The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use

The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use

Discussion Guide – Page 1

DISCUSSION GUIDE

Research Objective: Conduct in-depth interviews with rural youth aged 12–17 to gain a deeper understanding of their lives and values as well as explore how smokeless tobacco is in their environment and formative experiences with smokeless tobacco.

NOTE TO REVIEWER: This guide was created to facilitate an exploratory discussion.

All question probes that are italicized below each main question should be considered as optional probes that may change, be invalidated based on participant response, or not be asked by interviewers. There are suggestions for the interviewer to follow, however optional questions will be used as deemed relevant and necessary in the natural flow of discussion. Additionally, the research team (consisting of at least the interviewer and a note-taker) will highlight ‘must hit’ probes in order for the interviewer to understand the need for each of the questions and can feel confident in choosing which questions or sections will provide the most rich information.

Interviewer instructions are highlighted in yellow.

Items used by the interviewer are highlighted in blue.

Session Overview: Total time: up to 90 minutes

In-Depth Interview Discussion Guide Sections (up to 90 minutes)

SECTION I: Introduction

The interviewer will explain the purpose of the research, present the ground rules and privacy steps, allow the participant to ask any questions, and get to know the participant.

SECTION II: Day in the Life

The purpose of this section is to understand the background life of the participant–including their values, typical behavior, likes and dislikes, and overall home life. This section also includes an activity in which the participant is asked to list some of their favorite things and write out why they are important.

• Insights gathered from this portion of the discussion will help create messages that use settings and scenarios that feel authentic to this audience.

SECTION III: Tobacco Environment

The purpose of this section is to understand situations where participants see and hear about tobacco products.

• Insights gathered from this portion of the discussion will help in creating prevention messages that target what negative aspects of smokeless use might most resonate with this audience.

SECTION IV: Formative Smokeless Tobacco Experience

The purpose of this section is to gain a deep understanding of each participant’s personal experience with smokeless tobacco and, if applicable, their first-hand experience with using it.

• Insights gathered from this portion of the discussion will help in creating prevention messages that target what negative aspects of smokeless use might most resonate with this audience.

SECTION V: Summary/Messaging Territories

The purpose of this section is to get creative insight from youth on messaging areas that they believe would resonate with peers in order to prevent smokeless tobacco usage.

• Insights gathered from this portion of the discussion will help in creating prevention messages that target what negative aspects of smokeless use might most resonate with this audience. This section will also allow us to gather insights regarding language and phrasing that would feel most authentic to this audience.

SECTION VI: Community

The purpose of this section is to better understand the participant’s larger community. The interviewer will show a map of the participant’s town and will ask the participant to outline key places they visit (see attached Google Map Example Entire Town and Google Map Example Center of Town).

• Insights gathered from this portion of the discussion will help create messages that use settings and scenarios that feel authentic to this audience.

SECTION VII: Closing

The interviewer wraps up discussion and ensures that all questions have been answered and all comments have been heard.

Additionally, discussions will be focused on specific interview sections based on smokeless tobacco group of each participant. Interviewers will go through training conducted by the research team to understand purpose and prioritization of each section and any subsections.

SECTION I: INTRODUCTION

Thank you for taking the time to talk to me. My name is [Interviewer name], and we’ll be chatting together today.

Before we get started, I want to say a few things:

• There are no right or wrong answers. Our whole purpose for being here is to hear what you think – I’m here to listen to what is true for you.

• Your participation is voluntary and you have the right to withdraw from the study at any time. If I ask any questions you do not wish to answer, you are welcome to pass and do not have to respond.

• I understand that your classmates who aren’t participating in these interviews may be curious what happened – it is okay to talk about what we did, but it is not okay to talk about what was said.

• Everything we talk about here is private to the extent allowable by law. That means your individual responses will not be reported and your name will not be associated with anything you say in our reports. Most importantly, we will not share any information you provide on tobacco – including your beliefs, attitudes, or past experiences – with your parents, teachers, or anyone else. Additionally, your responses will not be posted anywhere on social media or anywhere else on the Internet.

• You’ve probably noticed there are a few extra people in the room. They are here to observe and take notes—that way I don’t have to worry about writing everything down. Also we would like to audio record the discussion, but that’s just so we can go back and make sure we captured all of your thoughts correctly.

Do you have any questions for me before we start?

SECTION II: DAY IN THE LIFE

[Interviewer will ask the following ‘Day in the Life’ questions as they find appropriate, based on the experiences of each participant and how enthusiastic or open the participant is to share certain types of information. For example, participants that do not have a summer job will not be asked any of the probes related to their summer job. To better facilitate the conversation, interviewer may ask participants to draw or write down certain aspects of their life on a plain sheet of paper.]

Now I’d like to ask you some questions about your life and what it’s like to be you.

Typical Behaviors, Likes, and Dislikes:

• Describe your typical weekday?

  • What do you do in the morning before school/in school/after school/

• Describe your typical weekend.

  • How do you spend your time on the weekends?

• [If not yet answered] What do you do in your free time?

  • Probe: activities done alone vs. in groups

  • Probe: hobbies, play any sports, sports events, gaming, belong to clubs

  • Probe: what kinds of video do you watch and where/how? E.g., what shows/kinds of shows do you watch, what videos do you look at online or on TV?

• Do you have a job? Describe it.

Influencers and Their Relationship to Participant:

• Tell me about your friends—what are they like?

  • What is your friend circle like? Does it include girls too?

  • What activities do you do with them?

  • How do you communicate with your friends when you’re not with them?

• How are you similar or different from other boys around here?

• What is your family like?

  • How much do you think you’re like your family?

    • How are you similar to them?

    • How are you different from them?

  • What types of things have you learned from your family (if needed: e.g. fishing, hunting, etc.)?

    • How did you learn these things?

• Are there other people around town you’re close with?

  • Who are they?

  • What is your relationship like with them?

• Who are some of the people that are important to you?

  • What is your relationship like with them? Probe: activities you do/things you talk about with them, how you talk to them connect with them, types of content shared if any

• Who are some people that you look up to Note: These could be people in your community or celebrity role models.

  • Why do you look up to them?

  • Are there any people that you “follow” online regularly?

Goals, Desires, and Life Outlook:

• How would you define a “good life” for yourself in the future? What do you hope your life will look like?

  • Probe: What do you think is most important in your life? Now vs. in the future?

• What do you look forward to in the future? What worries you about the future?

  • Probe: near-term vs. longer-term

  • Probe: What kinds of things or challenges are you working on now in your life?

Identity:

• How would your family describe you?

  • Probe: In what ways do you agree/disagree?

• How would your closest friends describe you?

Probe: In what ways do you agree/disagree?

• How about another important person in your life whose opinion you value? How would he or she describe you?

• What are one or two items or aspects of your life (favorite things, hobbies, skills) that feel unique to you? Explain.

Activity:

[Moderator will present a sheet for the participants to fill out where they go through and describe items that are meaningful in their life.]

Now I would like to learn more about things in your life that are meaningful to you by having you fill out this brief activity sheet [hand participant sheet, if there is time briefly talk about their responses].

SECTION III: TOBACCO ENVIRONMENT

[Interviewer will present de-identified, generic images of several types of tobacco products (e.g., chew, dip, snus, cigarettes etc.) and ask about terms. BOARD contains images of chew in a bag, plug of tobacco, loose leaf tobacco, moist snuff in a tin, moist snuff pouches in a tin, and snus in a tin, cigarettes, cigars, and e-cigarettes.]

I want to switch gears a little now – as you remember, part of our conversation today is going to be around tobacco. I’m going to show you some images of products [HOLD UP BOARD].

• Can you tell me what these products are?

• What are they called?

  • What do you and your friends call them?

[Throughout, probe on any comparisons of dip to other tobacco products. Probe more on the forms of tobacco they use/are particularly curious about, but anchor the conversation in dip/comparisons with dip.]

• Ok so think about these products. How popular are tobacco products around here?

  • What kinds of tobacco products are popular?

• How much cigarette smoking/e-cigarette smoking/smokeless tobacco use/cigars/[other tobacco] use do you see around you?

  • Where do you see it?

  • Who do you see using it? Probe: kids in school, family, friends, others?

  • What kinds of things are they saying about tobacco?

• What have you seen or heard about [Probe on each of the following as relevant: cigarettes, e-cigarettes or vaping, cigars, chewing tobacco, snuff, or dip]?

I am interested in hearing more from you about dip. Just to make sure we’re both on the same page, when I say dip, I am referring to this product [SHOW PICTURE OF DIP CAN].

[IF NEEDED: Even though we are calling it dip, we are still talking about this product [indicate DIP CAN image], which is the same product as what you are calling [TERM].

[Note: Interviewer will have the flexibility to use participant preferred terminology if they feel using ‘dip’ will detract from the conversation and help eliminate some of the rapport established earlier.]

I also want to remind you that we are here to learn about what is true for you and your experiences and everything you say will be kept private, so please feel free to be honest about your feelings and experiences. On the other hand, if you do not wish to answer a specific question, that’s totally fine too. Since we want to hear about your own experiences, try not to bring up any specific names of people for the next few sections—we can talk about things in general.

• What have you seen or heard related to dip?

• [If not already answered] How popular is dip around here?

  • How often do you see or hear about dip?

  • Are there some places you see or hear about it more?

    • Why do you think you see or hear about it more in those places?

  • Which types of situations do you typically find dip being used?

    • Are there activities you do where it is used more often?

    • Are there groups of people that it’s more commonly used among?

• What do people around town think about using dip? [Cover family, friends, and others they know]

  • How do they talk about dip?

  • What types of things do you think they associate with dip?

  • In general, how do you think [your family/your friends/girl/others] feels about dip?

    • How strongly do you think they feel?

    • Why do you think they feel that way?

    • [If relevant] How do they talk about dip?

  • How do they think dip is similar or different from other tobacco products?

• What groups of people do you associate with using dip?

  • Why do you think of those people?

• What groups of people do you associate with disapproving of dip?

  • Why do you think of those people?

SECTION IV: FORMATIVE SMOKELESS TOBACCO EXPERIENCES AND OTHER TOBACCO PRODUCTS

[Interviewer will go through Section IV based on the smokeless tobacco use status of the participant and ask probes as appropriate to the conversation and their usage status. The following lists the focus for each audience segment within this section:

• At-Risk: Situational Focus

• Experimenter: Situational and First Time Usage Focus

• Established User: First Time Usage, Typical Usage Patterns, Product Preference, and Future Use Focus].

FOR AT-RISK

[Note: Focus on them speaking about any situations they associate with SLT use].

• Have you ever been curious about dip?

  • Why/why not?

  • Did anything in particular spark your curiosity?

    • Describe the situation you were in.

      • When?

      • Where were you?

      • Were you with someone? Who were you with?

• Do you think you would try dip soon?

  • Why/why not?

• What if one of your close friends started using dip:

  • How would you feel?

• What sorts of things may make someone stop and think twice before trying dip?

• What are some things that could happen to you if you use dip?

  • If health reasons come up, probe: how do you think about your health now? What things worry you, or do you avoid because it might not be good for you? What kinds of things do you do that you think are good for you or your health?

• What do you think about dip compared to cigarettes or other tobacco products?

• Have you been curious about or tried other tobacco products?

  • Which ones?

  • What makes you curious about these products?

FOR EXPERIMENTERS

[Note: Focus on them telling their story of their first time SLT use and any situational use].

• [If hasn’t come up] Have you tried tobacco products? Which ones?

• [If relevant] Which tobacco product did you try first? Any reason why?

• [If relevant] Which tobacco product do you use the most?

• [If relevant] Are there certain situations you use one product over another? If so, what are they? [Note: If mention dip, probe on the difference between dip and another tobacco product][If not already answered] Have you ever tried dip?

• What was your first time using dip like? [probe extensively]

  • Describe the situation.

  • What led you to that first time? (What made up your mind?)

  • How long were you thinking about trying dip before you tried that first time?

  • Do you know if others have a similar experience their first time?

• Did you tell others about your first time using dip?

• Have you used dip more than once?

  • Were you with the same people? Same place?

• When do you typically use dip?

  • Where?

  • With who?

• Are there certain times or events that you use dip? Why then/there?

• Are there certain times or events that you do not use dip?

  • Why do you prefer not to use dip then?

  • Who would you not dip in front of?[probe on girls if not answered]

• Has your dipping behavior changed at all from when you started dipping? How so?

• Do you think there is any harm in using dip at all? Trying it once?

  • If so, in what way?

  • If no, why not?

• What, if any, benefits are there to using dip?

• Have you thought about not using dip again?

  • Why/why not?

  • Would anything encourage you to not use dip?

FOR ESTABLISHED USERS

[Note: Focus on them telling their story of their first time SLT use, any typical SLT use patterns, other product preferences, and quitting intentions].

• [If hasn’t come up] Have you tried tobacco products? Which ones?

  • Which tobacco product did you try first? Any reason why?

• How did you decide to try those tobacco products?

  • Which products do you like the best? Why?

  • Are there certain situations you use one product over another? If so, what are they? [Note: If mention dip, probe on the difference between dip and another tobacco product]

• [If not already answered] Have you ever tried dip?

  • In what situations do you use dip? Describe those situations.

  • What makes you use dip within those situations?

  • How often do you currently dip?

• How long have you dipped?

• Do you have close friends that also use dip?

  • Teammates? Family?

• What made you curious about dip?

• What was your first time using dip like? [probe extensively]

  • Describe the situation.

  • What led you to that first time? (What made up your mind?)

  • How long were you thinking about trying dip before you tried that first time?

  • Do others have a similar experience their first time?

• Did you tell others about your first time using dip?

• How long after your first time trying dip was it until your second time trying dip?

• Tell me about your experience from trying dip a few times to using more regularly?

• When do you typically use dip?

  • Where?

  • Do you plan it ahead?

  • Where do you get the dip from?

  • Do you dip at school?

  • Who would you typically dip in front of?[probe on girls if not answered]

• Are there certain times or events that you use dip?

• Are there certain times or events that you do not use dip?

  • Why do you prefer not to use dip then?

  • Who would you not dip in front of?

• How do you feel before using dip?

  • How do you feel afterwards?

• What are some reasons why you use dip? [probe extensively]

  • What makes you continue to use dip?

• What are some ways that dip has positively affected your life? [probe extensively]

  • Do you enjoy using dip?

  • What are some reasons that you use dip?

• What, if any, negative experiences have you had using dip or because of dip? [probe extensively]

  • What do you dislike about using dip?

• Do you think there is any harm in using dip at all? Trying it once?

  • If so, in what way?

    • If health reasons come up, probe: how do you think about your health now? What things worry you, or do you avoid because it might not be good for you? What kinds of things do you do that you think are good for you or your health?

  • If no, why not?

• Do you see yourself continuing to use dip?

  • Why or why not?

• Have you thought about not using dip?

  • Why/why not?

  • Would anything encourage you to stop using dip?

SECTION V: Summary/Messaging Territories

[Throughout the conversation, Interviewer will have been tracking and writing ideas on 8X11 index cards that they have heard from the participant as being particularly motivating or relevant to the participant. Topics that will be written on the cards will also be in line with the knowledge, attitudes, and behaviors and may include the following:

• Motivations to try dip for first time

• Motivations to continuously use dip

• Perceived benefits of using dip (practical, physical, social, and emotional)

• Perceived harm or drawbacks (practical, physical, social, and emotional)]

[Interviewer will pull out Index Cards]

So, here are some things I’ve been writing down as you’ve been talking and I want to review them with you to make sure I’ve heard you correctly and fully understand your perspectives.

Which of these feel more or less like a reason that a close friend of yours might consider avoiding trying dip for the first time?

• Which are more convincing? Why do you think that is?

• Which are less convincing? Why do you think that is?

• Do any of these feel like they may even make you or your friend even more interesting in trying? Why is that?

Ok, now apart from these cards, is there anything that you think is even more convincing than what we have here? [Interviewer will allow participant to re-write any of the statements or create new statements or words].

Great, this has been so helpful. So the next step is figuring out how to say these kinds of messages.

• Who would you need to be saying this in order for you or someone you know to really listen or take into consideration?

  • Is there anyone or any particular person that you feel is an opinion you would trust or consider? [Probe on people stated earlier in the conversation- coach, teacher, parents, friends, people who have experienced the harms of dip, etc.]

And last question. So we talked about how these messages would get your friend to avoid trying dip. Would you change these messages at all to stop people from continuously using dip? [Probe on any differences].

SECTION VI: COMMUNITY ASSIGMENT

I’d like to hear more about your town – How would you describe your town to someone who hasn’t been here before?

• What do you like about where you live?

• What’s one thing you don’t like about living here? Or what might you change if you could?

After meeting with you and some others in your school, I would like to explore your town a bit more and would like to hear your perspective on the best way to do that. So before our discussion, I went online and found a Google map of your town.

[Show Google Map Printout]

If you could pick one or more places that describe or represent your town or your community really well, where should I go?

• Why did you pick this/these?

[Give student a marker] Can you point out or circle some places you typically go to?

• Why do you go there?

• Do you have a favorite place to hang out?

  • Who do you typically go there with, if anyone?

Thanks, that’s great to know! Anything else about your town that you would like to share?

SECTION VII: CLOSING

[FALSE CLOSE – IF TIME]

Those are all the questions I have for you – is there anything you would like to share that you have not had the chance to before we wrap up?

Thank you very much for participating. I have enjoyed getting to know you, and appreciate your time. Your feedback has been extremely helpful.

If you have any questions or want any additional information please don’t hesitate to come see me or one of the study staff before you leave. And, feel free to pick up one of the pamphlets on the back table if you are interested in more information on tobacco prevention.