Community Web-Panel Survey
QUESTIONNAIRE FOR COMMUNITY WEB-PANEL SURVEY1 Form Approved
OMB No. 0920-xxxx
Expiration Date: XX/XX/XXXX
Overview of Questionnaire Sections
Background/demographics
General Tobacco Use
General tobacco quit attempts/Switching
Menthol FTP Use
Purchasing behaviors/Access
Menthol quit attempts/Switching
Perceptions/Belief
Sites with Implemented Policies
Comparison Sites
Survey Questionnaire
Introduction
Thank you for your interest in taking this online survey. This questionnaire is being administered on behalf of the Centers for Disease Control and Prevention (CDC). This survey will ask about your tobacco-related knowledge, attitudes and behaviors.
Your survey answers will help inform public health practice and improve commercial tobacco-related policies. “Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes.
This survey is voluntary and is designed to protect your privacy. We do not collect your name or other identifying information on the survey and results will only be reported collectively to preserve anonymity. The entire survey will take approximately 15 minutes to complete.
Thank you!
Section I: Background/demographics
Message to participant: This survey will begin with demographic questions before asking about knowledge, perceptions, and behaviors related to menthol and non-menthol tobacco.
# |
Reference |
Question |
Responses |
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BRFSS 2021, General demographic question |
What is your age? |
[--] age in years
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Office of the Chief Statistician of the U.S. SPD-15 |
What sex were you assigned at birth, on your original birth certificate? |
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Office of the Chief Statistician of the U.S., CDC, and NIH,
SPD-15 |
How do you currently describe yourself (mark all that apply)? |
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SOGI, General demographic question. Office of the Chief Statistician of the U.S. SPD-15 |
Which of the following best represents how you think of yourself? |
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new, General demographic question |
How long have you lived in your current city? |
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new, General demographic question |
What was your total household income in the past 12 months? |
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2023 NHIS |
What is the highest degree or year of school you completed? |
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What is your race and/or ethnicity? Select all that apply and enter additional details in the free text space. |
For example: Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc. [free-text]
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Section II: General Tobacco Use
# |
Reference |
Question |
Responses |
Indicator |
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New |
Have you ever used any of the following tobacco products fairly regularly (select all that apply)?
Fairly regularly is defined as using a product on a routine basis rather than trying a tobacco product only a few times. |
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Number of people who use tobacco products (all)
Number of people who use tobacco product by type
Difference in prevalence of [all types of] tobacco product use
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New |
How old were you when you first started using tobacco products fairly regularly? |
[--] age in years
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Difference in length of tobacco product use |
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New |
Have you completely stopped using all tobacco products?
(To stop "completely" refers to permanently quitting use of tobacco products without relapse.)
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Difference in cessation rate for tobacco products (This question was added for skip logic purposes) |
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New |
[If “Yes” to Q11]
Please enter the month and year in which you stopped using tobacco products completely |
[Free text] |
Difference in length of cessation of tobacco products
Number of people who quit tobacco products post-policy implementation |
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New |
[If “Yes” to Q12]
Before successfully quitting tobacco products, how many quit attempts of one day or longer did you have? |
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Difference in number of quit attempts made for tobacco products |
14.-20. |
New, based on 2023 NHIS |
[For those who selected at least one tobacco product in Q9 and where Q11 is not yes, list the corresponding products in the question below]
Do you now use any of the following tobacco products “every day,” “some days,” “rarely,” or “not at all”?
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Number of people who use tobacco products (all)
Number of people who currently use tobacco products by type
Number of people who report regularity of tobacco product use
Difference in prevalence of [all types of] tobacco product use
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Section III: General Tobacco Quit Attempts / Switching
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Reference |
Question |
Responses |
Indicators |
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New, based on TUS-CPS 2018–19 |
[For those who DID NOT select “No” for Q11] Have you ever tried to quit using tobacco products completely?
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Difference in [all types of] tobacco product quit attempts
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New, based on TUS-CPS 2018–19 |
[If “Yes” to “Have you ever tried to quit using tobacco products completely?”]
During the past 12 months, have you tried to quit using tobacco products completely? |
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Difference in [all types of] tobacco product quit attempts
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New, based on TUS-CPS 2018–19 |
[If “Yes” to “During the past 12 months, have you ever tried to quit using tobacco products completely?”]
During the past 6 months, have you tried to quit using tobacco products completely? |
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Number of people who use non-menthol products who have at least one quit attempt in the past six months
Difference in [all types of] tobacco product quit attempts
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New, based on TUS-CPS 2018–19 |
[If “Yes” to “During the past 6 months, have you tried to quit using tobacco products completely?”]
During the past 6 months, have you stopped using tobacco products for one day or longer because you were trying to quit? |
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Number of people who use non-menthol products who have at least one quit attempt in the past six months
Difference in [all types of] tobacco product quit attempts
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New, based on TUS-CPS 2018–19 |
[If “Yes” to “During the past 6 months, have you stopped using tobacco products for one day or longer because you were trying to quit?”]
During the past 6 months, have you stopped using tobacco products for 3 months or longer because you were trying to quit? |
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Number of people who use non-menthol products who have at least one quit attempt in the past six months
Number of people who have a sustained non-menthol product quit for three months or longer
Difference in sustained quits for 3 months or longer for [all types of] tobacco products |
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New, based on TUS-CPS 2018–19 |
[For those who selected at least one tobacco product in Q14–Q20]
Are you seriously considering quitting use of tobacco products within the next 6 months? |
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Number of people who have the intention to quit
Difference in [all types of] tobacco product quit attempts
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New |
[For those who selected at least one tobacco product in Q9, list the corresponding products in the question below]
In the past six months, have you permanently switched from using any of the following tobacco products (column on the left) to another tobacco product (listed in the top row)? (List products selected in Q10) |
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Added due to request by the FDA
Difference in switching behavior between types of tobacco product |
# |
Reference |
Question |
Responses |
Indicator |
28.-34. |
New |
[For those who selected at least one tobacco product in Q9, list the corresponding products in the question below]
The previous questions in the survey were about your general tobacco use. We will now ask you questions that focus on your use of menthol-flavored tobacco products (hereafter referred to as menthol tobacco products).
Have you ever used any of the following menthol-flavored tobacco products fairly regularly?
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Number of people who use menthol-flavored tobacco products
Number of people who use menthol tobacco products by type
Difference in prevalence of [all types of] menthol tobacco product use
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New |
[If “Yes” to one or more products in Q28–Q34]
How old were you when you first started using menthol tobacco products fairly regularly? |
[--] age in years
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Difference in length of menthol tobacco product use |
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New |
[If “Yes” to one or more products in Q28–Q34]
Have you completely stopped using all menthol tobacco products? |
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Difference in cessation rate of menthol tobacco products (This question was added for skip logic purposes) |
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New |
[If “Yes” to Q36]
Did you completely stop using menthol tobacco products more than six months ago? |
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This question was added for skip logic purposes only |
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New |
[If “Yes” to Q36]
In what month and year did you stop using menthol tobacco products completely? |
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Difference in length of cessation of menthol tobacco products
Number of people who quit menthol tobacco products post-policy implementation
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New |
[If “Yes” to Q36]
Before successfully quitting menthol tobacco products, how many quit attempts of one day or longer did you have?
Note: This question refers to attempts to quit menthol tobacco products specifically and not all tobacco products.
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Difference in number of quit attempts made for menthol tobacco products |
40.-46. |
New, based on NATS 2013-14 |
[For those who selected at least one menthol-flavored tobacco product in Q28–Q34 and Q36 not=”Yes”, list the corresponding products in the question below]
Do you now use any of the following menthol tobacco products “every day,” “some days,” “rarely,” or “not at all”?
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Number of people who use menthol tobacco products
Number of people who currently use menthol tobacco product by type
Number of people who report regularity of menthol tobacco use
Difference in prevalence of [all types of] menthol tobacco product use
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Section V: Purchasing Behavior / Access
Section VI: Menthol Quit Attempts / Switching
Section VII: Perceptions/Beliefs
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Reference |
Question |
Responses |
Indicators |
60.-62. |
New, based on 2018 Minnesota Adult Tobacco Survey |
Do you agree or disagree with the following statements?
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Number of people who believe that menthol tobacco products are better for a sore throat than non-menthol tobacco products
Number of people who believe that menthol- tobacco products are healthier than non-menthol tobacco products
Number of people who believe that menthol- tobacco products contain fewer chemical additives than non-menthol tobacco products
Number of people who believe that menthol tobacco products are less harmful than non-menthol tobacco products
Number of people who believe that non-menthol tobacco products are harder to quit than menthol tobacco products
Difference in perceived harms of menthol tobacco products (e.g., belief menthol is healthier, belief that it is harder or easier to quit, etc.)
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New, based on 2023 Spring Styles Survey |
Do you believe menthol tobacco products are less harmful, equally harmful, or more harmful to a person’s health than non-menthol tobacco products? |
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Difference in perceived harms of menthol tobacco products (e.g., belief menthol is healthier, belief that it is harder or easier to quit, etc.)
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New, based on 2023 Spring Styles Survey |
Which type of tobacco products do you believe are harder to quit using – menthol tobacco products (such as menthol cigarettes or menthol e-cigarettes) or non-menthol/regular tobacco products (such as non-menthol cigarettes or non-menthol e-cigarettes)? |
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Number of people who believe that non-menthol tobacco products are harder to quit than menthol tobacco products
Difference in perceived harms of menthol tobacco products (e.g., belief menthol is healthier, belief that it is harder or easier to quit, etc.)
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Section VIII: Sites with Implemented Sales Restrictions
Supplement to be adapted to each intervention site’s unique policy landscape.
# |
Reference |
Question |
Responses |
Indicator |
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New |
Are you aware of [insert name of policy/ordinance in relevant locality and brief overview of it, date implemented]?
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Number of people aware of the policy
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New |
[If “yes” or “Somewhat”]
How did you hear about the passage of [insert policy name and date]? Select all that apply.
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Ways in which people learned about the policy
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New |
To what extent do you agree with the passage of [insert policy name and date], which restricts sales of all flavored tobacco products, including menthol tobacco products?
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Number of people who agree with the policy
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New |
Do you agree or disagree with the following statement? [insert policy name and date] was passed to improve the health of people living in our city.
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Number of people who agree that the policy was enacted to improve the health of people living in the city
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New |
[If “Yes” to “Did you ever try to quit using tobacco products completely? OR If “Not at all” for Q14–Q20 AND If “Yes,” “Somewhat,” or “Prefer not to say” is selected for Q65]
Did the implementation of [insert policy name and date] contribute to your decision to attempt to quit using non-menthol tobacco products?
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Number of people who say policy contributed to tobacco product quit attempt |
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New |
[If “Yes” to “Did you ever try to quit using tobacco products completely? OR If “Not at all” for Q40–Q46 AND If “Yes,” “Somewhat,” or “Prefer not to say” is selected for Q65]
Did the implementation of [insert policy name and date] contribute to your decision to attempt to quit using menthol tobacco products?
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Number of people who say policy contributed to menthol tobacco product quit attempt |
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New |
[If “Yes” to “Have you ever switched from using a menthol tobacco product to using a non-menthol-tobacco product?” AND If “Yes,” “Somewhat,” or “Prefer not to say” is selected for Q65]
Did the implementation of [insert policy name and date] contribute to your decision to switch from a menthol tobacco product to a non-menthol tobacco product? |
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Number of people who say policy contributed to switching behavior |
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New |
[If “Yes” to “During the past 6 months, did you travel to another city or state for the purpose of purchasing a menthol tobacco product?” AND If “Yes,” “Somewhat,” or “Prefer not to say” is selected for Q65]
Did the implementation of [insert policy name and date] contribute to your decision to travel to a different city or state to purchase menthol tobacco products? |
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Number of people who say policy contributed to decision to travel to purchase menthol tobacco |
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New |
[If “Every day,” “Some days,” or “Rarely” to Q40–Q46?]
Since the implementation of [insert policy name and date], have you used menthol tobacco products less frequently?
[For example: you used to menthol tobacco products every day, but now you only use them rarely] |
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Number of people who used menthol tobacco products less frequently after policy passage |
Section IX: Comparison Sites
Supplement for survey respondents located in comparison sites (Atlanta, GA; Baltimore, MD; Cleveland, OH; Detroit, MI; Milwaukee, WI) only.
# |
Reference |
Question |
Responses |
Indicator |
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New |
Do you believe removing menthol tobacco products from stores will help or encourage people who use these products to quit? |
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Number of people who believe a menthol sales restriction helps cessation |
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New |
Do you believe restricting the sale of menthol tobacco products will negatively impact racial or ethnic minority groups?
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Number of people who believe that a menthol sales restriction negatively impacts racial or ethnic minority groups |
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New |
If there was a ban on the sale of menthol tobacco products in my city, I would: |
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Number of people who indicate that they would use menthol products less frequently under a menthol ban
Number of people who indicate that they would use menthol products more frequently under a menthol ban
Number of people who indicate that they would use menthol products about the same amount under a menthol ban |
Survey Completion Page
Thank you for completing the questionnaire. Your response has been submitted. For more information on menthol tobacco products, visit the CDC website on menthol tobacco. For resources on how to quit smoking, visit the CDC "Quit Smoking" webpage.
1 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including 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, GA 30333, ATTN: PRA (0920-xxxx).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Walsh Narrow, Kathryn |
File Modified | 0000-00-00 |
File Created | 2024-12-22 |