Qualitative Study on Acute Nicotine Toxicity Warnings for E-Liquids: Knowledge, Beliefs, and Perceptions

OMB No. 0910-0796

Exp. 06/30/18

Participant ID:_________

RTI/FDA Focus Groups - Adults
Screening Questionnaire

Qualitative Study on Acute Nicotine Toxicity Warnings for E-Liquids

Hello, this is _____________ from [FACILITY NAME], a local market research firm. May I please speak to_____________?

(Hello, this is _____________ from [FACILITY NAME], a local market research firm.) We are working with RTI International, a nonprofit research organization, and the Food and Drug Administration (FDA) on a research study about tobacco products, and would like to include your opinions. I want to assure you that we are not from a tobacco company or a company that sells quit-smoking aids.

We are holding a group discussion on [DATE] with approximately 11 other people like you. The discussion group starts at [TIME] and will last no longer than 60 minutes, as part of the discussion group you will also be asked to fill out a worksheet. For study purposes, the group discussion will be audio recorded, and other staff will observe the discussion in person or through livestreaming.

In appreciation for your participation, you will be reimbursed for your time, effort, and travel expenses. Participation in the groups is completely voluntary and your responses will be kept private to the extent allowable by law. Would it be OK if I ask you a few questions now in order to see if you are eligible to be in one of the groups?

Yes – Continue.

No – Thank and end call.

Q1. How old will you be on [DAY], [DATE]?

< 17 years Administer Youth Screener

18–24 Recruit for YA group.

25–34 Recruit a mix for Adult group.

35–49 Recruit a mix for Adult group.

50-65 Recruit a mix for Adult group.

>66 Thank and end call.

Q2. On a scale of 1-5, how comfortable are you understanding and speaking English? 1 is very uncomfortable, 3 is somewhat comfortable, and 5 is very comfortable. ______________

[TERMINATE if 4 or lower]

Q3. On a scale of 1-5, how comfortable are you talking in a group of people your age? 1 is very uncomfortable, 3 is somewhat comfortable, and 5 is very comfortable. _______________

[TERMINATE if 4 or lower]

The next questions are about electronic nicotine products, such as e-cigarettes, e-hookahs, vape pens, mods, vapes, and hookah pens. These products are battery-powered, use liquid nicotine or e-liquid rather than tobacco leaves, and produce vapor instead of smoke. Some common brands include Fin, Juul, NJOY, Blu, e-Go and Vuse.

Q4. Do you currently use any kind of electronic nicotine product?

Yes (if yes response)

How often:

Every day (go to Q5)

Some days (go to Q5)

Rarely Thank the respondent and terminate.

No Thank the respondent and terminate.

Don’t Know Thank the respondent and terminate.

Refused Thank the respondent and terminate.

Q5. Does the electronic nicotine product you use most often contain nicotine?

Yes (go to Q6)

No Thank the respondent and terminate.

Don’t Know Thank the respondent and terminate.

Refused Thank the respondent and terminate.

Some e-cigarettes can be bought as one-time, disposable products, while others can be bought as re-usable kits with a cartridge or tank system. Some people refill their own e-cigarettes with nicotine fluid, sometimes called “e-liquid” or “e-juice.”

Q6. Thinking of the electronic nicotine product you use most of the time, does it have a way for you to refill it with e-liquid or e-juice or for you to replace a part such as a cartridge when it runs out of e-liquid or e-juice?

Yes (go to Q7)

No Thank the respondent and terminate.

Don’t Know Thank the respondent and terminate.

Refused Thank the respondent and terminate.

Q7. Think about the electronic nicotine product that you use most of the time. What do you do when it runs out of e-liquid or e-juice?

You replace a cartridge or cartomizer on your electronic nicotine product

Recruit as “Closed ENDS (cartridge) user” and go to Q8.

You pour e-liquid or e-juice into the tank of your electronic nicotine product

Recruit as “Open ENDS users” and go to Q8.

You do both equally as much (replace cartridge or cartomizer and pour e-liquid or e-juice into the tank of your electronic nicotine product)

HOLD and contact RTI

Buy a new device Thank the respondent and terminate

Don’t Know Thank the respondent and terminate.

Refused Thank the respondent and terminate.

Q8. In the past 5 years, have you or any member of your household worked for any of the

following? (Read list. If yes to any, thank the respondent and terminate.)

A tobacco or cigarette company

A public health or community organization involved in communicating the dangers of smoking or the benefits of quitting

A marketing, advertising, or public relations agency or department

The Federal Government (Read list. If yes to any, thank the respondent and terminate.)

The U.S. Food and Drug Administration (FDA)

The National Institutes of Health (NIH)

The Centers for Disease Control and Prevention (CDC)

The Substance Abuse and Mental Health Services Administration (SAMHSA)

The Centers for Medicare & Medicaid Services (CMS)

The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)

The Alcohol and Tobacco Tax and Trade Bureau (TTB)

Q9. Have you or any member of your household ever lobbied on behalf of the tobacco industry or worked on behalf of a tobacco company in connection with a tobacco lawsuit?

Yes Thank the respondent and terminate.

No Continue.

Q10. Have you or any member of your household personally represented or worked on behalf of a tobacco company in connection with a tobacco lawsuit?

Yes Thank the respondent and terminate.

No Continue.

Q11. Have you participated in any paid market research in the past 6 months?

Yes Thank the respondent and terminate.

No Continue.

Q12. What is your sex? (Recruit about equal numbers of males and females per group)

Male Continue.

Female Continue.

Q13. What is the highest level of education that you have completed? (Read list. Recruit a mix to show per group. No more than two postgraduates per group.)

Less than high school diploma Continue.

High school graduate or GED Continue.

Some college or 2-year degree Continue.

College degree Continue.

Postgraduate degree Continue.

Q14. Are you Hispanic, Latino/a, or of Spanish origin?

• No, not of Hispanic, Latino/a, or Spanish origin -- Skip to Q16

• Yes

Q15. Choose all that apply.

• Mexican, Mexican American, Chicano/a

• Puerto Rican

• Cuban

• Another Hispanic, Latino/a, or Spanish origin

Q16. What is your race or ethnicity? Choose all that apply. (Read list. Recruit a mix.)

• White

• Black or African American

• American Indian or Alaska Native

• Asian Indian

• Chinese

• Filipino

• Japanese

• Korean

• Vietnamese

• Other Asian

• Native Hawaiian

• Guamanian or Chamorro

• Samoan

• Other Pacific Islander

Q17. Are there any children under the age of 6 years living in your household? They do not have to be your children. (Recruit at least 2 adults per group with children under age 6 living in household)

No

Yes

Great! You qualify for our study. The discussion group will be held on [DATE] at [TIME] and will last no longer than 60 minutes. For your time and opinions, you will receive $40 at the end of the session.

Q18. Would you like to participate in the group discussion at [TIME] on [DATE]?

Yes Continue.

No Thank the respondent and terminate.

Great! May I please have your mailing and/or e-mail address to send you a confirmation letter with directions? [Verify address and phone number.] We are asking for your contact information only for the purpose of sending you a reminder letter and giving you a call to remind you of the discussion group. We will destroy all contact information at the conclusion of the group.

We are only inviting a few people, so it is very important that you notify us as soon as possible if for some reason you are unable to attend. Please call [recruiter] at [telephone number] if this should happen. We look forward to seeing you on [date] at [time]. If you normally wear corrective lenses, contacts, or glasses to read please remember to have them with you during the focus group.

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 6 minutes per response to complete the Screener (the time estimated to read and review). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to [email protected].

Participant ID:_________

**NOTE** THIS PAGE MUST BE STORED SEPARATELY FROM THE SCREENER AND FOCUS GROUP DATA. PLEASE DESTROY UPON COMPLETION OF FOCUS GROUP.

NAME: ____________________________________________________________

ADDRESS: ________________________________________________________

CITY: _________________________________________________

ZIP CODE: _________________________________________________

E-MAIL_______________________________________________________

What is the best time to reach you? What is the best telephone number to reach you at that time?

BEST TIME TO BE REACHED: ________________________________________

BEST PHONE NUMBER: ________________________________________

Is there another time and number we can try if we miss you?

ALTERNATE TIME:

ALTERNATE PHONE NUMBER:

Thank you. That’s all the questions I have today. Please try to arrive at least 15 minutes before the starting time. If you have any questions or find that you are unable to attend, please call [facility’s phone number] as soon as possible. Thank you again for your time. We look forward to seeing you at [TIME] on [DATE].

Read if necessary:

If you have any questions about the study, you may contact Jennifer Alexander of RTI at 1‑800‑334‑8571, extension 28219. If you have concerns about how participants are being treated in the study, you may contact RTI’s Office of Research Protection toll-free at 1-866-214-2043.

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