Participant Feedback Questionnaire

Form Approved

OMB No. 0920-0910

Exp. Date 03/31/2018

National Tobacco Education Campaign

Participant Feedback Questionnaire for
Creative Concept Testing

Public reporting burden of this collection of information is estimated to average 5 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).

FOCUS GROUP NUMBER: _______________ CREATIVE CONCEPT VIEWED: ONE

Question 1. Please indicate how much you can relate to what you saw and heard in the ad, with 1 meaning that you “do not relate at all,” and 7 meaning that you “relate a lot.”

1	2	3	4	5	6	7
I do not relate at all						I relate a lot

Question 2. In one sentence, please explain why you selected the answer in question 1.

Question 3. People have different emotional reactions when they see ads like the ones you just saw. On a scale from 1 to 5, please indicate how much this ad made you feel shame.

1	2	3	4	5
I did not feel any shame	I felt a small amount of shame	I felt a moderate amount of shame	I felt an intense amount of shame	I felt an extreme amount of shame

Question 4. If you circled 2 through 5 in Question 3, how does this shame affect how you feel about quitting traditional cigarettes? Why?

Question 5. On a scale from 1 to 5, please indicate how much this ad made you feel angry.

1	2	3	4	5
I did not feel any anger	I felt a small amount of anger	I felt a moderate amount of anger	I felt an intense amount of anger	I felt an extreme amount of anger

Question 6. If you circled 2 through 5 in Question 6,, how does this anger affect how you feel about quitting traditional cigarettes? Why?

Question 7. Does this ad suggest that smokers are “bad people”?

1. Yes

2. No

FOCUS GROUP NUMBER: _______________ CREATIVE CONCEPT VIEWED: TWO

Question 1. Please indicate how much you can relate to what you saw and heard in the ad, with 1 meaning that you “do not relate at all,” and 7 meaning that you “relate a lot.”

1	2	3	4	5	6	7
I do not relate at all						I relate a lot

Question 2. In one sentence, please explain why you selected the answer in question 1.

Question 3. People have different emotional reactions when they see ads like the ones you just saw. On a scale from 1 to 5, please indicate how much this ad made you feel shame.

1	2	3	4	5
I did not feel any shame	I felt a small amount of shame	I felt a moderate amount of shame	I felt an intense amount of shame	I felt an extreme amount of shame

Question 4. If you circled 2 through 5 in Question 3, how does this shame affect how you feel about quitting traditional cigarettes? Why?

Question 5. On a scale from 1 to 5, please indicate how much this ad made you feel angry.

1	2	3	4	5
I did not feel any anger	I felt a small amount of anger	I felt a moderate amount of anger	I felt an intense amount of anger	I felt an extreme amount of anger

Question 6. If you circled 2 through 5 in Question 6,, how does this anger affect how you feel about quitting traditional cigarettes? Why?

Question 7. Does this ad suggest that smokers are “bad people”?

1. Yes

2. No

FOCUS GROUP NUMBER: _______________ CREATIVE CONCEPT VIEWED: THREE

Question 1. Please indicate how much you can relate to what you saw and heard in the ad, with 1 meaning that you “do not relate at all,” and 7 meaning that you “relate a lot.”

1	2	3	4	5	6	7
I do not relate at all						I relate a lot

Question 2. In one sentence, please explain why you selected the answer in question 1.

Question 3. People have different emotional reactions when they see ads like the ones you just saw. On a scale from 1 to 5, please indicate how much this ad made you feel shame.

1	2	3	4	5
I did not feel any shame	I felt a small amount of shame	I felt a moderate amount of shame	I felt an intense amount of shame	I felt an extreme amount of shame

Question 4. If you circled 2 through 5 in Question 3, how does this shame affect how you feel about quitting traditional cigarettes? Why?

Question 5. On a scale from 1 to 5, please indicate how much this ad made you feel angry.

1	2	3	4	5
I did not feel any anger	I felt a small amount of anger	I felt a moderate amount of anger	I felt an intense amount of anger	I felt an extreme amount of anger

Question 6. If you circled 2 through 5 in Question 6,, how does this anger affect how you feel about quitting traditional cigarettes? Why?

Question 7. Does this ad suggest that smokers are “bad people”?

1. Yes

2. No

FOCUS GROUP NUMBER: _______________ CREATIVE CONCEPT VIEWED: FOUR

Question 1. Please indicate how much you can relate to what you saw and heard in the ad, with 1 meaning that you “do not relate at all,” and 7 meaning that you “relate a lot.”

1	2	3	4	5	6	7
I do not relate at all						I relate a lot

Question 2. In one sentence, please explain why you selected the answer in question 1.

Question 3. People have different emotional reactions when they see ads like the ones you just saw. On a scale from 1 to 5, please indicate how much this ad made you feel shame.

1	2	3	4	5
I did not feel any shame	I felt a small amount of shame	I felt a moderate amount of shame	I felt an intense amount of shame	I felt an extreme amount of shame

Question 4. If you circled 2 through 5 in Question 3, how does this shame affect how you feel about quitting traditional cigarettes? Why?

Question 5. On a scale from 1 to 5, please indicate how much this ad made you feel angry.

1	2	3	4	5
I did not feel any anger	I felt a small amount of anger	I felt a moderate amount of anger	I felt an intense amount of anger	I felt an extreme amount of anger

Question 6. If you circled 2 through 5 in Question 6,, how does this anger affect how you feel about quitting traditional cigarettes? Why?

Question 7. Does this ad suggest that smokers are “bad people”?

1. Yes

2. No

Thank you! Please hand this form in to the moderator (do not put your name on it).