Screener

Form Approved

OMB No. 0920-0910

Exp. Date 05/31/2021

National Tobacco Education Campaign

Online Questionnaire Recruitment Screener for

Rough Cut Testing of Television Advertisements

Public reporting burden of this collection of information is estimated to average 2 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}

On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking related advertising that you might see in the media, such as on TV or the internet. Your opinions are very important to us! The purpose of this survey is to gather your opinions on health and smoking-related advertising only; it is not to see products. We will not report your answers individually. We will report results from this survey for the group as a whole. Thank you for taking the time to help us! It will take about 2 minutes to determine your eligibility and about 13 minutes to complete the survey.

Your participation in this survey is voluntary. You may stop participating at any time.

{Demographic Information}

DAGE2. What is your current age, in years?

_ _ _ age in years

{Open-end}

999 Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Terminate if <18 years old or >54 - go to GENERAL SCREEN OUT MESSAGE}

DEMO2: What state do you live in?

1. Alabama

2. Alaska

3. Arizona

4. Arkansas

5. California

6. Colorado

7. Connecticut

8. Delaware

9. Florida

10. Georgia

11. Hawaii

12. Idaho

13. Illinois

14. Indiana

15. Iowa

16. Kansas

17. Kentucky

18. Louisiana

19. Maine

20. Maryland

21. Massachusetts

22. Michigan

23. Minnesota

24. Mississippi

25. Missouri

26. Montana

27. Nebraska

28. Nevada

29. New Hampshire

30. New Jersey

31. New Mexico

32. New York

33. North Carolina

34. North Dakota

35. Ohio

36. Oklahoma

37. Oregon

38. Pennsylvania

39. Rhode Island

40. South Carolina

41. South Dakota

42. Tennessee

43. Texas

44. Utah

45. Vermont

46. Virginia

47. Washington

48. West Virginia

49. Wisconsin

50. Wyoming

51. District of Columbia

52. Other please specify

SES1. What is the highest level of education you have completed or the highest degree you have received? If you received your education in another country, please indicate the equivalent level below.

1. Less than high school

2. Completed high school

03 Completed General Education Diploma (GED)

04 Job-specific training program(s) after high school

5. Some college, but no degree

6. Associate Degree

7. College (such as B.A., B.S.)

8. Some graduate school, but no degree

9. Graduate degree (such as MBA, MS, M.D., Ph.D.)

10. Prefer not to answer

SES2. Which of the following income categories best describes your total 2016 household income before taxes?

1. Less than $15,000

2. $15,000 to $19,999

3. $20,000 to $24,999

4. $25,000 to $29,999

5. $30,000 to $34,999

6. $35,000 to $49,999

7. $50,000 to $74,999

8. $75,000 to $99,999

9. $100,000 or more

10. Prefer not to answer

SES3. Which statement best describes your current employment status?

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

{Smoking Behavior}

{PREAMBLE}

The next questions are about traditional cigarettes, which are any form of tobacco wrapped in paper. Traditional cigarettes typically come in packs of 20, and some brand examples include Marlboro, Newport, Camel, Lucky Strike and Pall Mall.

{Base = All respondents}

TS1. Have you smoked at least 100 traditional cigarettes in your entire life?

1. Yes

2. No

3. Don’t know/not sure {GENERAL SCREEN OUT MESSAGE}

4. Prefer not to answer {GENERAL SCREEN OUT MESSAGE}
   
   

{Base = TS1 = 01}

TS2. Do you now smoke traditional cigarettes every day, some days, or not at all?

1. I smoke every day

2. I smoke on some days

3. I do not smoke at all

{Base = TS2 = 01, 02}

TS3. On how many of the past 30 days did you smoke traditional cigarettes?

Enter number: _______

777 Don’t know/Not Sure {GENERAL SCREEN OUT MESSAGE}

999 Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Quota Groups}

Segments	Definition	Criteria
Cigarette Smokers between ages 27-54	Smokers who use cigarettes between ages 27-54	IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND DAGE2 = 27-54
Cigarette Smokers between ages 18-26	Smokers who use cigarettes between ages 18-26	IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND DAGE2 = 18-26
Low SES Cigarette Smokers between ages 18-54	Low SES Smokers (see definition below) who use cigarettes between ages 18-54	SES Composite = low SES AND Smokers who use cigarettes between ages 18-54
Nonsmokers between ages 18-54	Nonsmokers between ages 18-54	IF TS1 > 1 OR ((TS2_3) AND TS3 = 0 AND DAGE2 = 18-54

Definition	Criteria
Socio-Economic Status Index (SES_Index)	education score (SES1 of 1 thru 4 = 0, SES1 of 5 thru 9 = 1) + income score (SES2 of 1 thru 4 = 0, SES2 of 5 thru 9 = 1) + employment score (SES3 of 3, 4, 7 = 0, SES3 of 1,2,5,6 = 1)
Low SES Composite	low_ses = 1 if ses_index = 0 or if ses_index = 1 low_ses = 0 if ses_index = 2 or if ses_index = 3

{GENERAL SCREEN OUT MESSAGE}

Thank you for your participation in this study. Unfortunately, your responses indicate that you do not fit the specific criteria needed for this particular study, or that we have already reached our required quota of responses from participants similar to you. We appreciate your enthusiasm for our study and hope you will join us on future surveys!

{GENERAL ELIGIBILITY MESSAGE}

Thank you for your participation in this study. Your responses indicate that you qualify and fit the specific criteria needed for this particular study. Click “next” to go to the next question.

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