FDA CTP Public Education Materials Study

Generic Clearance for the Collection of Quantitative Data on Tobacco Products and Communications

App_E_PE_Materials_Study_INSTRUMENT

FDA CTP Public Education Materials Study

OMB: 0910-0810

Document [docx]
Download: docx | pdf


Appendix E. Online Survey Instrument


U.S. Food and Drug Administration (FDA) Center for Tobacco Products (CTP)

FDA CTP Public Education Materials Study

SURVEY INSTRUMENT


Note: The survey respondent will NOT see any of the blue text.


[Landing Page/Introduction]


Please select your conference from the list below: [Drop-down menu of 13 conferences in 2018—the complete list of these conferences is available in the study protocol]



What year were you born?

[Drop-down menu with years]

[TERMINATE SURVEY AND GO TO TERMINATION TEXT 2 IF RESPONDENT WAS BORN IN 1999 OR LATER; THIS WILL BE ALTERED SO ONLY THOSE 18 YEARS OR OLDER MAY PARTICIPATE]


[TERMINATION TEXT 2:] Based on your answer, you do not qualify for this survey. Thank you very much for your time and consideration.


[INSERT INFORMED CONSENT INFORMATION HERE]


[Beginning of survey]


1. Were you aware of the existence of the FDA’s Center for Tobacco Products (CTP) before today?

Please select the response option that best applies to you:

  • Yes

  • No

  • I don’t know

  • I prefer not to answer


2. Which of the following best describes you?

  1. General public

Please check the role that best describes you: [These options will only appear if the respondent checks “General public.”]

    1. A tobacco product consumer

    2. Concerned citizen

    3. Family or friend of product consumer

    4. Health information seeker

    5. Other (please specify): ___________ [Open-ended text box]

    6. I prefer not to answer

  1. Health care professional

Please check the role that best describes you: [These options will appear only if the respondent checks “Health care professional.”]

    1. Administrator

    2. Nurse in a clinical setting

    3. Nurse in a school setting

    4. Physician

    5. Physician Assistant

    6. Other (please specify): ___________ [Open-ended text box]

    7. I prefer not to answer

  1. Media professional

Please check the role that best describes you: [These options will appear only if the respondent checks “Media professional.”]

    1. Member of the press/reporter

    2. Other communications professional

    3. I prefer not to answer

  1. Public health professional

Please check the role that best describes you: [These options will only appear if the respondent checks “Public health professional.”]

    1. Advocate

    2. Communicator

    3. Educator/trainer

    4. Practitioner

    5. Researcher/scientist

    6. Other (please specify): ___________ [Open-ended text box]

    7. I prefer not to answer

  1. Tobacco industry representative

Please check the role that best describes you: [These options will only appear if the respondent checks “Tobacco industry representative.”]

    1. Importer

    2. Grower

    3. Manufacturer

    4. Retailer

    5. Trade association representative

    6. Wholesaler or distributor

    7. Other (please specify): ___________ [Open-ended text box]

    8. I prefer not to answer

  1. Other (please specify): ___________ [Open-ended text box]

  2. I prefer not to answer


3. Which of these populations do you primarily serve? [CHECK ALL THAT APPLY]

  • Asians/Asian Americans

  • Blacks/African Americans

  • General public

  • Hawaiians/Pacific Islanders

  • Health care professionals (for example, physicians and clinicians)

  • Hispanics/Latinos

  • Please check the population that best describes the one that you serve: [These options will only appear if the respondent checks “Hispanics/Latinos.”]

      1. English-dominant Hispanics/Latinos

      2. Spanish-dominant Hispanics/Latinos

      3. Bilingual Hispanics/Latinos

      4. A mixture of all the above

      5. I prefer not to answer

  • LGBTQI (lesbian, gay, bisexual, transgender, queer or questioning, and intersex people)

  • Media professionals

  • Native Americans/American Indians

  • Public health professionals (for example, public health educators and public health students)

  • Teachers

  • Tobacco industry representatives (for example, retailers and manufacturers)

  • Whites/Caucasians

  • Young adults

  • Youth/teens

  • Other (please specify): ____________ [open-ended text box]

  • I don’t know

  • None

  • I prefer not to answer


[Each survey respondent will view four tobacco education materials—materials will be rotated randomly among respondents. The random rotation will be programmed in the survey software.]


Next, you will be shown 4 materials. You will receive questions about the materials. The questions may seem repetitive but are necessary to evaluate the materials.


FIRST MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)


The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.


[First randomly selected material appears as a screen shot here.]


4. Have you seen this material before?

Please select the response option that best applies to you:

  • Yes

  • No

  • I don’t know

  • I prefer not to answer


5. To what extent does this material provide NEW information to you?

Please select the response option that best applies to you:

  • 100% (all) new information

  • Approximately 75% new information

  • Approximately 50% new information

  • Approximately 25% new information

  • 0% (no) new information

  • I don’t know

  • I prefer not to answer


6. To what extent is this material USEFUL to you?

Please select the response option that best applies to you:

  • 100% (all) useful information

  • Approximately 75% useful information

  • Approximately 50% useful information

  • Approximately 25% useful information

  • 0% (no) useful information

  • I don’t know

  • I prefer not to answer


7. How EASY TO UNDERSTAND is this material to you?

Please select the response option that best applies to you:

  • 100% (all) easy to understand information

  • Approximately 75% easy to understand information

  • Approximately 50% easy to understand information

  • Approximately 25% easy to understand information

  • 0% (no) easy to understand information

  • I don’t know

  • I prefer not to answer


SECOND MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)

The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.


[Second randomly selected material appears as a screen shot here.]


8. Have you seen this material before?

Please select the response option that best applies to you:

  • Yes

  • No

  • I don’t know

  • I prefer not to answer


9. To what extent does this material provide NEW information to you?

Please select the response option that best applies to you:

  • 100% (all) new information

  • Approximately 75% new information

  • Approximately 50% new information

  • Approximately 25% new information

  • 0% (no) new information

  • I don’t know

  • I prefer not to answer


10. To what extent is this material USEFUL to you?

Please select the response option that best applies to you:]

  • 100% (all) useful information

  • Approximately 75% useful information

  • Approximately 50% useful information

  • Approximately 25% useful information

  • 0% (no) useful information

  • I don’t know

  • I prefer not to answer


11. How EASY TO UNDERSTAND is this material to you?

Please select the response option that best applies to you:

  • 100% (all) easy to understand information

  • Approximately 75% easy to understand information

  • Approximately 50% easy to understand information

  • Approximately 25% easy to understand information

  • 0% (no) easy to understand information

  • I don’t know

  • I prefer not to answer


THIRD MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)

The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.


[Third randomly selected material appears as a screen shot here.]


12. Have you seen this material before?

Please select the response option that best applies to you:

  • Yes

  • No

  • I don’t know

  • I prefer not to answer


13. To what extent does this material provide NEW INFORMATION to the POPULATIONS you serve?

  • 100% (all) new information

  • Approximately 75% new information

  • Approximately 50% new information

  • Approximately 25% new information

  • 0% (no) new information

  • I don’t know

  • I prefer not to answer


14. To what extent is this material HELPFUL to the POPULATIONS you serve?

  • 100% (all) helpful information

  • Approximately 75% helpful information

  • Approximately 50% helpful information

  • Approximately 25% helpful information

  • 0% (no) helpful information

  • I don’t know

  • I prefer not to answer


15. To what extent is this material MOTIVATIONAL to the POPULATIONS you serve?

  • 100% (all) motivational information

  • Approximately 75% motivational information

  • Approximately 50% motivational information

  • Approximately 25% motivational information

  • 0% (no) motivational information

  • I don’t know

  • I prefer not to answer


FOURTH MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)

The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.


[Fourth randomly selected material appears as a screen shot here.]


16. Have you seen this material before?

Please select the response option that best applies to you:

  • Yes

  • No

  • I don’t know

  • I prefer not to answer


17. To what extent does this material provide NEW INFORMATION to the POPULATIONS you serve?

  • 100% (all) new information

  • Approximately 75% new information

  • Approximately 50% new information

  • Approximately 25% new information

  • 0% (no) new information

  • I don’t know

  • I prefer not to answer


18. To what extent is this material HELPFUL to the POPULATIONS you serve?

  • 100% (all) helpful information

  • Approximately 75% helpful information

  • Approximately 50% helpful information

  • Approximately 25% helpful information

  • 0% (no) helpful information

  • I don’t know

  • I prefer not to answer


19. To what extent is this material MOTIVATIONAL to the POPULATIONS you serve?

  • 100% (all) motivational information

  • Approximately 75% motivational information

  • Approximately 50% motivational information

  • Approximately 25% motivational information

  • 0% (no) motivational information

  • I don’t know

  • I prefer not to answer


We would like to know more about your tobacco education information needs.


20. You already told us which populations you serve. For what specific populations do you need additional tobacco education materials?

[CHECK ALL THAT APPLY]


  • Asians/Asian Americans

  • Blacks/African Americans

  • General public

  • Hawaiians/Pacific Islanders

  • Health care professionals (for example, physicians and clinicians)

  • Hispanics/Latinos

  • Please check the population that best describes the one for which you need additional tobacco education materials: [These options will only appear if the respondent checks “Hispanics/Latinos.”]

      1. English-dominant Hispanics/Latinos

      2. Spanish-dominant Hispanics/Latinos

      3. Bilingual Hispanics/Latinos

      4. A mixture of all the above

  • LGBTQI (lesbian, gay, bisexual, transgender, queer or questioning, and intersex people)

  • Media professionals

  • Native Americans/American Indians

  • Public health professionals (for example, public health educators and public health students)

  • Teachers

  • Tobacco industry representatives (for example, retailers and manufacturers)

  • Whites/Caucasians

  • Young adults

  • Youth/teens

  • Other (please specify): ____________ [open-ended text box]

  • I don’t know

  • None

  • I prefer not to answer


21. For which of the following topics would you like to see more tobacco education materials developed? [CHECK ALL THAT APPLY]

  • Novel or alternative tobacco products

Please check the novel or alternative tobacco products for which you need more information: [These options will appear only if the respondent checks “Novel or alternative tobacco products.”] [CHECK ALL THAT APPLY]

      1. Chewing tobacco (“spit,” “chew”)

      2. Cigarillos or little cigars

      3. Cigars

      4. Dissolvables or dissolvable tobacco (can take the form of orbs, strips, or sticks and resemble candy or mints)

      5. E-cigarettes and other electronic nicotine delivery systems (ENDS) such as hookah pens, e-pipes, vapes, and vaporizers

      6. Gels

      7. Kreteks (clove cigarettes that contain 60 percent to 90 percent tobacco)

      8. Menthol cigarettes

      9. Pipe tobacco

      10. Snuff (“pinch,” “dip”)

      11. Snus (spitless tobacco in teabag-like pouches)

      12. Waterpipe or hookah tobacco

      13. Other (please specify): ____________________ [open-ended text box]

      14. None of the above

  • Prevention of tobacco use

Please check the tobacco products for which you need more information: [These options will appear only if the respondent checks “Prevention of tobacco use.”] [CHECK ALL THAT APPLY]

      1. Chewing tobacco (“spit,” “chew”)

      2. Cigarillos or little cigars

      3. Cigars

      4. Dissolvables or dissolvable tobacco (can take the form of orbs, strips, or sticks and resemble candy or mints)

      5. E-cigarettes and other electronic nicotine delivery systems (ENDS) such as hookah pens, e-pipes, vapes, and vaporizers

      6. Gels

      7. Kreteks (clove cigarettes that contain 60 percent to 90 percent tobacco)

      8. Menthol cigarettes

      9. Pipe tobacco

      10. Snuff (“pinch,” “dip”)

      11. Snus (spitless tobacco in teabag-like pouches)

      12. Waterpipe or hookah tobacco

      13. Other (please specify): ____________________ [open-ended text box]

      14. None of the above

  • Treatment of tobacco-associated health conditions

  • The latest science in tobacco research

  • Other (please specify): ____________ [open-ended text box]

  • None

  • I don’t know

  • I prefer not to answer


22. For tobacco education, which of the following formats would you like used? [CHECK ALL THAT APPLY]

  • Brochures

  • Digital assets

  • Infographics

  • Fact sheets

  • Postcards

  • Posters

  • Videos

  • Other (please specify): ____________ [open-ended text box]

  • None

  • I don’t know

  • I prefer not to answer


23. Of the following ways to deliver materials to you, how would you prefer to receive materials? [PLEASE SELECT THE RESPONSE OPTION THAT BEST APPLIES TO YOU]

  • A real-time, interactive webinar

  • Electronic download (for example, a printable PDF)

  • Email

  • In person at a meeting or conference

  • Regular mail

  • Other (please specify): ____________ [open-ended text box]

  • None

  • I don’t know

  • I prefer not to answer


24. Which of the following engagement opportunities offered by the FDA Center for Tobacco Products interest you most? [CHECK ALL THAT APPLY]

  • In-person meetings (e.g., conferences, town hall meetings)

  • Teleconferences

  • Videos

  • Webinars

  • Other (please specify): ____________ [open-ended text box]

  • None

  • I don’t know

  • I prefer not to answer


25. In what country do you live? [Drop-down menu of countries]

    • I prefer not to answer


25a. [For those who responded “United States”] In what state do you work? [Drop-down menu of states]

    • I prefer not to answer


Thank you very much for taking the time to complete this survey!


The FDA Center for Tobacco Products (CTP) Team


Please go to the next page to submit your survey.


The Food and Drug Administration (FDA) is sponsoring this study. The mission of the FDA is to promote and protect public health. In conducting this study, FDA does not intend to sell tobacco, nor promote, condone, normalize, or encourage its use.


[End of survey]


Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average no more than 6 minutes per response to complete this survey (the time estimated to read and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to [email protected].”


Form Approved

OMB No. 0910-0810

Exp. Date11/2018

RIHSC #18-001


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorEverly Macario
File Modified0000-00-00
File Created2021-01-21

© 2024 OMB.report | Privacy Policy