Point-of-Sale Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Encourage Adult Smokers to Quit Smoking

Generic Clearance for the Collection of Quantitative Data on Tobacco Products and Communications

Attachment B_Screener

Point-of-Sale Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Encourage Adult Smokers to Quit Smoking

OMB: 0910-0810

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OMB# 0910-0810

Exp. 11/30/2018




Point-of-Sale Copy Testing, Screener



SCREENER


Title of Information Collection: Point-of-Sale Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Encourage Adult Smokers to Quit Smoking


Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 2 minutes per response to complete the survey (the time estimated to read and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to [email protected].



[Intro Language]


Thank you for your interest in participating in a study. We would like to ask you questions to determine your eligibility to participate in a survey about how you perceive different communication materials for a public health campaign. This eligibility survey should take about 5 minutes to complete.


Please select the next button to continue.


Question Type: Open End Text

Q1. How old are you?

Variable Label: Q1: Age




Lower Limit: 0

Upper Limit: 100


//PROGRAMMING NOTE: If Q1<25 or Q1>54, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Question Type: Multi Punch

Q2: In the past five years (including now), have you, a member of your immediate family or a close friend worked for any of the following types of businesses? Mark all that apply.

Variable Label: Q2: Profession


//PROGRAMMING NOTE: RANDOMIZE Q2_1-Q2_6//


Variable Name

Variable Text

Variable Label

Q2_1

An advertising or public relations firm

Q2_1 Profession: Advertising

Q2_2

A marketing or market research firm or department?

Q2_2 Profession: Market Research

Q2_3

A marketing or market research consultant?

Q2_3 Profession: Consultant

Q2_4

Any kind of media company – like a TV or radio station or newspaper?

Q2_4 Profession: Media

Q2_5

The federal government or a federal government agency?

Q2_5 Profession: Government Agency

Q2_6

A manufacturer or representative of tobacco?

Q2_6 Profession: Tobacco Company



//PROGRAMMING NOTE: If Q2_1-Q2_6 =1, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //







Q3: When, if ever, was the last time you participated in a marketing research study related to tobacco, such as a consumer interview or a group discussion on tobacco attitudes or behaviors?


Variable Name

Variable Text

Variable Label

Q3_1

Within the past six months

Q3_1 Study: Six Months

Q3_2

Over six months ago

Q3_2 Study: Over Six Months

Q3_3

Never

Q3_3 Study: Never


//PROGRAMMING NOTE: If Q3_1=1, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Cigarette Smoking Behavior


Question Type: Single Punch

Q4: Have you smoked at least 100 cigarettes in your entire life? (NOTE: 5 Packs=100 cigarettes)

Variable Label: Q4: Ever Smoked


Value

Value Label

01

Yes

02

No

99

Refused


//PROGRAMMING NOTE: IF Q4 ≠ 01, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Question Type: Single Punch

Q5: Do you now smoke cigarettes every day, some days, or not at all?

Variable Label: Q5: Smoke Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused


//PROGRAMMING NOTE: IF Q5=01 or Q5=99, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Question Type: Single Punch

Q6: During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

Variable Label: Q6: Quit Attempt


Value

Value Label

01

Yes

02

No

99

Refused


//PROGRAMMING NOTE: IF Q6 ≠ 01, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Cigarette Purchasing Behavior


Question Type: Multi Punch

Q7: Do you ever buy cigarettes at the following types of stores? Mark all that apply.

Variable Label: Q7: Purchase Location


//PROGRAMMING NOTE: RANDOMIZE Q7_1-Q7_6, but keep Q7_6 LAST//


Variable Name

Variable Text

Variable Label

Q7_1

Grocery Stores

Q7_1 Location: Grocery Stores

Q7_2

Drug Stores or Pharmacy

Q7_2 Location: Drug Stores

Q7_3

Convenience Stores or Gas Stations (like 7/11 of a local store)

Q7_3 Location: Convenience Stores

Q7_4

Tobacco Outlets

Q7_4 Location: Tobacco Outlets

Q7_5

Online

Q7_5 Location: Online

Q7_6

Other [open-end]

Q7_6 Location: Other [open-end]


Value

Value Label

01

Yes

02

No

99

Refused


//PROGRAMMING NOTE: IF Q7_3 ≠ 01 (is not selected), SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //


Question Type: Single Punch

Q8: How often would you say you visit convenience stores (like 7/11, or a local store)?

Variable Label: Q8: Convenience Store Frequency


Value

Value Label

01

More than daily

02

Daily

03

A few times a week

04

Once a week

05

Once a month

06

Less than once a month

99

Refused

//PROGRAMMING NOTE: IF Q8=06 or Q8=99, SKIP TO TERMINATION PAGE; OTHERWISE CONTINUE //



Other Forms of Tobacco Behavior (Poly-Users)


Question Type: Single Punch

Q9: Have you ever…


//PROGRAMMING NOTE: RANDOMIZE Q9_1-Q9_5//


Variable Name

Variable Text

Variable Label

Q9_1

Smoked a cigar, even one or two puffs?

Q 9_1: Ever Cigar

Q9_2

Smoked a cigarillo or little cigar (for example, Black & Mild or Swisher Sweets), even one or two puffs?

Q9_2: Ever Cigarillo

Q9_3

Used or tried any smokeless tobacco products such as chewing tobacco, snuff, or snus?

Note: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches, that is placed under the lip against the gum.

Q9_3: Ever Chew

Q9_4

Tried an electronic cigarette, or e-cigarette, even just one time?

Q9_4: Ever Electronic Cigarette

Q9_5

Tried ever tried smoking tobacco from a hookah or a waterpipe, even just one time?

Q9_5: Ever Hookah



Value

Value Label

01

Yes

02

No

99

Refused



//PROGRAMMING NOTE: ASK Q10_1 if Q9_1=1, OTHERWISE CONTINUE //


Question Type: Single Punch

Q10_1: Do you now smoke cigars every day, some days, or not at all?

Variable Label: Q10_1: Cigar Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused



//PROGRAMMING NOTE: ASK Q10_2 if Q9_2=1, OTHERWISE CONTINUE //


Question Type: Single Punch

Q10_2: Do you now smoke cigarillos or little cigars (for example, Black & Mild or Swisher Sweets), every day, some days, or not at all?

Variable Label: Q10_2: Cigarillo Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused


//PROGRAMMING NOTE: ASK Q10_3 if Q9_3=1, OTHERWISE CONTINUE //


Question Type: Single Punch

Q10_3: Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all?

Variable Label: Q10_3: Chew Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused


//PROGRAMMING NOTE: ASK Q10_4 if Q9_4=1, OTHERWISE CONTINUE //


Question Type: Single Punch

Q10_4: Do you currently use an electronic cigarette, or e-cigarette, every day, some days, or not at all?

Variable Label: Q10_4: Electronic Cigarette Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused


//PROGRAMMING NOTE: ASK Q10_5 if Q9_5=1, OTHERWISE CONTINUE //


Question Type: Single Punch

Q10_5: Do you currently smoke tobacco from a hookah or a waterpipe every day, some days, or not at all?

Variable Label: Q10_5: Electronic Cigarette Frequency


Value

Value Label

01

Not at all

02

Some days

03

Every day

99

Refused



Demographics


Question Type: Single Punch

Q11: What is your gender?

Variable Label: Q11: Gender


Value

Value Label

01

Male

02

Female

99

Refused


Question Type: Multi Punch

Q12: Which of the following best describes your racial or ethnic background? Mark all that apply.

Variable Label: Q12: Race


Variable Name

Variable Text

Variable Label

Q12_1

White or Caucasian

Q12_1 Race: White or Caucasian

Q12_2

Black or African American

Q12_2 Race: Black or African Americans

Q12_3

Asian

Q12_3 Race: Asian

Q12_4

Hispanic or Latino

Q12_4 Race: Hispanic or Latino

Q12_5

Native American or Alaska Native

Q12_5 Race: Native American or Alaska Native

Q12_6

Native Hawaiian or Other Pacific Islander

Q12_6 Race: Native Hawaiian or Other Pacific Islander

Q12_7

Mixed or Other

Q12_7 Race: Mixed or Other



Question Type: Date

Q13: What is your birthdate?

Variable Label: Q13: Birthdate


//PROGRAMMER NOTE: DATE CAPTURE TOOL//





Question Type: Open End Numerical

Q14: What is your zip code?

Variable Label: Q14: Zip Code


//PROGRAMMER NOTE: ONLY ALLOW 5 DIGIT NUMBERS//






[TERMINATION LANGUAGE]


Thank you for completing this survey. Unfortunately, based on the responses you provided, you do not meet the specifications we are looking for in this study. We appreciate your time today in answering the questions.


Additional termination language shown to potential participants who have been asked questions about tobacco use but do not screen in for the study:


If you are thinking about quitting, you are advised to speak with your healthcare provider for more information on ways to quit tobacco that could work for you.



[ELIGIBILITY LANGUAGE]


Thank you for your time today. We would like to invite you to participate in a survey. Please select the next button to continue.





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AuthorNikkita Sarna
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