Adolescent -Pretest

OMB #0910-NEW

Expires XX/YY/20XX

SESSSION 3 SURVEY INSTRUMENT

PROTOCOL

RESPONDENTS WILL BE RECRUITED BASED ON THEIR PARTICIPATION IN A PREVIOUS SURVEY, TAKEN APPROXIMATELY 2 WEEKS PRIOR. WITH EACH NEW DATA RECORD ON THIS CURRENT SURVEY, THE FOLLOWING VARIABLES SHOULD BE PASSED THROUGH AND INCLUDED IN THE DATASET:

• ID VARIABLE THAT ALLOWS LINKAGE TO THE PREVIOUS SURVEYS (I.E., A SINGLE, UNIQUE ID THAT CARRIES THROUGH ACROSS ALL 3 WAVES)

• VARIABLE INDICATING STUDY CONDITION ASSIGNMENT FROM BASELINE SURVEY

SECTION A: HEALTH BELIEFS

[DISPLAY THE STATEMENT BELOW ON A SINGLE PAGE]

[DISPLAY TEXT “OMB # 0910-NEW, expires XXXX” IN THE SAME PAGE]

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 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].

[DISPLAY THIS STATEMENT ONLY ON A SINGLE PAGE]

First, we would like to ask you some questions about your beliefs about smoking-related health effects.

Please tell us how much you agree or disagree with the following statements.

[RANDOMIZE ORDER OF ITEM “BLOCKS” ACCORDING TO ITEM PREFIXES WITH NUMBERS (I.E. RANDOMIZE A1_, A2_, A3_ SERIES, ETC.). ALSO RANDOMIZE ORDER OF QUESTIONS WITHIN BLOCKS. DISPLAY AS SCROLLING LIST.

ALSO, RANDOMLY SELECT ACONT1_1, ACONT2_1, OR ACONT3_1 AND DISPLAY AFTER 4^TH BLOCK. RANDOMLY SELECT AND DISPLAY ONE OF THE REMAINING TWO “ACONT_” ITEMS AFTER 8^TH BLOCK. DISPLAY THE FINAL “ACONT_” ITEM AFTER 12^TH BLOCK. ORDER OF ITEMS AND ITEM BLOCKS MAY BE DIFFERENT THAN SESSION 1 AND SESSION 2.]

[DO NOT DISPLAY: WARNING: Cigarettes are addictive]

A1_1. Cigarettes are addictive

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Tobacco smoke can harm your children]

A2_1. Tobacco smoke can harm your children

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking can kill you]

A3_1. Smoking can kill you

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes fatal lung disease in nonsmokers]

A4_1. Smoking causes fatal lung disease in nonsmokers

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Quitting smoking now greatly reduces serious risks to your health]

A5_1. Quitting smoking now greatly reduces serious risks to your health

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes head and neck cancer]

A6_1. Smoking causes head cancer

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A6_2. Smoking causes neck cancer

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: Smoking causes bladder cancer, which can lead to bloody urine]

A7_1. Smoking causes bladder cancer, which can lead to bloody urine

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A7_2. Smoking causes bladder cancer

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking during pregnancy stunts fetal growth]

A8_1. Smoking during pregnancy stunts fetal growth

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking can cause heart disease and strokes by clogging arteries]

A9_1. Smoking causes heart disease

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A9_2. Smoking causes strokes

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A9_3. Smoking clogs arteries

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A9_4. Smoking clogs arteries, which causes heart disease

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A9_5. Smoking clogs arteries, which causes strokes

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes COPD, a lung disease that can be fatal]

A10_1. Smoking causes COPD, a lung disease that can be fatal

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A10_2. Smoking causes COPD

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A10_3. Smoking causes lung disease that can be fatal

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking reduces blood flow, which can cause erectile dysfunction]

A12_1. Smoking reduces blood flow, which can cause erectile dysfunction

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A12_2. Smoking reduces blood flow

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A12_3. Smoking can cause erectile dysfunction

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking reduces blood flow to the limbs, which can require amputation]

A13_1. Smoking reduces blood flow to the limbs, which can require amputation

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A13_2. Smoking reduces blood flow to the limbs

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A13_3. Smoking can lead to amputation

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes type 2 diabetes, which raises blood sugar]

A14_1. Smoking causes type 2 diabetes, which raises blood sugar

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A14_2. Smoking causes type 2 diabetes

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes age-related macular degeneration, which can lead to blindness]

A15_1. Smoking causes age-related macular degeneration, which can lead to blindness

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A15_2. Smoking causes age-related macular degeneration

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A15_3. Smoking can lead to blindness

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: WARNING: Smoking causes cataracts, which can lead to blindness]

A16_1. Smoking causes cataracts, which can lead to blindness

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

A16_2. Smoking causes cataracts

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: CONTROL STATEMENT – NO ASSOCIATED WARNING LABEL]

ACONT1_1. Smoking causes migraines

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: CONTROL STATEMENT – NO ASSOCIATED WARNING LABEL]

ACONT2_1. Secondhand smoke causes sleep disorders like insomnia in children

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

[DO NOT DISPLAY: CONTROL STATEMENT – NO ASSOCIATED WARNING LABEL]

ACONT3_1. Smoking during pregnancy causes hearing loss in babies

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

9. Prefer not to answer

SECTION E: RECALL

E1. You recently took a survey in which you were shown a cigarette pack and advertisement with a warning on it. Which label do you remember seeing?

[POPULATE WITH 4 THUMBNAIL STIMULI ACCORDING TO THE FOLLOWING PROTOCOL:

• IF CONTROL GROUP (0): SHOW ALL 4 CONTROL STIMULI

• IF TREATMENT GROUP (1-16): SHOW 1 STIMULI CORRESPONDING TO ASSIGNED STUDY CONDITION + 3 RANDOMLY SELECTED REMAINING TREATMENT STIMULI (USING LEAST FILL)

RANDOMIZE ORDER OF STIMULI 1-4, FIX OPTIONS 5 AND 6 IN LAST POSITIONS. RECORD STIMULI ASSESSED.]

1. LABEL 1

2. LABEL 2

3. LABEL 3

4. LABEL 4

5. None of these

6. I don’t remember

ENDSCREEN: You’ve reached the end of the survey. Thank you for your participation.

[DISPLAY THE STATEMENT BELOW ON THE END SCREEN]

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 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].

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