0920-1083 Nonsmoker Survey Wave I_English 04JUN2021

NONSMOKER SURVEY

BASE: If DOV_SMOKER=2

OMB_NONSMOKER [DISP]

Form Approved

OMB No. 0920-1083

Exp. Date 3/31/2023

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign Nonsmoker Questionnaire

Public reporting burden of this collection of information is estimated to average 30 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1083).

BASE: If DOV_T8W1_SMOKE=2 (former smoker)

NA4 [S]

Have you smoked cigarettes at all, even one puff, in the past 12 months?

1. Yes

2. No

BASE: If NA4=1

NA4_x [S]

Was the last time you smoked a cigarette, even one or two puffs…?

1. Within the past 24 hours

2. Within the past 7 days

3. Within the past 30 days

4. Within the past 3 months

5. Within the past 6 months

6. Within the past 1 year

7. More than one year ago

BASE: If NA4=1

NA5 [S]

Have you quit smoking cigarettes completely in the past 6 months?

1. Yes

2. No

Scripter: Create DOV_RECENTQUIT=1 if NA5=1, 0 otherwise

BASE: If NA5=1

NB2 [N with range 0-999; prompt once]

During the past 3 months, that is, since [DOV_DATE2], how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

____ Number of times

Scripter: If NA5=2, autofill NB2=0

BASE: If NA5=1

NB2a [N with range NB2 value-999]

During the past 6 months, that is since [DOV_DATE4], how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

____ Number of times

Scripter: If NA5=2; autofill NB2a=0

BASE: If NA4=1

NB1 [N with range NB2A value-999; if NB2A refused, range NB2-999; prompt once]

During the past 12 months, that is, since [DOV_DATE3], how many times have you stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

____ Number of times

BASE: If NA4=1

NB3c [S]

In the past 12 months, have you used any of the following medications to help you quit smoking: nicotine skin patch, nicotine gum, nicotine lozenges, nicotine nasal spray, a nicotine inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline?

1. Yes

2. No

BASE: If NA5=1 or NB1>0 or NB2>0

NB4 [GRID; S ACROSS]

When you last tried to quit smoking, did you do any of the following?

Statements in row (randomize and record response order):

NB4_1. Give up cigarettes all at once

NB4_2. Gradually cut back on cigarettes

NB4_3. Switch completely to vaping (using e-cigarettes, vape pens, JUULs, mods, or other personal vaporizers)

NB4_4. Substituted some of your regular cigarettes with vaping (using e-cigarettes, vape pens, JUULs, mods, or other personal vaporizers)

NB4_5. Switch to mild or some other brand of cigarettes

NB4_6. Use nicotine replacements like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler

NB4_7. Use medications like Wellbutrin, Zyban, buproprion, Chantix, or varenicline

NB4_8. Get help from a telephone quit line

NB4_9. Get help from a website such as Smokefree.gov or CDC.gov/Tips

NB4_10. Get help from a doctor or other health professional

NB4_11. Get help from a pharmacist

NB4_12. Use a mobile App to help you quit smoking

NB4_13. Use a texting program to help you quit smoking

Answers in columns:

1. Yes

2. No

BASE: If NB1>0

NB5 [GRID; S Across]

When you last tried to quit smoking, did any of the following motivate you to try to quit?

Statements in row (randomize and record response order, with NB5_5 always last):

NB5_1. A family member or friend encouraged me to try to quit

NB5_2. Television commercials, radio ads, or other types of advertisements that focus on the health consequences of smoking

NB5_3. My doctor or other health professional advised me to quit smoking

NB5_4. Workplace restrictions on smoking

NB5_5. Cost of cigarettes is too high

NB5_6. Concern about COVID-19

NB5_7. Other, please specify: [O] _____

Answers in columns:

1. Yes

2. No

Scripter: If NB5_5 = “Yes” but nothing is entered in the verbatim, prompt with “Please tell us what else motivated you to quit smoking.”

BASE: If DOV_SMOKER=2

NB8. [S]

The next questions are about vaping (using e-cigarettes, vape pens, JUULs, mods, other personal vaporizers). Vaping products are battery-powered and produce vapor instead of smoke. They typically use a nicotine liquid, although the amount of nicotine can vary and some may not contain any nicotine at all. Some common brands are JUUL, Vuse, MarkTen, Logic, and Blu.

These questions concern electronic vaping products for nicotine use. The use of electronic vaping products for marijuana use is not included in these questions. Some examples of vaping products are pictured below.

[SHOW IMAGE “NEW_VAPE_IMAGE.png” centered on screen]

Have you ever used vaped, even one time?

1. Yes

2. No

BASE: If NB8=1

NB8a [S]

During the past 30 days, on how many days did you vape?

1. 0 days

2. 1 to 2 days

3. 3 to 5 days

4. 6 to 9 days

5. 10 to 19 days

6. 20 to 29 days

7. All 30 days

BASE: If NB8=1

NB9 [S]

Do you now vape…

1. Every day

2. Some days

3. Not at all

BASE: If NB9=1 or NB9=2

NB9a [S]

On the days that you vape, how often do you vape?

1. Rarely

2. Sometimes

3. Often

4. Very often

BASE: If NB9=1 or NB9=2

NB9b [S]

Do you usually vape with disposable devices, rechargeable devices that use pods or cartridges, or rechargeable devices that use large refillable tanks?

Please indicate the type of device that you vape most often.

1. Disposable devices that are not rechargeable or refillable

2. Rechargeable devices that use pods or cartridges, like JUULs

3. Rechargeable devices that have large refillable tanks

4. Unknown device type

BASE: If NB9=1 or NB9=2

NB9_1 [S]

When you vape, does the liquid/contents usually contain nicotine?

1. Yes

2. No

3. Don’t know

BASE: If NB8=1 and NB9 not refused

NB10 [M]

Are any of the following a reason why you [NB9=3: first tried / NB9=1 OR 2: currently use] electronic vapor products?

Randomize and record response order, with B10_15 always last

NB10_1. I can vape when or where smoking cigarettes is not allowed

NB10_2. Vaping might be less harmful to me than smoking cigarettes

NB10_3. I like the flavors

NB10_4. Vaping can help me quit or cut back on smoking cigarettes

NB10_5. Vaping helps me deal with cravings to smoke

NB10_6. A friend or family member suggested I vape as a way to quit smoking

NB10_7. A friend or family member [NB9=3: shared / NB9=1 or 2: shares] their vaping device with me

NB10_8. Vaping is popular among people my age

NB10_9. I [NB9=3: was / NB9=1 or 2: am] curious about vaping

NB10_10. Other, specify: [O] _____ [anchor]

BASE: If NB8=1

NB13 [Grid; S Across]

In your opinion, regularly vaping and smoking cigarettes is….

Scripter: Show numbers to the right of the response options

1. Much less harmful to one’s health than only smoking cigarettes

2. Slightly less harmful to one’s health than only smoking cigarettes

3. Equally harmful to one’s health as only smoking cigarettes

4. Slightly more harmful to one’s health than only smoking cigarettes

5. Much more harmful to one’s health than only smoking cigarettes

BASE: If NB9=1 or NB9=2

NB14 [S]

Do you want to quit vaping for good?

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE9a [S]

A telephone quitline is a free telephone-based service that connects people who smoke cigarettes with someone who can help them quit. In the past 3 months, that is since [DOV_DATE2], have you recommended any family members or friends that smoke to call a telephone quitline?

1. Yes

2. No

BASE: If NE9a=2

NE9b [S]

In the past 6 months, that is since [DOV_DATE4], have you recommended any family members or friends that smoke to call a telephone quitline?

1. Yes

2. No

Scripter: If NE9a=1, autopunch NE9b=1

BASE: If DOV_SMOKER=2

NE10 [S]

Have you heard of 1-800-QUIT-NOW?

1. Yes

2. No

BASE: If NE10=1

NE10a [S]

In the past 3 months, that is since [DOV_DATE2], have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

1. Yes

2. No

Scripter: If NE10=2, autopunch NE10a=2

BASE: If NE10a=2 and NE10=1

NE10b [S]

In the past 6 months, that is since [DOV_DATE4], have you recommended any family members or friends that smoke to call 1-800-QUIT-NOW?

1. Yes

2. No

Scripter: If NE10a=1, autopunch NE10b=1

BASE: If NE10a=1

NE11[S]

In the past 3 months, did you recommend your family and friends to ask about the following free medications when calling 1-800-QUIT-NOW: nicotine patches, gum, lozenges, nasal spray, inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline?

1. Yes

2. No

Scripter: If NE10=2 autopunch NE11=2

BASE: If NE11=2 and NE10b=1

NE11a [S]

In the past 6 months, since [DOV_DATE4], did you recommend your family and friends to ask about the following free medications when calling 1-800-QUIT-NOW: nicotine patches, gum, lozenges, nasal spray, inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline?

1. Yes

2. No

Scripter: If NE11=1, autopunch NE11a=1

BASE: If DOV_SMOKER=2

ND19 [S]

Please tell us if you strongly disagree, disagree, agree, or strongly agree with the following statements.

Smoking cigarettes can cause medical complications and diseases that require surgeries and medical procedures to treat.

1. Strongly disagree

2. Disagree

3. Agree

4. Strongly agree

ND15. Using e-cigarettes and vape products can result in serious lung injury or death.

1. Strongly disagree

2. Disagree

3. Agree

4. Strongly agree

BASE: If DOV_SMOKER=2

NC4a [S]

In your opinion, how likely is it that regularly breathing secondhand tobacco smoke would worsen asthma or cause infections or lung damage among nonsmokers?

1. Extremely likely

2. Very likely

3. Somewhat likely

4. Very unlikely

5. Extremely unlikely

BASE: If DOV_SMOKER=2

NC1 [Grid, S Across]

Do you believe cigarette smoking is related to:

Statements in row (randomize and record response order):

NC1_1. Lung Cancer

NC1_2. Cancer of the mouth or throat

NC1_3. Heart Disease

NC1_4. Diabetes

NC1_5. Emphysema

NC1_6. Stroke

NC1_7. Hole in throat (stoma or tracheotomy)

NC1_8. Buerger’s Disease

NC1_9. Amputations (removal of limbs)

NC1_10. Asthma

NC1_11. Gallstones

NC1_12. COPD or Chronic bronchitis

NC1_13. Periodontal or Gum Disease

NC1_14. Premature birth

NC1_15. Colorectal Cancer

NC1_16. Macular Degeneration or blindness

NC1_17. Depression

NCI_18. Anxiety disorder

NC1_19. Colon Cancer

NC1_20. COVID-19

Answers in columns:

1. Yes

2. No

BASE: If DOV_SMOKER=2

ND1[S]

Other than yourself, does anyone who lives in your home smoke cigarettes now?

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE8b [S]

Not counting decks, porches, or garages inside your home, is smoking….

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed

BASE: If DOV_SMOKER=2

NE9_1 [S]

Are you seriously considering increasing restrictions on smoking in your household?

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not

BASE: If DOV_SMOKER=2

ND4 [S]

During the past 3 months, that is since [DOV_DATE2], have you talked to any family members or friends about the dangers of smoking?

1. Yes

2. No

BASE: If DOV_SMOKER=2

ND5a [S]

During the past 3 months, that is since [DOV_DATE2], did you encourage a friend or family member to quit smoking?

1. Yes

2. No

BASE: If ND5a=2

ND5b [S]

During the past 6 months, that is since [DOV_DATE4], did you encourage a friend or family member to quit smoking?

1. Yes

2. No

Scripter: If ND5a=1, autopunch ND5b=1

BASE: If NE10c=2

NE10d [S]

In the past 6 months, that is since [DOV_DATE4], have you recommended any family members or friends that smoke to talk with a health care professional such as a physician, nurse, or dentist about quitting smoking?

1. Yes

2. No

Scripter: If NE10c=1 autopunch NE10d=1

BASE: If DOV_SMOKER=2

NE1 [S]

The next few questions are about media use.

On an average day, how much television do you watch?

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

BASE: If DOV_SMOKER=2

NE2 [S]

On an average day, how many hours do you listen to the radio?

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

BASE: If DOV_SMOKER=2

NE3 [S]

On an average day, how many hours do you use the Internet for personal reasons?

1. None

2. Less than one hour

3. About 1 hour

4. About 2 hours

5. About 3 hours

6. About 4 hours

7. 5 hours or more

BASE: If DOV_SMOKER=2

NE14 [S]

Have you heard of the Website www.cdc.gov/Tips?

1. Yes

2. No

BASE: If NE14=1

NE14x [S]

Have you visited www.cdc.gov/Tips in the past 3 months, since [DOV_DATE2]?

1. Yes

2. No

BASE: If NE14x=2

NE14a [S]

Have you visited www.cdc.gov/Tips in the past 6 months, since [DOV_DATE4]?

1. Yes

2. No

Scripter: If NE14X=1, autopunch NE14A=1

BASE: If NE14x=1 or NE14a=1

NE14b. [S]

In the past 3 months, that is since [DOV_DATE2], have you recommended any family members or friends that smoke to visit www.cdc.gov/Tips?

1. Yes

2. No

BASE: If NE14B=2

NE14c [S]

In the past 6 months, that is since [DOV_DATE4], have you recommended any family members or friends that smoke to visit www.cdc.gov/Tips?

1. Yes

2. No

Scripter: If NE14B=1, autopunch NE14C=1

BASE: If DOV_SMOKER=2

NE14d [S]

In the past 6 months, that is since [DOV_DATE4], have you seen or heard advertisements for medications or products to help people quit smoking such as Chantix, Wellbutrin, Zyban, verenicline, bupoprion, nicotine patches, or nicotine gums?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Always

BASE: If DOV_SMOKER=2

NE18 [Grid, S Across]

In the past 6 months, since [DOV_DATE4], have you seen or heard of any ads on television or radio with the following themes or slogans?

Statements in row (randomize and record response order):

NE18_1. Tips from Former Smokers

NE18_2. Truth

NE18_3. Every Try Counts

NE18_4. Fresh Empire

NE18_5. This Free Life

NE18_6. The Real Cost

Answers in columns:

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE20_1 [S]

Have you seen the following Facebook page or group when you have been online in the past 3 months, since [DOV_DATE2]?

[SHOW IMAGE “Tips Facebook.png” centered on screen]

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE20_2[S]

Have you seen the following YouTube channel or page when you have been online in the past 3 months, since [DOV_DATE2]?

[SHOW IMAGE “Tips Youtube.png” centered on screen]

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE20_3 [S]

Have you seen the following Twitter page when you have been online in the past 3 months, since [DOV_DATE2]?

[SHOW IMAGE “Tips Twitter.png” centered on screen]

1. Yes

2. No

BASE: If DOV_SMOKER=2

NE21 [Grid, S Across]

Sometimes people use the Internet specifically for health-related reasons. In the past 30 days, have you used the Internet for any of the following reasons?

Statements in row (randomize and record response order):

NE21_1. Looked for information about quitting smoking

NE21_2. Looked for information about vaping (using e-cigarettes or other vaping products)

NE21_3. Looked for information about nicotine replacement therapies (e.g., patches, gum, lozenges)

NE21_4. Downloaded a mobile app to help you quit smoking

NE21_5. Signed up for a text program to help you quit smoking

NE20_6. Created an online plan to help you quit smoking

Answers in columns:

1. Yes

2. No

NONSMOKER AD SECTION STARTS HERE.

BASE: If DOV_SMOKER=2

NONSMOKER_VID_INTRO [DISP]

Now, we would like you to view a series of advertisements that have been shown on television and online in the U.S. Please make sure your computer’s volume is set to an appropriate level. If the videos do not work, you’ll still be able to see images and descriptions of the advertisements.

When you are ready, please click the "Next" button below to view the first advertisement. Click or tap on each video to begin playback; the “Next” button will appear once the entire video has been shown.

There is a total of [PPETHM<>4 and DOV_PPETHM_ABS<>4 and ABS_NQRACE1_FRESH=1 (non-Hispanic): 7 ads / PPETHM=4 or DOV_PPETHM_ABS=4 or ABS_NQRACE1_FRESH=2-5 (Hispanic): 8 ads] to view. After you view each ad, there will be a few questions that ask about your opinions of the ad.

BASE: If DOV_SMOKER=2

Scripter: Show all respondents ads 1-5:

1= MICHAEL LIES_15SEC

2= REBECCA BOOT_15SEC

3= ASAAD AND LEAH_15SEC

4= TONYA_15SEC

5= CHRISTINE HEAD OF HOUSEHOLD_15SEC

Scripter: Randomly select and show 2 of ads 6-9:

6=DENISE AND BRIAN_15SEC

7=GERI TEXTING_15SEC

8=SHAWN_15SEC

9=SHARON TREADMILL_15SEC

Scripter: If PPETHM=4 or DOV_PPETHM_ABS=4 or ABS_NQRACE1_FRESH=2-5 (R is Hispanic), randomly select and show one of ads 10-12:

10=BRETT & FELICITA_30SEC

11=JESSICA_15SEC

12=ROSE_15SEC

Scripter: Add “_X” to variable names below that map to ad ID# above. For example:

F21_1 indicates “Were you able to view this video” for MICHEAL LIES.

F21_2 indicates “Were you able to view this video” for REBECCA BOOT.

F21_3 indicates “Were you able to view this video” for ASAAD AND LEAH.

Etc.

BASE: If DOV_SMOKER=2

NF21_x [S; prompt once]

Were you able to view this video?

1. Yes

2. No

BASE: If NF21_x=2 or refused

NF23_x [DISP]

Now we would like to show you some screen shots from a television advertisement that has been shown in the U.S. Please click the arrow to the right of each image to move to the next image.

Once you have viewed all the images, please click the "Next" button below to continue with the survey.

BASE: If NF21_x=2 or refused

[DISPLAY STORYBOARD IMAGES FOR AD_X]

BASE: If DOV_SMOKER=2

NF24_x [S; prompt once]

Have you seen this ad on television or online in the past 6 months, since March 23, 2020?

1. Yes

2. No

BASE: If NF24_x=1

NF24a_x_TV [S]

In the past 6 months, since March 23, 2020, how frequently have you seen this ad on television?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

BASE: If NF24_x=1

NF24a_x_COMPUTER [S]

In the past 6 months, since March 23, 2020, how frequently have you seen this ad on a laptop or desktop computer?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

BASE: If NF24_x=1

NF24a_x_MOBILE [S]

In the past 6 months, since March 23, 2020, how frequently have you seen this ad on a tablet or smartphone?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

Scripter: Show NF25_x – NF28_3x for 4 randomly selected ads from ads 1-14

BASE: If DOV_SMOKER=2

NF25_x [Grid, S Across]

Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements.

Statements in row (randomize and record response order):

NF25a_x. This ad is worth remembering.

NF25b_x. This ad grabbed my attention.

NF25c_x. This ad is powerful.

NF25d_x. This ad is informative.

NF25e_x. This ad is meaningful to me.

NF25f_x. This ad is convincing.

Answers in columns:

1. Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

BASE: If DOV_SMOKER=2

NF26_x [Grid, S Across]

On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this ad made you feel…

Statements in row (randomize and record response order):

NF26a_x. Sad

NF26b_x. Afraid

NF26d_x. Ashamed

NF26f_x. Hopeful

NF26g_x. Motivated

NF26h_x. Understood

Answers in columns:

1. Not at all

2

3

4

5. Very

BASE: If DOV_SMOKER=2

NEXT_AD [DISP]

Now, we would like you to watch another ad.

Scripter: Repeat the sequence of questions (NF21_x through NF28_3X) for each of the remaining ads per assignment protocol above

BASE: If DOV_SMOKER=2

Now, we would like you to listen to a streaming radio advertisement that you may have heard online in the U.S. Please make sure your computer’s volume is set to an appropriate level. You may be prompted by your computer to download a program enabling audio playback. When you are ready, please click on the link below to listen to the ad. After you listen to the ad, there will be a few questions that ask about your recent recall of the ad.

[RANDOMLY ASSIGN ALL RESPONDENTS TO LISTEN TO ONE OF THE FOLLOWING ADS]

1=Christine Eating Tip.mp3

2=Brian Heart Attack.mp3

3=Roosevelt Heart Tip.mp3

4=Rebecca Tip.mp3

[PLAY RADIO AD CHOSEN]

[ADD “_x” TO VARIABLE NAMES BELOW THAT MAP TO AD ID # ABOVE. FOR EXAMPLE:

F32_1 indicates “Were you able to listen to this ad” for Christine Radio.

F32_2 indicates “Were you able to listen to this ad” for Brian Radio.

F32_3 indicates “Were you able to listen to this ad” for Roosevelt Radio.

F32_4 indicates “Were you able to listen to this ad” for Rebecca Radio.

[sp]

NF35_x.

Have you heard this ad streaming or online in the past 3 months, since March 23, 2020?

1. Yes

2. No

[IF NF35_x=1, ASK NF35a_x]

[sp]

NF35a_x. In the past 3 months, since March 23, 2020 how frequently have you heard this ad streaming or online?

1. Rarely

2. Sometimes

3. Often

4. Very Often

BASE: If DOV_SMOKER=2

NS_PRINT_WEB1 [DISP]

Next, you will see some advertisements that have recently appeared on websites. There is 1 set of images to view, followed by a question about whether you have seen these ads before. When you are ready to view them, please click “Next.”

BASE: If DOV_SMOKER=2

NS_PRINT_WEB2 [DISP]

[SHOW IMAGE “Tips 2020 Digital Collage” centered on screen]

Please click “Next” to proceed to the next set of questions.

BASE: If DOV_SMOKER=2

NF36 [S]

In the past 3 months, since March 23, 2020, have you seen any of these ads on websites or other places online?

1. Yes

2. No

BASE: If NF36=1

NF37 [S]

Did you see these ads on digital devices such as a smartphone or tablet?

1. Yes

2. No

NONSMOKER AD SECTION ENDS HERE.

BASE: If DOV_SMOKER=2

NF38 [S]

When you go to a convenience store, supermarket, or gas station, how often do you see ads or promotions for vaping products?

1. I never go to a convenience store, supermarket, or gas station

2. Never

3. Rarely

4. Sometimes

5. Most of the time

6. Always

Demographic Section

BASE: All respondents

G1 [N with range 0-10; prompt once]

Next, how many children aged 17 or younger currently live in your household at least 50% of the time? If none, enter “0”.

Include babies and small children.

Type in the number of children 17 years of age or younger.

Custom refusal prompt: Your answer will help represent the entire U.S. population and will be kept confidential. Thank you!

BASE: If OFFPANEL=1

QEDUC [S]

What is the highest level of school you have completed?

1. Some high school or less – no diploma or GED

2. High school graduate – high school diploma or the equivalent (GED)

3. Some college, no degree

4. Associate degree

5. Bachelor’s degree

6. Master’s degree

7. Professional or Doctorate degree

BASE: If QEDUC=15

QEDUCa [S]

What is the highest level of school you have completed?

1. No formal education

2. 1st, 2nd, 3rd, or 4th grade

3. 5th or 6th grade

4. 7th or 8th grade

5. 9th grade

6. 10th grade

7. 11th grade

8. 12th grade NO DIPLOMA

SCRIPTER: Create data-only variables:

Variable name: PPEDUC [S]

Variable Text: Education - categorical

Response list:

1. No formal education

2. 1st, 2nd, 3rd or 4th grade

3. 5th or 6th grade

4. 7th or 8th grade

5. 9th grade

6. 10th grade

7. 11th grade

8. 12th grade NO DIPLOMA

9. HIGH SCHOOL GRADUATE – high school diploma or the equivalent (GED)

10. Some college, no degree

11. Associate degree

12. Bachelor’s degree

13. Master’s degree

14. Professional or Doctorate degree

QEDUC	QEDUCa	PPEDUC
	1	1
	2	2
	3	3
	4	4
	5	5
	6	6
	7	7
	8	8
9		9
10		10
11		11
12		12
13		13
14		14

Variable name: PPEDUCAT [S]

Variable Text: Education - categorical

Response list:

1. Less than HS

2. HS

3. Some college

4. Bachelor or higher

QEDUC	PPEDUCAT
15	1
9	2
10-11	3
12-14	4

BASE: If OFFPANEL=1ALL RESPONDENTS

QINC [S; prompt once]

How much is the combined income of all members of YOUR HOUSEHOLD for the past 12 months?

Please include your income PLUS the income of all members living in your household (including cohabiting partners and armed forces members living at home). Please count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net income from a business, interest, dividends, child support, alimony, and Social Security, public assistance, pensions, or retirement benefits).

1. Below $50,000

2. $50,000 or more

3. Don’t know [only show with the prompt if question is refused initially]

Custom refusal prompt: We realize that this is personal information. We will ONLY ASK the range of your household income, NOT the exact amount.

BASE: QINC=1

QINC2 [S]

We would like to get a better estimate of your total HOUSEHOLD income in the past 12 months before taxes. Was it...

1. Less than $5,000

2. $5,000 to $7,499

3. $7,500 to $9,999

4. $10,000 to $12,499

5. $12,500 to $14,999

6. $15,000 to $19,999

7. $20,000 to $24,999

8. $25,000 to $29,999

9. $30,000 to $34,999

10. $35,000 to $39,999

11. $40,000 to $49,999

BASE: QINC=2

QINC3 [S]

We would like to get a better estimate of your total HOUSEHOLD income in the past 12 months before taxes. Was it...

3. $50,000 to $59,999

4. $60,000 to $74,999

5. $75,000 to $84,999

6. $85,000 to $99,999

7. $100,000 to $124,999

8. $125,000 to $149,999

9. $150,000 to $174,999

10. $175,000 to $199,999

11. $200,000 to $249,999

12. $250,000 or more

SCRIPTER: Create data-only variable:

Variable name: PPINCIMP [S]

Variable Text: HH income – profile and imputed

Response list:

1. Less than $5,000

2. $5,000 to $7,499

3. $7,500 to $9,999

4. $10,000 to $12,499

5. $12,500 to $14,999

6. $15,000 to $19,999

7. $20,000 to $24,999

8. $25,000 to $29,999

9. $30,000 to $34,999

10. $35,000 to $39,999

11. $40,000 to $49,999

12. $50,000 to $59,999

13. $60,000 to $74,999

14. $75,000 to $84,999

15. $85,000 to $99,999

16. $100,000 to $124,999

17. $125,000 to $149,999

18. $150,000 to $174,999

19. $175,000 to $199,999

20. $200,000 to $249,999

21. $250,000 or more

QINC2	QINC3	PPINCIMP
1		1
2		2
3		3
4		4
5		5
6		6
7		7
8		8
9		9
10		10
11		11
	3	12
	4	13
	5	14
	6	15
	7	16
	8	17
	9	18
	10	19
	11	20
	12	21

BASE: If OFFPANEL=1

QMARIT [S]

Are you now...?

1. Married

2. Widowed

3. Divorced

4. Separated

5. Never married

BASE: If QMARIT=2 to 5 or refused

QPRTNR [S]

Are you currently living with a partner to whom you are not married?

1. Yes

2. No

SCRIPTER: Create data-only variable PPMARIT by using the below logic involving responses to QMARIT AND QPRTNR.

Create numeric variable, PPMARIT, range [1,6]

compute PPMARIT=QMARIT.

if (QPRTNR=1 and QMARIT=5) PPMARIT=6 (living with partner)

BASE: If OFFPANEL=1

E100 [S; prompt once]

Do any of the following currently describe you?

Statements in row:

1. Employed full time (35 hours or more per week) for pay with an organization or company

2. Employed part time (less than 35 hours per week) for pay with an organization or company

3. Self-employed full time (35 hours or more per week)

4. Self-employed part time (less than 35 hours per week)

Answers in columns:

1. Yes

2. No

SCRIPTER: Create DOV_EMPLOYED

If E100_1=1 or E100_2=1 or E100_3=1 or E100_4=1 DOV_EMPLOYED=1.

If E100A=2 and E100B=2 and E100C and E100D=2 DOV_EMPLOYED=2.

Else DOV_EMPLOYED=3.

1. Employed

2. Not employed

3. Refused

BASE: If DOV_EMPLOYED=2

E102 [GRID, S Across]

Do any of the following currently describe you?

Statements in row:

1. Looking for work

2. Unable to work due to a disability

3. On temporary layoff from a job

Answers in columns:

1. Yes

2. No

BASE: If OFFPANEL=1

E104 [GRID, S Across]

Do any of the following currently describe you?

Statements in row:

1. Retired

2. A student

3. A stay-at-home spouse or partner

4. Working in an unpaid job, such as an internship or volunteer position

Answers in columns:

1. Yes

2. No

SCRIPTER: Create data-only variable:

Variable name: QWORK [S]

Variable Text: Current employment status

Response list:

1. Working – as a paid employee

2. Working – self-employed

3. Not working – on temporary layoff from a job

4. Not working – looking for work

5. Not working – retired

6. Not working – disabled

7. Not working – other

Values must be assigned in the order below so that codes at the bottom of the table overwrite codes at the top:

E100	DOV_EMPLOYED	E102	E104	QWORK
	3			Refused
	2			7
			E104_2=1	7
			E104_3=1	7
			E104_4=1	7
		E102_2=1		6
			E104_1=1	5
		E102_1=1		4
		E102_3=1		3
E100_4=1				2
E100_2=1				1
E100_3=1				2
E100_1=1				1

BASE: If PPWORK=1 or 2 or QWORK=1 or 2

QWORK2 [S]

Altogether, how many jobs do you have?

1. One

2. Two

3. Three

4. Four or more

BASE: If (OFFPANEL=1 and (QWORK=1 or 2)) or ((PPWORK=1 or 2) and XIND1=MISSING)

IND1 [S]

Think about the industry in which you currently work. Which of the following kinds of industries is it?

[Alternate text if QWORK2=2, 3, or 4]

Think about the industry in which you currently work at your MAIN job. Which of the following kinds of industries is it?

11. Agriculture, Forestry, Fishing and Hunting

21. Mining, Quarrying, and Oil and Gas Extraction

22. Utilities

23. Construction

31-33. Manufacturing

42. Wholesale Trade

44-45. Retail Trade

48-49. Transportation and Warehousing

51. Information

52. Finance and Insurance

53. Real Estate and Rental and Leasing

54. Professional, Scientific, and Technical Services

55. Management of Companies and Enterprises

56. Administrative and Support and Waste Management and Remediation Services

61. Educational Services

62. Health Care and Social Assistance

71. Arts, Entertainment, and Recreation

72. Accommodation and Food Services

81. Other Services and Community/Non-Profit Organizations (except Public Administration)

92. Public Administration

93. Armed Forces

94.Utilities, Waste Management, and Remediation Services

95. Administrative and Support Services (such as Call Centers, Security, Landscaping, and Janitorial)

96. Child Day Care Services

97. Repairs and Maintenance

98. Personal Services (including Beauty, Pet Care, and Household)

100. Community/Non-Profit Organizations (including Religious and Political Organizations)

BASE: All respondents

G9 [S]

How many smoking or tobacco related web surveys like this have you completed during the past year?

1. None

2. 1 survey

3. 2 surveys

4. 3 surveys

5. 4 surveys

6. 5 or more surveys

BASE: All respondents

G10 [S]

Please indicate your current military service status.

1. Active duty

2. Reserves

3. National Guard

4. Veteran or Armed Services Retiree

5. Veteran or Retiree with a service connected disability

6. Civilian: NO military service record

BASE: All respondents

G11 [GRID, S Across]

Are you CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark “yes” or “no” for each type of coverage.

Statements in row:

G11_1. Insurance through a current or former employer or union

G11_2. Insurance purchased directly from an insurance company

G11_3. Medicare, for people age 65 and over, or people with certain disabilities

G11_4. Medicaid, or any kind of government assistance plan for those with low

incomes or disability

G11_5. TRICARE or other military health care

G11_6. VA (including those who have ever enrolled for or use VA health care)

G11_7. Indian Health Service

G11_8. Any other type of health insurance or health coverage plan

Answers in columns:

1. Yes

2. No

BASE: All respondents

G15 [GRID; S Across]

Have you been diagnosed by a physician or other qualified medical professional with any of the following medical conditions?

You may choose not to answer the question by simply clicking “Next”.

Statements in row (randomize and record response order, with G15_25 always last):

G15_1. Acid reflux disease

G15_2. ADHD or ADD

G15_3. Anxiety disorder

G15_4. Asthma, chronic bronchitis, or COPD

G15_5. Cancer (any type except skin cancer)

G15_6. Chronic pain (such as low back pain, neck pain, or Fibromyalgia)

G15_7. Depression

G15_8. Diabetes

G15_9. Heart attack

G15_10. Heart disease

G15_11. High blood pressure

G15_12. High cholesterol

G15_13. HIV/AIDS

G15_14. Kidney disease

G15_15. Mental health condition

G15_16. Multiple sclerosis

G15_17. Osteoarthritis, joint pain or inflammation

G15_18. Osteoporosis or osteopenia

G15_19. Rheumatoid arthritis

G15_20. Seasonal allergies

G15_21. Skin cancer

G15_22. Sleep disorders such as sleep apnea or insomnia

G15_23. Stroke

G15_24. COVID-19

G15_25. Something else [anchor]

Answers in columns:

1. Yes

2. No

BASE: If OFFPANEL=1 and DOV_RECONTACT=1

G20. [S]

Do you or anyone in this household connect to the Internet from home?

1. Yes

2. No

BASE: If OFFPANEL=1 and DOV_RECONTACT=2

G21 [S]

Do you live in a metro or non-metro area?

1. Non-Metro (Rural)

2. Suburban

3. Urban

BASE: If OFFPANEL=0

KP_THANKS [DISP]

Thank you for completing today’s survey. Your input will greatly help researchers assess the factors that impact quitting smoking.

You will be awarded 15,000 bonus points credited to your KnowledgePanel account for completing the survey.

BASE: If OFFPANEL=1 and DOV_RECONTACT=1

ADD0 [S]

Those are all of our questions. Thanks so much for your participation in our survey. As a token of our appreciation, we would like to send you $[IF SAMPLE=KP WITHDRAWN, $15; IF SAMPLE=ABS, INSERT INCENTIVE VALUE FROM LOOKUP TABLE based on MNO; IF SAMPLE=ABS and incentive value is missing from lookup table, insert: $20].

On the next screen, we would like to confirm your mailing information so that we may send you the check. This information will only be used to send you the check and will only be retained until November 2019. We’ll never sell or distribute this information. By completing the following information, you consent to the use of your personal information for the purpose described above.

1. I agree

2. No thank you

If ADD0=2, end survey.

BASE: If OFFPANEL=1 and DOV_RECONTACT=1

Scripter: Prompt if refused with custom text: “Complete and accurate information is needed in order to successfully mail your check”

Scripter: Show MP box next to the NAME_FINAL, ADDRESS_FINAL, CITY_FINAL, STATE_FINAL and ZIP_FINAL fields below

ADD1 [M]

Please verify your name and mailing address so that we can put the check in the mail. To ensure that you will be able to deposit or cash the check, please be sure to provide us with your full first AND last name. If you provide incomplete or inaccurate information, you may not be able to deposit the check. This information will not be connected with your survey responses in any way.

Please select the field(s) that you’d like to update. If all of the information is correct, please select “All of the above are correct”.

1. Name: [Insert NAME_FINAL from lookup table based on MNO. If NAME_FINAL in look up table is blank, insert: "not provided"]

[SPACE]

2. Mailing Address: [If any part of Address in lookup table (ADDRESS_FINAL, CITY_FINAL, STATE_FINAL, or ZIP_FINAL) is blank, insert: "not provided"]

[Insert ADDRESS_FINAL from lookup table based on MNO]

[Insert CITY_FINAL from lookup table based on MNO]

[Insert STATE_FINAL from lookup table based on MNO]

[Insert ZIP_FINAL from lookup table based on MNO]

[SPACE]

3. All of the above are correct [S]

[SPACE]

4. Prefer not to receive an incentive. [S]

BASE: If Add1=1 or name is missing from spreadsheet and DOV_RECONTACT=1

Scripter: Prompt if refused with custom text “Complete and accurate information is needed in order to successfully mail your check.”

ADD1_1 [O]

Please type in the name to whom you’d like us to send the incentive check:

Name (First/Last): [TEXTBOX]

BASE: If ADD1=2 or any part of address (address_final, city_final, state_final, or zip_final) is missing from spreadsheet and recontact=1

Scripter: Prompt if refused with custom text “Complete and accurate information is needed in order to successfully mail your check.”

ADD1_2 [O]

Please type in the address to where we should send the incentive check:

Street Address (If applicable, include unit number): [TEXTBOX]

City: [TEXTBOX]

State: [TEXTBOX]

Zip Code : [TEXTBOX]

BASE: [If ADD1=1-2]

Scripter: Prompt if refused with custom text “Complete and accurate information is needed in order to successfully mail your check.”

ADD2. [S]

Is the contact information below now up-to-date?

Name: [If asked Add1_1, insert name from Add1_1. If asked Add1_1 and Add1_1= refused, insert: Not provided. If not asked Add1_1, insert Name_Final from look up table based on MNO.]

Mailing Address:

[If not asked Add1_2, insert address from look up table based on MNO]

[If asked Add1_2, insert Street Address from Add1_2. If asked Add1_2 and Street Address=refused, insert: Street address: Not provided]

[If asked Add1_2, insert City from Q1_2. If asked Add1_2 and Add1_2_City=refused, insert: City: Not provided], [If asked Add1_2, insert State from Add1_2. If asked Add1_2 and Add1_2_State=refused, insert: State: Not provided] [If asked Add1_2, insert zip code from Add1_2. If asked Add1_2 and Add1_2_zip=refused, insert: Zip Code: Not provided]

1. Yes

2. No

Scripter: if Add2=refused after prompt, record answer as if respondent had selected 2 (no)

Scripter: if Add2=2; Loop back to Add1

BASE: If sample=abs and DOV_RECONTACT=2

ADD0_NEW [S]

Those are all of our questions. Thanks so much for your participation in our survey. As a token of our appreciation, we would like to send you [IF SAMPLE=KP WITHDRAWN, $15; IF SAMPLE=ABS AND ABS_G20=1 or -1, $20; IF SAMPLE=ABS and ABS_G20=2: $40].

On the next screen, we would like to confirm your mailing information so that we may send you the check. This information will only be used to send you the check and will only be retained until [FILL DATE]. We’ll never sell or distribute this information. By completing the following information, you consent to the use of your personal information for the purpose described above.

1. I agree

2. No thank you

If ADD0_NEW=2, end survey.

BASE: If sample=abs and DOV_RECONTACT=2

Scripter: Prompt if refused with custom text “Complete and accurate information is needed in order to successfully mail your check.”

ADD1_NEW. [O]

Please provide your name and mailing address so that we can put the check in the mail. To ensure that you will be able to deposit or cash the check, please be sure to provide us with your full first AND last name; if you provide incomplete or inaccurate information, you may not be able to deposit the check. This information will not be connected with your survey responses in any way.

After you have entered your information, please make sure to click “Next”.

Name (First/Last): [TEXTBOX]

Street Address (If applicable, include unit number): [TEXTBOX]

City: [TEXTBOX]

State: [TEXTBOX]

Zip Code : [TEXTBOX]

Prefer not to receive an incentive. [S]

BASE: If OFFPANEL=1

CONTACT_A [S]

Thank you for your participation in this important study! If you entered your address information on the previous question, your check for participation will arrive in the next 4 – 6 weeks.

The CDC will also have the opportunity to do at least one more survey in the future, with additional rewards and prizes for participation. Would you be willing to participate in another survey for the CDC?

1. Yes

2. No

BASE: If CONTACT_A=1

CONTACT_A1 [S]

Is this the address where you would like us to send your next CDC survey invitation?

[Insert Address_Final from look up table based on MNO]

[Insert City_final from look up table based on MNO], [Insert State_final from look up table based on MNO] [Insert Zip_final from look up table based on MNO]

1. Yes

2. No

BASE: If CONTACT_A1=2 or refused

CONTACT_A2. [O]

Please provide us with the address that you would like us to use to send you your next CDC survey invitation.

Street Address (If applicable, include unit number): [TEXTBOX]

City: [TEXTBOX]

State: [TEXTBOX]

Zip Code : [TEXTBOX]

Omit KP closing question QF1