Form Approved
OMB No. 0920-0910
Exp. Date 05/31/2021
National Tobacco Education Campaign
Online Questionnaire Recruitment Screener for
Rough
Cut Testing of 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).
{PREAMBLE1}
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.
_ _ _ 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}
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Other please specify
{Terminate if 52 Other Please Specify go to GENERAL SCREEN OUT MESSAGE}
Less than high school
Completed high school
03 Completed General Education Diploma (GED)
04 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
{PREAMBLE1}
The next questions are about traditional cigarettes, which are any form of tobacco wrapped in paper. Traditional cigarettes typically come in packages of 20, and some brand examples include Marlboro, Newport, Camel, Lucky Strike, and Pall Mall.
Please note that use of e-cigarettes should not be considered in your responses to the next three questions.
{Base = All respondents}
Yes
No
Don’t know/not sure {GENERAL SCREEN OUT MESSAGE}
Prefer not
to answer {GENERAL
SCREEN OUT MESSAGE}
{Base = TS1 = 01}
I smoke every day
I smoke on some days
I do not smoke at all
{Base = TS2 = 01, 02}
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 |
People between ages 27-54 who smoke cigarettes |
IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND DAGE2 = 27-54 |
Cigarette Smokers between ages 18-26 |
People between ages 18-26 who smoke cigarettes |
IF TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND DAGE2 = 18-26 |
Low SES Cigarette Smokers between ages 18-54 |
People between ages 18-54 who smoke cigarettes and are low SES (see definition below) |
SES Composite = low SES AND Smokers who use cigarettes between ages 18-54 |
Nonsmokers between ages 18-54 |
People between ages 18-54 who don’t smoke cigarettes |
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 |
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!
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.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |