Example Instrument: Screener for Focus Group Testing

Form Approved

OMB No. 0920-0910

Exp. Date XX/XX/XXXX

National Tobacco Education Campaign

Focus Group Recruitment Screener for Creative Concept Testing

Exclusive Conventional Cigarette Smokers and Dual Users
(Telephone Screen)

Public reporting burden of this collection of information is estimated to average 4 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).

{Note to recruiter:

1. Read only the portions that are highlighted in green and do not read the codes in front of the response items.

2. Please try to balance the groups in terms of:

• Age (18-26, 27-34, 35-44, 45-54)

• Gender

• Ethnicity (as listed below,)

• Smoking frequency (i.e., <20 cigarettes per day on days they smoke vs. 20+ cigarettes per day)

• SES status (based on education, income, and employment status, as annotated below)

3. At least 50% of each group should be low-SES and at least half should be male; beyond that, try for a mix of other demographics listed.}

READ:

On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking related advertising and messages that you might see in the media, such as on TV or the internet. Your opinions are very important to us! We are recruiting for a 90-minute in-person focus group. Your participation in the focus group is voluntary. If you choose to participate, you will receive $75 immediately upon completion of the focus group for participation in the study.

Demographic Information

{Base for section: All respondents}

DAGE2. What is your current age, in years?

_ _ _ 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}

DEMO1. What is your gender? {Note to recruiter: Aim for focus group composition of at least 50% males}

1. Male

2. Female

3. Prefer not to answer

DEMO3. Ethnicity

{PREAMBLE}

Please indicate your race or ethnic background. Are you….?

Please SELECT ONE

1. Hispanic or Latino

2. Not Hispanic or Latino

DEMO4. Race – What is your race?

SELECT ONE OR MORE

1. White

1. Black or African American

2. American Indian or Alaska Native

3. Native Hawaiian or Other Pacific Islander

4. Asian

SES1. What is the highest level of education you have completed or the highest degree you have received? If you received your education in another country, please indicate the equivalent level below.

{ Note to recruiter: Read this list only if necessary}

1. Less than high school {low SES}

2. Completed high school {low SES}

3. Completed General Education Diploma (GED) {low SES}

4. Job-specific training program(s) after high school {low SES}

5. Some college, but no degree

6. Associate Degree

7. College (such as B.A., B.S.)

8. Some graduate school, but no degree

9. Graduate degree (such as MBA, MS, M.D., Ph.D.)

10. Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

SES2. Which of the following income categories best describes your total 2015 household income before taxes?

1. Less than $15,000 {low SES}

2. $15,000 to $24,999 {low SES}

3. $25,000 to $49,999

4. $50,000 to $99,999

5. $100,000 or more

6. Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

SES3. Which statement best describes your current employment status?

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 {low SES}

05 Not working – retired

06 Not working – disabled

07 Not working – other {low SES}

08 Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{ Reminder note to recruiter: Low SES is determined based on responses from the education, income, and employment status items, indicated with brackets after select responses}

Smoking Behavior

{PREAMBLE}

The next questions are about traditional cigarettes which are any form of tobacco wrapped in paper. Traditional cigarettes typically come in packs of 20 and some brand examples include Marlboro, Newport, Camel, Lucky Strike and Pall Mall.

{Base = All respondents}

TS1. Have you smoked at least 100 traditional cigarettes in your entire life?

{ Note to recruiter: Read this list only if necessary}

1. Yes

2. No {GENERAL SCREEN OUT MESSAGE}

3. Don’t know/not sure {GENERAL SCREEN OUT MESSAGE}

4. Prefer not to answer {GENERAL SCREEN OUT MESSAGE}
   
   

{Base = TS1 = 01}

TS2. Do you now smoke traditional cigarettes every day, some days, or not at all?

{ Note to recruiter: Read this list only if necessary}

1. I smoke every day

2. I smoke on some days

3. I do not smoke at all {GENERAL SCREEN OUT MESSAGE}

{Base = TS2 = 01 or 02}

TS3. On how many of the past 30 days did you smoke traditional cigarettes?

Enter number: _______

1. Don’t know/Not Sure {GENERAL SCREEN OUT MESSAGE}

2. Prefer not to answer {GENERAL SCREEN OUT MESSAGE}

{Base = TS1 = 01 and (TS2 = 01 or TS2 = 02) and TS3 > 0}

TS4. On average, on days that you do smoke, how many traditional cigarettes do you now smoke a day?

[1 PACK = 20 CIGARETTES]

[RANGE 1-100]

Enter number: ______

1. Don’t know/Not Sure

2. Prefer not to answer

{ Reminder note to recruiter: Smoking frequency determined by number of cigarettes smoked, on days they smoke: <20 cigarettes per day on days they smoke vs. 20+ cigarettes per day on days they smoke}

E-Cigarette Behavior

{If TS1 = 01 AND (TS2 = 1 or TS2 = 2) AND TS3 > 0}

{PREAMBLE}

The next questions are about electronic vapor products. These are devices that usually contain a nicotine-based liquid that produces an aerosol that is inhaled. You may also know them as e-cigarettes, vape-pens, hookah-pens, electronic hookahs (e-hookahs), electronic cigars (e-cigars), electronic pipes (e-pipes), e-vaporizers, or tank systems. Some brand examples are Blu, NJOY, Vuse, MarkTen, and Starbuzz. For the rest of this survey we will call all of the products in this category e-cigarettes.

E1. Have you ever used an e-cigarette, even one time?

{ Note to recruiter: Read this list only if necessary}

1. Yes

1. No {GENERAL ELIGIBILITY MESSAGE}

{Base = E1 = 01}

E2. Do you now use e-cigarettes…?

2. Every day

3. Some days

4. Not at all {GENERAL ELIGIBILITY MESSAGE}

{Base = E1 = 01}

E3. On how many of the past 30 days did you use an e-cigarette?

Enter number: _______

1. Don’t Know/Not Sure

2. Prefer not to answer

Segments	Definition	Criteria
Exclusive Conventional Cigarette Smokers	Smokers who use only conventional cigarettes between ages 27-54	IF (DAGE2 >26 and <55) AND TS1 = 01 AND (TS2 = 1 or TS2 = 2) AND TS3 > 0 AND (E1 = 02 OR E2 = 03)
Young Adult Exclusive Conventional Cigarette Smokers	Smokers who use only conventional cigarettes between ages 18-26	IF (DAGE2 >17 and <27) AND TS1 = 01 AND (TS2 = 1 or TS2 = 2) AND TS3 > 0 AND (E1 = 02 OR E2 = 03)
Dual Users	Dual users of conventional cigarettes and e-cigarettes between ages 27-54	IF (DAGE2 >26 and <55) TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND E1 = 01 AND E2 = 01 or 02
Young Adult Dual Users	Dual users of conventional cigarettes and e-cigarettes between ages 18-26	IF (DAGE2 >17 and <27) TS1_1 AND (TS2_1 or TS2_2) AND TS3 > 0 AND E1 = 01 AND E2 = 01 or 02

{GENERAL SCREEN OUT MESSAGE}

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. We appreciate your enthusiasm for our study and hope you will join us on future studies!

{GENERAL ELIGIBILITY MESSAGE}

Thank you for your participation in this study. Your responses indicate that you fit the specific criteria needed for this particular focus group.

{SPECIFIC LANGUAGE ABOUT SCHEDULING INTERVIEW, DIFFERENT FOR EACH PARTICIPANT}

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