTING WITH THE WORST
FIT.

Rank #2:
Rank #3:

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Rank #2:
Rank #3:

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