Form Approved
OMB No. 0920-0910
Exp. Date 9/30/2026
National Tobacco Education Campaign
Online Questionnaire for
Rough Cut Testing of Television
Advertisements
(Cycle 3, October 4, 2024)
Public reporting burden of this collection of information is estimated to average 13 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).
{Base: All respondents}
SOGI1. What sex were you assigned at birth, on your original birth certificate?
01 Female
02 Male
SOGI2. How do you currently describe yourself (mark all that apply)?
01 Female
02 Male
03 Transgender
04 I use a different term [free-text]
01 Gay (lesbian or gay)
02 Straight, this is not gay (or lesbian or gay)
03 Bisexual
04 Something else
05 I don’t know the answer
06 Prefer not to answer/Decline
{Internal reference, do not display: PREAMBLE4}
The next questions are about cigarettes, which are any form of tobacco wrapped in paper that does not contain tobacco. Cigarettes typically come in packages of 20, and some brand examples include Marlboro, Newport, Camel, Lucky Strike, and Pall Mall.
Please note that use of e-cigarettes should not be considered “cigarettes” in the following questions.
{Base: Respondents who SMOKE EVERY DAY (IF SCREENER.TS2 = 01)}
{{1 PACK = 20 CIGARETTES}
{{RANGE 1-100}
{Numeric response}
{Base: Respondents who SMOKE ON SOME DAYS (IF SCREENER.TS2 = 02)}
{{1 PACK = 20 CIGARETTES}
{{RANGE 1-100}
{Numeric response}
{Base: Respondents who SMOKE EVERY DAY (IF SCREENER.TS2 = 01)}
Within 5 minutes
Within 6-30 minutes
Within 31-60 minutes
After 60 minutes
B3. Currently, when you smoke cigarettes, do you usually smoke menthol cigarettes?
01 Yes
02 No
03 Don’t know/Not sure
04 Refused
{B5 Base: Respondents who SMOKE MENTHOL CIGARETTES (IF B3 = 01)}
B5. For each of the following, please indicate whether it’s a reason you usually smoke menthol cigarettes. Please answer “yes” or “no” or “I don’t know” for each.
{Display each statement as a row in a grid. Columns are Yes, No, and I don’t know. Randomize and record response order}
B5_1. They are less harmful than non-menthol cigarettes.
B5_2. They have a better flavor than non-menthol cigarettes.
B5_3. They are less harsh on your THROAT than non-menthol cigarettes.
B5_4. They are less harsh on your CHEST than non-menthol cigarettes.
B5_5. They are easier to smoke than non-menthol cigarettes.
B6a. Are menthol cigarettes less harmful, no different, or more harmful than other (non-menthol) cigarettes?
Less harmful
No different
More harmful
B7a: Please tell us if you agree or disagree with the following statements about menthol cigarettes:
01 Strongly Agree
02 Agree
03 Neither Agree nor Disagree
04 Disagree
05 Strongly Disagree
{ANSWER ALL, DISPLAY AS GRID, RANDOMIZE ORDER}:
01 They are less harsh on your THROAT than non-menthol cigarettes.
02 They are less harsh on your CHEST than non-menthol cigarettes.
03 They are harder to quit compared to non-menthol cigarettes.
04 They are just as damaging as non-menthol cigarettes.
05 Tobacco companies aggressively target many communities with menthol cigarette advertising.
{Base: All respondents}
C1. Do you believe quitting smoking can decrease depression, anxiety, and stress?
01 Yes
02 No
03 Not sure/Uncertain
C3. Do you believe your risk for a smoking-related disease starts to drop as soon as you quit smoking?
01 Yes
02 No
03 Not sure/Uncertain
_____ Number of times
YES
NO
{ANSWER ALL, RANDOMIZE ORDER}
QA2_A. Give up cigarettes all at once
QA2_B. Gradually cut back on cigarettes
QA2_C. Substitute some of your cigarettes with heated tobacco products (using “heat not burn” tobacco products, iQOS, Glo, or Eclipse)
QA2_D. Switch completely to e-cigarettes, vapes, or mods (popular brands include NJOY, Blu, Logic, Vuse, Puff Bar and JUUL)
QA2_E. Switch to a different brand of cigarettes
QA2_F. Use nicotine replacement medications like the nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, or nicotine inhaler
QA2_G. Use quit smoking medications like Wellbutrin, Zyban, Bupropion, Chantix, or Varenicline
QA2_H. Get help from a telephone quitline (1-800-QUIT-NOW)
QA2_I. Get help from a website such as Smokefree.gov or cdc.gov/tips
QA2_J. Get help from a doctor or other health professional
QA2_K. Get help from a pharmacist
QA2_L. Use a texting program to help you quit smoking
QA2_M. Use a mobile app to help you quit smoking
QA2_N. Switch to smokeless tobacco (such as snuff, chew or snus) or dissolvable tobacco
{Base: If QA1 > 0}
QA30. When you last tried to quit smoking, did any of the following motivate you to try to quit?
Select all that apply.
A family member or friend encouraged me to try to quit
Anti-tobacco television commercials, online ads or videos, radio ads, or other types of advertisements that focus on the health consequences of smoking
My doctor or other health professional advised me to quit smoking
Workplace restrictions on smoking
Costs of cigarettes is too high
Concern about COVID-19
Other, please specify:
Not at all
A little
Somewhat
A lot
{Base: All respondents}
QA5. Do you plan to quit smoking cigarettes for good….
In the next 7 days
In the next 30 days
In the next 6 months
In the next 1 year
More than 1 year from now
I do not plan to quit smoking cigarettes for good
{Base: If QA1 > 0}
QA102. Has your doctor talked to you about quitting smoking?
01 Yes
02 No
03 Not sure/Uncertain
If you decided to give up smoking altogether in the next 12 months, how likely do you think you would be to succeed? Would you say…
01 Extremely likely
02 Very likely
03 Somewhat likely
04 Very unlikely
05 Extremely unlikely
{Base: All respondents}
Yes
No
{Base: All respondents}
Extremely likely
Very likely
Somewhat likely
Very unlikely
Extremely unlikely
{Randomly select an eligible ad}
We would now like to show you a television ad and then gather your reactions to that ad. Note that you can review the ad multiple times prior to moving forward. Please make sure the volume on your computer is turned up, so that you can both see and hear the video. Please click the forward arrow to continue. {Each respondent will review one ad}
{Programmer instruction: Display
selected ad through entirety before showing the “next”
button}
{OPEN END}
M2. What do you believe is the main message of this ad?
{OPEN END}
{Internal reference, do not display: Aided Response}
{At top of page, before question, insert thumbnail image of ad for the rest of the questions in this survey}
{Base: All respondents}
Extremely believable
Moderately believable
Slightly believable
Neither believable nor unbelievable
Slightly unbelievable
Moderately unbelievable
{Base: RC5a = 4-7}
{OPEN END}
{Base: All respondents}
On a scale from 1 to 5, where 1 indicates not feeling any emotion, and 5 indicates feeling emotion with extreme intensity, please indicate how much this ad made you feel:
I did not feel this emotion
Slight emotion
Moderate emotion
Very intense emotion
Extreme and intense emotion
{RANDOMIZED}
M3_1. Angry
M3_2. Afraid
M3_3. Ashamed
M3_4. Sad
M3_5. Hopeful
M3_6. Understood
M3_7. Surprised
M3_8. Trusting
M3_9. Motivated
M3_10. Regretful
M4. On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please indicate how much you disagree or agree with the following statements.
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
{RANDOMIZED}
M4_1. This ad is convincing
M4_2. This ad grabbed my attention
M4_3. This ad was easy to understand
M4_4. I learned something new from this ad
M4_5. I trust the information in this ad
M4_6. This ad is believable
M4_7. I would talk to someone else about this ad
M4_8. This ad is annoying
M4_9. This ad is worth remembering
M4_10. This ad is powerful
M4_11. This ad is informative
M4_12. This ad is meaningful
M4_13. I can identify with what this ad says
M4_14. This ad influenced me about whether or not to smoke cigarettes
{Allow select all that apply for 01-03. If 01, 02, and/or 03 are selected, do not allow 04.}
01 Confusing
02 Unclear
03 Hard to understand
04 None of the above
{Base: If M5a = 01-03}
{Open End}
{Base: M6a = 02}
{Open End}
{Base: M6a = 01}
{Open End}
In the next 7 days
In the next 30 days
In the next 6 months
In the next 1 year
More than 1 year from now
I do not plan to quit smoking cigarettes for good
Not sure/Uncertain
{Base: All respondents}
Call 1-800-QUIT-NOW for assistance in quitting smoking
Visit an informational government website, such as www.cdc.gov/tips or Smokefree.gov for information on quitting
Download an app to help you quit smoking
Talk to your doctor about quitting smoking
Not smoke around others
Follow the Tips campaign on social media (e.g., X [Formerly Twitter], Facebook, Pinterest)
Try to quit on your own
Use an electronic vaping product to help quit smoking cigarettes
Support smoke-free laws in your community
Use a texting program to help you quit smoking
Do nothing
Scale for items RC14.A-K:
Not at all likely
A little likely
Moderately likely
Very likely
Extremely likely
B6b. Are menthol cigarettes less harmful, no different, or more harmful than other (non-menthol) cigarettes?
Less harmful
No different
More harmful
B7b: Please tell us if you agree or disagree with the following statements about menthol cigarettes:
01 Strongly Agree
02 Agree
03 Neither Agree nor Disagree
04 Disagree
05 Strongly Disagree
{ANSWER ALL, DISPLAY AS GRID, RANDOMIZE ORDER}:
01 They are less harsh on your THROAT than non-menthol cigarettes.
02 They are less harsh on your CHEST than non-menthol cigarettes.
03 They are harder to quit compared to non-menthol cigarettes.
04 They are just as damaging as non-menthol cigarettes.
05 Tobacco companies aggressively target many communities with menthol cigarette advertising.
{Base: All respondents}
Not at all
Slightly
Moderately
Very
Extremely
RC32. Do you believe cigarette smoking is related to:
{Display each statement as a row in a grid. Randomize and record response order.}
D21_1. Lung Cancer
D21_2. Cancer of the mouth or throat
D21_3. Heart Disease
D21_4. Diabetes
D21_5. Emphysema
D21_6. Stroke
D21_7. Hole in throat (stoma or tracheotomy)
D21_8. Buerger’s Disease
D21_9. Amputations (removal of limbs)
D21_10. Asthma
D21_11. Gallstones
D21_12. COPD or Chronic bronchitis
D21_13. Periodontal or Gum Disease
D21_14. Premature birth
D21_15. Colorectal Cancer
D21_16. Macular degeneration or blindness
D21_17. Depression
D21_18. Anxiety Disorder
D21_19. Colon Cancer
D21_20. COVID-19
D21_21. Peripheral artery disease (PAD)
D21_22. Kidney Cancer
D21_23. Tooth loss
D21_24. Heart attack
Answers in columns:
1. Yes
2. No
{Base: All Respondents}
UAR_Art1. A few seconds before the ad you just saw ended, a written message was in white letters on a black screen. In addition to “You can quit. For free help, call 1-800-QUIT-NOW”, what other written message do you remember?
[OPEN-END]
{Base: All Respondents}
AR_Art2. Which of the following written messages do you remember from the ad you just saw?
If you have seen or heard the following messages before but NOT as part of the ad you just saw, please do NOT select them.
{Multi-Select, Randomized}
You can quit. For free help visit cdc.gov/tips.
Smoking causes heart disease.
Smoking can cause gum disease and tooth loss.
You can quit. For free help call 1-800-QUIT-NOW.
Menthol cigarettes are just as damaging as other cigarettes.
Smoking causes heart attacks.
Quitting smoking reduces the risk of heart disease.
Quitting smoking can decrease depression, anxiety and stress.
Tobacco companies aggressively target many communities with menthol cigarette advertising.
Quitting smoking lowers your risk for having a stroke.
Your risk for a smoking-related disease starts to drop as soon as you quit.
The people you love are worth quitting for.
Smoking causes throat cancer.
Menthol cigarettes can be harder to quit than other cigarettes.
I do not remember any written messages in the ad I just saw. {single select, exclusive, anchor}
Thank you for your participation in this study. We appreciate your enthusiasm for our study and hope you will join us on future surveys!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Goggans, Julie (CDC/ONDIEH/NCCDPHP) (CTR) |
File Modified | 0000-00-00 |
File Created | 2024-11-23 |