OSH Media Rough Cut Survey

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Form Approved
OMB No. 0920-0910
Exp. Date 03/31/2018








National Tobacco Education Campaign

Online Questionnaire Recruitment Screener for 
Creative Concept Testing 























Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0910).
{PREAMBLE}

On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking related advertising and messages that you might see in the media, such as on TV or the internet. Your opinions are very important to us!  The purpose of this survey is to gather your opinions on health and smoking-related advertising only; it is not to see products.  We will not report your answers individually. We will report results from this survey for the group as a whole. Thank you for taking the time to help us!  It will take about 2 minutes to determine your eligibility and about 13 minutes to complete the survey. Immediately upon completion of the survey, you will be provided with points equivalent to $0.50.
	
Your participation in this survey is voluntary. You may stop participating at any time.

{Demographic Information}

DAGE2. What is your current age, in years? 
_ _ _ age in years	
{Open-end}

999	Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Terminate if <18 years old or >54 - go to GENERAL SCREEN OUT MESSAGE}

DEMO2: What state do you live in?
    01 Alabama
    02 Alaska
    03 Arizona
    04 Arkansas
    05 California
    06 Colorado
    07 Connecticut
    08 Delaware
    09 Florida
    10 Georgia
    11 Hawaii
    12 Idaho
    13 Illinois
    14 Indiana
    15 Iowa
    16 Kansas
    17 Kentucky
    18 Louisiana
    19 Maine
    20 Maryland
    21 Massachusetts
    22 Michigan
    23 Minnesota
    24 Mississippi
    25 Missouri
    26 Montana
    27 Nebraska
    28 Nevada
    29 New Hampshire
    30 New Jersey
    31 New Mexico
    32 New York
    33 North Carolina
    34 North Dakota
    35 Ohio
    36 Oklahoma
    37 Oregon
    38 Pennsylvania
    39 Rhode Island
    40 South Carolina
    41 South Dakota
    42 Tennessee
    43 Texas
    44 Utah
    45 Vermont
    46 Virginia
    47 Washington
    48 West Virginia
    49 Wisconsin
    50 Wyoming
    51 District of Columbia
    52 Other please specify



{Smoking Behavior}

{PREAMBLE}

The next questions are about traditional cigarettes, which are any form of tobacco wrapped in paper. Traditional cigarettes typically come in packs of 20, and some brand examples include Marlboro, Newport, Camel, Lucky Strike and Pall Mall. 
	
{Base = All respondents}
TS1. Have you smoked at least 100 traditional cigarettes in your entire life?  
    01 Yes 
    02 No {GENERAL SCREEN OUT MESSAGE}
    03 Don’t know/not sure {GENERAL SCREEN OUT MESSAGE}
    04 Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Base = TS1 = 01}
TS2. Do you now smoke traditional cigarettes every day, some days, or not at all?
    01 I smoke every day
    02 I smoke on some days
    03 I do not smoke at all {GENERAL SCREEN OUT MESSAGE}

{Base = TS2 = 01, 02}
TS3.  On how many of the past 30 days did you smoke traditional cigarettes?
Enter number: _______
777 Don’t know/Not Sure {GENERAL SCREEN OUT MESSAGE}
999 Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Terminate if Respondent answers TS3 = 0, show GENERAL SCREEN OUT MESSAGE}

{If Respondent answers TS1 = 1 AND (TS2 = 1 or TS2 = 2) AND answers TS3 > 0, show GENERAL ELIGIBILITY MESSAGE and go to E-Cigarette Behavior}
{E-Cigarette Behavior} 

{PREAMBLE} 	

The next questions are about electronic vapor products. These are devices that usually contain a nicotine
based liquid that produces an aerosol that is inhaled by the user. You may also know them as e-cigarettes,
vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e
pipes), e-vaporizers, or tank systems. Some brand examples are Blu, NJOY, Vuse, MarkTen, and Starbuzz. For
the rest of this survey we will call all of the products in this category “e-cigarettes.”

{Base = All Current Smokers}
E1. Have you ever used an e-cigarette, even one time?
    01 Yes
    02 No 

{Base = E1 = 01}
E2. Do you now use e-cigarettes…?
    01 Every day
    02 Some days
    03 Not at all 

{Base = E2 = 01 or 02}
E3. On how many of the past 30 days did you use an e-cigarette?
Enter number: _______
777 Don’t know/Not Sure 
999 Prefer not to answer 

{If E1 = 01 AND E2 = 01 or 02, then segment as “Dual User,” show GENERAL ELIGIBILITY MESSAGE}

{Quota Groups}

Segments
Definition
Criteria
Exclusive Conventional Cigarette Smokers 

Smokers who use only conventional cigarettes between ages 18-54 
IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND (E1 = 02 OR E2 = 03) 
Young Adult Exclusive Conventional Cigarette Smokers
Smokers who use only conventional cigarettes between ages 18-26
IF “Exclusive Conventional Cigarette Smokers” AND DAGE2 = 18-26 (1998-1990)
Dual Users
Dual users of conventional cigarettes and e-cigarettes between ages 18-54
IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND E1 = 01 AND E2 = 01 or 02 
Young Adult Dual Users
Dual users of conventional cigarettes and e-cigarettes between ages 18-26
IF “Dual Users” AND DAGE2 = 18-26 (1998-1990)
{GENERAL SCREEN OUT MESSAGE}
Thank you for your participation in this study.  Unfortunately, your responses indicate that you do not fit the specific criteria needed for this particular study, or that we have already reached our required quota of responses from participants similar to you.  We appreciate your enthusiasm for our study and hope you will join us on future surveys!

{GENERAL ELIGIBILITY MESSAGE}
Thank you for your participation in this study. Your responses indicate that you qualify and fit the specific criteria needed for this particular study.  Click “next” to go to the next question.