Form Approved
OMB No. 0920-0621
Exp. Date 01/31/2024
Instructions:
Introduce yourself and ensure that tech is working; respondent should be able to access the web survey and share their screen.
Briefly discuss the goal of the larger survey and the goal of this interview (i.e., to understand how easy or hard these questions are to answer)
This is YOUR interview. YOUR chance to give important feedback so kids like you can have a better survey experience.
Remind the student of consent highlights:
If possible, take the survey in a private location, away from other family members or your parents.
Information will not be shared and is only used internally without your name and personal information
You can skip any question. But, if you feel the question is so uncomfortable that you want to skip it, I’ll ask you why you feel that way.
The interview will be recorded, and we will take notes.
Read the OMB statement:
CDC estimates the average public reporting burden for this collection of information as 2 hours per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 (0920-0621).
Explain process.
Read each question to yourself and answer it through the web survey.
Pause when you see a stop sign in the survey and I’ll ask you some questions about how you answered.
There are no wrong answers to any of the questions you will see. In fact, we aren’t going to use the answers you provide in any way. We are more interested in what you think of the questions and response choices you will see. We want your honest feedback about what you think about these questions and response choices. We didn’t write any of these questions so nothing you say about them will bother us.
Jump in with comments as you’re trying to answer.
Start with a practice question to make sure they understand how probes work.
Avoid use or reference to the National Youth Tobacco Survey or NYTS to minimize the introduction of bias.
After you explain the instructions ask if the respondent has any questions.
Generic probes (use these when the respondent hesitates or appears confused about an item):
In your own words, what is this question asking?
Are there any unfamiliar or confusing words in this question?
How sure are you about your answer? Why?
How do you think we could make this question less confusing or easier to understand?
Was anything about this question uncertain or uncomfortable?
If so, what is it?
If so, do you think others would not want to respond honestly to this question?
Question/Screen (verbatim from NYTS interview) |
Question-specific Probes (if required) |
Notes (for interviewer use) |
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The next several sections of questions ask about your use of particular kinds of tobacco products, such as e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, roll-your own-cigarettes, pipes, snus, dissolvable tobacco, bidis, heated tobacco products, and nicotine pouches.
At the beginning of each section, you will see a brief description and an image showing examples of each kind of tobacco product. |
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The next several questions are about the use of chewing tobacco, snuff, or dip, such as Copenhagen, Grizzly, Skoal, or Red Seal. Do not think about snus or dissolvable tobacco products when you answer these questions.
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Have you ever used chewing tobacco, snuff, or dip, even just a small amount?
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[INTERVIEWER: CONTINUE BELOW FOR EVER CHEWING TOBACCO USERS. NEVER USERS SKIP TO PAGE X.] |
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Question Universe: ever smokeless tobacco users [known] How old were you when you first used chewing tobacco, snuff, or dip, even just a small amount?
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Question Universe: ever smokeless tobacco users [or unknown] During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?
Specify: |__|__| (Range 0 – 30) |
[IF NOT ALREADY PROBED]:
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[INTERVIEWER: CONTINUE BELOW FOR PAST 30 DAY CHEWING TOBACCO USERS. EVER USERS SKIP TO PAGE X.] |
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Question Universe: ever smokeless tobacco users [known] During the past 30 days, what brands of chewing tobacco, snuff, or dip did you use? (Select one or more)
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Question Universe: past 30-day chewing tobacco, snuff, or dip user reporting >1 brand [known] During the past 30 days, what brand of chewing tobacco, snuff, or dip did you usually use? (Choose only one answer)
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Question Universe: past 30-day smokeless tobacco user [known] Was any of the chewing tobacco, snuff, or dip that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcoholic drinks, candy, fruit, chocolate, or any other non-tobacco flavor? Do not think about tobacco flavor when answering this question.
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What does “non-tobacco flavor” mean to you in this question? What does “tobacco flavor” mean? Would you have answered differently if it didn’t say “Do not think about tobacco flavor when answering this question?
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Question Universe: past 30-day smokeless tobacco user [known] Was any of the chewing tobacco, snuff, or dip that you used in the past 30 days flavored to taste like tobacco?
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What does “flavored to taste like tobacco” mean to you?
Did you think about added artificial flavorings, naturally occurring tobacco flavor, or both? |
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Question Universe: past 30-day users of flavored smokeless tobacco What flavors was the chewing tobacco, snuff, or dip that you have used in the past 30 days? (Select one or more)
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What do you think of the answer choices? What’s the difference between menthol and mint?
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Question Universe: past 30-day smokeless tobacco user [known] During the past 30 days, how did you get your chewing tobacco, snuff, or dip? (Select one or more)
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Question Universe: past 30-day smokeless tobacco user [known] During the past 30 days, where did you buy your chewing tobacco, snuff, or dip? (Select one or more)
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Question Universe: past 30-day smokeless tobacco user (who got a product from someone else) Earlier you mentioned that you got or bought your chewing tobacco, snuff, or dip from another person, such as a friend or family member. How old was this person?
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Question Group Probes:
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[INTERVIEWER: CONTINUE BELOW FOR NEVER CHEWING TOBACCO USERS. CURRENT USERS SKIP TO PAGE X.] |
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Question Universe: never smokeless tobacco product users [known] Have you ever been curious about using chewing tobacco, snuff, or dip?
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Question Group Probes:
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The next few questions are about snus, such as Camel Snus, Marlboro Snus, or General Snus. Snus is a type of smokeless tobacco that comes in a small pouch that you put under your lip. Snus is different from some other smokeless tobacco products such as nicotine pouches, because it does contain tobacco leaf.
Do not think about chewing tobacco, snuff, dip, nicotine pouches, or other oral nicotine products when answering these questions.
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Have you ever used snus, even just one time?
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[INTERVIEWER: CONTINUE BELOW FOR EVER SNUS USERS. NEVER USERS SKIP TO PAGE X.] |
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Question Universe: ever users of snus [or unknown] During the past 30 days, on how many days did you use snus? Specify: |__|__| (Range 0 – 30) |
[IF NOT PROBED ALREADY]:
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[INTERVIEWER: CONTINUE BELOW FOR PAST 30 DAY SNUS USERS. EVER USERS SKIP TO PAGE X.] |
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Question Universe: past 30-day snus user [known] Was any of the snus that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcoholic drinks, candy, fruit, chocolate, or any other non-tobacco flavor? Do not think about tobacco flavor when answering this question.
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Question Universe: past 30-day snus user [known] Was any of the snus that you used in the past 30 days flavored to taste like tobacco?
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Question Universe: past 30-day users of flavored snus What flavors was the snus that you have used in the past 30 days? (Select one or more)
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Question Universe: past 30-day snus user [known] During the past 30 days, how did you get your snus? (Select one or more)
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Question Universe: past 30-day snus user [known] During the past 30 days, where did you buy your snus? (Select one or more)
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Question Group Probes:
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The next section is about nicotine pouches such as Zyn, on!, Velo, or Rogue. These small, flavored pouches are filled with a nicotine-containing powder. Users place nicotine pouches in their mouth and do not need to spit. Nicotine pouches are different from some other smokeless tobacco products such as snus, dip, or chewing tobacco, because they do not contain any tobacco leaf. Do not think about chewing tobacco, snuff, dip, snus, or other oral nicotine products when answering these questions.
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Before today, have you heard of nicotine pouches?
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Have you ever used a nicotine pouch, even just one time?
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[IF DON’T KNOW]:
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[INTERVIEWER: CONTINUE BELOW FOR EVER (OR DK) NICOTINE POUCH USERS. NEVER USERS SKIP TO PAGE X. |
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Question Universe: ever nicotine pouch user [or unknown/don’t know] During the past 30 days, on how many days did you use a nicotine pouch? Specify: |__|__| (Range 0 – 30) |
[IF NOT ALREADY PROBED]:
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[INTERVIEWER: CONTINUE BELOW FOR PAST 30 DAY NICOTINE POUCH USERS. EVER USERS SKIP TO PAGE X. |
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Question Universe: past 30-day nicotine pouch user [known] During the past 30 days, what nicotine pouch brands did you use? (Select one or more)
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Question Universe: past 30-day nicotine pouch user reporting >1 brand [known] During the past 30 days, what brand of nicotine pouches did you usually use? (Choose only one answer)
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Question Universe: past 30-day nicotine pouch user [known] Were any of the nicotine pouches that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcoholic drinks, candy, fruit, chocolate, or any other non-tobacco flavor? Do not think about tobacco flavor when answering this question.
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[if not already prompted] What does “non-tobacco flavor” mean to you in this question? What does “tobacco flavor” mean? Would you have answered differently if it didn’t say “Do not think about tobacco flavor when answering this question?
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Question Universe: past 30-day user of nicotine pouches [known] Were any of the nicotine pouches that you used in the past 30 days flavored to taste like tobacco?
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[if not already prompted] What does “flavored to taste like tobacco” mean to you?
Did you think about added artificial flavorings, naturally occurring tobacco flavor, or both? |
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Question Universe: past 30-day users of flavored nicotine pouches What flavors were the nicotine pouches that you have used in the past 30 days? (Select one or more)
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What do you think of the answer choices? What’s the difference between menthol and mint?
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Question Universe: past 30-day user of flavored nicotine pouches Did any of the flavors that you used in the past 30 days have names or descriptions that included the word “ice” or “iced” (for example, blueberry ice or strawberry ice)?
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Question Universe: past 30-day user of flavored nicotine pouches Did any of the flavors that you used in the past 30 days have a name that did not describe a specific flavor, such as “solar,” “purple,” “jazz,” “island bash,” “fusion” or some other word or phrase?
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Are any example words (e.g., jazz) missing? |
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Question Universe: past 30-day nicotine pouch user [known] During the past 30 days, how did you get your nicotine pouches? (Select one or more)
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Question Universe: past 30-day nicotine pouch user [known] During the past 30 days, where did you buy your nicotine pouches? (Select one or more)
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Question Group Probes:
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The next few questions are about other oral nicotine products. Oral nicotine products come in a variety of shapes and types, such as lozenges, discs, tablets, gums, dissolvable tobacco products, and other products. Examples of these products include Velo Nicotine Lozenges, Rogue Lozenges, Rogue Tablets, Verve discs, or Stonewall. Most oral nicotine products dissolve in your mouth and do not require spitting.
Do not think about chewing tobacco, snuff, dip, snus or nicotine pouches when answering these questions. |
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Have you ever used oral nicotine products, even just one time?
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[INTERVIEWER: CONTINUE BELOW FOR EVER DISSOLVABLE TOBACCO USERS. NEVER USERS SKIP TO PAGE X. |
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Question Universe: ever users of oral nicotine products [or unknown] During the past 30 days, on how many days did you use oral nicotine products?
Specify: |__|__| (Range 0 – 30) |
[IF NOT PROBED ALREADY]:
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[INTERVIEWER: CONTINUE BELOW FOR PAST 30 DAY DISSOLVABLE TOBACCO USERS. EVER USERS SKIP TO PAGE X.] |
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Question Universe: past 30-day oral nicotine user [known] Were any of the oral nicotine products that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcoholic drinks, candy, fruit, chocolate, or any other non-tobacco flavor? Do not think about tobacco flavor when answering this question.
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Question Universe: past 30-day oral nicotine product user [known] Were any of the oral nicotine products that you used in the past 30 days flavored to taste like tobacco?
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Question Universe: past 30-day users of flavored oral nicotine products What flavors were the oral nicotine products that you have used in the past 30 days? (Select one or more)
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Question Universe: past 30-day oral nicotine user [known] During the past 30 days, how did you get your oral nicotine products? (Select one or more)
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Question Universe: past 30-day oral nicotine user [known] During the past 30 days, where did you buy your oral nicotine products? (Select one or more)
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Question Group Probes:
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[INTERVIEWER: CONTINUE BELOW FOR PAST 30-DAY USERS OF ANY TOBACCO PRODUCT (SEE SCREENER RESPONSES). FOR NEVER OR FORMER USERS, SKIP TO PAGE X. |
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Instruction Universe: current (past 30-day) tobacco product user (any product) [known]
In answering the next 5 questions, please think about all of the tobacco products that you have used in the past 30 days, including e-cigarettes, cigarettes, cigars, smokeless tobacco, snus, nicotine pouches, other oral nicotine products, hookahs, heated tobacco products, pipe tobacco, bidis, and roll-your own-cigarettes.
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Question Universe: current (past 30-day) tobacco product user (any product) [known]
During the past 30 days, on how many days did you use any tobacco product(s)? Specify: |__|__| (Range 1 – 30) |
Walk me through how you answered this question (particularly if respondent uses more than 1 tobacco product). |
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Question Universe: past 30-day users of any tobacco product [known]
During the past 30 days, have you had a strong craving or felt like you really needed to use a tobacco product of any kind?
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Question Universe: past 30-day users of any tobacco product [known] How soon after you wake up do you want to use a tobacco product of any kind?
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Question Universe: past 30-day tobacco product users (any product) [known] Are you seriously thinking about quitting the use of all tobacco products? (Please choose the first answer that fits)
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Question Universe: past 30-day tobacco product users (any product) [known] During the past 12 months, how many times have you stopped using all tobacco products for one day or longer because you were trying to quit all tobacco products for good?
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Instruction Universe: past 30-day tobacco product users (any product) [known] The next few questions are about getting tobacco products. |
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Question Universe: past 30-day tobacco product users (any product) [known] During the past 30 days, did anyone refuse to sell you any tobacco products because of your age?
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INTERVIEWER: CONTINUE HERE FOR ALL RESPONDENTS. |
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Instruction Universe: never, former users of any tobacco product [known/unknown] The next two questions ask your thoughts about getting tobacco products. |
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How easy do you think it is for people your age to buy tobacco products in a store?
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How easy do you think it is for people your age to buy tobacco products online?
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The next several questions are about visits to a doctor, dentist, nurse, or other health professional during the past 12 months. |
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Have you visited a doctor, dentist, or nurse in the past 12 months?
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Please think about cigarettes, only, when answering the next two questions. |
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During any of these visits to a doctor, dentist, nurse, or other health professional, were you asked if you used cigarettes?
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During any of these visits, were you advised to not use cigarettes?
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Please think about e-cigarettes, only, when answering the next two questions. |
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During any of these visits to a doctor, dentist, nurse, or other health professional, were you asked if you used e-cigarettes?
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During any of these visits, were you advised to not use e-cigarettes?
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Please think about all other tobacco products when answering the next two questions. This includes: cigars, chewing tobacco, snuff, or dip, smokeless tobacco products, snus, nicotine pouches, other oral nicotine products, hookah, heated tobacco products, pipe tobacco, bidis, or roll-your-own cigarettes. Do not think of e-cigarettes or manufactured cigarettes when answering these questions. |
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During any of these visits to a doctor, dentist, nurse, or other health professional, were you asked if you used any of these other tobacco products?
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During any of these visits, were you advised to not use any of these other tobacco products?
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Question Group Probes:
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The next 8 questions ask about your thoughts on tobacco products. |
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Compared to a typical cigarette, would you think that a cigarette advertised as low nicotine would be…
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Do you think that e-cigarettes…
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How strongly do you agree with the statement ‘All tobacco products are dangerous’?
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What products did you consider? |
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Do you think that breathing the vapor from other people’s e-cigarettes causes…
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Can you describe what this question is asking in your own words (specifically what “breathing the vapor from other people’s e-cigarettes” means)? |
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Not including the vapor from e-cigarettes, do you think that breathing smoke from other people’s cigarettes or other tobacco products causes…
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Can you describe what this question is asking in your own words? |
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Out of every 10 students in your grade at school, how many do you think smoke cigarettes?
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Out of every 10 students in your grade at school, how many do you think use e-cigarettes?
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Please complete the following sentence. My friends think that e-cigarette use is…
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Question Group Probes:
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How true are each of the following statements about your neighborhood? Response options: Not at all true, A little true, Sort of true, Very true
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The last fourteen questions ask about your experiences at home and at school. |
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Does anyone who lives with you now…? (Select one or more)
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Do you speak a language other than English at home?
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Sexual orientation is a person’s emotional, romantic, and/or sexual attraction to another person. There are many ways a person can describe their sexual orientation and many labels a person can use. Which of these options best describes your sexual orientation?
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Some people describe themselves as transgender and/or nonbinary when the way they think or feel about their gender is different from their sex assigned at birth. Do you identify as transgender and/or nonbinary?
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During the past two weeks, how often have you been bothered by any of the following problems? Response options: Not at all, Several Days, More than half of the days, Nearly every day
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Does your family own a vehicle (such as a car, van, or truck)?
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Do you have your own bedroom?
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How many computers (including laptops and tablets, not including game consoles and smartphones) does your family own?
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During the past 12 months, how many times did you travel on vacation with your family?
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During the past 12 months, how would you describe your grades in school?
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Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
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Question Group Probes:
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Report Template Blue |
Author | Microsoft Office User |
File Modified | 0000-00-00 |
File Created | 2022-04-07 |