Attachment E Comparison of Items

E - Comparison of Items.xlsx

Health Information National Trends Survey 4 (HINTS 4) (NCI)

Attachment E Comparison of Items

OMB: 0925-0538

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Overview

A. Construct Overview by Survey
B. HINTS-FDA Items

Sheet 1: A. Construct Overview by Survey
Survey Years Conducted Sample size Mode Study Design Primary purpose
HINTS communication core Tobacco Message Exposure Source/Frequency/Reaction Tobacco use phenotypes Menthol Product constituents Risk perceptions about tobacco products Attitudes and beliefs about product regulation Tobacco product claims and labels
2014-2015 TUS-CPS 1992-1993, 1995-
1996, 1998-1999,
2000, 2001-2002,
2003, 2006-2007, and 2010-11
 ~ 240,000 64% by telephone and 36% in
person
 Cross-sectional NCI-sponsored survey of tobacco use administered as part of the US Census Bureau's Current Population Survey
No No Yes Yes No No No No
2014 NHIS Annually, since 1957 ~ 35,000 households In-person Cross-sectional NHIS data on a broad range of health topics are collected through personal household interviews. The U.S. Census Bureau is the data collection agent.
No No Yes No No No No No
2013 BRFSS Annually, since 1984 More than 500,000 adults are interviewed each year Telephone Cross-sectional BRFSS collects data via telephone in all 50 states plus DC on health-related risk behaviors and events (including tobacco use), chronic health conditions, and use of preventive services.
No No Yes No No No No No
2013-2014 ATS-CDC / NATS 33 CDC supported ATS's were conducted in 19 states from 2003-
2007; 2009 - Present NATS (yearly)
 ~75,000 RDD design telephone survey (Final questionnaires were developed by each state) Cross-sectional NATS seeks to determine tobacco use prevalence and the factors promoting and impeding tobacco use among adults in a nationally representative sample of adults and will provide time-critical monitoring data needed to evaluate the effectiveness of new regulatory authorities given to FDA under the Family Smoking Prevention and Tobacco Control Act (the Tobacco Control Act)
No Yes Yes Yes Yes Yes No No
2013 NSDUH Periodically since
1972 and annually since 1991
 Approximately 70,000 individuals, age 12 and older In-person interviews with sample persons Cross-sectional The NSDUH provides data on prevalence and correlates of substance use, serious mental illness, related problems, and treatment in the civilian population aged 12 or older in the U.S.
No No Yes Yes No No No No
2013 NYTS and 2014 NYTS 1999, 2000, 2002,
2004, 2006, 2009, 2011, 2012		 18,406 in 2013 In school, self- administered survey via pencil Cross-sectional The NYTS provides prevalence estimates for selected tobacco use behaviors among middle
school and high school students regarding tobacco.
No Yes Yes Yes No Yes No No
2015 YRBS Every odd year since
1991
 ~15,000 School-based, self-administered questionnaire Cross-sectional The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults.
No No Yes No No No No No
2012 MTF Annually since 1975 ~50,000 School-based, self-administered questionnaire
with mailed follow up
 Cross-sectional with annual follow-up mailed questionnaires among a sample of each graduating class. MTF is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults.
No No Yes No No Yes No No
2011 YTS Periodically since
1999 in participating states		 ~27,000, varies by year and state School-based survey of students in grades 6 through 12. Cross-sectional The YTS is intended to enhance the capacity of agencies and organizations to design, implement, and evaluate tobacco prevention and control programs.
No Yes Yes Yes No Yes No No
2013-2014 NHANES A series of surveys since 1959; 1999-
2000, 2001-02, 2003-
04, 2005-06, 2007-08, 2009-10, 2011-12, 2013-14		 ~5,000 In-person inteviews and physician examinations Cross-sectional NHANES findings are used to determine the prevalence of major diseases and risk factors for diseases, assess nutritional status and its association with health promotion and
disease prevention.
No No Yes Yes No No No No
2013 Adult PATH Baseline data collection began in September 2013 and followed annually for at least two additional data collection waves ~60,000 In-person Longitudinal PATH findings will be used to inform FDA's regulatory authority over tobacco products.
No Yes Yes Yes Yes Yes No No
HINTS 2003, 2005, 2007, yearly from 2011-2014 (in progress) ~3,500 Mailed survey; additional RDD telephone sample in 2005 Cross-sectional NCI-sponsored survey that collects nationally representative data routinely about adults’ access to and use of health information in the broad public communication environment. The FDA Cycle will collect data relevant to the Family Smoking Prevention and Tobacco Control Act. Data will be used to inform FDA’s tobacco prevention campaigns and tobacco control outreach and education.
Yes Yes Yes Yes Yes Yes Yes Yes

Sheet 2: B. HINTS-FDA Items
Item Text Item number 2014-2015 TUS-CPS 2014 NHIS 2013 BRFSS 2013-2014 NATS 2013 NSDUH 2013 NYTS and 2014 NYTS 2015 YRBS 2012 MTF 2011 YTS 2013-2014 NHANES 2013 Adult PATH Justification for Inclusion in Instrument
HINTS Communication Core
Have you ever looked for information on electronic cigarettes from any source? Y/N A8 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' electronic-cigarette-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
What kinds of information on electronic cigarettes have you ever looked for from any source?
0 Health effects
0 Using electronic cigarettes to quit or reduce smoking
0 List of chemicals in electronic cigarettes
0 Cost/Coupons
0 Instructions/Tutorials
0 Where to buy
0 Reviews/Ratings of brands
0 Something else – Specify
A9 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' electronic-cigarette-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
What information did you look for the most recent time you looked for information about electronic cigarettes?
0 Health effects
0 Using electronic cigarettes to quit or reduce smoking
0 List of chemicals in electronic cigarettes
0 Cost/Coupons
0 Instructions/Tutorials
0 Where to buy
0 Reviews/Ratings of brands
0 Something else – Specify
[Mark only one]		 A10 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' electronic-cigarette-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
In general, how much would you trust information about the health effects of electronic cigarettes from each of the following? [scale]
a. a doctor/ pharmacist / health care provider;
b. Family or friends;
c. Government health agencies (e.g., the Food and Drug Administration (FDA), National Institutes of Health (NIH) or Centers for Disease Control and Prevention (CDC);
d. Health organizations or groups (such as the American Cancer Society, American Lung Association or others);
e. Religious organizations and leaders;
f. Tobacco companies
g. Electronic cigarette companies		 A11 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' tobacco-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
Have you ever looked for any of the following information about tobacco products (e.g., cigarettes, cigars, or chewing tobacco) from any source?
0 Health effects
0 Products that claim to reduce exposure to certain chemicals or present less risk of disease
0 Quitting help/information
0 List of chemicals in tobacco products
0 Cost/Coupons
0 Instructions/Tutorials
0 Where to buy
0 Information about new kinds of tobacco products
0 Never looked for any of this information
0 Something else – Specify
[Mark all that apply]		 A12 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' tobacco-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
If you have looked for information about tobacco products, what information did you look for the most recent time you looked?
0 Health effects
0 Products that claim to reduce exposure to certain chemicals or present less risk of disease
0 Quitting help/information
0 List of chemicals in tobacco products
0 Cost/Coupons
0 Instructions/Tutorials
0 Where to buy
0 Information about new kinds of tobacco products
0 Something else – Specify
[Mark all that apply]		 A13 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' tobacco-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
Overall, how confident are you that you could get health information about tobacco products if you needed it?
[scale]
 A14 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This question is a variation a standard question in the HINTS “communication core,” which allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. This question will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education, by allowing investigators to assess how respondents' self-efficacy about tobacco-specific information seeking is associated with their tobacco use behaviors, knowledge, etc.
In general, how much would you trust information about the health effects of using tobacco from each of the following? [scale]
a. a doctor/ pharmacist / health care provider;
b. Family or friends;
c. Government health agencies (e.g., the Food and Drug Administration (FDA), National Institutes of Health (NIH) or Centers for Disease Control and Prevention (CDC);
d. Health organizations or groups (such as the American Cancer Society, American Lung Association or others);
e. Religious organizations and leaders;
f. Tobacco companies 		A15 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This question is unique to the HINTS program and assesses trust in different sources about tobacco. This allows investigators to assess how public information exposure and information seeking influence health knowledge, attitudes, and behavior at the population level. A similar item is contained in the HINTS "communication core", however this item is specific to information about tobacco. This item will be integral to informing FDA’s tobacco prevention campaigns and tobacco outreach and education. By allowing investigators to assess how respondents' trust in tobacco information sources is associated with their tobacco use behaviors, knowledge, etc., we will gain a better understanding of outlets that may be best used to reach particular populations. Trust questions are particularly important for planning campaigns and outreach efforts.
Tobacco Message Exposure Source/Frequency/Reaction
In the past 30 days, how often have you seen, heard, or read a message about the health effects of tobacco use from each of the following sources? [scale]:

a. Television
b. News websites (e.g. CNN.com)
c. Health websites (e.g. WebMD.com)
d. Government websites (e.g. FDA.gov)
e. Social Media (such as Facebook or Twitter)
f. Magazine
g. Newspaper
h. Radio
i. Billboard
j. Public transportation
k. Mailings
l. Community event
m. Point of sale (such as at or inside convenience stores, drug stores or supermarkets)
A16 Not included Not included Not included Similar "In the past 30 days, have you noticed any health warnings on tobacco advertisements in stores
where tobacco products are sold?"		 Not included Not included Not included Not included Not included Not included Similar "Thinking about everything that happens around you, in the last 6 months -- since [6 month anchor] -- how often have you noticed things that promote tobacco? " (individual questions for Point of sale and email) This question assesses both the types and frequency of tobacco messaging that people are exposed to, as well as the sources from which people receive exposure to both pro- and anti-tobacco messaging. It is much more detailed than similar questions found on other surveys, and its level of detail is consistent with the objectives of HINTS, as the government's primary survey for assessing communication-related constructs. Assessing this level of tobacco message exposure will help to inform CTP's regulatory authority and activities, particularly around campaign planning and outreach and education.
Tobacco use phenotypes
Have you smoked at least 100 cigarettes in your entire life? Y/N C1 Included Included Included Included Included Similar "About how many cigarettes have you smoked in your entire life?"
 Not included Not included Similar "About how many cigarettes have you smoked in your entire life?" Included Similar "How many cigarettes have you smoked in your entire life? A pack usually has 20 cigarettes in it." This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Do you now smoke cigarettes every day, some days or not at all?
0 Everyday    
0 Some days   
0 Not at all
 C2 Included Included Included Included Not included Similar " During the past 30 days, on how many days did you smoke cigarettes?" Similar "33. During the past 30 days, on how many days did you smoke cigarettes?" Similar "How frequently have you smoked cigarettes during the past
30 days?"		 Similar "During the past 30 days, on how many days did you smoke cigarettes?" Included Indirect "On average, about how many cigarettes do you now smoke each day? A pack usually has 20 cigarettes in
it."		 This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Are you seriously considering quitting smoking cigarettes in the next six months? Y/N C3 Included Not included Not included Similar " Are you thinking about quitting cigarettes for good?"
If yes, "How soon are you likely to quit smoking? Would you say…
1. within the next 30 days
2. within the next 6 months
3. within the year
4. longer than a year"		 Not included Similar "Are you seriously thinking about quitting cigarettes?…" [MC 30 Days to over a year] Not included Not included Not included Not included Similar "When do you plan to quit for good?" This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
About how long has it been since you completely quit smoking cigarettes?
0 Less than 2 weeks
0 2 weeks to less than 1 month ago
0 1 month to less than 3 months ago
0 3 months to less than 6 months ago
0 6 months to less than 1 year ago
0 1 year to less than 5 years ago
0 5 years to less than 15 years ago
0 15 years ago or more
 C4 Included (But not MC) Similar "How long has it been since you quit smoking cigarettes?" (Not MC) Similar "How long has it been since you last smoked a cigarette, even one or two puffs? (MC)" Included Not included Not Included Not included Not included Not included Similar "How long has it been since you quit smoking cigarettes?" (Not MC) Included This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
How much do you agree or disagree with this statement: smoking behavior is something basic about a person that they can't change very much [scale] C5 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item is unique to HINTS. It is used to assess beliefs about whether smoking behavior can be changed, and is analyzed in conjunction with other health behavior and communication variables in the survey, and is derived from Carol Dweck’s Self-Theories which are associated with self-beleifs about the ability to engage in a behavior.
There are a number of resources that people use to help them stop smoking such as telephone quitlines (e.g., 1-800-QUIT-NOW) or websites (e.g., www.smokefree.gov)

Before being contacted for this survey (and regardless of whether or not you smoke), had you ever heard of telephone quitlines or websites for help with quitting smoking?
Y/N		 C6 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item assesses awareness of cessation resources. This information could be used to improve public communication about such resources as well as examining the communication patterns and tobacco use patterns of those that are aware or not of these resources.
Have you ever called a telephone quitline or visited a website for help with quitting smoking? C7 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item assesses use of cessation resources. This information could be used to improve public communication about such resources as well as examining the communication patterns and tobacco use patterns of those that use those resources.
How likely would you be to call a quitline or visit a website for help with quitting smoking in the future? [scale] C8 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item assesses use of cessation resources. This information could be used to improve public communication about such resources as well as examining the communication patterns and tobacco use patterns of those that use those resources.
How many cigars, cigarillos, or little filtered cigars have you smoked in your entire life? Some popular brands include Macanudo, Romeo y Julieta, Black and Mild, Swisher Sweets, Prime Time, and Cheyenne. [scale] C9 Not included Not included Not included Similar "Have you smoked cigars, cigarillos, or little filtered cigars at least 50 times in your entire life?" Not included Not Included Not included Not included Not included Not included Included This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Do you now smoke cigars, cigarilllos or little cigars every day, somedays, or not at all? C10 Included Not included Not included Similar "Do you now smoke cigars, cigarillos, or little filtered cigars every day, some days, rarely, or not
at all?		 Not included Similar "During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?" Similar "40. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?" Not included Similar "During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?" Not included Indirect "On average, about how many [CIGARFILL]s do you now smoke each day?" This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Is the size of the cigars, cigarillos, or litle filtered cigars that you usually smoke
0 Regular or large cigars like Macanudo, Romeo y Julieta, Arturo Fuente, or others
0 Medium cigars or cigarillos like Black and Mild, Swisher Sweets, Dutch Masters, Phillies Blunts, or others
0 Little filtered cigars like Prime Time little filtered cigars, Winchester little filtered cigars, or others
[Mark only one]
 C11 Similar "During the PAST 30 days, what type of CIGAR did you use MOST OFTEN?

(1) Regular/large cigars
(2) “Cigarillos”
(3) Little, filtered cigars

UNREAD codes:
(4) none of the above;
(5) more than one of the above;
"		 Not included Not included Included Not included Not Included Not included Not included Not included Not included Similar "Please look at the picture below. Which one is the length of the [CIGARFILL] you usually smoke?" This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Before this survey, which of the following tobacco products have you ever heard of?
Mark all that apply.
0 Hookah or water pipe filled with tobacco
0 Electronic Cigarettes (such as blu, NJOY or Logic, also known as vape-pens, hookah-pens, e-hookahs, or e-vaporizers)
0 Pipe filled with tobacco
0 “Roll your own” cigarettes
0 Snus (such as Camel snus, General snus, Marlboro snus, and Nordic Ice)
0 I have not heard of any of these tobacco products
C12 Not included Not included Not included Similar only asks "Before today, had you ever heard of electronic cigarettes or e‐cigarettes?" Not included Included 2013, Not included 2014 Not included Not included Not included Not included Included (as multiple items) This question assesses awareness of “new and emerging” tobacco products that are of interest to CTP. This item will be used to get a population-level scan of awareness, but more importantly awareness of these products will be examined in the context of exposure to tobacco-relevant messaging through various media channels, risk perceptions of tobacco products and trust in various information sources. This information will be used by CTP to inform its regulatory authority over certain traditional tobacco products and its communication campaigns and education outreach efforts.
Which of the following tobacco products have you ever tried even once?
0 Hookah or water pipe filled with tobacco
0 Electronic Cigarettes (such as blu, NJOY or Logic)
0 Pipe filled with tobacco
0 “Roll your own” cigarettes
0 Snus (such as Camel, Marlboro, Skoal or Swedish Match snus)
0 I have never tried any of these tobacco products
[Mark all that apply]		 C13 Included (separate questions) Does not include "Roll your own" Not included Not included Similar- Separate questions: Ever used an electronic cigarette, ever tried snus, ever smoked tobacco in a hookah. However, does not address ever trying "Roll your own" Not included Included Not included Not included Included Not included Similar- Separate questions for each This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Have you used chewing tobacco, snus, snuff, or dip, at least 20 times in your entire life? Some popular brands include Redman, Levi Garrett, Beechnut, Skoal or Copenhagen, Y/N C14 Not included Not included Not included Similar " Have you used chewing tobacco, snuff or dip at least 20 times in your entire life?" Not included Not Included Not included Not included Not included Not included Similar "How many [times I snus pouches] have you used [smokeless tobacco] in your entire life?" This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.

Do you now use chewing tobacco, snus, snuff or dip every day, some days, or not at all?
[scale]		 C15 Similar "(Do you/Does [name]) NOW (smoke/use) [fill entry in J1a] every day, some days or not at all?"

J1a@4 SMOKELESS tobacco, such as moist snuff, dip, spit, chew tobacco or snus. 		Smiliar "Do you NOW use smokeless tobacco products every day, some days, rarely, or not at all?" Similar "Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all?" Similar "Do you now use chewing tobacco, snuff, or dip every day, some days, rarely, or not at all?" Similar 2 separate questions- "In the past 30 days, have you used [snuff/ chewing tobacco] even once" Similar 2013 "During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?"

Similar 2014 "During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?"		 Similar "During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?" Not included Similar "During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?" Not included Similar "On average, about how many [times do you now use smokeless tobacco each day I snus pouches do you
now use each day]?"		 This question will be used to assess tobacco use. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Were any of the tobacco products you used in the past 30 days flavored to taste like menthol (mint), clove, spice, alcohol (wine, cognac), candy, fruit, chocolate, or other sweets? Y/N/Don't know/ Have not used… C16 Similar "Some tobacco products come in flavors such as menthol or mint, clove, spice, candy, fruit, chocolate, alcohol, or other flavors."

"When you ….[fill as appropriate entry J2a1- 3 – smoke a cigar /smoke a regular pipe
filled with tobacco / smoke a water/hookah pipe filled with tobacco
(for Jnflvr (1-3) / use an E-cigarette (for Jnflv35) /
use smokeless tobacco / use dissolvable tobacco (for Jnflvr (4-5)] ..
….. is it usually flavored?
"		 Not included Not included Included Not included Similar 2013 "In the past 30 days, which of the following products have
you used on at least one day? (You can CHOOSE ONE
ANSWER or MORE THAN ONE ANSWER)- (e) Flavored little cigars (such as mint, clove, spice,
alcohol (wine, cognac), candy, fruit, chocolate, or
other sweets)
Simlar 2014 "Which of the following tobacco products that you used in the past 30 days were flavored to taste like menthol (mint), alcohol (wine, cognac), candy, fruit, chocolate, or other sweets? (CHOOSE ALL THAT APPLY)-MC		 Not included Not included Not included Not included Similar "[Is / was] [your regular brand I the last brand] you [use I used] flavored to taste like menthol, mint, clove,
spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?"		 This question will be used to assess tobacco use, specifically flavored tobacco products. Along with other questions in this section it will allow analysts to categorize respondents and never/former/current users of various flavored tobacco products to allow for stratified analysis or including those tobacco use variables in other analyses.
Of the five closest friends or acquantances that you spend time with on a regular basis, how many of them use any kind of tobacco? [0-5] C17 Not included Not included Not included Not included Not included Included 2013, Not included 2014 Not included Not included Not included Not included Not included These items assess potential social norms about tobacco use, specifically examining use of tobacco products by someone else in the same household, a reliable predictor of tobacco use. This information will be used by CTP to inform its communication campaigns and education outreach efforts.
Addiction












How soon after you wake up do you usually use any tobacco product?
0 I do not use tobacco products
0 Within 5 minutes
0 6 to 30 minutes
0 31 minutes to 1 hour
0 After 60 minutes
0 I rarely want to use a tobacco product		 C18 Included as two separate questions. One for cigarettes and one for other tobacco products Not included Not included Included Not included Included Not included Not included Not included Included Included (as separate questions) This item is derived from the Fagerstrom Test for Nicotine dependence, a measure of physical dependence to nicotine and heaviness of use of smokeless tobacco products. It will be used to classify current tobacco users’ level of dependence and heaviness of use to segment respondents and examine group differences in beliefs, information seeking, and media exposure. This information will be used by CTP to inform its regulatory authority over tobacco products with specific respect to nicotine as well as communication campaigns and education outreach efforts.
How much you agree or disagree with the following statements?
a. Nicotine is the main substance in tobacco that makes people want to smoke.
b. The nicotine in cigarettes is the substance that causes most of the cancer caused by smoking
c. Addiction to nicotine is something that I am concerned about		 C19 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Included (1 only) These items assess beliefs about nicotine, which are critical to CTP’s regulatory authority over levels of nicotine in tobacco products. These items will serve as baseline measures of population-level beliefs about nicotine which will inform CTP policies and associated communication efforts. In addition the association between these items, tobacco use, risk perceptions and beliefs will be examined in more detail to inform CTP’s efforts.
Overall, how addictive do you believe each of the following is?
a. Cigarette smoking;
b. Cigar smoking;
c. Smokeless tobacco use;
d. Using electronic cigarettes, also known as vape-pens, hookah-pens, e-hookahs, or e-vaporizers
e. Smoking tobacco in a hookah;
f. Smoking “roll your own” cigarettes;
g. Smoking a pipe filled with tobacco		 C20 Not included Not included Not included Similar- asks 3 separate addiction questions on Cigarettes, Cigars, and Smokeless. Does not address
d-g 		Not included Not included Not included Not included Not included Not included Not included These items assess beliefs about nicotine, which are critical to CTP’s regulatory authority over levels of nicotine in tobacco products. These items will serve as baseline measures of population-level beliefs about nicotine which will inform CTP policies and associated communication efforts. In addition the association between these items, tobacco use, risk perceptions and beliefs will be examined in more detail to inform CTP’s efforts.
Product constituents












In the past year, how often have you thought about the chemicals contained in tobacco products? [scale] D1 Not included Not included Not included Included Not included Not Included Not included Not included Not included Not included Included This set of items focuses of harmful and potentially harmful constituents of tobacco products and tobacco smoke. As of April 2013 CTP is required to display in a way “understandable to the lay person and not misleading” such a list organized by brand and sub-brand of tobacco products. This item assesses general thoughts/awareness of chemicals in tobacco products
Where do you think the chemicals in cigarettes and cigarette smoke come from?
0 All the chemicals come from the tobacco leaf
0 Most of the chemicals come from the tobacco leaf
0 The chemicals come equally from the tobacco leaf and things added to the tobacco
0 Most of the chemicals come from things added to the tobacco
0 All the chemicals come from things added to the tobacco
0 I do not believe there are any chemicals in cigarettes and cigarette smoke
[Mark only one]		 D2 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This set of items focuses of harmful and potentially harmful constituents of tobacco products and tobacco smoke. As of April 2013 CTP is required to display in a way “understandable to the lay person and not misleading” such a list organized by brand and sub-brand of tobacco products. This item assesses knowledge of a messages that represents a key communication objectives of the list of constituents and the surrounding communication and education efforts. These knowledge items will be used to examine impact of the list and communication efforts, target future communication efforts to rectify misunderstanding, as well as to examine differences in knowledge by demographic, tobacco phenotype, exposure to tobacco messages in media, information seeking and other constructs.
Risk perceptions about tobacco products









How long do you think someone has to smoke cigarettes before it harms their health? [scale] D3 Not included Not included Not included Similar "How long do you think someone has to smoke before it harms their health? Would you say…" Not included Not included Not included Not included Not included Not included Not included This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
How much do you think people harm themselves when they smoke a few cigarettes every day? [scale] D4 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
How much do you think people harm themselves when they smoke 10 or more cigarettes every day? [scale] D5 Not included Not included Not included Not included Similar "How much do people risk harming themselves physically and in other ways when they smoke one or more packs of
cigarettes per day?"		 Not Included Not included Similar" How much do you
think people risk harming themselves (physically or in other
ways), if they . . .
A: . . . Smoke one or more packs of cigarettes per day?"		 Not included Not included Not included This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.

How harmful do you think each of the following is to a person's health? [scale]
a. cigarette smoking
b. cigar smoking
c. smokeless tobacco use
d. electronic cigarette use
e. smoking tobacco in a hookah
f. smoking "roll your own" cigarettes
g. smoking a pipe filled with tobacco		 D6 Not included Not included Not included Similar- asks 4 separate harm questions on Cigarettes, Cigars, Smokeless, E-cigarettes, and Dissolvable. Not included Not included Not included Not included Not included Not included Included (Cigarette smoking only) This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
New types of cigarettes are now available called electronic cigarettes (also known as e-cigarettes, vape-pens, hookah-pens, e-hookahs, or e-vaporizers). These products deliver nicotine through a vapor. Compared to smoking cigarettes, would you say that electronic cigarettes are …
1 Much less harmful,
2 Less harmful,
3 Just as harmful,
4 More harmful,
5 Much more harmful, or
6 I’ve never heard of electronic cigarettes
 D7 Not included Not included Not included Not included Not included Not included 2013, Similar 2014- "Do you believe that e-cigarettes are (less harmful, equally harmful, or more harmful) than regular cigarettes?" Not included Not included Not included Not included Similar "Is using e-cigarettes less harmful, about the same, or more harmful than smoking cigarettes" This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
In your opinion, do you think that some smokeless tobacco products, such as chewing tobacco, snus and snuff are less harmful to a person's health than cigarettes?
1 Yes
2 No
3 Don't know
 D8 Not included Not included Not included Not included Not included Similar 2013- "Do you believe any of the following are less harmful than
smoking cigarettes? (You can CHOOSE ONE ANSWER
or MORE THAN ONE ANSWER)" (a) Using chewing tobacco, snuff, or dip,
Similar 2014- "Do you believe that chewing tobacco, snuff, dip, or snus is (less harmful, equally harmful, or more harmful) than cigarettes?"		 Not included Not included Not included Not included Similar "Is using smokeless tobacco less harmful, about the same, or more harmful than smoking cigarettes?" This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
How much do you think people harm themselves when they use smokeless tobacco such as chewing tobacco, snuff, dip, or snus every day? [scale] D9 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from alternative tobacco products.
How much do you think people harm themselves when they use smokeless tobacco such as chewing tobacco, snuff, dip, or snus some days but not every day? [scale] D10 Not included Not included Not included Not included Not included Not included 2013, Included 2014 Not included Not included Not included Not included Not included This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
Please indicate how much you agree or disagree with the following statement: Tobacco is safer to use now than it was 5 years ago [scale] D11 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Similar "How harmful do you think today’s cigarettes are compared to those of five years ago?" This item is of particular importance in informing FDA's regulatory authority over tobacco, as it is unclear how regulation is currently perceived in terms of product safety for cigarettes. It will be analyzed in conjunction with other risk perception items to get a full picture of the public's beliefs about tobacco product risks.
In your opinion, do you think that some types of cigarettes are less harmful to a person's health than other types?
1 Yes
2 No
3 Don't know
 D12 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Indirect "Do you think the brand of cigarettes you [usually smoke I usually smoked | last smoked] might be less
harmful, no different, or more harmful, compared to other cigarette brands?"		 This item assesses knowledge about the negative health effects of tobacco. This information will be used by CTP to inform its communication campaigns and education outreach efforts related to FDA's regulatory authority over tobacco. It will be analyzed in conjunction with items assessing other beliefs about health risks, including beliefs about potential reduced harm from other tobacco products or Modified Risk Tobacco Products.
Attitudes and beliefs about product regulation
Do you believe that anyone regulates statements from tobacco companies about the contents or health effects of their tobacco products?
0 Yes
0 No   
0 Don’t know  
 D13 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This item assesses knowledge of messages that represent key communication objectives of the list of constituents and the surrounding communication and education efforts. These knowledge items will be used to examine impact of the list and communication efforts, target future communication efforts to rectify misunderstanding, as well as to examine differences in knowledge by demographic, tobacco phenotype, exposure to tobacco messages in media, information seeking and other constructs.
Who do you believe regulates statements that tobacco companies make about the contents or health effects of their tobacco products?
0 Centers for Disease Control and Prevention (CDC)
0 Federal Trade Commission (FTC)
0 Food and Drug Administration (FDA)
0 National Institutes of Health (NIH)
0 Surgeon General
0 Tobacco industry/tobacco companies
0 None of the above
[Mark all that apply]		 D14 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item assesses knowledge about FDA regulatory authority. It will be used to in conjunction with other HINTS items to assess whether beliefs about regulation are associated with beliefs about product harm, as well as to examine differences in knowledge by demographic, tobacco phenotype, exposure to tobacco messages in media, information seeking and other constructs.
Do you believe that the United States Food and Drug Administration (FDA) regulates tobacco products in the U.S.? Y/N/Don't know D15 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included This item assesses knowledge about FDA regulatory authority, specific to Modified Risk Tobacco Product claims. It will be used to in conjunction with other HINTS items to assess whether beliefs about regulation are associated with beliefs about product harm, as well as to examine differences in knowledge by demographic, tobacco phenotype, exposure to tobacco messages in media, information seeking and other constructs.
In your opinion, how qualified is the United States Food and Drug Administration (FDA) to regulate tobacco products?
0 Not at all
0 A little
0 Somewhat
0 Very
 D16 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included This question is unique to the HINTS program and assess perceptions of FDA cigarette regulation. This item will allow investigators to assess perceptions of the FDA in the context of other items such as those related to health communication, tobacco behavior, risk perceptions, and knoweldge. This question has never been asked in HINTS or any other national survey. This item is important because understanding attitudes towards the FDA could influence other important factors including risk perceptions about tobacco products. This item is integral to informing FDA’s regulatory authority and activities by allowing investigators to assess how attitudes towards the FDA are associated with health communication, tobacco use behaviors, perceptions, knowledge, etc, an dusing that information to inform how FDA positions itself within the tobacco control space as well as in its public-facing media campaigns and education outreach efforts.
Tobacco product claims and labels
Compared to a typical cigarette, would you think that a cigarette advertised as “low nicotine”would be…
0 Much more harmful to your health than a typical cigarette?
0 Slightly more harmful to your health than a typical cigarette?
0 Equally harmful to your health as a typical cigarette?
0 Slightly less harmful to your health than a typical cigarette?
0 Much less harmful to your health than a typical cigarette?

 E1 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included The items in this section examine perceptions of tobacco modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evalautions of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
Compared to a typical cigarette, would you think that a cigarette advertised as "low nicotine" would be…
[scale]		 E2 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included The items in this section examine perceptions of tobacco modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evalautions of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
How believable is it that a cigarette could be "low nicotine"?
[scale]

 E3 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included The items in this section examine perceptions of tobacco modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evalautions of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
How likley do you think it is that tobacco products could be made without some of the chemicals that are harmful to health? [scale] E4 Not included Not included Not included Not included Not included Not Included Not included Not included Not included Not included Not included The items in this section examine perceptions of tobacco modified risk claims. This item specifically asks about the belief in the possibility of a modified risk tobacco product, a key belief when examining responses to items asking about specific types of modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evaluations of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
If a tobacco product made a claim that it was less addictive than other tobacco products, how likely would you be to use that product?
[scale]		 E5 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included The items in this section examine perceptions of tobacco modified risk claims. This item specifically asks about evaluation of a modified risk tobacco product cliam, a key belief when examining responses to items asking about specific types of modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evaluations of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?
[scale]		 E6 Not included Not included Not included Not included Not included Not included Not included Not included Not included Not included Included The items in this section examine perceptions of tobacco modified risk claims. This item specifically asks about evaluation of a modified risk tobacco product cliam, a key belief when examining responses to items asking about specific types of modified risk claims. This information is critical to CTP’s regulatory authority which includes review of industry studies and applications for modified risk tobacco products through understanding consumer's beliefs, perceptions and evaluations of tobacco product claims as well as enforcement actions against companies that make such claims with a marketing order from FDA.
Household Tobacco Use
Do you live in the same household with someone who uses tobacco products? Y/N
How many people in your household use tobacco products? 		I19, I20 Not included Not included Not included Not included Not included Similar "Does anyone who lives with you now…? (CHECK ALL THAT APPLY)." Not included Not included Similar "Does anyone who lives with you now…? (CHECK ALL THAT APPLY).
A. Smoke cigarettes
B. Use chewing tobacco, snuff, or dip
C. Use snus
D. Smoke cigars, cigarillos, or little cigars
E. Smoke tobacco using a hookah or waterpipe
F. Smoke tobacco out of a pipe other than a hookah or waterpipe
G. Smoke bidis (small brown cigarettes wrapped in a leaf)
H. Smoke kreteks (clove cigarettes)
I. Use any other form of tobacco
J. No one who lives with me now uses any form of tobacco"		 Similar "How many people who live here smoke cigarettes, cigars, little cigars, pipes, water pipes, hookah, or any other tobacco product?" Similar "Does anyone who lives with you now smoke cigarettes?"/ "Does anyone who lives with you now use chewing tobacco, snuff, or dip?" These items assess potential social norms about tobacco use, specifically examining use of tobacco products by someone else in the same household, a reliable predictor of tobacco use. This information will be used by CTP to inform its communication campaigns and education outreach efforts.
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