Form Approved
OMB No. 0920-0910
Exp. Date 03/31/2018
National Tobacco Prevention and Control Public Education Campaign:
Rough
Cut Testing of English Language Television, Radio, Print, and Digital
Advertisements for the 2016 Tips Campaign
Main Questionnaire
Public reporting burden of this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0910).
{PREAMBLE SHOWN DURING SCREENER}
On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking-specific advertising that you see in the media. Your opinions are very important to us! Please be assured that the purpose of this survey is to gather feedback regarding specific health-related advertising. We do not plan to report your answers individually. We plan to report results from this survey for the group as a whole. Thank you for taking the time to help us!
Your participation in this survey is voluntary.
Anxiety/Depression (Quota Requirement)
{Base = All respondents}
Anxiety disorder
Depression
Other mental health condition (specify) ____________________________________
None of these [Single select, anchor]
{If answered ADQ1.04 is selected, then ask:}
Anxiety disorder
Depression
Other mental health condition
None of these [Single select, anchor]
{If ADQ1 or ADQ2 = 03, 04 then do not include as part of Anxiety/Depression quota}
Not at all
Several days
More than half the days
Nearly every day
a. Feeling nervous, anxious, or on edge
b. Not being able to stop or control worrying
c. Little interest or pleasure in doing things
d. Feeling down, depressed or hopeless
Less than high school
Completed high school
10 Completed General Education Diploma (GED)
Job-specific training program(s) after high school
Some college, but no degree
Associate Degree
College (such as B.A., B.S.)
Some graduate school, but no degree
Graduate degree (such as MBA, MS, M.D., Ph.D.)
Prefer not to answer
Less than $15,000
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 or more
Prefer not to answer
01 Working – as a paid employee
02 Working – self-employed
03 Not working – on temporary layoff from a job
04 Not working – looking for work
05 Not working – retired
06 Not working – disabled
07 Not working – other
08 Prefer not to answer
1 Yes
2 No
8 Don’t know
9 Refused
{Base = Current smokers}
{RANDOMIZE}
Smoking cigarettes is a social thing to do when I’m out with friends
Smoking cigarettes is something to do at parties
I’m addicted to smoking
Smoking cigarettes goes well with/after meals
I like the taste of regular cigarettes
Smoking cigarettes helps me relax
Smoking cigarettes goes well when I’m drinking alcohol
Smoking cigarettes helps me stay awake
Smoking cigarettes helps when I’m stressed
Smoking cigarettes excites me
Smoking cigarettes is something to do when I’m bored
Smoking cigarettes helps me lose weight / not gain weight
I have tried to quit smoking cigarettes and cannot
Smoking cigarettes is something I can do with others while working
Smoking cigarettes helps me when I’m depressed
Smoking cigarettes helps me when I’m anxious
Smoking cigarettes is pleasurable {recode as 18}
Other specify {recode as 17}
{Base = All respondents}
Very dangerous
Dangerous
Neither dangerous nor safe
Safe
Very safe
{Base = Current smokers}
Definitely not
Probably not
Probably yes
Definitely yes
Not Sure
{Base = Current Smokers and Former Smokers}
Yes
No
{Base = Answers Yes to D1a}
Every day
Some days
Not at all
{Base = Current Smokers and Former Smokers}
Yes
No
{Base = Answers Yes to D3a}
Every day
Some days
Not at all
Categories Set #3 |
SCREENING LOGIC |
Current Chewing Tobacco, Snuff, Dip User |
Answers 1 to D1A & 1 or 2 to D1b |
Current Snus User |
Answers 1 to D3a & 1 or 2 to D3b |
{Base = all respondents}
Excellent
Very Good
Good
Fair
Poor
{Base = Respondents who SMOKE EVERY DAY (IF TS2 (in screener) = 1)}
Note that 1 PACK = 20 CIGARETTES
[RANGE 1-100]
{Numeric response}
{Base = Respondents who SMOKE EVERY DAY (IF TS2 (in screener) = 1)}
Within 5 minutes
6-30 minutes
31-60 minutes
After 60 minutes
{Base = current smokers}
_ _ _ age in years
Note that 1 PACK = 20 CIGARETTES
[RANGE 1-100]
{Numeric response}
{Current E-Cig Users}
Please indicate the type of electronic vapor product that you use the most.
Disposable electronic vapor product
Electronic vapor product that use cartridges
Electronic vapor product that use tanks
{Current E-Cig Users}
Very dangerous
Dangerous
Neither dangerous nor safe
Safe
Very safe
{Current E-Cig Users}
[SELECT ALL THAT APPLY, PRESENT RANDOMLY]
Yes No
B10_1. They cost less than other forms of tobacco
B10_2. They can be used in places where smoking regular cigarettes isn’t allowed
B10_3. They might be less harmful to me than regular cigarettes
B10_4. They might be less harmful to people around me than regular cigarettes
B10_5. Electronic vapor products come in flavors I like
B10_6. Electronic vapor products can help me quit smoking regular cigarettes
B10_7. Electronic vapor products can help me reduce the number of regular cigarettes I smoke
B10_8. Electronic vapor products don’t smell
B10_9. Using an electronic vapor product feels like smoking a regular cigarette
B10_10. Electronic vapor products don’t bother people who don’t use tobacco
B10_11. The advertising for electronic vapor products appeals to me
B10_12. They help me deal with cravings to smoke
B10_13. I have a friend or family member who suggested I use electronic vapor products as a way to quit smoking regular cigarettes
B10_14. I was curious about electronic vapor products
B10_15. Other, specify________________________
{Current E-Cig Users}
Yes
No
{Current E-Cig Users}
1. Yes
2. No
B12a_1. Restaurants or bars
B12a_2. Stores or shopping malls
B12a_3. Airplanes
B12a_4. Beaches, parks, or other outdoor places
B12a_5. In your car or other type of vehicle
B12a_6. In your home
B12a_7. Somewhere else, specify _______________
{Base = smokers}
_____ Number of times
{Base = current smokers who answered 1 or more to QA1}
YES
NO
[PRESENT IN RANDOM ORDER]
QA3_A. Give up cigarettes all at once
QA3_B. Gradually cut back on cigarettes
QA3_C. Substitute some of your regular cigarettes with an electronic vapor product
QA3_D. Switch completely to an electronic vapor product
QA3_E. Switch to mild or some other brand of cigarettes
QA3_F. Use nicotine replacement products such as a nicotine patch or nicotine gum
QA3_G. Use medications like Zyban or Chantix
QA3_H. Get help from a telephone quit line
QA3_I. Get help from a website such as cdc.gov/Tips
QA3_J. Get help from a doctor or other health professional
{Base = smokers}
Yes
No
{Base = current smokers who answered 1 or more to QA1}
Not at all
A little
Somewhat
A lot
{Base = current smokers who answered 1 or more to QA1}
In the next 7 days,
In the next 30 days,
In the next 6 months,
In the next 1 year, or
More than 1 year from now
I don’t plan to quit smoking cigarettes
Not sure/Uncertain
{Base = current smokers who answered 1 or more to QA1}
Not at all,
A little likely,
Somewhat likely, or
Very likely
{Base = current smokers who answered 1 or more to QA1}
YES
NO
[RANDOMIZE ORDER]
Cost of medicines or products to help with quitting
Cost of classes to help with quitting
Fear of gaining weight
Loss of a way to handle stress
Other people smoking around me
Cravings for a cigarette
Lack of support from others to quit
Worsening depression
Worsening anxiety
Loss of enjoyment from smoking cigarettes
Some other reason, specify ________________
Yes
No
Don’t Know/Not Sure
{BASE for this section is all RESPONDENTS}
01 Heterosexual / Straight
02 Lesbian
03 Gay
04 Bisexual
05 Transgender
06 Something else – please specify ______________
07 Prefer not to answer
None
1-2 children
3-4 children
5 or more children
Now married
Living with my partner
Widowed
Divorced
Separated
Never married
Prefer not to answer
{If DEMO3.01 or DEMO3.02}
Yes
No
{BASE = answers DEMO3b_01}
DEMO3c. Has your partner or spouse tried to quit smoking cigarettes?
Yes
No
{BASE for this section is all RESPONDENTS}
01 At a search engine such as Google, Bing or Yahoo
02 At a site that specializes in topical information, like WebMD
03 At a more general site like Wikipedia, that contains information on all kinds of topics
04 At a social network site like Facebook
05 Other specify
Yes
No
Don’t Know/Not Sure
{BASE = answers T2_01}
Yes,
No
Not sure
{BASE = answers T3_01 & Current Smoker}
Yes
No
Don’t Know/Not Sure
{BASE = answers T3_01 & Current Smoker}
Yes
No
Don’t Know/Not Sure
{BASE for this section is all RESPONDENTS}
{if EAD1 = 01}
On the Internet
In newspapers or magazines
Convenience stores, supermarkets, gas stations, or shopping malls
On TV
At the movies
On the radio
On billboards or other outdoor ads
Other specify
{if EAD1 = 01}
Quit smoking
Cut back on the number of cigarettes I smoke
Use electronic vapor products
Switch to mild or some other brand of cigarettes
Use nicotine replacements like the nicotine patch or nicotine gum
Use medications like Zyban or Chantix
Call a telephone quit line
Visit a web site such as Smokefree.gov or CDC.gov/Tips
Talk to a doctor or other health professional about quitting
Yes
No
{Base = recall anti-smoking advertising (OAS1/1)}
[OPEN END]
{Based on segment type, randomly select an eligible ad type, and randomly select an eligible ad}
{Assign hidden variable to Ad Type selected and Assign hidden variable to Ad selected}
{IF Ad Type is “TV”, use this language}
We
would now like to show you a television ad and then gather your
reactions to that ad. Please make sure the volume on your computer
is turned up, so that you can both see and hear the video. Please
click the forward arrow to continue.
[Each respondent will
review one TV ad]
{IF Ad Type is “Radio”, use this language}
Please
make sure the volume on your computer is turned up, so that you may
hear the audio. Please
click the forward arrow at the bottom of the screen to continue.
[Each respondent will
review one radio ad]
{IF Ad Type is “Print” or “Digital”, use this language}
We
would now like to show you an ad and then gather your reactions to
that ad. Please click
“Next” to continue.
[Each respondent will
review one print ad]
{For Ad Types = TV or Print: }
At
top of page, before question, insert thumbnail image of ad for the
rest of the questions in this survey}
{BASE = all RESPONDENTS and all Ad Types}
[OPEN END]
{BASE = all RESPONDENTS and all Ad Types}
Extremely believable
Moderately believable
Slightly believable
Neither believable nor unbelievable
Slightly unbelievable
Moderately unbelievable
Extremely unbelievable
{BASE = ONLY respondents exposed to Kristy’s ads in all media formats}
[Randomize Order except for last response item]
Smoking regular cigarettes
Using electronic vapor products
Using electronic vapor products in combination with smoking regular cigarettes
Other health conditions not related to smoking regular cigarettes or using electronic vapor products
None of the above
{BASE = all RESPONDENTS and all Ad Types}
On a scale from 1 to 5, where 1 indicates not feeling any emotion, and 5 indicates feeling emotion extremely intensely, please indicate how much this advertisement made you feel:
Angry
Afraid
Ashamed
Sad
Hopeful
Understood
Surprised
Trusting
Motivated
Regretful
Scale for items RC3.A-J:
I do not feel this emotion
Slight emotion
Moderate emotion
Very intense emotion
Extreme and intense emotion
{BASE = all RESPONDENTS and all Ad Types}
This ad is convincing
This ad grabbed my attention
This ad was easy to understand
I learned something new by {TEXTFILL: if ad type = TV or Print or Digital, “viewing”; if ad type = Radio, “hearing”} this ad
I trust the information in this ad
This ad is believable
I would talk to someone else about this ad
This ad is annoying
The people in this ad are believable
This ad is worth remembering
This ad is powerful
This ad is informative
This ad is meaningful
I can identify with what the ad says
This ad made me more confident that I can quit
Scale for items RC4.A-N:
Strongly disagree
Somewhat disagree
Neither agree or disagree
Somewhat agree
Strongly agree
{BASE = all RESPONDENTS and all Ad Types}
Confusing
Unclear
Hard to understand
None of the above
[Base = IF RC5 is any of 1, 2, or 3]
{Open End}
{BASE = all RESPONDENTS and all Ad Types}
Yes
No
{Base = ask only if Rc7.01}
{Open End}
{BASE = all RESPONDENTS and all Ad Types}
Yes
No
{Base = ask only if Rc9.01}
{Open End}
{BASE = Smokers and all Ad Types}
Yes
No
{Base = ask only if Rc11.02}
{Open End}
{Base = ask only if Rc11.01}
{Open End}
Strongly Disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
[RANDOMIZE ORDER]
RC19a. [non-current e-cigarette smokers only] This ad makes me want to try an electronic vapor product.
RC19b. This ad makes me want to switch to electronic vapor products completely and quit smoking regular cigarettes.
RC19c. This ad makes me want to use electronic vapor products as a way to cut back on smoking regular cigarettes.
RC19d. This ad makes me want to use electronic vapor products in places where you normally cannot smoke regular cigarettes.
RC19e. I want a cigarette right now.
{BASE = Smokers and all Ad Types}
Call 1-800-QUIT-NOW for assistance in quitting smoking
Visit an informational government website, such as www.cdc.gov/tips for information on quitting
Talk to your doctor about quitting smoking
Not smoke around others
Follow the Tips campaign on Twitter
Try to quit on your own
Use an electronic vapor product to help quit smoking regular cigarettes
Support smoke-free laws in your community
Do nothing
Scale for items RC14.A-H:
Not at all likely
A little likely
Moderately likely
Very likely
Extremely likely
RC14c. In the future, because you {TEXTFILL: if ad type = TV, “saw or heard this ad on television”; if ad type = Print, “saw this ad in a newspaper or magazine”; if ad type = Digital, “saw this ad in online”; if ad type = Radio, “heard this ad on the radio”}, on a scale from 1 to 5, where 1 indicates not at all likely and 5 is extremely likely, how likely would you be to take the following actions in the next 6 months?
[PRESENT IN RANDOM ORDER]
[ANSWER ALL]
Not at all likely
A little likely
Moderately likely
Very likely
Extremely likely
C4_1. Give up cigarettes all at once
C4_2. Gradually cut back on the number of regular cigarettes smoked
C4_3. Switch completely to electronic vapor products
C4_4. Substitute some of your regular cigarettes with electronic vapor products
C4_5. Switch to mild or some other brand of cigarettes
Yes
No
Don’t Know/Not Sure
{BASE = Non-Smokers and all Ad Types}
This question is about the possibility of encouraging someone you care about to quit smoking, based on the message you just {TEXTFILL: if ad type = TV or Print or Digital, “saw”; if ad type = Radio, “heard”} in the ad.
{BASE = Non-Smokers and all Ad Types}
Yes
No
{Base = ask only if Rc15.02}
{Open End}
{Base = ask only if Rc15.01}
{Open End}
{BASE = Non-Smokers and all Ad Types}
Call 1-800-QUIT-NOW for information to help someone you care about quit smoking
Visit an informational government website, such as www.cdc.gov/tips for information to help someone you care about quit smoking
Talk to your doctor about helping someone you care about quit smoking
Ask someone to not smoke around you or others
Encourage someone you care about to use an electronic vapor product to help quit smoking regular cigarettes
Follow the Tips campaign on Twitter
Support smoke-free laws in your community
Encourage someone you care about to quit smoking
Do nothing
Scale for items RC18.A-H:
Not at all likely
A little likely
Moderately likely
Very likely
Extremely likely
{BASE = All respondents, all ad types}
Not at all
Slightly
Moderately
Very
Extremely
{BASE = All respondents, all ad types}
Not at all
Slightly
Moderately
Very
Extremely
{BASE = All respondents, all ad types}
Extremely negative
Somewhat negative
Neither positive or negative
Somewhat positive
Extremely positive
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | OSH Media Rough Cut Survey |
Author | Carol Haney |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |