OMB No. 0910-0810 Exp.
Date: 10/31/2021
Attachment I: Adult Questionnaire
FDA Tobacco Prevention Broad Quantitative Research Package
Adult Questionnaire
WELCOME PAGE
[TEXT FOR PARTICIPANTS]: “Please answer the questions on the following pages as accurately as possible. Remember to read the instructions carefully.”
[Each item on the Copy Testing Questionnaire will be presented in a separate page, separated by a “NEXT” button. There will also be a “BACK” button presented on each page in case youth accidentally skip a question.]
[Not all questions will be asked to all participants, participants will get questions based on how they screen into the study. All surveys will take no longer than 20 minutes to complete]
PART I
[Questions to be presented prior to showing rough-cut advertisements to ALL PARTICIPANTS – (Part 1 questions are only asked once)]
A_1. How many cigarettes per day do you typically smoke?
10 or fewer (half a pack)
11 to 20 (about a pack a day)
21 to 30 (about a pack and a half a day)
More than 31 (2 packs or more a day)
A_2. On the days that you smoke, how soon after you wake up do you smoke your first cigarette?
Within 5 minutes
6 to 30 minutes
31 to 60 minutes
After 60 minutes
PART II
[(Questions to be provided after rough-cut advertisement) – AD VIEW PARTICIPANTS ONLY]
[TEXT FOR PARTICIPANTS]: “Please watch the video below. Please make sure your device volume is on so you can hear the audio.
To start watching the video, click on the video or press the play button. When the video ends, click on the button at the bottom of the page to continue with the survey.”
The ad will play twice before questions begin.
B_1. What do you think [or would you say] is the main message of this ad? Please be as specific as possible.
[OPEN END]
B_2. Is there anything confusing, unclear, or hard to understand in this ad?
Yes → go to B3
No → skip to B4
B_3. What about this ad is confusing, unclear, or hard to understand?
[OPEN END]
B_4. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements: [RANDOMIZE ORDER]
This ad is worth remembering
This ad grabbed my attention
This ad is powerful
This ad is informative
This ad is meaningful to me
This ad is convincing
This ad seemed to be written with someone like me in mind
B_5. What age group do you think this ad is designed for?
Kids (under 12 years old)
Teenagers (12-17 yr olds)
Young adults (18-24 yr olds)
Adults (25-54 yr olds)
Older Adults (55 yr olds and older)
B_6. How much do you agree with each of the following statements below:
B_6A. I think this ad was intended for a person who has never used an e-cigarette but might be considering trying one soon.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
B_6B. I think this ad was intended for a person who is a current user of e-cigarettes.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
B_6C. I think this ad was intended for a person who is a current user of e-cigarettes and interested in quitting e-cigarettes.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
“Sometimes we ask different kinds of questions to make sure that our participants are reading the questions carefully and answering as accurately as possible.”
B_7. Please select Tuesday and Friday from the list below. [RANDOMIZE ORDER]
Sunday
Tuesday
Thursday
Friday
PART III
[ALL PARTICIPANTS]
INSTRUCTIONS
[TEXT FOR PARTICIPANTS]: “Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements. Please click ‘Next’ to continue.”
C_1. E-cigarettes are a helpful tool to help someone quit smoking cigarettes.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C_2. If I quit smoking cigarettes my health will improve.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C_3. On a scale of 1–7, where 1 is “not at all important” and 7 is “very important,” how important is it for you to try to quit smoking cigarettes?
Click to slide the bar to the desired response. Only whole numbers 1 through 7 are accepted.
Not at all Important |
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Very Important |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
“Sometimes we ask different kinds of questions to make sure that our participants are reading the questions carefully and answering as accurately as possible.”
C_4. Jack’s favorite color is red. What is Jack’s favorite color?
Blue
Red
Green
Yellow
C_5. Are you thinking about trying to quit smoking cigarettes?
Yes → go to C_6
No → skip to C_7
C_6. How soon are you likely to try to quit smoking cigarettes? Would you say…
Within the next 30 days
Within the next 6 months
Within the year
Longer than a year
C_7. On a scale of 1–7, where 1 is “not at all motivated” and 7 is “highly motivated,” how motivated are you to quit smoking cigarettes in the next 12 months? Click to slide the bar to the desired response. Only whole numbers 1 through 7 are accepted.
Not at all Motivated |
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Highly Motivated |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
C_8. On a scale of 1–7, where 1 is “not at all” and 7 is “very much,” please indicate how likely you are to try any of the following because you think it will help you quit cigarettes.
Not at all
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Very much |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Nicotine Replacement Therapy (NRT) like nicotine gum, patch, lozenge, nasal spray, or inhaler
E-cigarettes
Prescription medication like Chantix
Call 1-800-QUIT-NOW for assistance in quitting smoking cigarettes
Talk to my doctor about quitting smoking cigarettes
Visit a website to help me quit such as smokefree.gov
Other (please specify)
C_9. In the next month, how likely are you to use an e-cigarette product [e.g., Juul, e-cigarette, vape, vape pen, e-hookah].
Very likely
Somewhat likely
Neither likely nor unlikely
Somewhat unlikely
Very unlikely
[If select A or B for C_9 CONTINUE TO C_10, ALL ELSE CONTINUE TO C_11]
C_10. Please select below all the reasons you think you would use an e-cigarette in the next month:
To try to quit using cigarettes
They cost less than cigarettes
They are easier to get than cigarettes
Famous people on TV or in movies use them
They are less harmful than cigarettes
They are available in flavors, such as mint, candy, fruit, or chocolate
D They can be used in areas where cigarettes are not allowed
I would use them for some other reason (please describe) ______________________
Please provide a response to the following questions
C_11: Compared to cigarettes, how addictive do you think the following are: |
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Not at all addictive |
Somewhat Addictive |
Slightly Addictive |
Very Addictive |
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E-cigarettes |
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Smokeless tobacco |
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Cigars |
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Cigarillos, little cigars |
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Hookah |
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Low Nicotine Cigarettes |
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Nicotine Replacement Therapy (NRT) like nicotine gum, patch, lozenge, nasal spray, or inhaler
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Nicotine |
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C_12. Please provide a response to the following questions
Compared to cigarettes, how dangerous do you think the following are: |
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Not at all dangerous |
Somewhat dangerous |
Slightly dangerous |
Very dangerous |
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E-cigarettes |
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Smokeless tobacco |
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Cigars |
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Cigarillos, little cigars |
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Hookah |
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Low Nicotine Cigarettes |
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Nicotine Replacement Therapy (NRT) like nicotine gum, patch, lozenge, nasal spray, or inhaler |
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Nicotine |
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C_13. If I were to switch completely from cigarettes to e-cigarettes, my health would improve:
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C_14. If I were to replace some of my cigarette use with using an e-cigarette, my health would improve:
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
D_1. Stop-smoking products with nicotine (like patches and gum) provide the help I need to quit smoking.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
[Programmer note: Ask if Q1_3 = Every day or some days]
D_2. Nicotine products provide the help I need to quit smoking.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
[Programmer note: Ask if Q1_3 = Every day or some days]
D_3. Vaping provides the help I need to quit smoking.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
[Programmer note: Ask if Q1_3 = Every day or some days]
D_4. Vaping could help me quit smoking cigarettes.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
[Programmer note: Ask if Q1_3 = Every day or some days]
D_5. Vaping could help me reduce the number of regular cigarettes I smoke.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
D_6. Nicotine medications like the patch help people to feel less irritable when they quit smoking.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
D_7. Before today, have you ever heard that nicotine is in cigarette smoke?
1 Yes
2 No
D_8. Below are several medical conditions or diseases. Please indicate whether you think nicotine in tobacco causes these conditions or diseases.
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Yes |
No |
Don’t know |
a. High blood pressure |
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b. Stroke |
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c. Lung cancer |
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d. Asthma |
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e. Respiratory allergies |
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f. Coronary heart disease |
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g. Gum disease |
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h. Oral cancers |
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i. Increased wrinkling of the skin |
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j. Colon cancer |
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k. Diabetes |
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l. Cataracts |
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m. Heart attack |
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n. Emphysema |
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o. Liver disease |
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D_9. Do you believe nicotine is the chemical that causes most of the cancer caused by smoking cigarettes?
1 Definitely yes
2 Probably yes
3 Probably not
4 Definitely not
D_10. Do you believe nicotine is the main substance in tobacco that makes people want to use tobacco products?
1 Definitely Yes
2 Probably yes
3 Probably not
4 Definitely not
E_1. Compared to a typical cigarette, do you think that a “low nicotine” cigarette is:
1 Much less harmful to your health than a typical cigarette
2 Slightly less harmful to your health than a typical cigarette
3 Equally harmful to your health as a typical cigarette
4 Slightly more harmful to your health than a typical cigarette
5 Much more harmful to your health than a typical cigarette
E_2. Compared to a typical cigarette, do you think that a “low nicotine” cigarette is:
1 Much less addictive than a typical cigarette
2 Slightly less addictive than a typical cigarette
3 Equally addictive as a typical cigarette
4 Slightly more addictive than a typical cigarette
5 Much more addictive than a typical cigarette
E_3. Compared to a typical cigarette, do you think that a “low nicotine” cigarette has a…
1 Much lower risk of causing lung cancer than a typical cigarette
2 Slightly lower risk of causing lung cancer than a typical cigarette
3 Equal risk of causing lung cancer than a typical cigarette
4 Slightly higher risk of causing lung cancer than a typical cigarette
5 Much higher risk of causing lung cancer than a typical cigarette
E_4. In your opinion, do you think that “low nicotine” cigarettes are less harmful to a person’s health than typical cigarettes?
1 Yes
2 No
3 I don’t know
E_5. It is easier to quit smoking if you use a “low nicotine” cigarette than a typical cigarette.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
E_6. If you could only buy “low nicotine cigarettes,” how likely would you be to… ?
a. Smoke cigarettes more often
b. Inhale more deeply when you smoke cigarettes
c. [Start using/increase how much you use] smokeless tobacco
d. [Start smoking/increase how much you smoke] hookah
e. [Start vaping/increase how much you vape] nicotine
f. [Start smoking/increase how much you smoke] cigars, little cigars, or cigarillos
g. [Start using/increase how much you use] nicotine gum, patch, or lozenge
1 Not at all
2 A little
3 Somewhat
4 Very
5 Extremely
F_1. Do you believe what the FDA says about the risks of tobacco products?
Yes
No
F_2. In your opinion, how qualified is the FDA to regulate tobacco products?
1 Not at all
2 A little
3 Somewhat
4 Very
F_3. I think Americans need to be protected from the activities of the tobacco industry.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
F_4. It is important that the tobacco industry is regulated.
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
F_5. Do you think that the FDA should reduce nicotine in cigarettes if it would cause fewer kids to become addicted or hooked on smoking?
1 Yes
2 No
Thank you for taking this survey! For more information on ways to quit smoking, please visit https://smokefree.gov/.
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 20 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]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Cameron Wimpy |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |