Multicultural Campaign: Wave 3 focus group study of reactions to creative advertising concepts designed to prevent multicultural youth tobacco use

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

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First Name:

Last Name:

Last Classroom #/Teacher Today:

Phone:

Last Classroom #/Teacher on

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

:

(Circle One: CELL or HOME)

Last Classroom #/Teacher on

10) Have you ever been curious about
using an electronic cigarette, ecigarette, vape pen, or hookah pen?

5) Do you think you will smoke a
cigarette in the next year?

b. 12 years old

a. Definitely yes

a. Very curious

c. 13 years old

b. Probably yes

b. Somewhat curious

d. 14 years old

c. Probably not

c. A little curious

e. 15 years old

d. Definitely not

d. Not at all curious

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?

2) Have you ever tried cigarette
smoking, even one or two puffs?

a. Definitely yes

a. Yes

c. Probably not

b. No
3) About how many cigarettes have
you smoked in your entire life? A
pack usually has 20 cigarettes in it.
a. I have never smoked cigarettes,
not even one or two puffs
b. 1 or more puffs but never a whole
cigarette

e. 11 to 20 cigarettes (about ½ pack
to 1 pack)
f. 21 to 51 cigarettes (more than 1
pack but less than 3 packs)
g. 51 to 99 cigarettes (more than 2 ½
packs but less than 5 packs)
h. 100 or more cigarettes (5 packs or
more)
4) Do you think that you will
smoke a cigarette soon?
a. Definitely yes

b. No

b. Probably yes

12) Have you ever been curious about
smoking tobacco from a hookah or
waterpipe?

d. Definitely not
7) 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

a. Very curious
c. A little curious

d. Definitely not

d. Not at all curious

b. Male
14) Are you Hispanic or Latino?
a. Yes

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

d. Not at all curious
9) 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?

b. No

c. A little curious

b. No

b. Somewhat curious

c. Probably not

b. Somewhat curious

a. Female

8) Have you ever been curious about
smoking a cigar, cigarillo, or little
cigar?

a. Yes

a. Very curious

13) What is your sex?

b. No

b. Probably yes

11) Have you ever smoked tobacco in a
hookah or waterpipe, even one or two
puffs?
a. Yes

c. 1 cigarette
d. 2 to 10 cigarettes (about ½ pack
total)

:

a. American Indian or Alaska Native
b. Asian
c. Black or African American
d. Native Hawaiian or Other Pacific
Islander
e. White
f. Other

CONTINUE ON NEXT PAGE

16) RANK THE 3 PEOPLE THAT

Rank #1:

WOULD BEST FIT IN YOUR
MAIN GROUP OF FRIENDS,
STARTING WITH THE BEST FIT.

Rank #2:

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

Rank #3:

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

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

Rank #1:

19) 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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