Smoker Survey - Wave E (English and Spanish)

Attachment D-2. Changes to Waves A-E Smoker Survey

Item	Currently Approved	Change Type	Revised	Justification
C1b	In the past 4 monhts, during any of the weeks listed below did you quit smoking entirely for at least one day because you were trying to quit smoking?	Deletion	N/A	Question is no longer needed as we will have full baseline data for purposes of tracking pre-campaign to post-campaign changes in key variables.
C1c	On which days did you try to quit smoking during these weeks over the past 4 months? Using your cursor, click on each day that you did not smoke cigarettes because you were trying to quit smoking. Your best guess is fine. If you did not try to quit smoking on any day during the following weeks in the past four months, select the ‘Did Not’ response below.	Deletion	N/A	Question is no longer needed as we will have full baseline data for purposes of tracking pre-campaign to post-campaign changes in key variables.
C1d_1	Did you use electronic vapor products on at least one day during any of the following weeks in the past 4 months?	Deletion	N/A	Question is no longer needed as we will have full baseline data for purposes of tracking pre-campaign to post-campaign changes in key variables.
C3	How long has it been since you last smoked a cigarette? __________ [ENTER NUMBER] Hours (0 – 24) Days (0 – 10) Weeks (0 – 26) Months (0 – 6)	Deletion	N/A	Question is no longer needed.
C4	When you last tried to quit smoking, did you do any of the following? 1. Yes 2. No C4_1. Give up cigarettes all at once. C4_2. Gradually cut back on cigarettes C4_3. Switch completely to electronic vapor products such as e-cigarettes, vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers C4_4. Substitute some of your regular cigarettes with electronic vapor products such as e-cigarettes, vape-pens, hookah pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers C4_5. Switch to mild or some other brand of cigarettes C4_6. Use nicotine replacements like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler C4_7. Use medications like Wellbutrin, Zyban, buproprion, Chantix, or varenicline C4_8. Get help from a telephone quit line C4_9. Get help from a website such as Smokefree.gov C4_10. Get help from a doctor or other health professional	Revision (Minor)	When you last tried to quit smoking, did you do any of the following? 1. Yes 2. No C4_1. Give up cigarettes all at once. C4_2. Gradually cut back on cigarettes C4_3. Switch completely to electronic vapor products such as e-cigarettes, vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers C4_4. Substitute some of your regular cigarettes with electronic vapor products such as e-cigarettes, vape-pens, hookah pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers C4_5. Switch to mild or some other brand of cigarettes C4_6. Use nicotine replacements like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler C4_7. Use medications like Wellbutrin, Zyban, buproprion, Chantix, or varenicline C4_8. Get help from a telephone quit line C4_9. Get help from a website such as Smokefree.gov C4_10. Get help from a doctor or other health professional C4_11. Get help from a pharmacist	Added “pharmacist” to grid list to account for additional avenues of help from health professionals that smokers may seek out in attempting to quit.
C5a	During the past 6 months, that is since [FILL DATE], have you talked to any of the following types of doctors or health care professionals about quitting smoking? 1. Yes 2. No C5a_1. Primary care physician C5a_2. Nurse C5a_3. Physician’s Assistant (PA) or Nurse Practitioner (NP) C5a_4. Pharmacist C5a_5. Dentist or dental hygienist C5a_6. Eye doctor, optometrist, or ophthalmologist C5a_7. Therapist, psychologist, psychiatrist C5a_8. Cardiologist C5a_9. Gastroenterologist or colorectal surgeon	Deletion	N/A	Item is no longer needed as the next phases of The Campaign do not feature messages that are focused on health professionals. There is no need to track this item.
C15	Among close relatives, do…. All of them smoke? Most of them smoke? Most them not smoke? None of them smoke?	Deletion	N/A	Item is no longer needed for analysis.
B9a	N/A	Addition	On the days that you use electronic vapor products, how often do you use them? Rarely Sometimes Often Very Often	This item is being added to provide a more rigorous measurement of e-cigarette consumption to capture intensity or levels of consumption.
D1-D7	Please tell us if you strongly disagree, disagree, agree, or strongly agree with the following statements. Strongly disagree Disagree Agree Strongly agree D1. Smoking cigarettes is pleasurable D2. Smoking cigarettes relieves tension D3. Smoking helps me concentrate and do better work D4. I would be more energetic right now if I didn’t smoke D5. I’m embarrassed that I have to smoke D6. Smoking is hazardous to my health D7. Smoking is harmful to others around me	Deletion	N/A	These items are not linked to any current Tips ad messages and thus do not need to be tracked for evaluation of the next phases of The Campaign.
D14-D16	Please tell us if you strongly disagree, disagree, agree, or strongly agree with the following statements. Strongly disagree Disagree Agree Strongly agree D14. Smoking will severely lower my quality of life in the future D16. Smokers should take warnings about cigarette smoking and lung cancer seriously	Deletion	N/A	These items are not linked to any current Tips ad messages and thus do not need to be tracked for evaluation of the next phases of The Campaign.
D19	N/A	Addition	Please tell us if you strongly disagree, disagree, agree, or strongly agree with the following statements. Strongly disagree Disagree Agree Strongly agree D19. Smoking cigarettes can cause medical complications and diseases that require surgeries and medical procedures to treat.	This item is being added as future Campaign ads may feature messages that highlight smoking-related medical procedures and surgeries.
D21	Do you believe cigarette smoking is related to Yes No D21_1. Lung cancer D21_2. Cancer of the mouth or throat D21_3. Heart Disease D21_4. Diabetes D21_5. Emphysema D21_6. Stroke D21_7. Hole in throat (stoma or tracheotomy) D21_8. Buerger’s Disease D21_9. Amputations (removal of limbs) D21_10. Asthma D21_11. Gallstones D21_12. COPD or Chronic bronchitis D21_13. Periodontal or gum disease D21_14. Premature birth D21_15. Colorectal cancer D21_16. Macular degeneration or blindness D21_17. Depression D21_18. Anxiety Disorder	Revision (Minor)	Do you believe cigarette smoking is related to Yes No D21_1. Lung cancer D21_2. Cancer of the mouth or throat D21_3. Heart Disease D21_4. Diabetes D21_5. Emphysema D21_6. Stroke D21_7. Hole in throat (stoma or tracheotomy) D21_8. Buerger’s Disease D21_9. Amputations (removal of limbs) D21_10. Asthma D21_11. Gallstones D21_12. COPD or Chronic bronchitis D21_13. Periodontal or gum disease D21_14. Premature birth D21_15. Colorectal cancer D21_16. Macular degeneration or blindness D21_17. Depression D21_18. Anxiety Disorder D21_19. Colon cancer	Added “Colon Cancer” to the smoking-related diseases grid as future Campaign ads will feature messages that focus on this disease condition.
F24d_x	You previously indicated that you have seen this ad on either a laptop or desktop computer. When you saw this ad on your computer, did you… Yes No F24d_x_1. Notice the ad on a Website that you were visiting? F24d_x_2. Search for the ad on YouTube, Google, or other Internet search engine?	Deletion	N/A	This item is no longer needed for analysis.
F25_x	Please tell us if you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree with the following statements. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree F25a_x. This ad is worth remembering F25b_x. This ad grabbed my attention F25c_x. This ad is powerful F25d_x. This ad is informative F25e_x. This ad is meaningful to me F25f_x. This ad is convincing F25g_x. This ad is ridiculous F25h_x. This ad is terrible F25i_x. This ad was difficult to watch	Revision (Minor)	Please tell us if you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree with the following statements. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree F25a_x. This ad is worth remembering F25b_x. This ad grabbed my attention F25c_x. This ad is powerful F25d_x. This ad is informative F25e_x. This ad is meaningful to me F25f_x. This ad is convincing	Items F25g_x, F25h_x, and F25i_x have been removed from this grid as these questions are no longer needed for analysis.
F26_x	On a scale of 1 to 5, where 1 means “not at all” and 5 means “very,” please indicate how much this ad made you feel…. 1 (not at all) 2 3 4 5 (very) F26a_x. Sad F26b_x. Afraid F26c_x. Irritated F26d_x. Ashamed F26e_x. Discouraged F26f_x. Hopeful F26g_x. Motivated F26h_x. Understood F26i_x. Angry	Revision (Minor)	On a scale of 1 to 5, where 1 means “not at all” and 5 means “very,” please indicate how much this ad made you feel…. 1 (not at all) 2 3 4 5 (very) F26a_x. Sad F26b_x. Afraid F26d_x. Ashamed F26f_x. Hopeful F26g_x. Motivated F26h_x. Understood	Items F26c_x, F26e_x, and F26i_x have been removed from this grid as these questions are no longer needed for analysis.
F31_x	Did seeing these ads make you want to do any of the following? Quit smoking Cut back on the number of cigarettes I smoke Use electronic vapor products, such as e-cigarettes, vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e- cigars), electronic pipes (e-pipes), or e-vaporizers Switch to mild or some other brand of cigarettes Use nicotine replacements like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler Use medications like Wellbutrin, Zyban, buproprion, Chantix, or varenicline Call a telephone quitline Visit a web site such as Smokefree.gov or CDC.gov/Tips Talk to a doctor or other health professional about quitting	Deletion	N/A	This item is no longer needed for analysis.
F35a_x	In the past [FILL MONTHS SINCE CAMPAIGN LAUNCH], how frequently have you heard this ad on the radio? Rarely Sometimes Often Very Often	Deletion	N/A	This item is no longer needed for analysis. Measurement of simple awareness (yes/no) is sufficient for these purposes.
F38	N/A	Addition	When you go to a convenience store, supermarket, or gas station, how often do you see ads or promotions for electronic cigarettes or e-cigarettes? I never go to a convenience store, supermarket, or gas station Never Rarely Sometimes Most of the time Always	This question has been added to measure exposure to e-cigarette advertising at the point-of-sale as this is the most common type of e-cigarette advertising. This is important to measure since exposure to these messages may moderate or mediate impact of The Campaign on smoking-related outcomes.
G8a	N/A	Addition	In your main job, what kind of work do you do? Select one answer only. Medical Doctor (such as physician, surgeon, dentist, veterinarian) Other Health Care Practitioner (such as nurse, pharmacist, chiropractor, dietician) Health Technologist or Technician (such as paramedic, lab technician) Health Care Support (such as nursing aide, orderly, dental assistant) Service Protective Service ( police, firefighters) Food Preparation and Serving Building and Grounds Cleaning and Maintenance Personal Care and Service(hair stylists, gaming workers, entertainment) Sales Sales Representative Retail Sales Other Sales Office and Administrative Support Farming, Forestry, and Fishing Precision Production, Craft and Repair  Construction and Extraction Installation, Maintenance, and Repair Precision Production (such as machinist, welder, baker, printer, tailor) Transportation and Material Moving Armed Forces Other, please specify________ Management Business and Financial Operations Professional  Computer and Mathematical Architecture and Engineering Life, Physical, and Social Sciences Community and Social Services Lawyer or Judge Teacher, except college and university Teacher, college and university Other Professional	Occupation has been added to facilitate enhanced analysis of the campaign’s impact among subgroups of smokers and nonsmokers.
G11	N/A	Addition	Are you currently covered by any of the following types of health insurance or health coverage plans? Mark “yes” or “no” for each type of coverage. Yes No G15_1. Insurance through a current or former employer or union G15_2. Insurance purchased directly from an insurance company G15_3. Medicare, for people age 64 and over, or people with certain disabilities G15_4. Medicaid, or any kind of government assistance plan for those with low incomes or disability G15_5. TRICARE or other military health care G15_6. VA (including those who have ever enrolled for or used VA health care) G15_7. Indian Health Service G15_8. Any other type of health insurance or health coverage plan	Type of insurance coverage has been added to enable stratified analyses of Campaign effects by types of insurance coverage. This will potentially allow the evaluation to address how the campaign benefits populations that are served by particular insurance programs and health systems such as Medicaid. This will potentially expand the evidence base for The Campaign’s cost effectiveness.