Developing Brand & Creative Concepts Designed to Prevent AI/AN Youth Tobacco Use

Unique ID:____________

CREATIVE CONCEPT SURVEY
Instructions: For each statement, fill in the one bubble that best represents your level of agreement
or disagreement. Please fill in your selected responses like this:

○○●○○○

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

OMB# 0910-0796 Exp. 07/31/2021

Strongly
Disagree

Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Strongly
Disagree
Disagree

○
○
○
○
○
○

○
○
○
○
○
○

Unique ID:____________

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

OMB# 0910-0796 Exp. 07/31/2021

Strongly
Disagree
Disagree

○
○
○
○
○
○

○
○
○
○
○
○

Strongly
Disagree
Disagree

○
○
○
○
○
○

○
○
○
○
○
○

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Unique ID:____________

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

Concept: ______________
1

This ad is worth remembering.

2

This ad grabbed my attention.

3

This ad is powerful.

4

This ad is informative.

5

This ad is meaningful.

6

This ad is convincing.

Strongly
Disagree

Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Strongly
Disagree

Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

○
○
○
○
○
○

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 9
minutes per response to complete the Creative Concepts Survey (the time estimated to read, review, and complete). Send comments
regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to
[email protected].
OMB# 0910-0796 Exp. 07/31/2021