Form
Approved
OMB No. xxxx-xxxx
Exp. Date xx/xx/xxxx
Evaluation of the Fresh Empire Campaign on Tobacco (EFECT) –
Pre-Campaign Survey
Subjects for Questionnaire:
Section S_a: Study Screener
Section A: Demographics
Section B: Tobacco Use Behavior
Section C: Tobacco Use Intentions and Self-Efficacy
Section D: Cessation (Intention, Behavior, Motivation)
Section E: Attitudes, Beliefs, Risk Perceptions and Social Norms
Section F: Media Use and Awareness
Section G: Environment
Section S_b: Study Screener, continued
Section S_a: Study Screener
S1. How old are you?
1 11 years old or younger
2 12 years old
3 13 years old
4 14 years old
5 15 years old
6 16 years old
7 17 years old
8 18 years old or older
9 Prefer not to answer
S2. What is your gender?
1 Female
2 Male
3 Other (Please specify _______________)
9 Prefer not to answer
[RANDOMIZE ORDER OF S3 AND S4.]
[DISPLAY I-BASE PHOTO ARRAY OF 36 FEMALES, then ask S3a and S3b.]
S3a. Rank the three people that would BEST FIT in your main group of friends, starting with the best fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
S3b. Rank the three people that would LEAST FIT in your main group of friends, starting with the worst fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
[DISPLAY I-BASE PHOTO ARRAY OF 36 MALES, then ask S4a and S4b.]
S4a. Rank the three people that would BEST FIT in your main group of friends, starting with the best fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
S4b. Rank the three people that would WORST FIT in your main group of friends, starting with the worst fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
S5. How much do you agree or disagree with the following statements?
[RANDOMIZE S5_1-S5_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
S5_1. |
I would like to explore strange places. |
1 |
2 |
3 |
4 |
5 |
9 |
S5_2. |
I like to do frightening things. |
1 |
2 |
3 |
4 |
5 |
9 |
S5_3. |
I like new and exciting experiences, even if I have to break the rules. |
1 |
2 |
3 |
4 |
5 |
9 |
S5_4. |
I prefer friends who are exciting and unpredictable. |
1 |
2 |
3 |
4 |
5 |
9 |
[ASK S6 AND S7 FOR RESPONDENTS TAKING WEB SURVEY]
S6. What is your zip code?
3 Don’t know
9 Prefer not to answer
S7. What county do you live in?
[DROP DOWN MENU BASED ON ZIP]
3 Don’t know
9 Prefer not to answer
Section A: Demographics
A1. Are you Hispanic, Latino/a, or Spanish origin?
[PROGRAM SO THAT RESPONDENTS CAN SELECT MORE THAN ONE RESPONSE ON 2-5]
1 No, not of Hispanic, Latino, Latina, or Spanish origin
2 Yes, Mexican, Mexican American, Chicano or Chicana
3 Yes, Puerto Rican
4 Yes, Cuban
5 Yes, Another Hispanic, Latino/a or Spanish origin
9 Prefer not to answer
A2. What race or races do you consider yourself to be? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER or YOU MAY SKIP THIS QUESTION)
|
1 Yes |
|
|
A2_1. American Indian or Alaska Native |
1 |
|
|
A2_2. Asian |
1 |
|
|
A2_3. Black or African American |
1 |
|
|
A2_4. Native Hawaiian or Other Pacific Islander |
1 |
|
|
A2_5. White |
1 |
|
|
A3. In general, do you usually speak…
1 Only Spanish
2 Spanish more than English
3 Spanish and English equally
4 English more than Spanish
5 English only
6 Some other language (please specify___________)
9 Prefer not to answer
A4. What grade are you in?
1 6th grade or lower
2 7th grade
3 8th grade
4 9th grade
5 10th grade
6 11th grade
7 12th grade
8 Ungraded or other grade
9 Out of school
99 Prefer not to answer
A5. During the past 30 days, about how much money did you have each week to spend any way you wanted to?
1 None
2 $5 or less
3 $6 to $10
4 $11 to $20
5 $21 to $35
6 $36 to $50
7 $51 to $75
8 $76 to $125
9 $126 or more
99 Prefer not to answer
Section B: Tobacco Use Behavior
Cigarette Use
B1. Have you ever tried cigarette smoking, even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
[IF B1=1 or 9, ASK B2. IF B1=2, ASK B8]
B2. How old were you when you first tried cigarette smoking, even one or two puffs?
1 8 years old or younger
2 9 years old
3 10 years old
4 11 years old
5 12 years old
6 13 years old
7 14 years old
8 15 years old
9 16 years old
10 17 years old
11 18 years old or older
99 Prefer not to answer
B3. During the past 30 days, on how many days did you smoke cigarettes?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
[IF B3=1, ASK B6, otherwise ASK B4]
B4. Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?
1 Yes
2 No
9 Prefer not to answer
B5. During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?
1 Less than 1 cigarette per day
2 1 cigarette per day
3 2 to 5 cigarettes per day
4 6 to 10 cigarettes per day
5 11 to 20 cigarettes per day
6 More than 20 cigarettes per day
9 Prefer not to answer
B6. About how many cigarettes have you smoked in your entire life? Your best guess is fine.
1 I have never smoked cigarettes, not even one or two puffs
2 1 or more puffs but never a whole cigarette
3 1 cigarette
4 2 to 5 cigarettes
5 6 to 15 cigarettes (about 1/2 a pack total)
6 16 to 25 cigarettes (about 1 pack total)
7 26 to 99 cigarettes (more than 1 pack, but less than 5 packs)
8 100 or more cigarettes (5 or more packs)
9 Prefer not to answer
B7. Do you consider yourself a smoker?
1 Yes
2 No
9 Prefer not to answer
Other Tobacco Use
B8. Have you ever used smokeless tobacco, such as chewing tobacco, snuff, snus or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal, even just a small amount?
1 Yes
2 No
9 Prefer not to answer
[IF B8=1 or 9, ASK B9. IF B8=2, ASK B10.]
B9. During the past 30 days, on how many days did you use chewing tobacco, snuff, snus or dip?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B10. Have you ever tried smoking cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s, even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B10=1 or 9, ASK B11a and B11b. IF B10=2, ASK B12]
B11a. During the past 30 days, on how many days did you smoke blunts (cigars, cigarillos, or little cigars with marijuana added)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B11b. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars without added marijuana? Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s.
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B12. Have you ever tried smoking tobacco out of a water pipe (also called “hookah”), even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B12=1 or 9, ASK B13. IF B12=2, ASK B14]
B13. During the past 30 days, on how many days did you smoke tobacco out of a water pipe (also called “hookah”)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B14. [EMBED SCREENSHOT OF PRODUCTS] These are examples of electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”. Electronic cigarettes sometimes look like regular cigarettes, but run on a battery and produce vapor instead of smoke. Have you ever tried electronic cigarettes, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE], even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
[IF B14=1 or 9, ASK B15. IF B14=2, ASK B16]
B15. During the past 30 days, on how many days did you use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B16. Have you ever tried marijuana, even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B16=1 or 9, ASK B17. OTHERWISE, SKIP TO C1.]
B17. During the past 30 days, on how many days did you use marijuana?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
Section C: Tobacco Use Intentions and Self-Efficacy
C1. Thinking about the future…
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
9 |
C1_1. |
Do you think that you will smoke a cigarette soon? |
1 |
2 |
3 |
4 |
9 |
C1_2. |
Do you think you will smoke a cigarette at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_3. |
If one of your best friends were to offer you a cigarette, would you smoke it? |
1 |
2 |
3 |
4 |
9 |
C2. How sure are you that, if you really wanted to, you could say no to a cigarette offer if…
[RANDOMIZE C2_1-C2_3]
|
1 Not at all sure |
2 Slightly sure |
3 Somewhat sure |
4 Mostly sure |
5 Completely sure |
9 |
|
C2_1.
|
You are at a party where most people are smoking? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_2. |
A very close friend offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_3. |
Someone you know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
Section D: Cessation (Intention, Behavior, Motivation)
[ASK IF B3=2-9]
D1. Do you want to stop smoking cigarettes for good?
1 Yes
2 No
9 Prefer not to answer
[IF D1=1 or 9, ASK D2. IF D1=2, ASK D4.]
D2. How much do you want to stop smoking cigarettes for good?
1 Not at all
2 A little
3 Somewhat
4 A lot
9 Prefer not to answer
D3. I plan to stop smoking cigarettes for good within the next… (PLEASE CHOOSE THE FIRST ANSWER THAT FITS)
1 7 days
2 30 days
3 6 months
4 1 year
5 I do not plan to stop smoking cigarettes within the next year
9 Prefer not to answer
D4. During the past 3 months, did you stop smoking cigarettes for one day or longer because you were trying to quit smoking cigarettes for good?
1 Yes
2 No
9 Prefer not to answer
Section E: Attitudes, Beliefs, Risk Perceptions and Social Norms
[Ask ALL] The next set of questions asks for your opinions on cigarette use and other tobacco products.
Attitudes, Beliefs and Risk Perceptions
E1. How much do you agree or disagree with the following statements about people who are tobacco-free?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E1_1. |
People who are tobacco-free are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_2. |
People who are tobacco-free are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_3. |
People who are tobacco-free are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_4. |
People who are tobacco-free are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_5. |
People who are tobacco-free are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_6. |
People who are tobacco-free are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_7. |
People who are tobacco-free are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_8. |
People who are tobacco-free are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_9. |
People who are tobacco-free are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_10. |
People who are tobacco-free are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_11. |
People who are tobacco-free are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_12. |
People who are tobacco-free are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E1_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2. How much do you agree or disagree with the following statements about people who smoke cigarettes?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E2_1. |
People who smoke cigarettes are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_2. |
People who smoke cigarettes are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_3. |
People who smoke cigarettes are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_4. |
People who smoke cigarettes are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_5. |
People who smoke cigarettes are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_6. |
People who smoke cigarettes are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_7. |
People who smoke cigarettes are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_8. |
People who smoke cigarettes are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_9. |
People who smoke cigarettes are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_10. |
People who smoke cigarettes are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_11. |
People who smoke cigarettes are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_12. |
People who smoke cigarettes are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E3. Smoking cigarettes is… (pick one)
[RANDOMIZE E3_1-E3_2] [MAKE THIS ITEM SKIPPABLE]
E3_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
E3_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
E4. How much do you agree or disagree with the following statements?
[RANDOMIZE E4_1-E4_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E4_1. |
I am proud to live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E4_2. |
Living tobacco-free is important to me. |
1 |
2 |
3 |
4 |
5 |
9 |
E4_3. |
I am proud to tell other people I live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E5. How much do you agree or disagree with the following statements? If I smoke cigarettes, I will…
[RANDOMIZE ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E5_1. |
Damage my body |
1 |
2 |
3 |
4 |
5 |
9 |
E5_2. |
Not harm my body |
1 |
2 |
3 |
4 |
5 |
9 |
E5_3. |
Shorten my life |
1 |
2 |
3 |
4 |
5 |
9 |
E5_4. |
Live just as long |
1 |
2 |
3 |
4 |
5 |
9 |
E5_5. |
Be controlled by smoking |
1 |
2 |
3 |
4 |
5 |
9 |
E5_6. |
Be able to stop smoking when I want to |
1 |
2 |
3 |
4 |
5 |
9 |
E5_7. |
Become addicted to smoking |
1 |
2 |
3 |
4 |
5 |
9 |
E5_8. |
Decide when and where to smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_9. |
Be less attractive to others |
1 |
2 |
3 |
4 |
5 |
9 |
E5_10. |
Be more attractive to others |
1 |
2 |
3 |
4 |
5 |
9 |
E5_11. |
Have bad breath and stinky hair |
1 |
2 |
3 |
4 |
5 |
9 |
E5_12. |
Not smell like cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
E5_13. |
Be a good influence on my younger brothers, sisters, cousins, family or friends |
1 |
2 |
3 |
4 |
5 |
9 |
E5_14. |
Be a bad role model for my younger brothers, sisters, cousins, family or friends |
1 |
2 |
3 |
4 |
5 |
9 |
E5_15. |
Harm others with secondhand smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_16. |
Not hurt anyone with my secondhand smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_17. |
Achieve my goals more easily |
1 |
2 |
3 |
4 |
5 |
9 |
E5_18. |
Have trouble reaching my goals |
1 |
2 |
3 |
4 |
5 |
9 |
E5_19. |
Be less successful |
1 |
2 |
3 |
4 |
5 |
9 |
E5_20. |
Be just as successful |
1 |
2 |
3 |
4 |
5 |
9 |
E5_21. |
[INSERT RISK PERCEPTION] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_22. |
[INSERT RISK PERCEPTION] |
1 |
2 |
3 |
4 |
5 |
9 |
Social Norms
E6. How many of your four closest friends…
|
|
0 None |
1 One |
2 Two |
3 Three |
4 Four |
9 |
E6_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_2. |
Smoke menthol cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_3. |
Use smokeless tobacco, such as chewing tobacco, snuff, snus or dip? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_4. |
Use marijuana? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_5. |
Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_6. |
Smoke cigars, cigarillos, or little cigars without added marijuana?
Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s. |
0 |
1 |
2 |
3 |
4 |
9 |
E6_7. |
Use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]? |
0 |
1 |
2 |
3 |
4 |
9 |
E7. How many of the people who hang out where you hang out…
|
|
0 None |
1 A few |
2 Some |
3 Most |
4 All |
9 |
E7_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_2. |
Smoke menthol cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_3. |
Use smokeless tobacco, such as chewing tobacco, snuff, snus or dip? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_4. |
Use marijuana? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_5. |
Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_6. |
Smoke cigars, cigarillos, or little cigars without added marijuana?
Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s. |
0 |
1 |
2 |
3 |
4 |
9 |
E7_7. |
Use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]? |
0 |
1 |
2 |
3 |
4 |
9 |
E8. Thinking about the people who hang out where you hang out, do you think tobacco use is…
1 Increasing
2 Decreasing
3 Staying the same
4 Not sure
9 Prefer not to answer
Perceived Approval
E9. How much do you agree or disagree with the following statements?
[RANDOMIZE E9_1-E9_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E9_1. |
According to my family, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_2. |
According to my friends, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_3. |
According to most people my age, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_4. |
According to the people who hang out where I hang out, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
APPROVAL OF SMOKING
E10. This next set of questions asks about how willing or unwilling you are to do things with people who smoke cigarettes.
|
|
1 Definitely Willing |
2 Probably Willing |
3 Probably Unwilling |
4 Definitely Unwilling |
9 |
E10_1. |
How would you feel about going to a party, concert or event where people are smoking cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_2. |
How would you feel about hanging out with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_3. |
How would you feel about dancing with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_4. |
How would you feel about kissing someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_5. |
How would you feel about going out with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
Perceived Peer Crowd Smoking
[E11 items displaying a single I-Base hip hop photo or mainstream photo] [RANDOMIZE PRESENTATION OF PHOTOS]
[DISPLAY I-BASE PHOTO OF HIP HOP MALE, then ask E11_1]
E11_1. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF HIP HOP FEMALE, then ask E11_2]
E11_2. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF MAINSTREAM MALE, then ask E11_3]
E11_3. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF MAINSTREAM FEMALE, then ask E11_4]
E11_4. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
Perceived Popularity
E12. How much do you agree or disagree with the following statements?
[RANDOMIZE E12_1-E12_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 |
3 Agree |
4 Strongly Agree |
9 |
E12_1. |
Most successful people smoke cigarettes once a month or more. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_2. |
More fresh people smoke cigarettes than people who are not fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_3. |
Rich and famous people are more likely to smoke cigarettes than people who aren’t rich and famous. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_4. |
My favorite hip hop artists probably smoke cigarettes once a month or more. |
1 |
2 |
3 |
4 |
5 |
9 |
Section F: Media Use and Awareness
First, we’d like to ask you about your use of TV and other media.
|
1 None |
2 5 min – less than 30 min |
3 30 min – 1 hour |
4 More than 1 hour – 3 hours |
5 More than 3 hours |
9 Prefer Not to Answer |
F1. Thinking only about yesterday, about how much time did you spend watching TV shows on any platform including a TV set, a computer, laptop or tablet, a smartphone or an iPod or MP3 player? |
1 |
2 |
3 |
4 |
5 |
9 |
F2. Thinking only about yesterday, about how much time did you spend doing the following activities?
|
None |
At least one minute, but less than 1 hour |
1 hour or more, but less than 2 hours |
2 hours or more, but less than 3 hours |
More than 3 hours |
Prefer Not to Answer |
Listening to Music |
|
|
|
|
|
|
F2_1. Listening to music across all devices including iPods, MP3 players, cell phones, computer, laptop, tablet, Internet radio like Pandora or Spotify, CD players, and car radios |
1 |
2 |
3 |
4 |
5 |
9 |
Using a Cellphone/Smartphone |
|
|
|
|
|
|
F2_2. Text messaging on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_3. Watching or uploading videos, such as on YouTube, on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_4. Going to social networking sites like Twitter, Instagram or Facebook on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_5. Browsing any other type of website on a cell phone/smartphone like news or entertainment. Include smartphone apps. |
1 |
2 |
3 |
4 |
5 |
9 |
Using a Computer, Laptop, or Tablet (not a smartphone) |
|
|
|
|
|
|
F2_6. Watching or uploading videos, such as on YouTube, on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F2_7. Using social networking sites like Twitter, Instagram, or Facebook on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F2_8. Browsing any other type of website for anything besides schoolwork on a computer, laptop, or tablet, like news or entertainment |
1 |
2 |
3 |
4 |
5 |
9 |
F2_9. Instant messaging or Video chatting (on Skype, Googletalk, iChat, etc.) on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
Radio and Reading |
|
|
|
|
|
|
F2_10. Listening to the radio |
1 |
2 |
3 |
4 |
5 |
9 |
F2_11. Looking at or reading any magazines? Do not include time spent reading magazines on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F3. How often do you go to the movies at a movie theater?
1 Once a week or more often
2 One or two times a month
3 Once every two or three months
4 One or two times a year
5 I do not see movies at a movie theater
9 Prefer not to answer
F4. How often do you go to concerts, live shows, or other events at a store, local stage, community center, or music venue?
1 Once a week or more often
2 One or two times a month
3 Once every two or three months
4 One or two times a year
5 I do not attend concerts, live shows, or other events
9 Prefer not to answer
BRAND AWARENESS
F5. We want to ask you about some brands that might or might not have appeared in the media around here, as part of ads or videos about tobacco or at concerts, live shows, or other events.
[RANDOMIZE F5_1-F5_4]
F5_1. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
[INSERT any brands of local/state campaigns that are being run in markets]
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_2. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
Digital Youth Against Tobacco (DYAT)
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_3. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
The Real Cost
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_4. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
Fresh Empire
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
AWARENESS OF EVENTS, VIDEOS
F5_5a. In the past 3 months, that is since [FILL DATE], have you heard of an event in your area sponsored by, or associated with, Fresh Empire? (DISPLAY LOGO)
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
F5_5b. In the past 3 months, that is since [FILL DATE], have you seen a Fresh Empire video online? (DISPLAY LOGO)
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
AD AWARENESS OTHER TC CAMPAIGNS (TO USE AS CONTROLS)
F6. The next set of questions asks whether or not you’ve seen any of the following ads.
[RANDOMIZE F6_1-F6_2]
F6_1. In the past 3 months, that is since [FILL DATE], have you seen a Tips from Former Smokers (Tips) ad? Examples of some Tips from Former Smokers ads are shown below.
[DISPLAY Tips from Former Smokers PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F6_2. In the past 3 months, that is since [FILL DATE], have you seen a truth® campaign ad? Examples of some truth® campaign ads are shown below.
[DISPLAY truth® PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F6_3. In the past 3 months, that is since [FILL DATE], have you seen a The Real Cost campaign ad? Examples of some The Real Cost campaign ads are shown below.
[DISPLAY The Real Cost PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
[IF F6_1 AND/OR F6_2=YES, ASK F7_1 AND/OR F7_2; IF NO OPTIONS ARE SELECTED, GO TO F9. ASK F8 IF F6_1 AND/OR F6_2=YES.]
F7_1. Where have you seen a Tips from Former Smokers (Tips) ad? Examples of some Tips from Former Smokers ads are shown below.
[DISPLAY Tips from Former Smokers PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F7_2. Where have you seen a truth® campaign ad? Examples of some truth® campaign ads are shown below.
[DISPLAY truth® campaign PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F7_3. Where have you seen a The Real Cost campaign ad? Examples of some The Real Cost campaign ads are shown below.
[DISPLAY The Real Cost campaign PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F8. In the past 3 months, that is since [FILL DATE], how frequently have you seen these ads on television?
1 Rarely
2 Sometimes
3 Often
4 Very Often
9 Prefer not to answer
HOME ENVIRONMENT
These next questions ask about your parent(s) or guardian(s). Some people your age have parents who they do not live with. As you answer these questions, please think only about the parent(s) or guardian(s) you live with.
F9. Do your parent(s) or guardian(s) have rules about how much time you can spend using media, such as TV, computer, video games, cell phones, and music?
1 Yes, my parent(s) or guardian(s) have lots of rules about it.
2 Yes, my parent(s) or guardian(s) have a few rules about it.
3 No, my parent(s) or guardian(s) don’t have any rules about it.
9 Prefer not to answer
F10. Do your parent(s) or guardian(s) have rules about what you are allowed to do on the computer, which video games you are allowed to play, or what music you’re allowed to listen to?
1 Yes, my parent(s) or guardian(s) have lots of rules about it.
2 Yes, my parent(s) or guardian(s) have a few rules about it.
3 No, my parent(s) or guardian(s) don’t have any rules about it.
9 Prefer not to answer
F11. In general, how often do your parent(s) or guardian(s) make sure you follow the rules they have about using media, such as TV, computers, video games, and music?
1 Most of the time
2 Some of the time
3 A little of the time
4 Never
5 My parent(s) or guardian(s) don’t have rules about using media
9 Prefer not to answer
F12. How often do your parent(s) or guardian(s) let you watch movies or videos that are rated R?
1 Never
2 Once in awhile
3 Sometimes
4 All the time
9 Prefer not to answer
F13. How often do your parent(s) or guardian(s) let you go to concerts, live shows, or other events?
1 Never
2 Once in awhile
3 Sometimes
4 All the time
9 Prefer not to answer
Section G: Environment
The next section asks some questions about your household and peers.
G1. Other than you, has anyone who lives with you used any of the following during the past 30 days…? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER)
1 cigarettes
2 smokeless tobacco, such as chewing tobacco, snuff, snus or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal
3 cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s
4 tobacco out of a water pipe (also called “hookah”)
5 electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs” such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]
6 any other form of tobacco ___________ (please specify)
7 No, no one who lives with me has used any form of tobacco during the past 30 days
9 Prefer not to answer
G2. Have any of your brother(s) and/or sister(s) smoked cigarettes during the past 30 days?
1 Yes
2 No
3 I don’t know
4 I don’t have any brothers or sisters
9 Prefer not to answer
G3. Which statement best describes the rules about smoking in your home? Would you say…
1 Smoking is not allowed anywhere inside your home
2 Smoking is allowed in some places or at some times
3 Smoking is allowed anywhere inside the home
4 There are no rules about smoking inside the home
9 Prefer not to answer
G4. How well would you say you have done in school? Would you say…
1 Much better than average
2 Better than average
3 Average
4 Below average
5 Much worse than average
9 Prefer not to answer
G5. How much do you agree or disagree with the following statements?
[RANDOMIZE G5_1-G5_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
G5_1. |
I feel close to people at my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G5_2. |
I am happy to be at my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G5_3. |
I feel like I am a part of my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G6. How far do you think you will go in school?
1 I don’t plan to go to school anymore
2 6th grade
3 7th grade
4 8th grade
5 9th grade
6 10th grade
7 11th grade
8 12th grade or GED
9 Some college or technical school but no degree
10 Technical school degree
11 College degree
12 Graduate school, medical school, or law school
99 Prefer not to answer
G7. How many close friends do you have? (Close friends include people whom you feel at ease with, can talk to about private matters, and can call on for help.)
__________ MIN 0 MAX 7
9 Prefer not to answer
G8. How often do you attend church or religious services? Would you say…
1 Never
2 Less than once a month
3 About once a month
4 About 2 or 3 times a month
5 Once a week
6 More than once a week
9 Prefer not to answer
G9. How much do you agree or disagree with the following statements?
[RANDOMIZE G9_1-G9_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
G9_1. |
I would like to explore strange places. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_2. |
I like to do frightening things. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_3. |
I like new and exciting experiences, even if I have to break the rules. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_4. |
I prefer friends who are exciting and unpredictable. |
1 |
2 |
3 |
4 |
5 |
9 |
G10. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
_____ Number of days
2 None
3 Don’t know
9 Prefer not to answer
These next questions ask about your relationship with your parent(s) or guardian(s). Some people your age have parents who they do not live with. As you answer these questions, please think only about the parent(s) or guardian(s) you live with.
G11. Thinking about the parent(s) or guardian(s) you live with, how satisfied are you with the way you communicate with each other?
1 Not at all satisfied
2 Not very satisfied
3 Somewhat satisfied
4 Quite satisfied
5 Very satisfied
9 Prefer not to answer
G12. How close do you feel to your parent(s) or guardian(s)?
1 Not at all close
2 Not very close
3 Somewhat close
4 Quite close
5 Very close
9 Prefer not to answer
G13. How many times has your parent(s) or guardian(s) said things that really hurt your feelings or made you feel like you were not wanted or loved?
1 1 time
2 2 times
3 3 to 5 times
4 6 to 10 times
5 More than 10 times
6 Never
7 Don’t know
9 Prefer not to answer
G14. Has your parent(s) or guardian(s) ever talked to you about reasons for not smoking cigarettes or using other types of tobacco like cigars or chewing tobacco?
1 Yes
2 No
9 Prefer not to answer
G15. During the past 7 days, on how many days did you and your parent(s) or guardian(s) do something together just for fun?
__________ MIN 0 MAX 7
9 Prefer not to answer
Section S_b: Study Screener, continued
[IN PERSON INTERVIEW ONLY]
Next I have some questions about the people who live in this home.
S01. Please think about all of the people who live in this home who are 17 years old or younger. Including yourself, how many people live in this home who are 17 years old or younger?
__________ MIN 0 MAX 7
9 Prefer not to answer
S02. If S01>1. Please tell me more about these people, starting with the oldest. How old is this person?
__________ MIN 0 MAX 17
9 Prefer not to answer
S02a. If S02=12-17. What is this person’s name?
__________
9 Prefer not to answer
S03. If S01>2 How old is the next oldest person in the household who is 17 years old or younger?
__________ MIN 0 MAX 17
9 Prefer not to answer
S03a. If S03=12-17. What is this person’s name?
__________
9 Prefer not to answer
[ASK FOR ALL HOUSEHOLD MEMBERS 17 YEARS OLD OR YOUNGER. GENERATE A SCREENING INSTRUMENT FOR EACH MEMBER AGE 12-17. SCREEN EACH ADOLESCENT RESIDENT.]
Thank you for taking time to complete this survey.
Evaluation of the Fresh Empire Campaign on Tobacco (EFECT) –
Post-Campaign Survey
Subjects for Questionnaire:
Section S: Online Study Screener
Section A: Demographics
Section B: Tobacco Use Behavior
Section C: Tobacco Use Intentions and Self-Efficacy
Section D: Cessation (Intention, Behavior, Motivation)
Section E: Attitudes, Beliefs, Risk Perceptions and Social Norms
Section F: Media Use and Awareness
Section G: Environment
Section S_b: Online Study Screener, continued
Section S: Study Screener
S1. How old are you?
1 11 years old or younger
2 12 years old
3 13 years old
4 14 years old
5 15 years old
6 16 years old
7 17 years old
8 18 years old or older
9 Prefer not to answer
S2. What is your gender?
1 Female
2 Male
3 Other (Please specify _______________)
9 Prefer not to answer
[RANDOMIZE ORDER OF S3 AND S4. ]
[DISPLAY I-BASE PHOTO ARRAY OF 36 FEMALES, then ask S3a and S3b.]
S3a. Rank the three people that would BEST FIT in your main group of friends, starting with the best fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
S3b. Rank the three people that would LEAST FIT in your main group of friends, starting with the worst fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
[DISPLAY I-BASE PHOTO ARRAY OF 36 MALES, then ask S4a and S4b.]
S4a. Rank the three people that would BEST FIT in your main group of friends, starting with the best fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
S4b. Rank the three people that would WORST FIT in your main group of friends, starting with the worst fit.
1 ____
2 ____
3 ____
9 Prefer not to answer
[ASK S5 AND S6 FOR RESPONDENTS TAKING WEB SURVEY]
S6. What is your zip code?
3 Don’t know
9 Prefer not to answer
S7. What county do you live in?
[DROP DOWN MENU BASED ON ZIP]
3 Don’t know
9 Prefer not to answer
Section A: Demographics
A1. Are you Hispanic, Latino/a, or Spanish origin?
[PROGRAM SO THAT RESPONDENTS CAN SELECT MORE THAN ONE RESPONSE ON 2-5]
1 No, not of Hispanic, Latino, Latina, or Spanish origin
2 Yes, Mexican, Mexican American, Chicano or Chicana
3 Yes, Puerto Rican
4 Yes, Cuban
5 Yes, Another Hispanic, Latino/a or Spanish origin
9 Prefer not to answer
A2. What race or races do you consider yourself to be? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER or YOU MAY SKIP THIS QUESTION)
|
1 Yes |
|
|
A2_1. American Indian or Alaska Native |
1 |
|
|
A2_2. Asian |
1 |
|
|
A2_3. Black or African American |
1 |
|
|
A2_4. Native Hawaiian or Other Pacific Islander |
1 |
|
|
A2_5. White |
1 |
|
|
A3. In general, do you usually speak…
1 Only Spanish
2 Spanish more than English
3 Spanish and English equally
4 English more than Spanish
5 English only
6 Some other language (please specify___________)
9 Prefer not to answer
A4. What grade are you in?
1 6th grade or lower
2 7th grade
3 8th grade
4 9th grade
5 10th grade
6 11th grade
7 12th grade
8 Ungraded or other grade
9 Out of school
99 Prefer not to answer
A5. During the past 30 days, about how much money did you have each week to spend any way you wanted to?
1 None
2 $5 or less
3 $6 to $10
4 $11 to $20
5 $21 to $35
6 $36 to $50
7 $51 to $75
8 $76 to $125
9 $126 or more
99 Prefer not to answer
Section B: Tobacco Use Behavior
Cigarette Use
B1. Have you ever tried cigarette smoking, even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
[IF B1=1 or 9, ASK B2. IF B1=2, ASK B8]
B2. How old were you when you first tried cigarette smoking, even one or two puffs?
1 8 years old or younger
2 9 years old
3 10 years old
4 11 years old
5 12 years old
6 13 years old
7 14 years old
8 15 years old
9 16 years old
10 17 years old
11 18 years old or older
99 Prefer not to answer
B3. During the past 30 days, on how many days did you smoke cigarettes?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
[IF B3=1, ASK B6, otherwise ASK B4]
B4. Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?
1 Yes
2 No
9 Prefer not to answer
B5. During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?
1 Less than 1 cigarette per day
2 1 cigarette per day
3 2 to 5 cigarettes per day
4 6 to 10 cigarettes per day
5 11 to 20 cigarettes per day
6 More than 20 cigarettes per day
9 Prefer not to answer
B6. About how many cigarettes have you smoked in your entire life? Your best guess is fine.
1 I have never smoked cigarettes, not even one or two puffs
2 1 or more puffs but never a whole cigarette
3 1 cigarette
4 2 to 5 cigarettes
5 6 to 15 cigarettes (about 1/2 a pack total)
6 16 to 25 cigarettes (about 1 pack total)
7 26 to 99 cigarettes (more than 1 pack, but less than 5 packs)
8 100 or more cigarettes (5 or more packs)
9 Prefer not to answer
B7. Do you consider yourself a smoker?
1 Yes
2 No
9 Prefer not to answer
Other Tobacco Use
B8. Have you ever used smokeless tobacco, such as chewing tobacco, snuff, snus or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal, even just a small amount?
1 Yes
2 No
9 Prefer not to answer
[IF B8=1 or 9, ASK B9. IF B8=2, ASK B10]
B9. During the past 30 days, on how many days did you use chewing tobacco, snuff, snus or dip?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B10. Have you ever tried smoking cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s, even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B10=1 or 9, ASK B11a and B11b. IF B10=2, ASK B12]
B11a. During the past 30 days, on how many days did you smoke blunts (cigars, cigarillos, or little cigars with marijuana added)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B11b. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars without added marijuana? Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s.
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B12. Have you ever tried smoking tobacco out of a water pipe (also called “hookah”), even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B12=1 or 9, ASK B13. IF B12=2, ASK B14]
B13. During the past 30 days, on how many days did you smoke tobacco out of a water pipe (also called “hookah”)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
B14. [EMBED SCREENSHOT OF PRODUCTS] These are examples of electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”. Electronic cigarettes sometimes look like regular cigarettes, but run on a battery and produce vapor instead of smoke. Have you ever tried electronic cigarettes, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE], even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
[IF B14=1 or 9, ASK B15. IF B14=2, ASK B16]
B15. During the past 30 days, on how many days did you use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B16. Have you ever tried marijuana, even one time?
1 Yes
2 No
9 Prefer not to answer
[IF B16=1 or 9, ASK B17. OTHERWISE, SKIP TO C1]
B17. During the past 30 days, on how many days did you use marijuana?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
Section C: Tobacco Use Intentions and Self-Efficacy
C1. Thinking about the future…
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
9 |
C1_1. |
Do you think that you will smoke a cigarette soon? |
1 |
2 |
3 |
4 |
9 |
C1_2. |
Do you think you will smoke a cigarette at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_3. |
If one of your best friends were to offer you a cigarette, would you smoke it? |
1 |
2 |
3 |
4 |
9 |
C2. How sure are you that, if you really wanted to, you could say no to a cigarette offer if…
[RANDOMIZE C2_1-C2_3]
|
1 Not at all sure |
2 Slightly sure |
3 Somewhat sure |
4 Mostly sure |
5 Completely sure |
9 |
|
C2_1.
|
You are at a party where most people are smoking? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_2. |
A very close friend offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_3. |
Someone you know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
Section D: Cessation (Intention, Behavior, Motivation)
[ASK IF B3=2-9]
D1. Do you want to stop smoking cigarettes for good?
1 Yes
2 No
9 Prefer not to answer
[IF D1=1 or 9, ASK D2. IF D1=2, ASK D4.]
D2. How much do you want to stop smoking cigarettes for good?
1 Not at all
2 A little
3 Somewhat
4 A lot
9 Prefer not to answer
D3. I plan to stop smoking cigarettes for good within the next… (PLEASE CHOOSE THE FIRST ANSWER THAT FITS)
1 7 days
2 30 days
3 6 months
4 1 year
5 I do not plan to stop smoking cigarettes within the next year
9 Prefer not to answer
D4. During the past 3 months, did you stop smoking cigarettes for one day or longer because you were trying to quit smoking cigarettes for good?
1 Yes
2 No
9 Prefer not to answer
Section E: Attitudes, Beliefs, Risk Perceptions and Social Norms
[Ask ALL] The next set of questions asks for your opinions on cigarette use and other tobacco products.
Attitudes, Beliefs and Risk Perceptions
E1. How much do you agree or disagree with the following statements about people who are tobacco-free?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E1_1. |
People who are tobacco-free are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_2. |
People who are tobacco-free are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_3. |
People who are tobacco-free are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_4. |
People who are tobacco-free are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_5. |
People who are tobacco-free are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_6. |
People who are tobacco-free are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_7. |
People who are tobacco-free are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_8. |
People who are tobacco-free are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_9. |
People who are tobacco-free are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_10. |
People who are tobacco-free are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_11. |
People who are tobacco-free are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_12. |
People who are tobacco-free are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E1_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2. How much do you agree or disagree with the following statements about people who smoke cigarettes?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E2_1. |
People who smoke cigarettes are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_2. |
People who smoke cigarettes are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_3. |
People who smoke cigarettes are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_4. |
People who smoke cigarettes are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_5. |
People who smoke cigarettes are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_6. |
People who smoke cigarettes are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_7. |
People who smoke cigarettes are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_8. |
People who smoke cigarettes are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_9. |
People who smoke cigarettes are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_10. |
People who smoke cigarettes are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_11. |
People who smoke cigarettes are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_12. |
People who smoke cigarettes are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E3. Smoking cigarettes is… (pick one)
[RANDOMIZE E3_1-E3_2] [MAKE THIS ITEM SKIPPABLE]
E3_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
E3_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
E4. How much do you agree or disagree with the following statements?
[RANDOMIZE E4_1-E4_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E4_1. |
I am proud to live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E4_2. |
Living tobacco-free is important to me. |
1 |
2 |
3 |
4 |
5 |
9 |
E4_3. |
I am proud to tell other people I live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E5. How much do you agree or disagree with the following statements? If I smoke cigarettes, I will…
[RANDOMIZE ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E5_1. |
Damage my body |
1 |
2 |
3 |
4 |
5 |
9 |
E5_2. |
Not harm my body |
1 |
2 |
3 |
4 |
5 |
9 |
E5_3. |
Shorten my life |
1 |
2 |
3 |
4 |
5 |
9 |
E5_4. |
Live just as long |
1 |
2 |
3 |
4 |
5 |
9 |
E5_5. |
Be controlled by smoking |
1 |
2 |
3 |
4 |
5 |
9 |
E5_6. |
Be able to stop smoking when I want to |
1 |
2 |
3 |
4 |
5 |
9 |
E5_7. |
Become addicted to smoking |
1 |
2 |
3 |
4 |
5 |
9 |
E5_8. |
Decide when and where to smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_9. |
Be less attractive to others |
1 |
2 |
3 |
4 |
5 |
9 |
E5_10. |
Be more attractive to others |
1 |
2 |
3 |
4 |
5 |
9 |
E5_11. |
Have bad breath and stinky hair |
1 |
2 |
3 |
4 |
5 |
9 |
E5_12. |
Not smell like cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
E5_13. |
Be a good influence on my younger brothers, sisters, cousins, family or friends |
1 |
2 |
3 |
4 |
5 |
9 |
E5_14. |
Be a bad role model for my younger brothers, sisters, cousins, family or friends |
1 |
2 |
3 |
4 |
5 |
9 |
E5_15. |
Harm others with secondhand smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_16. |
Not hurt anyone with my secondhand smoke |
1 |
2 |
3 |
4 |
5 |
9 |
E5_17. |
Achieve my goals more easily |
1 |
2 |
3 |
4 |
5 |
9 |
E5_18. |
Have trouble reaching my goals |
1 |
2 |
3 |
4 |
5 |
9 |
E5_19. |
Be less successful |
1 |
2 |
3 |
4 |
5 |
9 |
E5_20. |
Be just as successful |
1 |
2 |
3 |
4 |
5 |
9 |
E5_21. |
[INSERT RISK PERCEPTION] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_22. |
[INSERT RISK PERCEPTION] |
1 |
2 |
3 |
4 |
5 |
9 |
Social Norms
E6. How many of your four closest friends…
|
|
0 None |
1 One |
2 Two |
3 Three |
4 Four |
9 |
E6_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_2. |
Smoke menthol cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_3. |
Use smokeless tobacco, such as chewing tobacco, snuff, snus or dip? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_4. |
Use marijuana? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_5. |
Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_6. |
Smoke cigars, cigarillos, or little cigars without added marijuana?
Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s. |
0 |
1 |
2 |
3 |
4 |
9 |
E6_7. |
Use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]? |
0 |
1 |
2 |
3 |
4 |
9 |
E7. How many of the people who hang out where you hang out…
|
|
0 None |
1 A few |
2 Some |
3 Most |
4 All |
9 |
E7_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_2. |
Smoke menthol cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_3. |
Use smokeless tobacco, such as chewing tobacco, snuff, snus or dip? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_4. |
Use marijuana? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_5. |
Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)? |
0 |
1 |
2 |
3 |
4 |
9 |
E7_6. |
Smoke cigars, cigarillos, or little cigars without added marijuana?
Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s. |
0 |
1 |
2 |
3 |
4 |
9 |
E7_7. |
Use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”, such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]? |
0 |
1 |
2 |
3 |
4 |
9 |
E8. Thinking about the people who hang out where you hang out, do you think tobacco use is…
1 Increasing
2 Decreasing
3 Staying the same
4 Not sure
9 Prefer not to answer
Perceived Approval
E9. How much do you agree or disagree with the following statements?
[RANDOMIZE E9_1-E9_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E9_1. |
According to my family, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_2. |
According to my friends, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_3. |
According to most people my age, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_4. |
According to the people who hang out where I hang out, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
APPROVAL OF SMOKING
E10. This next set of questions asks about how willing or unwilling you are to do things with people who smoke cigarettes.
|
|
1 Definitely Willing |
2 Probably Willing |
3 Probably Unwilling |
4 Definitely Unwilling |
9 |
E10_1. |
How would you feel about going to a party, concert or event where people are smoking cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_2. |
How would you feel about hanging out with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_3. |
How would you feel about dancing with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_4. |
How would you feel about kissing someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E10_5. |
How would you feel about going out with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
Perceived Peer Crowd Smoking
[E11 items displaying a single I-Base hip hop photo or mainstream photo] [RANDOMIZE PRESENTATION OF PHOTOS]
[DISPLAY I-BASE PHOTO OF HIP HOP MALE, then ask E11_1]
E11_1. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF HIP HOP FEMALE, then ask E11_2]
E11_2. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF MAINSTREAM MALE, then ask E11_3]
E11_3. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
[DISPLAY I-BASE PHOTO OF MAINSTREAM MALE, then ask E11_4]
E11_4. Do you think this person smokes cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
9 Prefer not to answer
Perceived Popularity
E12. How much do you agree or disagree with the following statements?
[RANDOMIZE E12_1-E12_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 |
3 Agree |
4 Strongly Agree |
9 |
E12_1. |
Most successful people smoke cigarettes once a month or more. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_2. |
More fresh people smoke cigarettes than people who are not fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_3. |
Rich and famous people are more likely to smoke cigarettes than people who aren’t rich and famous. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_4. |
My favorite hip hop artists probably smoke cigarettes once a month or more. |
1 |
2 |
3 |
4 |
5 |
9 |
Section F: Media Use and Awareness
First, we’d like to ask you about your use of TV and other media.
|
1 None |
2 5 min – less than 30 min |
3 30 min – 1 hour |
4 More than 1 hour – 3 hours |
5 More than 3 hours |
9 Prefer Not to Answer |
F1. Thinking only about yesterday, about how much time did you spend watching TV shows on any platform including a TV set, a computer, laptop or tablet, a smartphone or an iPod or MP3 player? |
1 |
2 |
3 |
4 |
5 |
9 |
F2. Thinking only about yesterday, about how much time did you spend doing the following activities?
|
None |
At least one minute, but less than 1 hour |
1 hour or more, but less than 2 hours |
2 hours or more, but less than 3 hours |
More than 3 hours |
Prefer Not to Answer |
Listening to Music |
|
|
|
|
|
|
F2_1. Listening to music across all devices including iPods, MP3 players, cell phones, computer, laptop, tablet, Internet radio like Pandora or Spotify, CD players, and car radios |
1 |
2 |
3 |
4 |
5 |
9 |
Using a Cellphone/Smartphone |
|
|
|
|
|
|
F2_2. Text messaging on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_3. Watching or uploading videos, such as on YouTube, on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_4. Going to social networking sites like Twitter, Instagram or Facebook on a cell phone/smartphone |
1 |
2 |
3 |
4 |
5 |
9 |
F2_5. Browsing any other type of website on a cell phone/smartphone like news or entertainment. Include smartphone apps. |
1 |
2 |
3 |
4 |
5 |
9 |
Using a Computer, Laptop, or Tablet (not a smartphone) |
|
|
|
|
|
|
F2_6. Watching or uploading videos, such as on YouTube, on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F2_7. Using social networking sites like Twitter, Instagram, or Facebook on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F2_8. Browsing any other type of website for anything besides schoolwork on a computer, laptop, or tablet, like news or entertainment |
1 |
2 |
3 |
4 |
5 |
9 |
F2_9. Instant messaging or Video chatting (on Skype, Googletalk, iChat, etc.) on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
Radio and Reading |
|
|
|
|
|
|
F2_10. Listening to the radio |
1 |
2 |
3 |
4 |
5 |
9 |
F2_11. Looking at or reading any magazines? Do not include time spent reading magazines on a computer, laptop, or tablet |
1 |
2 |
3 |
4 |
5 |
9 |
F3. How often do you go to the movies at a movie theater?
1 Once a week or more often
2 One or two times a month
3 Once every two or three months
4 One or two times a year
5 I do not see movies at a movie theater
9 Prefer not to answer
F4. How often do you go to concerts, live shows, or other events at a store, local stage, community center, or music venue?
1 Once a week or more often
2 One or two times a month
3 Once every two or three months
4 One or two times a year
5 I do not attend concerts, live shows, or other events
9 Prefer not to answer
F14. Thinking about the past 3 months, that is since [FILL DATE], how frequently have you watched the following shows? [RANDOMIZE F14_1 – F14_4]
|
Never |
Rarely |
Sometimes |
Often |
Very Often |
Prefer Not to Answer |
F14_1. The show [Title] on [Channel]?
|
1 |
2 |
3 |
4 |
5 |
9 |
F14_2. The show [Title] on [Channel]?
|
1 |
2 |
3 |
4 |
5 |
9 |
F14_3. The show [Title] on [Channel]?
|
1 |
2 |
3 |
4 |
5 |
9 |
F14_4. The show [Title] on [Channel]?
|
1 |
2 |
3 |
4 |
5 |
9 |
F15. In the past 3 months, that is since [FILL DATE], how frequently have you been on YouTube or Hulu?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F16. In the past 3 months, that is since [FILL DATE], how frequently have you been on Twitter?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F17. In the past 3 months, that is since [FILL DATE], how frequently have you been on Instagram?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F18. In the past 3 months, that is since [FILL DATE], how frequently have you been on Facebook?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F18_x. In the past 3 months, that is since [FILL DATE], how frequently have you been on [INSERT WEBSITE THAT FEATURES CONTENT]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F19. In the past 3 months, that is since [FILL DATE], how frequently have you used Pandora or Spotify?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F20. In the past 3 months, that is since [FILL DATE], how frequently have you used PlayStation or Xbox?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F20_x. In the past 3 months, that is since [FILL DATE], how frequently have you used [INSERT PLACEHOLDER FOR VIDEO EXPOSURE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
BRAND AWARENESS
F5. We want to ask you about some brands that might or might not have appeared in the media around here, as part of ads or videos about tobacco or at concerts, live shows, or other events.
F5_1. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
[INSERT any brands of local/state campaigns that are being run in markets]
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_2. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
Digital Youth Against Tobacco (DYAT)
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_3. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
The Real Cost
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F5_4. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
Fresh Empire
[DISPLAY CAMPAIGN LOGO]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
AD AWARENESS OTHER TC CAMPAIGNS (TO USE AS CONTROLS)
F6. The next set of questions asks whether or not you’ve seen any of the following ads.
[RANDOMIZE F6_1-F6_2]
F6_1. In the past 3 months, that is since [FILL DATE], have you seen a Tips from Former Smokers (Tips) ad? Examples of some Tips from Former Smokers ads are shown below.
[DISPLAY Tips from Former Smokers PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F6_2. In the past 3 months, that is since [FILL DATE], have you seen a truth® campaign ad? Examples of some truth® campaign ads are shown below.
[DISPLAY truth® PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
F6_3. In the past 3 months, that is since [FILL DATE], have you seen a The Real Cost campaign ad? Examples of some The Real Cost campaign ads are shown below.
[DISPLAY The Real Cost PHOTO COLLAGE]
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to answer
[IF F6_1 AND/OR F6_2=YES, ASK F7_1 AND/OR F7_2; IF NO OPTIONS ARE SELECTED, GO TO F9. ASK F8 IF F6_1 AND/OR F6_2=YES.]
F7_1. Where have you seen a Tips from Former Smokers (Tips) ad? Examples of some Tips from Former Smokers ads are shown below.
[DISPLAY Tips from Former Smokers PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F7_2. Where have you seen a truth® campaign ad? Examples of some truth® campaign ads are shown below.
[DISPLAY truth® campaign PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F7_3. Where have you seen a The Real Cost campaign ad? Examples of some The Real Cost campaign ads are shown below.
[DISPLAY The Real Cost campaign PHOTO COLLAGE]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ On TV
2___ On the radio
3___ In newspapers or magazines
4___ On the Internet or anywhere online
5___ Billboards or other outdoor ads
6___ Not Sure
9___ Prefer not to answer
F8. In the past 3 months, that is since [FILL DATE], how frequently have you seen these ads on television?
1 Rarely
2 Sometimes
3 Often
4 Very Often
9 Prefer not to answer
CHANNELS OF FRESH EMPIRE AWARENESS
[IF F5_4= 1 or 3, Ask F21.]
F21. Where have you seen or heard about Fresh Empire? Check all that apply
1
Yes
[RANDOMIZE; ALL APPEAR ON SCREEN AT ONCE (IF NOT ABLE TO DISPLAY ALL, MAKE ITEM SKIPPABLE AND REMOVE F21_m)]
F21_a. On TV
F21_b. On the radio
F21_c. In magazines
F21_d. On the Internet or anywhere online
F21_e. Billboards or other outdoor ads
F21_f. At a movie theatre
F21_g. At an event
F21_h. At a mall
F21_i. At a convenience store
F21_j. [INSERT PLACEHOLDER FOR CHANNEL OF EXPOSURE]
F21_k. [INSERT PLACEHOLDER FOR CHANNEL OF EXPOSURE]
F21_l. Some other place (please specify____________)
F21_m. Prefer not to answer
F22. The Fresh Empire campaign is online. Have you ever seen the Fresh Empire on…
Check all that apply
1
Yes
[RANDOMIZE; ALL APPEAR ON SCREEN AT ONCE (IF NOT ABLE TO DISPLAY ALL, MAKE ITEM SKIPPABLE AND REMOVE F22_17)]
F22_1. Twitter?
F22_2. Instagram?
F22_3. Facebook?
F22_4. YouTube?
F22_5. Pandora or Spotify?
F22_6. Dime?
F22_7. Complex?
F22_8. NiceKicks?
F22_9. DatPiff?
F22_10. XXL?
F22_11. Rap-Up
F22_12. ThatGrapeJuice?
F22_13. Boombox?
F22_14. [INSERT PLACEHOLDER FOR ADDITIONAL WEBSITE]
F22_15. [INSERT PLACEHOLDER FOR ADDITIONAL WEBSITE]
F22_16. Other (please specify____________)
F22_17. Prefer not to answer
EVENTS AWARENESS, CHANNEL OF AWARENESS
F5_5a. In the past 3 months, that is since [FILL DATE], have you heard of an event in your area sponsored by, or associated with, Fresh Empire? (DISPLAY LOGO)
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
IF F5_5a=1,3, or 9 ASK F23
F23_1. How frequently have you heard of an event in your area sponsored by, or associated with Fresh Empire, in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F23_2. How did you hear about the Fresh Empire event?
1__ Poster
2__ Flyer or promotional materials
3__ Radio ad
4__ Video ad
5__ Friend
6__ [INSERT PLACEHOLDER FOR OTHER EVENT PROMOTION]
7__ [INSERT PLACEHOLDER FOR OTHER EVENT PROMOTION]
8__ Other (please specify_______________)
9__ Not sure
99__ Prefer not to answer
EVENT ATTENDANCE AND REACTIONS
F24. Have you ever attended an event sponsored by, or associated with Fresh Empire?
1 Yes
2 No
9 Prefer not to answer
IF F24=2 GO TO VIDEO AWARENESS (F5_5b)
F25. Which Fresh Empire event/s did you attend? Check all that apply.
1 Location #1
2 Location #2
3 Location #3
4 Additional Locations
5 Not sure
9 Prefer not to answer
F26. How would you describe the event/s? [RANDOMIZE F26_1-F26_2] [MAKE THIS ITEM SKIPPABLE]
F26_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F26_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
F27_x. How much do you agree or disagree with the following statements?
|
|
1 |
2 |
3 |
4 |
5 |
9 |
F27_1. |
The event/s was worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F27_2. |
The event/s grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F27_3. |
The event/s was powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F27_4. |
The event/s was informative |
1 |
2 |
3 |
4 |
5 |
9 |
F27_5. |
The event/s was meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F27_6. |
The event/s was convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F27_7. |
The event/s was terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F27_8. |
The event/s told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F27_9. |
The event/s gave me good reasons NOT to smoke cigarettes |
|
|
|
|
|
|
F27_10. |
The event/s gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F28_a. On a scale of 1 to 5, indicate whether the event/s made smoking cigarettes seem like something you would or wouldn’t want to do.
1. The event/s makes me want to smoke cigarettes
2
3
4
5. The event/s makes me want to NOT smoke cigarettes
9__ Prefer not to answer
F28_b. On a scale of 1 to 5, indicate whether the event/s made using tobacco seem like something you would or wouldn’t want to do.
1. The event/s makes me want to use tobacco
2
3
4
5. The event/s makes me want to NOT use tobacco
9__ Prefer not to answer
VIDEO AWARENESS
F5_5b. In the past 3 months, that is since [FILL DATE], have you seen a Fresh Empire video online? (DISPLAY LOGO)
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
F29. Now we would like to show you some videos that have been shown in the U.S. Once you have viewed the video, please click on the forward arrow below to continue with the survey.
[DISPLAY VIDEOS OR SCREENSHOTS IN RANDOM ORDER. Use VIDEO for Fresh Empire ads and fake ad if relevant, Use SCREENSHOTS for truth® and Tips from Former Smokers ads if relevant]
[RANDOMIZE]
F29_x. Apart from this survey, how frequently have you seen this video [SCREENSHOT LANGUAGE: these ads] in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
LOOP BACK TO ASK ABOUT NEXT VIDEO HERE. SHOW ALL VIDEOS BEFORE ASKING ANY RECEPTIVITY QUESTIONS.
REACTIONS TO VIDEOS
F30_x. What is the main message of this video?
[RANDOMIZE ORDER OF CHECKBOX LIST]
1___ Live tobacco-free for the love of your family
2___ Reject cigarettes to regain control
3___ Be heard when you live tobacco-free
4___ Smelling like cigarettes is gross
5___ Cigarettes can take even the finest down
6___ Choose to live tobacco-free because secondhand smoke causes death and disease
7___ Laws make it difficult for teens to buy cigarettes at convenient stores
8___ Being with friends is more important than smoking
9___ This generation of teens can play a big role in stopping smoking
10___ When you smoke cigarettes, your younger brothers and sisters are more likely to smoke too.
11___ Tobacco is addictive
12___ Cigarettes cause 1,300 people to die every day
13___ Smoking tobacco can make your breath and hair stink
14___ Tobacco smokers are found to be less attractive
15___ Secondhand smoke causes an estimated 41,300 deaths per year
16___ The legal age for buying cigarettes is going up
17__ [INSERT MAIN MESSAGE OF NEW CAMPAIGN VIDEOS OR DIGITAL CONTENT]
98___ Not sure
99___ Prefer not to answer
F31_x. How would you describe this video? [RANDOMIZE F31_1-F31_2] [MAKE THIS ITEM SKIPPABLE]
F31_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F31_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
F32_x. How much do you agree or disagree with the following statements?
|
|
1 |
2 |
3 |
4 |
5 |
9 |
F32_1. |
This video is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F32_2. |
This video grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F32_3. |
This video is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F32_4. |
This video is informative |
1 |
2 |
3 |
4 |
5 |
9 |
F32_5. |
This video is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F32_6. |
This video is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F32_7. |
This video is terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F32_8. |
This video told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F32_9 |
This video gave me good reasons NOT to smoke cigarettes |
|
|
|
|
|
|
F32_10. |
This video gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F33_x_a. On a scale of 1 to 5, indicate whether the video made smoking cigarettes look like something you would or wouldn’t want to do.
1. The video makes me want to smoke cigarettes
2
3
4
5. The video makes me want to NOT smoke cigarettes
9. Prefer not to answer
F33_x_b. On a scale of 1 to 5, indicate whether the video made using tobacco look like something you would or wouldn’t want to do.
1. The video makes me want to use tobacco
2
3
4
5. The video makes me want to NOT use tobacco
9. Prefer not to answer
F34_x. On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this video made you feel…
1 2 3 4 5
Not at all Very
[RANDOMIZE ORDER, THIS ITEM MUST BE SKIPPABLE]
F34_a. Afraid
F34_b. Hopeful
F34_c. Motivated
F34_d. Worried
F34_e. Understood
F34_f. Surprised
F34_g. INSERT OTHER EMOTION HERE if necessary based on new campaign content
F34_h. INSERT OTHER EMOTION HERE if necessary based on new campaign content
RADIO AWARENESS
F35. In the past 3 months, that is since [FILL DATE], have you heard about Fresh Empire on the radio? (DISPLAY LOGO)
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
Now we would like to play you some radio clips that have aired in the U.S. Once you have listened the clip, please click on the forward arrow below to continue with the survey.
[RANDOMIZE]
F36_x. Apart from this survey, how frequently have you heard this on the radio in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
LOOP BACK TO ASK ABOUT NEXT RADIO CLIP HERE. PRESENT ALL CLIPS BEFORE ASKING ANY RECEPTIVITY QUESTIONS.
DIGITAL CONTENT AWARENESS
Now we would like to show you some digital content that you may have seen online.
[DISPLAY
SCREENSHOT OF MATERIALS]
F37a. Apart from this survey, have you seen this content online in the past 3 months, that is since [FILL DATE]?
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
IF F37a=1,3, or 9 ASK F37b
F37b. How frequently have you seen this content online in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
PROMOTIONAL MATERIALS AWARENESS
Now we would like to show you some materials that have been circulating in some cities in the U.S.
[DISPLAY
SCREENSHOT OF MATERIALS]
F38a. Apart from this survey, have you seen promotional materials like this in the past 3 months, that is since [FILL DATE]?
1__ Yes
2__ No
3__ Not sure
9__ Prefer not to answer
IF F38a=1,3, or 9 ASK F38b
F38b. How frequently have you seen promotional materials like this in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
[ASK F38a and F38b UNTIL ALL MATERIALS HAVE BEEN SEEN]
POSTTEST OF KEY BELIEFS
[ASK E1 & E2 IF RESPONDENT WAS NOT PREVIOUSLY AWARE OF FRESH EMPIRE]
E1. How much do you agree or disagree with the following statements about people who are tobacco-free?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E1_1. |
People who are tobacco-free are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_2. |
People who are tobacco-free are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_3. |
People who are tobacco-free are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_4. |
People who are tobacco-free are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_5. |
People who are tobacco-free are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_6. |
People who are tobacco-free are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_7. |
People who are tobacco-free are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_8. |
People who are tobacco-free are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_9. |
People who are tobacco-free are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_10. |
People who are tobacco-free are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_11. |
People who are tobacco-free are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_12. |
People who are tobacco-free are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E1_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2. How much do you agree or disagree with the following statements about people who smoke cigarettes?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
E2_1. |
People who smoke cigarettes are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_2. |
People who smoke cigarettes are fresh. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_3. |
People who smoke cigarettes are trendsetters. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_4. |
People who smoke cigarettes are in control. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_5. |
People who smoke cigarettes are real. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_6. |
People who smoke cigarettes are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_7. |
People who smoke cigarettes are lame. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_8. |
People who smoke cigarettes are fake. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_9. |
People who smoke cigarettes are annoying. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_10. |
People who smoke cigarettes are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_11. |
People who smoke cigarettes are corny. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_12. |
People who smoke cigarettes are followers. |
1 |
2 |
3 |
4 |
5 |
9 |
E2_13 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
E2_14 |
[INSERT BELIEF] |
1 |
2 |
3 |
4 |
5 |
9 |
F39. How much do you agree or disagree with the following statements about Fresh Empire?
[RANDOMIZE F39_1-F39_3]
|
|
1 |
2 |
3 |
4 |
5 |
9 |
F39_1 |
I want to help promote Fresh Empire |
1 |
2 |
3 |
4 |
5 |
9 |
F39_2 |
I’d defend Fresh Empire if someone was hating on it |
1 |
2 |
3 |
4 |
5 |
9 |
F39_3 |
I’d wear a Fresh Empire T-shirt |
1 |
2 |
3 |
4 |
5 |
9 |
[RANDOMIZE ITEMS BELOW WITH F39_7/F39_8 ASKED TOGETHER IN THAT ORDER]
F39_6 |
I talk to my friends about Fresh Empire |
1 |
2 |
3 |
4 |
5 |
9 |
F39_7 |
If I had the chance, I would tell people I know to watch the Fresh Empire videos |
1 |
2 |
3 |
4 |
5 |
9 |
F39_8 |
If I had the chance, I would tell people I know to check out Fresh Empire at events |
1 |
2 |
3 |
4 |
5 |
9 |
F39_9 |
If I see anything from Fresh Empire, I check it out |
1 |
2 |
3 |
4 |
5 |
9 |
[RANDOMIZE ITEMS BELOW WITH F39_4/F39_5 AND F39_16/F39_17 ASKED TOGETHER IN THAT ORDER]
F39_12 |
Fresh Empire is popular with people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F39_13 |
People are buzzing about Fresh Empire
|
1 |
2 |
3 |
4 |
5 |
9 |
F39_14 |
Fresh Empire videos are becoming more popular with the people who hang out where I hang out |
1 |
2 |
3 |
4 |
5 |
9 |
F39_15 |
Checking out Fresh Empire at events is becoming more popular with the people who hang out where I hang out |
1 |
2 |
3 |
4 |
5 |
9 |
F39_16 |
Fresh Empire videos are for people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F39_17 |
Fresh Empire events are for people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F40_x. To what extent do you agree that each of the traits or statements listed below describe Fresh Empire?
|
|
1 |
2 |
3 |
4 |
5 |
9 |
F40_1 |
Trendy |
1 |
2 |
3 |
4 |
5 |
9 |
F40_2 |
Fresh |
1 |
2 |
3 |
4 |
5 |
9 |
F40_3 |
In control |
1 |
2 |
3 |
4 |
5 |
9 |
F40_4 |
Keeps it 100 |
1 |
2 |
3 |
4 |
5 |
9 |
F40_5 |
Hosts the best parties |
1 |
2 |
3 |
4 |
5 |
9 |
F40_6 |
Always looks good |
1 |
2 |
3 |
4 |
5 |
9 |
F41. How much do you agree or disagree with the following statements?
When I think of Fresh Empire, I think…
|
|
1 |
2 |
3 |
4 |
5 |
9 |
F41_1 |
I can keep it fresh by living tobacco-free |
1 |
2 |
3 |
4 |
5 |
9 |
F41_2 |
Using tobacco will get in the way of my goals, dreams, and success |
1 |
2 |
3 |
4 |
5 |
9 |
F41_3 |
Tobacco use is not fresh |
1 |
2 |
3 |
4 |
5 |
9 |
Section G: Environment
The next section asks some questions about your household and peers.
G1. Other than you, has anyone who lives with you used any of the following during the past 30 days…? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER)
1 cigarettes
2 smokeless tobacco, such as chewing tobacco, snuff, snus or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal
3 cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s
4 tobacco out of a water pipe (also called “hookah”)
5 electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs” such as [INSERT TOP BRANDS OF E-CIGARETTES HERE]
6 any other form of tobacco ___________ (please specify)
7 No, no one who lives with me has used any form of tobacco during the past 30 days
9 Prefer not to answer
G2. Have any of your brother(s) and/or sister(s) smoked cigarettes during the past 30 days?
1 Yes
2 No
3 I don’t know
4 I don’t have any brothers
G3. Which statement best describes the rules about smoking in your home? Would you say…
1 Smoking is not allowed anywhere inside your home
2 Smoking is allowed in some places or at some times
3 Smoking is allowed anywhere inside the home
4 There are no rules about smoking inside the home
9 Prefer not to answer
G4. How well would you say you have done in school? Would you say…
1 Much better than average
2 Better than average
3 Average
4 Below average
5 Much worse than average
9 Prefer not to answer
G5. How much do you agree or disagree with the following statements?
[RANDOMIZE G5_1-G5_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
G5_1. |
I feel close to people at my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G5_2. |
I am happy to be at my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G5_3. |
I feel like I am a part of my school. |
1 |
2 |
3 |
4 |
5 |
9 |
G6. How far do you think you will go in school?
1 I don’t plan to go to school anymore
2 6th grade
3 7th grade
4 8th grade
5 9th grade
6 10th grade
7 11th grade
8 12th grade or GED
9 Some college or technical school but no degree
10 Technical school degree
11 College degree
12 Graduate school, medical school, or law school
99 Prefer not to answer
G7. How many close friends do you have? (Close friends include people whom you feel at ease with, can talk to about private matters, and can call on for help.)
__________ MIN 0 MAX 7
9 Prefer not to answer
G8. How often do you attend church or religious services? Would you say…
1 Never
2 Less than once a month
3 About once a month
4 About 2 or 3 times a month
5 Once a week
6 More than once a week
9 Prefer not to answer
G9. How much do you agree or disagree with the following statements?
[RANDOMIZE G9_1-G9_4]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 |
G9_1. |
I would like to explore strange places. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_2. |
I like to do frightening things. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_3. |
I like new and exciting experiences, even if I have to break the rules. |
1 |
2 |
3 |
4 |
5 |
9 |
G9_4. |
I prefer friends who are exciting and unpredictable. |
1 |
2 |
3 |
4 |
5 |
9 |
G10. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
_____ Number of days
2 None
3 Don’t know
9 Prefer not to answer
These next questions ask about your relationship with your parent(s) or guardian(s). Some people your age have parents who they do not live with. As you answer these questions, please think only about the parent(s) or guardian(s) you live with.
G11. Thinking about the parent(s) or guardian(s) you live with, how satisfied are you with the way you communicate with each other?
1 Not at all satisfied
2 Not very satisfied
3 Somewhat satisfied
4 Quite satisfied
5 Very satisfied
9 Prefer not to answer
G12. How close do you feel to your parent(s) or guardian(s)?
1 Not at all close
2 Not very close
3 Somewhat close
4 Quite close
5 Very close
9 Prefer not to answer
G13. How many times has your parent(s) or guardian(s) said things that really hurt your feelings or made you feel like you were not wanted or loved?
1 1 time
2 2 times
3 3 to 5 times
4 6 to 10 times
5 More than 10 times
6 Never
7 Don’t know
9 Prefer not to answer
G14. Has your parent(s) or guardian(s) ever talked to you about reasons for not smoking cigarettes or using other types of tobacco like cigars or chewing tobacco?
1 Yes
2 No
9 Prefer not to answer
G15. During the past 7 days, on how many days did you and your parent(s) or guardian(s) do something together just for fun?
__________ MIN 0 MAX 7
9 Prefer not to answer
Section S_b: Study Screener, continued
[IN PERSON INTERVIEW ONLY]
Next I have some questions about the people who live in this home.
S01. Please think about all of the people who live in this home who are 17 years old or younger. Including yourself, how many people live in this home who are 17 years old or younger?
__________ MIN 0 MAX 7
9 Prefer not to answer
S02. If S01>1. Please tell me more about these people, starting with the oldest. How old is this person?
__________ MIN 0 MAX 17
9 Prefer not to answer
S02a. If S02=12-17. What is this person’s name?
__________
9 Prefer not to answer
S03. If S01>2 How old is the next oldest person in the household who is 17 years old or younger?
__________ MIN 0 MAX 17
9 Prefer not to answer
S03a. If S03=12-17. What is this person’s name?
__________
9 Prefer not to answer
[ASK FOR ALL HOUSEHOLD MEMBERS 17 YEARS OLD OR YOUNGER. GENERATE A SCREENING INSTRUMENT FOR EACH MEMBER AGE 12-17. SCREEN EACH ADOLESCENT RESIDENT.]
Thank you for taking time to complete this survey.
Additional Questions for Pre- and Post-Campaign Surveys
Pending Finalized Campaign Materials and Media Buy
BRAND AWARENESS
We want to ask you about some brands you might or might not have seen.
[RANDOMIZE PRESENTATION OF F5_6 through F5_8]
F5_6
In the past 3 months, that is since [FILL DATE], have you seen or heard of the following brand?
Nike
1___ Yes
2___ No
3___ Not Sure
9__ Prefer not to Answer
F5_7
In the past 3 months, that is since [FILL DATE], have you seen or heard of the following brand?
World Star Hip Hop
1___ Yes
2___ No
3___ Not Sure
9__ Prefer not to Answer
F5_8
In the past 3 months, that is since [FILL DATE], have you seen or heard of the following brand?
Air Jordan
1___ Yes
2___ No
3___ Not Sure
9___ Prefer not to Answer
REACTIONS TO VIDEOS
F32_x. How much do you agree or disagree with the following statements?
F32_11 |
This video is silly |
F32_12 |
I trust the information in this video |
F32_13 |
The person/people in this video are like me |
F32_14 |
This video is annoying
|
F32_15 |
This video was difficult to watch |
F32_16 |
I can identify with what the video says |
F32_17 |
This video is different from other anti-tobacco videos I’ve seen or heard |
F33_x_c. On a scale of 1 to 5, how would you rate the claims or arguments in this video:
1. Not believable
2
3
4
5. Believable
9__ Prefer not to answer
Randomize respondents to be asked C8 through C14 for ALL Fresh Empire videos for which they report prior exposure IF TIME PERMITS. Otherwise, ask for a subset of x/x videos.
[DISPLAY SCREENSHOT AD FOR AD_x]
C8_x. After seeing this video, did you look for more information online?
1 Yes
2 No
9 Prefer not to answer
C9_x. After seeing this video, did you visit [insert campaign name] website or Twitter page?
1 Yes
2 No
9 Prefer not to answer
C10_x. After seeing this video, did you share [insert campaign name] YouTube channel with a friend?
1 Yes
2 No
9 Prefer not to answer
C11_x. After seeing this video, did you mention it on social media?
1 Yes
2 No
9 Prefer not to answer
C12_x. Did you talk to anyone about this video?
1 Yes
2 No
9 Prefer not to answer
[IF C12_x =1, ASK C13_x]
C13_x. When you talked about the video, did you talk about any of the following topics?
1 2 9
Yes No Prefer not to answer
[RANDOMIZE]
C13_1. This video was good
C13_2. This video was NOT good
C13_3. I should not smoke cigarettes
C13_4. The person I was talking to or someone else I know should not smoke cigarettes
C13_5. I should not use tobacco
C13_6. The person I was talking to or someone else I know should not use tobacco
C13_7. Other, please specify________________________
C14_x. What do you take away from this video? [check all that apply]
[RANDOMIZE ORDER OF CHECKBOX LIST]
1 __ [Add targeted belief #1 from video]
2__ [Add targeted belief #2 from video]
3__ [Add targeted belief #3 from video]
4__ [Add other targeted belief from video]
5__ One cigarette is not all that bad
6__ Adults want to control me
7__ Smokers don’t care what other people think
8 __ Not sure
9 __Prefer not to answer
REPEAT C8_x through C14_x. FOR ALL Fresh Empire videos if possible.
Otherwise, ask for a subset of x/x videos.
Reactions to DIGITAL CONTENT
C20. How would you describe the Fresh Empire digital content? [this item must be skippable]
C20_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
C20_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
C21x. How much do you agree or disagree with the following statements?
|
|
1 |
2 |
3 |
4 |
5 |
9 |
C21_1 |
This digital content is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
C21_2 |
This digital content grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
C21_3 |
This digital content is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
C21_4 |
This digital content is informative |
1 |
2 |
3 |
4 |
5 |
9 |
C21_5 |
This digital content is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
C21_6 |
This digital content is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
C21_7 |
This digital content is terrible |
1 |
2 |
3 |
4 |
5 |
9 |
C21_8 |
This digital content told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
C21_9 |
This digital content gave me good reason NOT to smoke cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
C21_10 |
This digital content gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
C21_11 |
This digital content is silly |
1 |
2 |
3 |
4 |
5 |
9 |
C21_12 |
I trust the information in this digital content |
|
|
|
|
|
|
C21_13 |
The person/people in this digital content are like me |
1 |
2 |
3 |
4 |
5 |
9 |
C21_14 |
This digital content is annoying |
1 |
2 |
3 |
4 |
5 |
9 |
C21_15 |
This digital content was difficult to watch |
1 |
2 |
3 |
4 |
5 |
9 |
C21_16 |
I can identify with what the digital content says |
1 |
2 |
3 |
4 |
5 |
9 |
C21_17 |
This digital content is different from other anti-tobacco digital content I’ve seen or heard |
1 |
2 |
3 |
4 |
5 |
9 |
C22_x_a. On a scale of 1 to 5, indicate whether the Fresh Empire digital content made smoking cigarettes look like something you would or wouldn’t want to do.
1. The content makes me want to smoke cigarettes
2
3
4
5. The content makes me want to NOT smoke cigarettes
9__ Prefer not to answer
C22_x_b. On a scale of 1 to 5, indicate whether the Fresh Empire digital content made using tobacco look like something you would or wouldn’t want to do.
1. The content makes me want to use tobacco
2
3
4
5. The content makes me want to NOT use tobacco
9__ Prefer not to answer
Reactions to RADIO
C23. How would you describe the Fresh Empire radio clips? [this item must be skippable]
C23_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
C23_2. |
Not enjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
C24_x_a. On a scale of 1 to 5, indicate whether the Fresh Empire radio clips made smoking cigarettes look like something you would or wouldn’t want to do.
1. The radio clips make me want to smoke cigarettes
2
3
4
5. The radio clips make me want to NOT smoke cigarettes
9__ Prefer not to answer
C24_x_b. On a scale of 1 to 5, indicate whether the Fresh Empire radio clips made using tobacco look like something you would or wouldn’t want to do.
1. The radio clips make me want to use tobacco
2
3
4
5. The radio clips make me want to NOT use tobacco
9__ Prefer not to answer
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Rao, Pamela * |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |