“Hookah Purchase Journey: Online Hookah User Survey” - Appendix II

Appendix II: Screener and Consent Document

Participants will be screened and consented online. Participants will have access to the online survey (Appendix III) if participants qualify and consent.

Screener

Thank you for being willing to be screened for this research study conducted by SmartAnalyst, a research and consulting company. We would like to understand the waterpipe/hookah market. All responses will be kept confidential and will only be used for this research to understand waterpipe/hookah market. There are no risks nor benefits that would accrue to you by your participation, however if you complete the survey, your compensation will be the equivalent of a minimum of $1,80.

SmartAnalyst conforms to all national and international laws on data protection and complies with all Market Research Codes of Conduct, and we will not provide any personally identifying details to any other party. This study is covered by a special protection, called a Certificate of Confidentiality. This special protection requires that researchers involved in this study protect your privacy. This means researchers cannot provide any information that could identify you, to anyone who is not connected with the research. Researchers cannot share this information in court or during other legal proceedings, unless you agree, even if there is a court order for the information. However, in other settings, researchers may share study information that could identify you if:

• you agree to share information (for example, to get medical treatment);

• the study information is used for other scientific research that follows federal law;

• a law requires sharing information (for example, if researchers hear threats of harm to others).

The Certificate of Confidentiality does not prevent you from sharing any personal information or information about your involvement in this study with others. For example, you can share that you are in this research study.

• [Check box] I consent to take this survey

• [Check box] I do not want to take this survey

S1. How old are you? (SELECT ONE)

1. Under 18 [TERMINATE]

2. 18-24

3. 25-34

4. 35-44

5. 45-54

6. 55-64

7. 65+

S2. Please indicate your gender. (SELECT ONE)

1. Male

2. Female

S3. From the drop-down list provided, please select the state in which you live. [INSERT U.S. DROP-DOWN LIST. RESPONDENT MUST LIVE IN THE U.S. SEND-OUT: U.S. CENSUS REPRESENTATIVE. NO QUOTAS ON RETURNS.]. (SELECT ONE)

S4. We are interested in talking with people about their smoking habits. Which of the following, have you smoked in the last 12 months? (SELECT ALL THAT APPLY)

1. Cigars

2. E-cigarettes

3. Regular cigarettes

4. Hookah [MUST BE SELECTED TO CONTINUE]

5. Pipe

6. Other

S5. You indicated that you have smoked hookah in the last 12 months. Have you smoked hookah…? [YES/NO FOR EACH]

1. In your home or someone else’s home in the last 12 months [IF SELECTED, ASK QUESTIONS FOR IN-HOME USE. CREATE HIDDEN PUNCH.]

2. At a hookah lounge, bar, or restaurant in the last 12 months [IF SELECTED, ASK QUESTIONS FOR ON-PREMISE USE. CREATE HIDDEN PUNCH.]

S6. Have you, yourself, purchased any hookah tobacco or herbal (non-tobacco) shisha in the last 12 months either for use in-home or use at a hookah bar/lounge?

1. Yes [MUST BE SELECTED TO CONTINUE]

2. No [TERMINATE]

Consent

Thank you for taking the time to participate in this research study. We are working on a project to understand how hookah/waterpipe market in the U.S. The study is government funded.

The survey will take up to 20 minutes and you will receive the equivalent of up to $1.80 for your time. Your participation is voluntary. You may choose to not answer any question and you can stop this survey at any time. If you choose to end this survey, you will not receive compensation.

There are no known risks to taking part of the study. All the information that we collect will be kept private and we will never use your name in our reports. There are also no direct benefits to taking part, but your answers will help us improve the survey.

Do you have any questions before we get started? Please contact: [email protected]

• [Check box] I consent to participate in this survey

• [Check box] I do not consent to participate in this survey

Version 11.1 PI: Carolina Ramôa, PhD

Date: April 18, 2019 Protocol 18-065CTP