Qualitative Study on Consumer perceptions of Cigarettes Health Warning Images

GHW Qualitative Study

Focus Groups – Image Statement Testing

Moderator Guide – Set 3

RESEARCH QUESTIONS (for reference only)

1. What information do the images alone convey to consumers? What information do people take away from the image?

2. Which images convey the clearest information to consumers about the health consequences of cigarette smoking?

3. Which image statement parings convey the clearest information to consumers about the health consequences of cigarette smoking?

4. Does each image accurately depict the health consequence of smoking described in its paired warning statement?

5. Are the people/organs/conditions depicted in each image believable/realistic?

6. How do the images aid in comprehension/understanding of the health effect of smoking beyond the statement alone?

7. In instances where there are multiple images for the same health condition, which image statement pairing provides the clearest information to consumers?

1. MODERATOR INTRODUCTION (5 minutes)

Welcome and thank you for participating in today/tonight’s discussion. My name is _________________. [All groups except adolescent susceptible:] You have been asked to participate in today/tonight’s discussion because you smoke or have recently smoked cigarettes. Today I would like to get your reactions to some pictures that might be used as part of health warnings on cigarette packages in the future. Before we begin, I want to go over a few ground rules for our discussion tonight, which will last about an hour.

• Your participation is voluntary and you have the right to not answer any question or withdraw from the study at any time.

• If at any time you are uncomfortable with my questions, you can choose not to answer. Just let me know that you prefer not to answer.

• Everything we discuss today will be kept private to the extent allowable by law. Your name and contact information, which only the study staff knows, will not be given to anyone else, and no one will contact you after this discussion is over. [youth groups: nothing you say here will be shared with your parent or guardian]

• Tonight’s discussion will be audio-recorded. The recording will be kept in a secure location and will help me write the final report. We will then give it to FDA and they will destroy it once the project ends. No names will be mentioned in the final report created from our discussion.

• Behind me is a one-way mirror. Behind that are some of my colleagues. We are also video streaming our group discussion for some colleagues who couldn’t be here. They’re watching to make sure that I ask you all the questions I have for you today. Near the end of our conversation, I’m going to go into the back and see if they have any last-minute questions for you.

• Most importantly, there are no right or wrong answers. I want to know your opinions. I do not work for the people sponsoring this research and I didn’t create anything we are going to look at, so don’t hold back on giving me your honest opinions.

• I’m not a medical doctor or an expert on smoking or tobacco, so I can’t answer specific questions about those topics.

• Please silence your cell phones.

• Do you have any questions before we begin?

2. WARM-UP/ICE BREAKER (2 minutes)

Names: Everyone introduces themselves.

Icebreaker: What would you be doing if you were not here?

3. OVERVIEW OF DISCUSSION (1 minute)

Today/tonight, the only tobacco product we will be discussing is cigarettes. I am going to show you several pictures that might be used in the future on cigarette packages and on advertisements as a part of a warning. Sometimes the pictures will be alone and sometimes they will be with a short sentence. For each picture, I will ask you a few questions to get your thoughts about it. Try not to compare them as we go – we will do that at the end.

4. IMAGE AND IMAGE-TEXT PAIRING DISCUSSION

TOPIC: Heart Disease

4.1 IMAGE DISCUSSION (~4 minutes for each image) Let’s look at our first image. Please open your booklet to Item 1 and take a moment to look at the image.
ITEM 1 (4.1a):	[PARTICIPANTS VIEW HEART DISEASE IMAGE M ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet and look at Item 2.
ITEM 2 (4.1b)	[PARTICIPANTS VIEW HEART DISEASE IMAGE N ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet and look at Item 3.
ITEM 3 (4.1c)	[PARTICIPANTS VIEW HEART DISEASE IMAGE O ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet where you will see Items 4, 5, and 6.
4.2 COMPARISON IMAGE WITH TEXT DISCUSSION Now we are going to look at the same pictures we just discussed along with some short sentences. These pictures are supposed to be about tobacco smoke [and heart disease].
ITEMS 4, 5, AND 6 (4.2a)	[PARTICIPANTS VIEW HEART DISEASE IMAGE M, N, AND O WITH TEXT 17]
	Take a moment to look at the different pictures associated with the sentence: “WARNING: Cigarettes cause strokes and heart disease”. Please circle the picture that you think goes best with the sentence and raise your hand when you are finished.
	Which picture goes best with this sentence? Why?
	Which picture and sentence combination would help you understand the relationship between smoking and [heart disease] the best? Why?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet where you will see Items 7, 8, and 9.
ITEMS 7, 8, AND 9 (4.2b)	[PARTICIPANTS VIEW HEART DISEASE IMAGE M, N, AND O WITH TEXT 18]
	Take a moment to look at the different pictures associated with the sentence: “WARNING: Smoking can cause heart disease and strokes by clogging arteries”. Please circle the picture that you think goes best with the sentence and raise your hand when you are finished.
	Which picture goes best with this sentence? Why?
	Which picture and sentence combination would help you understand the relationship between smoking and [heart disease] the best? Why?
Transition:	Now we are going to look at another set of items. Please turn to the next page where you will see Item 10.

TOPIC: Death

4.1 IMAGE DISCUSSION (~4 minutes for each image) Please take a moment to look at Item 10.
ITEM 10 (4.1d):	[PARTICIPANTS VIEW DEATH IMAGE P ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet and look at Item 11.
4.2 COMPARISON IMAGE WITH TEXT DISCUSSION Now we are going to look at the same picture we just discussed along with some short sentences. These pictures are supposed to be about tobacco smoke and [death].
ITEM 11 (4.2c)	[PARTICIPANTS VIEW DEATH IMAGE P WITH TEXT 19]
	Now that you see the picture together with the sentence “WARNING: Smoking can kill you,” does the sentence help you understand what the picture is?
	Do the words change anything about what you think the picture is trying to tell you?
	Do the sentence and picture together teach you anything about the relationship between smoking and [death]? What?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet where you will see Item 12.
ITEM 12 (4.2d)	[PARTICIPANTS VIEW DEATH IMAGE P WITH TEXT 13]
	Now that you see the picture together with the sentence “WARNING: Cigarettes cause fatal lung disease,” does the sentence help you understand what the picture is?
	Do the words change anything about what you think the picture is trying to tell you?
	Do the sentence and picture together teach you anything about the relationship between smoking and [death]? What?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet where you will see Item 13.
ITEM 13 (4.2e)	[PARTICIPANTS VIEW DEATH IMAGE P WITH TEXT 15]
	Now that you see the picture together with the sentence “WARNING: Smoking causes COPD, a lung disease that can be fatal,” does the sentence help you understand what the picture is? [Moderators/Notetakers: If participants ask what COPD stands for, say that you cannot provide any additional information. Notetakers should note that participants asked for more information and what they asked for.]
	Do the words change anything about what you think the picture is trying to tell you?
	Do the sentence and picture together teach you anything about the relationship between smoking and [death]? What?
Transition:	Now we are going to look at another set of items. Please turn to the next page where you will see Item 14.

TOPIC: Amputation/Sex

4.1 IMAGE DISCUSSION (~4 minutes for each image) Please take a moment to look at Item 14.
ITEM 14 (4.1e):	[PARTICIPANTS VIEW AMPUTATION IMAGE E ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet and look at Item 15.
4.2 COMPARISON IMAGE WITH TEXT DISCUSSION Now we are going to look at the same picture we just discussed along with a short sentence. This picture is supposed to be about tobacco smoke and [amputation].
ITEM 15 (4.2f)	[PARTICIPANTS VIEW AMPUTATION IMAGE E WITH TEXT 7]
	Now that you see the picture together with the sentence “WARNING: Smoking reduces blood flow to the limbs, which can require amputation,” does the sentence help you understand what the picture is?
	Do the words change anything about what you think the picture is trying to tell you?
	Do the sentence and picture together teach you anything about the relationship between smoking and [amputation]? What?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet where you will see Item 16.
4.1 IMAGE DISCUSSION (~4 minutes for each image) Please take a moment to look at Item 16.
ITEM 16 (4.1f):	[PARTICIPANTS VIEW SEX IMAGE F ALONE]
	Please tell me what you think is being shown in this picture.
	Is there anything confusing or unclear about this picture? Is there anything that you don’t know what it is?
	Do you find this picture to be realistic or accurate? Why or why not?
Verbal Instructions:	Thank you. Now please turn to the next page in your booklet and look at Item 17.
4.2 COMPARISON IMAGE WITH TEXT DISCUSSION Now we are going to look at the same picture we just discussed along with a short sentence. This picture is supposed to be about tobacco smoke and [sex].
ITEM 17 (4.2g)	[PARTICIPANTS VIEW SEX IMAGE F WITH TEXT 8]
	Now that you see the picture together with the sentence “WARNING: Smoking reduces blood flow, which can cause erectile dysfunction,” does the sentence help you understand what the picture is?
	Do the words change anything about what you think the picture is trying to tell you?
	Do the sentence and picture together teach you anything about the relationship between smoking and [sex]? What?
Transition:	Thank you. Now please turn to the next page in your booklet.

5. INDIVIDUAL ASSESSMENT (5 minutes)

We just talked about several picture and sentence combinations. This individual worksheet in Part 2 contains all the pictures we just talked about and some that we may not have reviewed. We would like to get your opinion on how the pictures compare to each other. Please take five minutes to fill out the worksheet.

[PARTICIPANTS COMPLETE WORKSHEET INDIVIDUALLY – SEE PART 2 - PARTICPANT BOOKLET]

6. CLOSING (1 minute)

That concludes the questions I have for you. Let me check in the back to see if there are any additional questions they have for you.

[RETURN TO ROOM TO ASK QUESTIONS FROM OBSERVERS; IF NO QUESTIONS COMPLETE CLOSING]

I would like to thank you for coming here today and participating in this discussion. This research was sponsored by the Food and Drug Administration. Your opinions will be very useful in helping them to understand people’s reactions and thoughts about the images and statements we have talked about. If you want to get more information on the health effects of smoking there is more information on the FDA website at fda.gov/tobacco.