Form Approved
OMB No. 0920-0910
Exp. Date 05/31/2021
National Tobacco Education Campaign
Online Questionnaire for
Rough Cut Testing of Advertisements
Public reporting burden of this collection of information is estimated to average 13 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).
{PREAMBLE2}
The next several questions are about electronic cigarettes or e-cigarettes, such as JUUL, Vuse, blu, and Logic. E-cigarettes are battery powered devices that usually contain a nicotine-based liquid that is vaporized and inhaled. You may also know them as e-cigs, vape-pens, e-hookahs, vapes, or mods.
E-Cigarettes:
{Base = All Current Smokers}
Yes
No
{Base = E1 = 01}
Every day
Some days
Rarely
Not at all
{Base = E2 = 01 or 02}
Enter number: _______
777 Don’t know/Not Sure
999 Prefer not to answer
Male
Female
Prefer not to answer
{PREAMBLE}
Please indicate your race or ethnic background. Are you….?
SELECT ONE
Hispanic or Latino
Not Hispanic or Latino
SELECT ONE OR MORE
White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
{PREAMBLE4}
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 “traditional cigarettes” in the following questions.
{Base: Respondents who SMOKE EVERY DAY (IF SCREENER.TS2 = 01)}
{{1 PACK = 20 CIGARETTES}
{{RANGE 1-100}
{Numeric response}
{Base: Respondents who SMOKE ON SOME DAYS (IF SCREENER.TS2 = 02)}
{{1 PACK = 20 CIGARETTES}
{{RANGE 1-100}
{Numeric response}
{Base: Respondents who SMOKE EVERY DAY (IF SCREENER.TS2 = 01)}
Within 5 minutes
Within 6-30 minutes
Within 31-60 minutes
After 60 minutes
_____ Number of times
YES
NO
{ANSWER ALL, RANDOMIZE ORDER}
QA3_A. Give up traditional cigarettes all at once
QA3_B. Gradually cut back on traditional cigarettes
QA3_C. Substitute some of your traditional cigarettes with e-cigarettes such as vape-pens, hookah pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers
QA3_D. Switch completely to e-cigarettes, vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), or e-vaporizers
QA3_E. Switch to some other brand of traditional cigarettes
QA3_F. Use nicotine replacement products like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler
QA3_G. Use medications like Wellbutrin, Zyban, Buproprion, Chantix, or Varenicline
QA3_H. Get help from a telephone quit line
QA3_L. Enroll in a texting program
QA3_M. Download an app
QA3_N. Seek information on social media
QA3_I. Get help from a website such as cdc.gov/tips
QA3_J. Get help from a doctor or other health professional
QA3_K. Get help from a pharmacist
{Base: If QA1 > 0}
QA30. What did you find most helpful when you last tried quitting smoking?
{OPEN END}
Not at all
A little
Somewhat
A lot
{Base: All Smokers}
QA5. Do you plan to quit smoking traditional cigarettes for good….
In the next 7 days
In the next 30 days
In the next 6 months
In the next 1 year
More than 1 year from now
I am not planning to quit
{Base: If QA1 > 0}
QA102. Has your doctor talked to you about quitting smoking?
Yes
No
Not sure/uncertain
Yes
No
{Base: All Smokers}
Yes
No
{Base: All Smokers}
Yes
No
{Base: All Smokers}
Yes
No
D210.
Please tell us if you agree or disagree with the following
statement:
Smoking
can cause immediate damage to your body, which can lead to long-term
health consequences.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
{Base: All Smokers}
D211.
Please tell us if you agree or disagree with the following statement:
Smoking traditional cigarettes can cause medical
complications and diseases that require surgeries and medical
procedures to treat.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
{Base: All respondents}
P8. Are you aware of any advertising or tobacco education campaigns against smoking, tobacco products, or tobacco companies that are now taking place?
Yes
No
{Base: If P8=01}
P9. Please comment on what you remember about these ads or tobacco education campaigns against smoking, tobacco products, or tobacco companies.
{OPEN END}
P10. Are you aware of the Tips From Former Smokers® campaign against smoking, sponsored by the Centers for Disease Control and Prevention?
01 Yes
02 No
{Base: If P10=01}
P11. Please comment on what you remember about the Tips From Former Smokers® campaign.
{OPEN END}
{Randomly select an eligible ad}
Television Ad.
We would now like to show you a television ad and then gather your reactions to that ad. Note that you can review the ad multiple times prior to moving forward. 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 ad]
{Programmer instruction: Display selected ad through entirety
before showing the “next” button}
{OPEN END}
{OPEN END}
{At top of page, before question, insert thumbnail image of ad for the rest of the questions in this survey}
{Base: All respondents}
Extremely believable
Moderately believable
Slightly believable
Neither believable nor unbelievable
Slightly unbelievable
Moderately unbelievable
{Base: RC5a = 4-7}
{OPEN END}
{Base: All respondents}
On a scale from 1 to 5, where 1 indicates not feeling any emotion, and 5 indicates feeling emotion with extreme intensity, please indicate how much this ad made you feel:
I did not feel this emotion
Slight emotion
Moderate emotion
Very intense emotion
Extreme and intense emotion
{RANDOMIZED}
M3_1. Angry
M3_2. Afraid
M3_3. Ashamed
M3_4. Sad
M3_5. Hopeful
M3_6. Understood
M3_7. Surprised
M3_8. Trusting
M3_9. Motivated
M3_10. Regretful
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
{RANDOMIZED}
M4_1. This ad is convincing
M4_2. This ad grabbed my attention
M4_3. This ad was easy to understand
M4_4. I learned something new from this ad
M4_5. I trust the information in this ad
M4_6. This ad is believable
M4_7. I would talk to someone else about this ad
M4_8. This ad is annoying
M4_9. This ad is worth remembering
M4_10. This ad is powerful
M4_11. This ad is informative
M4_12. This ad is meaningful
M4_13. I can identify with what this ad says
M4_14. This ad makes me more confident that I will not smoke cigarettes in the future. {nonsmokers}
M4_15. This ad influenced me about whether or not to smoke traditional cigarettes.
01 Confusing
02 Unclear
03 Hard to understand
04 None of the above
{Base: If M5a = 01-03}
{Open End}
Yes
No
{Base: M6a = 02}
{Open End}
{Base: M6a = 01}
{Open End}
{Base: All Smokers}
In the next 7 days
In the next 30 days
In the next 6 months
In the next 1 year
More than 1 year from now
I am not planning to quit
Not sure/uncertain
{Base: All Smokers}
Call 1-800-QUIT-NOW for assistance in quitting smoking
Visit an informational government website, such as www.cdc.gov/tips or Smokefree.gov for information on quitting
Download an app to help you quit smoking
Talk to your doctor about quitting smoking
Not smoke around others
Follow the Tips campaign on social media (e.g., Twitter, Facebook, Pinterest)
Try to quit on your own
Use an electronic vapor product to help quit smoking traditional cigarettes
Support smoke-free laws in your community
Enroll in a texting program to help you quit smoking
Do nothing
Scale for items RC14.A-H:
{Base: Nonsmokers}
Yes
No
{Base = ask only if Rc15.02}
{Open End}
{Base = ask only if Rc15.01}
{Open End}
{Base: All Nonsmokers}
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 or Smokefree.gov 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 traditional cigarettes
Encourage someone you care about to quit smoking traditional cigarettes completely
Follow the Tips campaign on social media (e.g., Twitter. Facebook, Pinterest)
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
{Base: All respondents}
Not at all
Slightly
Moderately
Very
Extremely
{Base: All Respondents}
UAR_Art1. A few seconds before the ad you just saw ended, a written message was in white letters on a black screen. In addition to “You can quit. For free help, call 1-800-QUIT-NOW”, what other written message do you remember?
[OPEN-END]
{Base: All Respondents}
AR_Art2. Which of the following written messages do you remember from the ad you just saw?
If you have seen or heard the following messages before but NOT as part of the ad you just saw, please do NOT select them.
{Multi-Select, Randomized}
More than 16 million Americans live with a disease caused by smoking
You’re not just quitting for yourself
The people you love are worth quitting for
Smoking doesn’t just affect you.
Smoking effects more than the smoker.
Smoking effects everyone around you.
I do not remember any written messages in the ad I just saw (single select, exclusive, anchor)
{Base: All Smokers}
{Thumbnail Image of SUPER/ART CARD}
AM_Art3. A few seconds before the ad you just saw ended, a written message was in white letters on a black screen, as you may remember from the image above.
Does this message make you want to quit smoking traditional cigarettes?
01 Yes
02 No
{Base: AM_Art3 = 02}
{Thumbnail Image of SUPER/ART CARD}
AM_Art4. What was it about this message that didn’t make you want to quit smoking traditional cigarettes? Please be as specific as possible.
[OPEN-END]
Thank you for your participation in this study. We appreciate your enthusiasm for our study and hope you will join us on future surveys!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |