National Adult Tobacco Survey Questionnaire

Health Marketing

National Adult Tobacco Survey Questionnaire - English

National Adult Tobacco Survey Questionnaire

OMB: 0920-0798

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OMB #0920-0798

Expiration Date: 01/31/2011





HEALTH MARKETING


National Adult Tobacco Survey Questionnaire – English




























Public reporting burden of this collection of information is estimated to average 22 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 Reports Clearance Officer, 1600 Clifton Road, MS-74, Atlanta, GA 30333, ATTN: PRA (0920-XXXX).



DRAFT National Adult Tobacco Survey Questionnaire
Version 5.5, May 6, 2009


Cell Phone Screener


RELEVANT STAFF: A RESPONDENT, ESPECIALLY A CELL PHONE RESPONDENT, COULD ASK TO BE CALLED BACK AT A DIFFERENT TIME OR A DIFFERENT NUMBER AT ANY TIME DURING THE SURVEY. PLEASE ENSURE THAT THERE IS A STANDARD PROCEDURE, SEPARATE FROM INDIVIDUAL QUESTIONS, FOR THIS CONTINGENCY, SINCE IT COULD OCCUR AT ANY QUESTION.

INTERVIEWER: THROUGHOUT THIS qUESTIONNAIRE, only TEXT THAT APPEARS IN upper and lower case LETTERS should BE READ ALOUD TO RESPONDENTS. text THAT APPEARS in upper case only should not be read aloud.

clintro

interviewer: if respondent expresses concerns about the survey, please read one or more of the following, as appropriate:

The survey takes about nn to nn minutes to complete, depending on your situation.

Your number was selected by chance from a list of all cell telephone numbers in the US.

The CDC uses the data collected by this study to develop more effective public health programs to help people quit smoking and to help keep people from starting to smoke.

I can give you a 1-800 number to call to verify that this is a legitimate survey. Would you like that 1-800 number? IF YES: 1‑800‑xxx‑xxxx.

If you are eligible for the study, you will receive a gift code worth $10 at Amazon-dot-com at the end of the interview.

C1. Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. We're gathering information on health and tobacco from selected cell phone users across the United States. Your phone number has been chosen randomly from a list of all cell phone numbers in the US.. If you are eligible for the study, you will receive a $10 gift for responding to our questions.


Is respondent continuing with the interview?


1. YES

2. NO à Assign disposition code


Cltelno

interviewer: if respondent expresses concerns about the survey, please read one or more of the following, as appropriate:

The survey takes about 15 to 25 minutes to complete, depending on your situation.

Your number was selected by chance from a list of all cell telephone numbers in the US.

The CDC uses the data collected by this study to develop more effective public health programs to help people quit smoking and to help keep people from starting to smoke.

I can give you a 1-800 number to call to verify that this is a legitimate survey. Would you like that 1-800 number? IF YES: 1‑800‑xxx‑xxxx.

C2. First, I need to confirm that this is a cell phone. Is this a cell phone?

INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.

INTERVIEWER: if 2. no, read:

Thank you very much but we are only interviewing people who we reach on cell phones at this time.

INTERVIEWER: if 4. not a safe time—driving or other reason, read:

Thank you very much. We will contact you at a later time.

INTERVIEWER: IF 7. DON’T KNOW/NOT SURE, read:

Is there someone else who uses this telephone that I can speak to?


PROVIDE TEXT?

1. YES

2. NO Assign disposition code

3. DOES NOT WANT TO BE CALLED AT THIS NUMBER GO TO C5 CLCALLBACK

4. NOT A SAFE TIME—DRIVING OR OTHER REASON Assign disposition code


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


cldriving

C3. Your safety is important to us. Are you driving a car or other vehicle right now?


interviewer: if 1. yes, read:

Thank you very much. We will contact you at a later time.

1. YES à Assign disposition code

2. NO


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clcanttalk

C4. Are you in a location or situation where talking on the phone is safe and where you can talk freely?


interviewer: if 2. NO, read:

Thank you very much. We will contact you at a later time.

1. YES go to C10 CTELNOCORR

2. NO à Assign disposition code


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clcallback

IF C2 CLTELNO EQ 3


C5. Is there a better number at which we can call you back?


1. YES

2. NO Assign disposition code


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clbetterno

C6. What is that telephone number?


_ _ _ - _ _ _ -_ _ _ _ TELEPHONE NUMBER


9999. REFUSED à Assign disposition code


clbesttime

C7. What would be the best time to try to call back?


_ _ : _ _ _ m


9999. REFUSED à Assign disposition code


clname

C8. To make sure that we talk to you when we call back, please give us a name to ask for? You can make up a name if you like. A first name only is fine.


_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


9999. REFUSED à Assign disposition code


clINTRO2

C9. Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. We're gathering information on health and tobacco from selected people across the United States. May I speak with [FILL: CLNAME]?


[IF CLNAME DID NOT ANSWER PHONE Hello, my name is [NAME FILL]. I’m calling for the CDC, the Centers for Disease Control and Prevention.] We are calling because you asked us to call you at this time on this number to answer questions on health and tobacco.


IS RESPONDENT CONTINUING WITH THE INTERVIEW?


1. YES

2. NO à Assign disposition code


cltelnocorr

interviewer: if respondent expresses concerns about the survey, please read one or more of the following, as appropriate:

The survey takes about nn to nn minutes to complete, depending on your situation.

Your number was selected by chance from a list of all cell telephone numbers in the US.

The CDC uses the data collected by this study to develop more effective public health programs to help people quit smoking and to help keep people from starting to smoke.

I can give you a 1-800 number to call to verify that this is a legitimate survey. Would you like that 1-800 number? IF YES: 1‑800‑xxx‑xxxx.

C10. [IF C4 CLCANTTALK = 2] I need to verify that we have dialed the number correctly. Is this [phone number FILL]?


[ELSE] I need to verify that we dialed the original number correctly. Was the telephone number we originally called you at, [FILL ORIGINAL CELL PHONE NUMBER]?


INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.

INTERVIEWER: IF 2. NO, read:

Thank you very much, but we seem to have dialed the wrong number. It's possible that your number may be called at a later time.

1. YES

2. NO à Assign disposition code


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clbusonly

C11. Is [FROM CALLED NUMBER: this/FROM RESPONDENT-DIRECTED NUMBER: the] cell phone number used for business calls only, personal calls only, or for both business and personal calls?


INTERVIEWER: IF 1. business calls only, read:

Thank you very much, but we are only interviewing people at cell phone numbers that are used for personal calls.

1. BUSINESS CALLS ONLY Assign disposition code

2. PERSONAL CALLS ONLY

3. BOTH BUSINESS AND PERSONAL CALLS


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


cllandline

INTERVIEWER: If respondent asks what a home landline telephone is, read:

By ”home landline telephone,” we mean a telephone that can only be used in your home or just outside your home. It can be corded or cordless. Calls made to a home computer should be counted as being made to a home landline number.


C12. Is there also a home landline telephone number at which you can be reached?


INTERVIEWER: IF 1. YES, read:

Thank you very much, but we are only interviewing people who can be reached only by cell phone.

1. YES Assign disposition code

2. NO


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


cladult

C13. Are you 18 years of age or older?


INTERVIEWER: IF 2. no, read:

Thank you very much, but we are only interviewing people 18 years of age or older.

1. YES

2. NO à Assign disposition code


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clprivres

interviewer: if respondent is unsure about WHAT a “private residence” IS, read:

Examples of places where people live that are not private residences are barracks, dormitories, and nursing homes. Is the place where you live more like a house, an apartment or condominium, or more like a barracks, a dormitory, or a nursing home?


C14. Do you live in a house, an apartment, a condominium, or other type of private residence?


INTERVIEWER: IF 2. NO, read:

Thank you very much, but we are only interviewing people who live in private residences.

1. YES

2. NO à [AUTOMATICALLY Assign disposition code 420]


7. DON’T KNOW/NOT SURE à Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


clconfidential

C15. You are eligible to be interviewed. I won't ask for your name, address, or other personal information that can identify you. You don’t have to answer any question you don’t want to, and you can end the interview at any time. The interview may take up to about nn to nn minutes, depending on your situation, and any information you give me will be confidential. If you have any questions about this survey, I will provide a telephone number for you to call to get more information.


Is respondent continuing with the interview?


1. YES

2. NO Assign disposition code


Landline Screener


lintro

L1. Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. We're gathering information on health and tobacco from selected people across the United States. Your phone number has been chosen randomly.


Is respondent continuing with the interview?


1. YES


ltelnocorr

interviewer: if respondent expresses concerns about the survey, please read one or more of the following, as appropriate:

The survey takes about nn to nn minutes to complete, depending on your situation.

Your number was selected by chance from a list of all cell telephone numbers in the US.

The CDC uses the data collected by this study to develop more effective public health programs to help people quit smoking and to help keep people from starting to smoke.

I can give you a 1-800 number to call to verify that this is a legitimate survey. Would you like that 1-800 number? IF YES: 1‑800‑xxx‑xxxx.

L2. First, I need to verify that we have dialed the number. Is this [phone number FILL]?


INTERVIEWER: IF 2. NO, read:

Thank you very much, but I seem to have dialed the wrong number. It's possible that your number may be called at a later time.

INTERVIEWER: IF 7. DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


LCELLPHONE

L3 Is this a cellular telephone?


INTERVIEWER: if necessary, Read:

By cellular telephone we mean a telephone that is mobile and usable outside of your neighborhood.

1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code



Thank you very much, but we are only interviewing people on landline telephones.


lprivres

interviewer: if respondent is unsure about WHAT a “private residence” IS, read:

Examples of places where people live that are not private residences are barracks, dormitories, and nursing homes. Is the place where you live more like a house, an apartment or condominium, or more like a barracks, a dormitory, or a nursing home?


L4. Is this a house, an apartment, a condominium, or other type of private residence?


INTERVIEWER: IF 2. NO, read:

Thank you very much, but we are only interviewing private residences.

INTERVIEWER: IF DON’T 7. KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. YES

2. NO [AUTOMATICALLY Assign disposition code 420]


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


lnoadult

L5. I need to randomly select one adult who lives in your household to be interviewed. How many members of your household, including yourself, are 18 years of age or older?


INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

_ _. Number of adults If noadult >1 Go to L10 NOMEN


77. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up) Assign disposition code


[RANGE: 1-76]


lareyouadult

L6. Are you the adult?


INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. YES

2. NO. Go to L8 ISADULTMW


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


lareyoumf

INTERVIEWER: Ask only if necessary.

L7. Then you are the person I need to speak with. Are you male or female?


1. Male Go to L14 LSELRESPINTRO

2. Female Go to L14 LSELRESPINTRO


7. DON’T KNOW/NOT SURE Assign disposition code

9. REFUSED (Including hang-up) Assign disposition code


lisadultmw

L8. Is the adult a man or a woman?


INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. A man

2. A woman


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


lspeakadult

L9. May I speak with [fill in: him OR her from previous question]?


INTERVIEWER: IF NO, TRY TO SCHEDULE AN APPOINTMENT. PROVIDE TEXT?

INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. YES Go to S13 SELRESPINTRO

2. NO

7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


lnomen

L10. You said there are [FILL NUMBER OF ADULTS] adults in your household? How many are men?


INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

_ _ Number of men


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up) Assign disposition code


IF NUMBER OF MEN EQUALS THE NUMBER OF ADULTS, GO TO LSELRESP


[RANGE: 1-76]

[Verification screen if Lnomen >=5]


lnowomen

L11. How many of these adults are women?


INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

_ _ Number of women


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up) Assign disposition code


[RANGE: 1-76]

[Verification screen if Lnowomen >=5]


lselresp

[CATI PROGRAMMER: RANDOMLY SELECT RESPONDENT BY AGE RANK AND GENDER. USE CODE BELOW TO IDENTIFY SELECTED RESPONDENT IN SUBMITTED DATA SET.]


101. Oldest male

102. Second oldest male

103. Third oldest male

199. Ninety-ninth oldest male


201. Oldest female

202. Second oldest female

203. Third oldest female

299. Ninety-ninth oldest female


Lselrespphone

L12. The person in your household that I need to speak with is the [age rank and gender of selected respondent FILL]. Are you the [age rank and gender of selected respondent FILL]?


INTERVIEWER: IF YES, read:

Then you are the person I need to speak with.

INTERVIEWER: IF DON’T KNOW/NOT SURE, Ask to speak to someone else. PROVIDE TEXT?

1. YES Go to L14 LCONFIDENTIAL

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED (Including hang-up) Assign disposition code


lselrespintro

L13. Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. We're gathering information on health and tobacco from selected people across the United States. Your phone number has been chosen randomly.


Is respondent continuing with the interview?


1. YES

2. NO à Assign disposition code


lconfidential

L14. I won't ask for your name, address, or other personal information that can identify you. You don’t have to answer any question you don’t want to, and you can end the interview at any time. The interview may take up to about 20 minutes and any information you give me will be confidential. If you have any questions about this survey, I will provide a telephone number for you to call to get more information.


Is respondent continuing with the interview?


1. YES

2. NO Assign disposition code


General Health


genhealth

Rationale: Provides an easy opening to the survey and can prove a useful covariate in analysis. Is a Healthy People 2010 overarching quality of life measure.


1. Would you say that in general your health is…?


1. Excellent

2. Very good

3. Good

4. Fair

5. Poor


7. DON’T KNOW/NOT SURE

9. REFUSED


TOBACCO USE


cigarette smoking


smok100

Rationale: Key Outcome Indicators 2.08.3, 3.14.1(Core), 1.14.2


HELP: 100 CIGARETTES = 5 PACKS

2. Have you smoked at least 100 cigarettes in your entire life?


1. YES

2. NO GO TO Q5 SMOKEVER


7. DON’T KNOW/NOT SURE Go to Q5 SMOKEVER

9. REFUSED Go to Q30 SLTEVER2


smoknow

Rationale: Key Outcome Indicators 2.08.3, 3.14.1(Core)


3. Do you now smoke cigarettes every day, some days, or not at all?


1. Every day

2. Some days à Go to Q8 SMOKDAYS30

3. Not at all à Go to q6 smoklast


9. REFUSED à Go to Q30 SLTEVER2


smokperday

Rationale: Key Outcome Indicator 2.08.2


interviewer: if respondent is unsure or states a range, read:

[You said you smoke about x to y cigarettes a day.] Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the average number of cigarettes you smoke in one day?

4. On the average, about how many cigarettes a day do you now smoke?


HELP: 1 PACK = 20 CIGARETTES.

_ _ _. Number of cigarettes à Go to Q13 SMOKWHOLAGE


666. Less than one cigarette a day à Go to Q13 SMOKWHOLAGE

888. NONE à Go to Q13 SMOKWHOLAGE


777. DON’T KNOW/NOT SUREà Go to Q13 SMOKWHOLAGE

999. REFUSED à Go to Q30 SLTEVER2


[RANGE: 1-180]

[Verification screen if number of cigarettes >= 61]


smokever

Asked of respondents who have not smoked at least 100 cigarettes in their entire life or who don’t know if they have smoked at least 100 cigarettes in their entire life.


Rationale: Identification of episodic smokers and screener for Key Outcome Indicators 1.10.5 (Youth, Core), 1.13.2 (Youth)


5. Have you ever tried cigarette smoking, even one or two puffs?


1. YES

2. NO à Go to q18 FUTURSMOK2


7. DON’T KNOW/NOT SURE à Go to Q30 SLTEVER2

9. REFUSED à Go to Q30 SLTEVER2


smoklast

Asked of respondents (who have not smoked at least 100 cigarettes in their entire life and have smoked at least one or two puffs) or (who have smoked 100 or more cigarettes and do not smoke now).


Rationale: Key Outcome Indicators 3.13.1, 3.13.2


interviewer: Pause between each response category to allow respondent to answer “yes” or “No” to each category. enter the response code for the first “yes” and then continue to the next question.

6. For the next question, I’m going to read to you a set of possible answers. Please answer “Yes” or “No” to each answer. Was the last time you smoked a cigarette, even one or two puffs…?


01. Within the past 24 hours à Go to Q8 SMOKDAYS30

02. Within the past 7 days

03. Within the past 30 days

04. Within the past 3 months

05. Within the past 6 months

06. Within the past 1 year

07. Within the past 5 years à Go to q12 SMOKWHOLCIG

08. Within the past 10 years à Go to q12 SMOKWHOLCIG

09. Within the past 15 years à Go to q12 SMOKWHOLCIG

10. More than 15 years ago à Go to q12 SMOKWHOLCIG


77. DON’T KNOW/NOT SURE à Go to q18 FUTURSMOK2

99. REFUSED à Go to Q30 SLTEVER2


smokorquit

Asked of respondents who last smoked a cigarette more than 24 hours ago and within the past 1 year.


Rationale: Key Outcome Indicator 3.13.2


7. You said that you last smoked [Q6 SMOKLAST]. Have you not smoked [Q6 SMOKLAST] because you are trying to quit smoking for good?


1. yes, RESPONDENT is trying TO QUIT SMOKING for good à Go to Q12 SMOKWHOLCIG

2. no, RESPONDENT is not trying TO QUIT SMOKING for good.


7. DON’T KNOW/NOT SURE

9. REFUSED


IF Q6 SMOKLAST EQ 05 OR 06, GO TO Q10 SMOKPASTYR


smokdays30

Asked of respondents who (have at least puffed on a cigarette in the past 30 days or who now smoke some days) and who want to continue smoking.


Rationale: Key Outcome Indicators 1.14.2, 2.08.2


interviewer: if respondent is unsure or states a range, read:

[You said you smoked cigarettes on x to y days.] Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the number of days you smoked cigarettes in the past 30 days?

8. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke cigarettes?


_ _. Number of Days


88. NONE à Go to q12 SMOKWHOLCIG


77. DON’T KNOW/NOT SURE à Go to q12 SMOKWHOLCIG

99. REFUSED à Go to Q30 SLTEVER2


[RANGE: 1-30]


smoksomeday

Rationale: Key Outcome Indicator 2.08.2


interviewer: if respondent is unsure or states a range, read:

[You said you smoke about x to y cigarettes a day on days when you smoke cigarettes.] Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the average number of cigarettes you smoked in one day on days when you smoked cigarettes in the past 30 days?

9. On the average, on days when you smoked during the past 30 days, that is, since [DATE FILL], about how many cigarettes did you smoke a day?


HELP: 1 pack=20 cigarettes.

_ _ _. Number of cigarettes


666. Less than one cigarette a day

888. NONE


777. DON’T KNOW/NOT SURE

999. REFUSED à Go to Q30 SLTEVER2


if q2 smok100 = (2 or 7), go to q12 smokwholecig;
else if q2 smok100 = 1, go to q13 smokwholage

[RANGE: 1-180]

[Verification screen if number of cigarettes >= 061]


smokpastyr

Asked of respondents who last smoked 31 days ago to 1 year ago and who want to continue smoking.


Rationale: To identify occasional smokers who might be missed by current measures and programs.


interviewer: if respondent is unsure or states a range, read:

[You said you smoked cigarettes on x to y days.] Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the number of days you smoked cigarettes in the past year?

10. In the past year, that is, since [DATE FILL], on about how many days did you smoke cigarettes, even just one puff?


_ _. Number of Days


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


smokYRNUM

Rationale: Key Outcome Indicator 2.08.2


interviewer: if respondent is unsure or states a range, read:

[You said you smoke about x to y cigarettes a day.] Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the average number of cigarettes you smoked in one day on days when you smoked cigarettes in the past year?

11. On the average, on days when you smoked during the past year, that is, since [DATE FILL], about how many cigarettes did you smoke a day?


HELP: 1 pack=20 cigarettes.

_ _ _. Number of cigarettes


666. Less than one cigarette a day

888. NONE


777. DON’T KNOW/NOT SURE

999. REFUSED à Go to Q30 SLTEVER2


[RANGE: 1-180]

[Verification screen if number of cigarettes >= 061]


smokwholcig

Asked of respondents who have not smoked at least 100 cigarettes in their entire life and who have smoked at least one or two puffs.


Rationale: Screener for Key Outcome Indicator 1.13.1 (Youth, Core)


12. Have you ever smoked a whole cigarette?


1. YES

2. NO à IF q6 smoklast <= 6 go to q17 SMOKYRago,
else if q6 smoklast >= 7 go to q18 futursmok2


7. DON’T KNOW/NOT SURE à IF q6 smoklast <= 6 go to q17 SMOKYRago,
else if q6 smoklast >= 7 go to q18 futursmok2

9. REFUSED à Go to Q30 SLTEVER2


smokwholage

Rationale: Key Outcome Indicator 1.13.1 (Youth, Core)


13. How old were you when you smoked a whole cigarette for the first time?


_ _. age in years à if q3 smoknow = 1, go to q15 smok30dage


88. RESPONDENT HAS NEVER SMOKED A WHOLE CIGARETTE à
IF q6 smoklast <= 6 go to q17 SMOKYRago,
else if q6 smoklast >= 7 go to q18 futursmok2


77. DON’T KNOW/NOT SURE

99. REFUSED à Go to Q30 SLTEVER2


[RANGE: 1-76]

[Verification screen if number of years <= 9]

[Verification screen if number of years >= 30]

[Verification screen if number of years > age]


smok30dever

Asked of respondents (who have smoked fewer than 100 cigarettes in their entire life and have smoked a whole cigarette) or (who have smoked 100 or more cigarettes and do not smoke now) or (who have smoked 100 or more cigarettes and now smoke some days).


Rationale: To identify all respondents who are former daily smokers.


14. Have you ever smoked at least one cigarette every day for 30 days in a row?


1. YES

2. NO à IF q6 smoklast >= 7,GO TO Q18 FUTURSMOK2;
ELSE IF q6 smoklast <= 6 GO TO Q17 SMOKYRAGO


7. DON’T KNOW/NOT SURE à IF q6 smoklast >= 7,GO TO Q18 FUTURSMOK2;
ELSE IF q6 smoklast <= 6 GO TO Q17 SMOKYRAGO

9. REFUSED à Go to Q30 SLTEVER2


smok30dage

Rationale: Used to estimate the number of persons who become regular smokers each year.


15. How old were you when you first smoked at least one cigarette every day for 30 days in a row?


_ _. age in years


77. DON’T KNOW/NOT SURE

99. REFUSED à Go to Q30 SLTEVER2


IF Q3 SMOKNOW = 1, GO TO Q17 SMOKYRAGO

[RANGE: 1-76]

[Verification screen if number of years <= 9]

[Verification screen if number of years >= 30]

[Verification screen if number of years > age]


smok30dlast

Rationale: To accurately measure successful quiting.


interviewer: Pause between each response category to allow respondent to answer “yes” or “No” to each category. enter the response code for the first “yes” and then continue to the next question.

16. For the next question, I’m going to read to you a set of possible answers. Please answer “Yes” or “No” to each answer. Think about the last time you smoked at least one cigarette every day for 30 days in a row. How long ago was the last day of those 30 days? Was it…?


01. Today or yesterday

02. In the past 7 days

03. In the past 30 days

04. In the past 1 year

05. In the past 5 years à Go to q18 futursmok20

06. In the past 10 years à Go to q18 futursmok2

07. In the past 15 years à Go to q18 futursmok2

08. More than 15 years ago à Go to q18 futursmok2


77. DON’T KNOW/NOT SURE à Go to q18 FUTURSMOK2

99. REFUSED à Go to Q30 SLTEVER2


smokyrago

Asked of respondents (who have at least puffed on a cigarette in the past year) or (who now smoke every day or some days).


Rationale: Smoking status in the prior year indicates whether smoking status has changed.


17. Around this time last year, were you smoking cigarettes every day, some days, or not at all?


1. Every day

2. Some days

3. Not at all


7. Don't know/Not sure

9. REFUSED à Go to Q30 SLTEVER2


[IF Q3 SMOKNOW = 1 OR 2 GO TO Q19 SMOKEWAKE]


futursmok2

Asked of respondents who have not smoked at least 100 cigarettes in their entire life or who don’t smoke now.


Rationale: Key Outcome Indicator 1.10.5 (Youth, Core), Susceptibility


18. How likely are you to smoke a cigarette in the next year—…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Very likely

2. Somewhat likely

3. Not at all likely


7. DON’T KNOW/NOT SURE

9. REFUSED


[IF Q5 SMOKEVER = 2 OR q6 smoklast >= 4, Go to Q30 SLTEVER2

[IF q6 smoklast <= 3, GO TO Q23 BGHTPAST30D]


Gilpin EA, White, VM, Pierce JP. Nicotine and Tobacco Research 7 (Oct 2005): 747-759.


smokwake

Asked of respondents who now smoke every day or some days.


Rationale: Provides an indicator of addiction (Heaviness of Smoking Index, or HSI) to nicotine when used with Q4 SMOKPERDAY.


19. How soon after you wake up do you usually have your first cigarette…?


1. Within 5 minutes

2. From 6 to 30 minutes

3. From more than 30 minutes to 1 hour

4. After more than 1 hour


7. DON’T KNOW/NOT SURE

9. REFUSED à Go to Q30 SLTEVER2


mentholcigs2

Asked of respondents who now smoke some days or every day.


Rationale: To track changes in industry marketing strategies.


20. During the past 30 days, that is, since [DATE FILL], were the cigarettes that you usually smoked menthol?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED à Go to Q30 SLTEVER2


cigflavor

Rationale: To determine prevalence of flavored cigarette use.


21. Were any of the cigarettes that you smoked in the past 30 days flavored to taste like candy, fruit, chocolate, or other sweets?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED



brand2

Rationale: To track changes in cigarette brand use.


22. During the past 30 days, that is, since [DATE FILL], what brand of cigarettes did you smoke most often?


INTERVIEWER: Do not read response categories, SELECT only one.

01. Basic (Branded discount)

02. Camel

03. Doral (Branded discount)

04. Forsyth (Private label)

05. GPC (Branded discount)

06. Kool

07. Marlboro

08. Misty (Branded discount)

09. Newport

10. Pall Mall

11. Parliament

12. Salem

13. Sonoma (Branded discount)

14. USA Gold (Branded discount)

15. Virginia Slims

16. Winston

17. Other (specify)


66. DID NOT SMOKE A USUAL BRAND DURING THE PAST 30 DAYS

77. DON’T KNOW/NOT SURE

99. REFUSED à Go to Q30 SLTEVER2


[GO TO Q25 BUYQUANT2]


bghtpast30d

Asked of respondents (who have smoked fewer than 100 cigarettes in their entire life and have at least puffed on a cigarette in the past 30 days) or (who have smoked 100 or more cigarettes in their entire life, do not smoke now, and have at least puffed on a cigarette in the past 30 days).


Rationale: Screener for Q24 BRANDPAST30D.


23. Have you bought any cigarettes for yourself in the past 30 days (that is, since [DATE FILL])?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED à Go to Q30 SLTEVER2


brandpast30d

Rationale: To track changes in cigarette brand use.


24. During the past 30 days, that is, since [DATE FILL], what brand of cigarettes did you buy most often?


INTERVIEWER: Do not read response categories, SELECT only one.

01. Basic (Branded discount)

02. Camel

03. Doral (Branded discount)

04. Forsyth (Private label)

05. GPC (Branded discount)

06. Kool

07. Marlboro

08. Misty (Branded discount)

09. Newport

10. Pall Mall

11. Parliament

12. Salem

13. Sonoma (Branded discount)

14. USA Gold (Branded discount)

15. Virginia Slims

16. Winston

17. Other (specify)


66. DID NOT BUY ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS

77. DON’T KNOW/NOT SURE

99. REFUSED à Go to Q30 SLTEVER2


buyquant2

Asked of respondents (who have at least puffed on a cigarette in the past 30 days) or (who now smoke some days or every day).


Rationale: Screener for Q26 COSTPACK2 AND Q27 COSTCARTON2.


25. The last time you bought cigarettes for yourself, did you buy them by the pack or by the carton?


1. By the pack

2. By the carton à Go to q27 COSTCARTON2

3. OTHER (SPECIFY) à Go to Q30 SLTEVER2


7. DON’T KNOW/NOT SURE à Go to Q30 SLTEVER2

9. REFUSED à Go to Q30 SLTEVER2


costpack2

Rationale: To measure the effect of price on cigarette consumption.


26. What price did you pay for the last pack of cigarettes you bought?


Interviewer: If respondent asks about discounts or coupons, READ:

Please report the cost after discounts or coupons.

_ _ _ _. Amount paid for last pack of cigarettes (in cents,
2 implied decimals)
à IF Q3 SMOKNOW = (1 OR 2) GO TO Q28 SPECOFFERS, ELSE Go to Q30 SLTEVER2


7777. DON’T KNOW/NOT SURE à IF Q3 SMOKNOW = (1 OR 2) GO TO Q28 SPECOFFERS, ELSE Go to Q30 SLTEVER2

9999. REFUSED à Go to Q30 SLTEVER2


[RANGE: 0001-2000]

[Verification screen if amount paid <= 0199]

[Verification screen if amount paid >= 0400]


costcarton2

Rationale: To measure the effect of price on cigarette consumption.


27. What price did you pay for the last carton of cigarettes you bought?


Interviewer: If respondent asks about discounts or coupons, READ:

Please report the cost after discounts or coupons.

_ _ _ _. Amount paid for last carton of cigarettes (in cents, 2 implied decimals) à IF Q3 SMOKNOW <> (1 OR 2), GO TO Q30 SLTEVER2


7777. DON’T KNOW/NOT SURE à IF Q3 SMOKNOW <> (1 OR 2), GO TO Q30 SLTEVER2

9999. REFUSED à Go to Q30 SLTEVER2


[RANGE: 0100-4000]

[Verification screen if amount paid <= 01500]

[Verification screen if amount paid >= 10000]


specoffers

Asked of respondents who now smoke some days or every day.


Rationale: To track changes in industry marketing strategies.


28. The last time you bought cigarettes, did you take advantage of coupons, rebates, buy 1 get 1 free, 2 for 1, or any other special promotions for cigarettes?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED à Go to Q30 SLTEVER2


buynet2

Rationale: To determine the extent to which smokers are by-passing restrictions on cost and availability of cigarettes.


29. In the past 12 months, that is, since [DATE FILL], have you bought cigarettes over the Internet?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


other tobacco use


Now I would like to ask you some questions about your use of other tobacco products.


sltever2

Asked of all respondents.


Rationale: Key Outcome Indicators 1.13.2 (Youth), Skip for 1.14.2 (Youth), 3.14.1


interviewer: pronounce “levi” as lee-vie

30. Have you ever tried chewing tobacco, snuff, or dip, such as Skoal, Copenhagen, Grizzly, Levi Garrett, Red Man, or Day’s Work, even just one time in your entire life?


1. YES

2. NO à Go to Q33 SNUSEVER


7. DON’T KNOW/NOT SURE à Go to Q33 SNUSEVER

9. REFUSED à Go to Q33 SNUSEVER


sltnodays

Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1


31. During the past 30 days, that is, since [DATE FILL], on how many days did you use chewing tobacco, snuff, or dip?


_ _ NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 1-30]


sltbrand

Rationale: To track changes in smokeless tobacco brand use.


32. During the past 30 days, that is, since [DATE FILL], what brand of smokeless tobacco did you use most often?


INTERVIEWER: Do not read response categories, SELECT only one.

01. Beech-Nut Regular

02. Copenhagen

03. Grizzly

04. Kodiak

05. Levi Garrett

06. Longhorn

07. Morgan's

08. Red Man

09. Red Man Golden Blend

10. Red Seal

11. Skoal

12. Southern Pride

13. Stoker Chew

14. Taylor's Pride

15. Timber Wolf

16. Other (specify)


66. DID NOT USE ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS

77. DON’T KNOW/NOT SURE

99. REFUSED


snusever

Asked of all respondents.


Rationale: Key Outcome Indicators 1.13.2 (Youth), Skip for 1.14.2 (Youth), 3.14.1


INTERVIEWER: Pronounce “snus” to rhyme with goose

33. “Snus” is moist, smokeless tobacco, usually sold in individual or pre-packaged small pouches that are placed under the lip against the gum. Have you ever tried snus, even just one time in your entire life?


1. YES

2. NO à Go to q36 CIGAREVER


7. DON’T KNOW/NOT SURE à Go to q36 CIGAREVER

9. REFUSED à Go to q36 CIGAREVER


snusnodays

Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1


34. During the past 30 days, that is, since [DATE FILL], on how many days did you use snus?


_ _ NUMBER OF DAYS


88. NONE à Go to q36 CIGAREVER


77. DON’T KNOW/NOT SURE à Go to q36 CIGAREVER

99. REFUSED à Go to q36 CIGAREVER


[RANGE: 1-30]


sltsub

Rationale: To measure substitution of smokeless tobacco for smoking in places where smoking is restricted.


35. Have you ever used chewing tobacco, snuff, dip, or snus instead of smoking a cigarette or other tobacco product because you were in a place where smoking was not allowed?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


cigarever

Rationale: Key Outcome Indicator 1.13.2 (Youth), Skip for 1.14.2 (Youth), 3.14.1


36. Have you ever tried smoking cigars, cigarillos, or very small cigars that look like cigarettes in your entire life, even one or two puffs?


1. YES

2. NO à Go to q39 PIPEwtrEVER


7. DON’T KNOW/NOT SURE à Go to q39 PIPEwtrEVER

9. REFUSED à Go to q39 PIPEwtrEVER


cigarnodays

Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1


37. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke cigars, cigarillos, or very small cigars that look like cigarettes?


_ _ NUMBER OF DAYS


88. NONE à Go to q39 PIPEwtrEVER


77. DON’T KNOW/NOT SURE à Go to q39 PIPEwtrEVER

99. REFUSED à Go to q39 PIPEwtrEVER


cigarflavr

Rationale: Candy and fruit flavored cigars/cigarillos are popular with some young adults and youth. Knowledge of the extent of use will allow programs to assess initiation and evaluate and inform future communication and education campaigns, and tax, advertising, and other policy initiatives.


38. Were any of the cigars, cigarillos, or very small cigars that look like cigarettes that you smoked in the past 30 days flavored to taste like candy, fruit, chocolate, or other sweets?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


pipewtrever

Rationale: Key Outcome Indicator 1.13.2 (Youth), Skip for 1.14.2 (Youth), 3.14.1


39. The next question asks you about smoking tobacco in a water pipe. A water pipe is also called a hookah. Have you ever tried smoking tobacco in a water pipe in your entire life, even one or two puffs?


1. YES

2. NO à Go to q41 PIPEOTHEVER


7. DON’T KNOW/NOT SURE à Go to q41 PIPEOTHEVER

9. REFUSED à Go to q41 PIPEOTHEVER


pipewtrdays

Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1


40. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke tobacco in a water pipe?


_ _ NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 1-30]


pipeothever

Rationale: Key Outcome Indicator 1.13.2 (Youth) , Skip for 1.14.2 (Youth), 3.14.1


41. Have you ever smoked tobacco in a pipe other than a water pipe in your entire life, even one or two puffs?


1. YES

2. NO à IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5 SMOKEVER = 2 OR q6 smoklast >=4], Go to q43 qtlineawrnt; else go to q44 qtlineawrt


7. DON’T KNOW/NOT SUREà IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5 SMOKEVER = 2 OR q6 smoklast >=4], Go to q43 qtlineawrnt; else go to q44 qtlineawrt

9. REFUSED à IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5 SMOKEVER = 2 OR q6 smoklast >= 4], Go to q43 qtlineawrnt; else go to q44 qtlineawrt


pipeothdays

Rationale: Key Outcome Indicator 1.14.2 (Youth), 3.14.1


42. During the past 30 days, that is, since [DATE FILL], on how many days did you smoke tobacco in a pipe other than a water pipe?


_ _ NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 1-30]


IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5 SMOKEVER = 2 OR q6 smoklast >= 4], Go to q43 qtlineawrnt; else go to q44 qtlineawrt


Cessation


awareness of quitlines and counter-marketing


qtlineawrnt

Asked of respondents (who have smoked fewer than 100 cigarettes in their life or who now smoke not at all) and (who have not puffed on a cigarette ever or in the last 30 days).


Rationale: Non-users of tobacco can influence tobacco users to use quitline services


43. A telephone quitline is a free telephone-based service that connects people who smoke cigarettes with trained counselors who can help them quit. Are you aware of any telephone quitline services that are available to help people quit smoking?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


[IF Q6 SMOKLAST EQ (4, 5, OR 6), GO TO Q48 QTATT2; ELSE GO TO Q58 HCWCARE2]


qtlineawrt

Asked of respondents (who have smoked at least 100 cigarettes in their entire life and who now smoke every day or some days) or (who have at least puffed on a cigarette in the past 30 days).


Rationale: Key Outcome Indicator 3.08.6


44. A telephone quitline is a free telephone-based service that connects people who smoke cigarettes with trained counselors who can help them quit. Are you aware of any telephone quitline services that are available to help you quit smoking?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtasstawr

Rationale: Key Outcome Indicator 3.08.6


45. Are you aware of any individual or group counseling services, other than quitlines, that are available to help you quit smoking cigarettes?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtads

Asked of respondents (who have smoked at least 100 cigarettes in their entire life and who now smoke every day or some days) or (who have at least puffed on a cigarette in the past 30 days).


Rationale: Key Outcome Indicator 3.08.1


46. In the past 30 days, have you seen, read, or heard any ads about quitting cigarettes?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtexads

Rationale: Key Outcome Indicator 3.08.1


47. Have you ever seen or heard the slogan “Become an EX” in an ad? "EX" is spelled E-X.


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


[IF q6 smoklast >= 7, GO TO Q58 HCWCARE2]


quit attempts


qtatt2

Asked of respondents (who have smoked at least 100 cigarettes in their entire life and who now smoke every day or some days) or (who have at least puffed on a cigarette in the past 12 months).


Rationale: To identify lifetime prevalence of quit attempts.


interviewer: if respondent is unsure or states a range, read:

You said you have tried to quit smoking cigarettes about x to y times in your entire life. Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the number of times in your whole life that you have stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

48. In your whole life, 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


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 01-76]

[VERIFICATION SCREEN IF NUMBER OF TIMES >= 10]

[IF [Q48 QTATT2 = (88 OR 77 OR 99) AND q6 smoklast <= 5 GO TO Q53 QTWANT, ELSE GO TO q58 HCWCARE2]


qt12mos

Rationale: Key Outcome Indicator 3.11.1 (Core), Skip question for 3.11.3 (Core)


interviewer: if respondent is unsure or states a range, read:

You said you have tried to quit smoking cigarettes about x to y times in the past twelve months. Your answer doesn’t have to be exact, but I do need to report one number. What is your best guess of the number of times in the past 12 months that you have stopped smoking for one day or longer because you were trying to quit smoking cigarettes for good?

49. During the past 12 months, that is, since [DATE FILL], 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


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 01-76]

[IF [Q49 QT12MOS = (88 OR 77 OR 99) GO TO Q53 QTWANT]



qtline

Rationale: Key Outcome Indicator 3.11.3 (Core)


50. [IF q6 smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3:] The last time you tried to quit smoking,…]


did you call a telephone quitline?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtasst2

Rationale: Key Outcome Indicators 3.11.3 (Core), 3.07.4


51. [IF q6 smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3:] The last time you tried to quit smoking,…]


did you use a class or program or one-on-one counseling from a healthcare provider to assist you in quitting?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


IF Q6 SMOKLAST =6 GO TO Q59 HCWCARE2


qtmed2

Rationale: Key Outcome Indicator 3.11.3 (Core)


52. [IF q6 smoklast =(4, 5, OR 6):] When you quit smoking,…]
[IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3:] The last time you tried to quit smoking,…]


INTERVIEWER: PRONOUNCE “Wellbutrin” AS Well BYOU trin, “Zyban” AS Z‑EYE ban, “BU PRO PRI ON” as byou pro pri on, “Chantix” AS SHAN tix, and “varenicline” as var en ih clean.

interviewer: please read the list slowly.

did you use any of the following medications: a nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, a nicotine inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline to help you quit?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtwant

Asked of respondents who now smoke some days or every day or who have smoked in the past six months.


Rationale: Key Outcome Indicator 3.08.3


53. Do you want to quit smoking cigarettes for good?


1. YES

2. NO à Go to q58 HCWCARE2


7. DON’T KNOW/NOT SURE à Go to q58 HCWCARE2

9. REFUSED à Go to q58 HCWCARE2


qtframe

Rationale: Key Outcome Indicator 3.08.3


54. Do you have a time frame in mind for quitting?


1. YES

2. NO à Go to q58 HCWCARE2


7. DON’T KNOW/NOT SURE à Go to q58 HCWCARE2

9. REFUSED à Go to q58 HCWCARE2


qtwhen

Rationale: Key Outcome Indicator 3.08.3


interviewer: Pause between each response category to allow respondent to answer “yes” or “No” to each category. enter the response code for the first “yes” and then continue to the next question.

55. For the next question, I’m going to read to you a set of possible answers. Please answer “Yes” or “No” to each answer. Do you plan to quit smoking cigarettes for good …


1. in the next 7 days,

2. in the next 30 days,

3. in the next 6 months,

4. in the next 1 year,

5. more than 1 year from now?


7. DON’T KNOW/NOT SURE à Go to q58 HCWCARE2

9. REFUSED à GO TO Q58 HCWCARE2


qtfutasst

Rationale: Key Outcome Indicator 3.08.4


56. When you try to quit smoking, do you plan to use a telephone quitline, a class or program or one-on-one counseling from a healthcare provider to help you quit?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


qtfutmed

Rationale: Key Outcome Indicator 3.08.4


INTERVIEWER: PRONOUNCE “Wellbutrin” AS Well BYOU trin, “Zyban” AS Z‑EYE ban, “BU PRO PRI ON” as byou pro pri on, “Chantix” AS SHAN tix, and “varenicline” as var en ih clean.

interviewer: please read the list slowly.

57. When you try to quit smoking, do you plan to use a nicotine patch, nicotine gum, lozenges, nasal spray, an inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline to help you quit?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


health professional advice to quit


hcwcare2

Asked of respondents who have at least puffed on a cigarette in the past year or who now smoke every day or some days.


Rationale: Screener for Key Outcome Indicators 3.09.2 – 3.09.6


58. In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse, or other health professional?


1. YES

2. NO à Go to q69 hccoverage


7. DON’T KNOW/NOT SURE à Go to q69 hccoverage

9. REFUSED à Go to q69 hccoverage


hcwadvise2

Rationale: Key Outcome Indicator 3.09.3


59. In the past 12 months, that is, since [DATE FILL], did any doctor, dentist, nurse, or other health professional advise you to quit smoking cigarettes or using any other tobacco products?


1. YES

2. NO à Go to q68 HCWASK


7. DON’T KNOW/NOT SURE à Go to q68 HCWASK

9. REFUSED à Go to q68 HCWASK


hcwqtask

Rationale: Key Outcome Indicator 3.09.4


60. The last time a health professional advised you to quit using tobacco, did they also ask if you wanted to try to quit?


1. YES

2. NO à Go to q62 hcwmoradvice


7. DON’T KNOW/NOT SURE

9. REFUSED


hcwqtresp

Rationale: Screener for Key Outcome Indicator 3.09.5


61. When the health professional asked if you wanted to try to quit, did you say…?


1. That you did want to quit, or

2. That you did not want to quit


7. DON’T KNOW/NOT SURE

9. REFUSED


hcwmoradvice

Rationale: Key Outcome Indicator 3.09.5


62. The last time a health professional advised you to quit using tobacco, did they also offer any assistance, information, or additional advice to help you quit?


1. YES

2. NO à IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3 Go to q69 HCcoverage, else go to q72 smokhome7d2


7. DON’T KNOW/NOT SURE à IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3 Go to q69 HCcoverage, else go to q72 smokhome7d2

9. REFUSED à IF Q3 SMOKNOW = (1 OR 2) OR q6 smoklast <=3 Go to q69 HCcoverage, else go to q72 smokhome7d2


hcwmaterials2

Rationale: Key Outcome Indicator 3.09.5


63. The last time a health professional advised you to quit using tobacco, did they provide you with booklets, videos, website addresses, or other information to help you quit?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


hcwsugasst2

Rationale: Key Outcome Indicator 3.09.5


64. (The last time a health professional advised you to quit using tobacco,) Did they put you in contact with, or tell you how to contact, a telephone quitline, a class or program, or one-on-one counseling?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


[IF Q61 HCWQTRESP = (2 OR 7 OR 9) GO TO Q69 HCCOVERAGE]


hcwsetdate2

Rationale: Key Outcome Indicator 3.09.5


65. Did they help you set a specific date to quit using tobacco products?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


hcwmed2

Rationale: Key Outcome Indicator 3.09.5


INTERVIEWER: PRONOUNCE “Wellbutrin” AS Well BYOU trin, “Zyban” AS Z‑EYE ban, “BU PRO PRI ON” as byou pro pri on, “Chantix” AS SHAN tix, and “varenicline” as var en ih clean.

interviewer: please read the list slowly.

66. (Did they) Recommend or prescribe a nicotine patch, nicotine gum, lozenges, nasal spray, an inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


hcwfollowup

Rationale: Key Outcome Indicator 3.09.6


67. (Did they) Schedule any follow-up contacts, either in person or by phone, or arrange for someone else to call you to see how your quit attempt was going?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


[GO TO Q69 HCCOVERAGE]


hcwask

Rationale: Key Outcome Indicator 3.09.2


68. In the past 12 months, that is, since [DATE FILL], did any doctor, dentist, nurse, or other health professional ask if you smoke cigarettes or use any other tobacco products?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


insurance for cessation


hccoverage

Asked of respondents who have at least puffed on a cigarette in the past 30 days or who now smoke every day or some days or who, in the past 30 days, have used chewing tobacco, snuff, dip, or snus or have smoked a cigar, a cigarillo, a little cigar, or a pipe.


Rationale: Screener for Key Outcome Indicator 3.08.7


69. Now I am going to ask some questions about health insurance and quitting tobacco. Do you have any kind of health insurance, including prepaid plans such as HMOs or government plans such as Medicare or Medicaid?


1. YES à IF Q5 SMOKEVER >= 2 OR Q6 SMOKLAST >= 04, GO TO Q71 HCCPAYQO

2. NO à Go to q72 SMOKHOME7D2


7. DON’T KNOW/NOT SURE à Go to q72 SMOKHOME7D2

9. REFUSED à Go to q72 SMOKHOME7D2


hccpayqs

Asked of respondents who have at least puffed on a cigarette in the past 30 days or who now smoke every day or some days.


Rationale: Key Outcome Indicator 3.08.7


70. Does your health insurance help pay for counseling or medications to help people stop smoking cigarettes?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


[IF Q30 SLTEVER2 >= 2 AND Q33 SNUSEVER >= 2 AND Q36 CIGAREVER >= 2 AND Q39 PIPEWTREVER >= 2 AND Q41 PIPEOTHEVER >=2, GO TO Q72 SMOKHOME7D2]


hccpayqo

Asked of respondents who, in the past 30 days, have used chewing tobacco, snuff, dip, or snus or have smoked a cigar, a cigarillo, a little cigar, or a pipe.


Rationale: Key Outcome Indicator 3.08.7


71. Does your health insurance help pay for counseling or medications to help people stop using tobacco products other than cigarettes?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


hccpayqcopn

Asked of all respondents.

. The next question asks for your opinion about what health insurance should cover. For people who want to quit using cigarettes or other tobacco products, should health insurance help pay for treatments that can help them quit?

1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED

secondhand smoke and tobacco-free policies


at home


Now I’m going to ask you some questions about smoking inside the home.


smokhome7d2

Asked of all respondents.


Rationale: Numerator for Key Outcome Indicators 2.06.4, 2.07.3 (Core), 2.07.5 (Core)


72. Not counting decks, porches, or garages, during the past 7 days, that is, since [DATEFILL], on how many days did someone other than you smoke tobacco inside your home while you were at home?


0_. NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 01-07]


homerules2

Rationale: Key Outcome Indicator 2.04.4 (Core)


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


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed à Go to q75 homerulesopn

2. Allowed only at some times or in some places

3. Never allowed à if q72 smokhome7d2 = (1-7) Go to q75 homerulesopn


7. DON’T KNOW/NOT SURE à Go to q75 homerulesopn

9. REFUSED à Go to q75 homerulesopn


homecmpl

Asked of respondents who were not exposed to secondhand smoke in the home in the past 7 days or who live in homes where smoking is allowed at some times or in some places.


Rationale: Key Outcome Indicator: 2.06.4


74. Not counting decks, porches, or garages, to your knowledge, during the past 7 days, that is, since [DATEFILL], has anyone, including yourself, smoked tobacco inside your home when he or she was not supposed to?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


homerulesopn

Rationale: Key Outcome Indicator 2.03.8


75. In your opinion, inside a home, should smoking….


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always be allowed

2. Be allowed only at some times or in some places

3. Never be allowed


4. SMOKING RESTRICTIONS INSIDE A HOME SHOULD BE WHATEVER THE PEOPLE WHO LIVE THERE DECIDE (Note to reader: The interviewer will not read this response. It will only be coded if the respondent volunteers the response.)


7. DON’T KNOW/NOT SURE

9. REFUSED


in the workplace


Now I am going to ask you about some questions about policies on tobacco use in the place where you work. But first, I need to know about your employment status.


employ2

Asked of all respondents.


Rationale: Screener for Key Outcome Indicators 2.04.3 (Core), 2.06.1 (Core), and 2.07.1 (Core)


76. Are you currently working for pay or are self-employed, either part-time or full-time?


1. YES

2. NOà GO TO Q86 SHSVEHEXP


7. Don’t know à Go to Q86 SHSVEHEXP

9. REFUSEDà Go to Q86 SHSVEHEXP


nojobs

Rationale: Screener for Key Outcome Indicators 2.04.3 (Core), 2.06.1 (Core), and 2.07.1 (Core)


77. Do you currently have one job or more than one job?


1. ONE JOB

2. MORE THAN ONE JOB


7. Don’t know à Go to Q86 SHSVEHEXP

9. REFUSEDà Go to Q86 SHSVEHEXP


INTERVIEWER: IF RESPONDENT HAS MORE THAN ONE JOB, PLEASE READ THE FOLLOWING SENTENCE:

Please answer the following questions for the job at which you spend the most time.


interviewer: if the respondent spends the most time at two or more jobs equally, ask them to choose the one at which they have been working the longest. if they still can’t choose one job, ask them to choose the one they like the most.

workplace

Rationale: Screener for Key Outcome Indicators 2.04.3 (Core), 2.06.1 (Core), and 2.07.1 (Core)


78. Most of the time, do you work…?


1. Outdoors

2. In a vehicle

3. Indoors at home

4. Indoors in a place like an office building, retail store, restaurant, or factory

5. Somewhere else (Specify)


7. Don’t know/NOT SURE à Go to Q86 SHSVEHEXP

9. REFUSEDà Go to Q86 SHSVEHEXP


INTERVIEWER: IF RESPONDENT works in more than one, PLEASE READ THE FOLLOWING SENTENCE:

Please choose the setting in which you spend the most time.


interviewer: if the respondent spends the most time at two or more settings equally, ask them to choose the one at which they have been working the longest. if they still can’t choose, ask them to choose the one they like the most.


shsexpwork

Rationale: Key Outcome Indicators 2.07.1 (Core), 2.07.5 (Core)


79. Now I’m going to ask you about smoke you might have breathed at work because someone else was smoking, either indoors or outdoors. During the past 7 days, that is, since [DATE FILL], either indoors or outdoors at your workplace, on how many days did you breathe the smoke from someone other than you who was smoking tobacco?


0_. NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


IF Q78 WORKPLACE = 1, GO TO Q81 WORKSMOKOUT

[RANGE: 01-07]


worksmokind

Rationale: Key Outcome Indicator 2.04.3 (Core)


80. At your workplace, is smoking in indoor areas…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed


7. DON’T KNOW/NOT SUREà Go to Q84 WORKINDOPN2

9. REFUSEDà Go to Q84 WORKINDOPN2


worksmokout

Rationale: Key Outcome Indicator 2.04.3 (Core)


81. At your workplace, is smoking in outdoor areas…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed


7. DON’T KNOW/NOT SUREà Go to Q84 WORKINDOPN2

9. REFUSEDà Go to Q84 WORKINDOPN2


worksmokless

Rationale: Key Outcome Indicator 2.04.3 (Core)


82. At your workplace, is the use of chewing tobacco, snuff, dip, or snus …?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed


7. DON’T KNOW/NOT SUREà Go to Q84 WORKINDOPN2

9. REFUSEDà Go to Q84 WORKINDOPN2


[IF Q80 WORKSMOKIND = 1 AND Q81 WORKSMOKOUT = 1 AND Q82 WORKSMOKLESS = 1, GO TO Q84 WORKINDOPN2]

shscompwork

Rationale: Key Outcome Indicator 2.06.1 (Core)


83. To your knowledge, during the past 30 days, that is, since [DATE FILL], has anyone, including yourself, used tobacco of any kind at your work when he or she was not supposed to?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


workindopn2

Rationale: Key Outcome Indicator 2.03.7 (Core)


84. At workplaces, do you think smoking indoors should be…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed


7. DON’T KNOW/NOT SURE

9. REFUSED


workoutdopn2

Rationale: Key Outcome Indicator 2.03.7 (Core)


85. At workplaces, do you think smoking outdoors should be…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed

2. Allowed only at some times or in some places

3. Never allowed


7. DON’T KNOW/NOT SURE

9. REFUSED


in vehicles


Now we have two questions about smoking in vehicles.


shsvehexp

Asked of all respondents.


Rationale: Key Outcome Indicators 2.07.3 (Core), 2.07.5 (Core)


86. During the past 7 days, that is, since [DATE FILL], on how many days did you ride in a vehicle where someone other than you was smoking tobacco?


0_. NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 01-07]


shsvehpol

Rationale: Key Outcome Indicator 2.04.4 (Core)


87. Not counting motorcycles, in the vehicles that you or family members who live with you own or lease, is smoking…


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always allowed in all vehicles

2. Sometimes allowed in at least one vehicle

3. Never allowed in any vehicle


8. RESPONDENT’S FAMILY DOES NOT OWN A VEHICLE

7. DON’T KNOW/NOT SURE

9. REFUSED


in public places


The next several questions ask about tobacco use in indoor and outdoor public places. Examples of indoor public places are the indoor areas of stores, restaurants, bars, casinos, clubs, and sports arenas. Examples of outdoor public places are stadiums and parks.


shsexppub

Rationale: Key Outcome Indicator 2.07.2, 2.07.5 (Core)


88. [IF Q76 EMPLOY2 = 1: Not counting times while you were at work,] during the past 7 days, that is, since [DATE FILL], on how many days did you breathe the smoke from someone else who was smoking in an indoor or outdoor public place?


0_. NUMBER OF DAYS


88. NONE


77. DON’T KNOW/NOT SURE

99. REFUSED


[RANGE: 01-07]


shscomppub

Rationale: Key Outcome Indicator 2.06.2


89. [IF Q76 EMPLOY2 = 1: Not counting times while you were at work,] to your knowledge, during the past 7 days, that is, since [DATE FILL], has anyone, including yourself, used tobacco of any kind in an indoor or outdoor public place when he or she was not supposed to?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


Now we have three questions about your opinions on smoking in indoor and outdoor public places.


shsindropn1

Rationale: Key Outcome Indicator 2.03.7 (Core). Restricting smoking in restaurants is currently an important issue.


90. Should smoking indoors in restaurants…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always be allowed

2. Be allowed only at some times or in some places

3. Never be allowed


7. DON’T KNOW/NOT SURE

9. REFUSED


shsindropn2

Rationale: Key Outcome Indicator 2.03.7 (Core). Bars, casinos, and clubs are the indoor public places for which there is the least support for smoke-free policies. Support for smoke-free policies in these venues is the cutting edge in support for smoke-free policies in all public places.


91. Should smoking indoors in bars, casinos, or clubs…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always be allowed

2. Be allowed only at some times or in some places

3. Never be allowed


7. DON’T KNOW/NOT SURE

9. REFUSED


shsoutdropn

Rationale: Key Outcome Indicator 2.03.7 (Core)


92. Should smoking at parks…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Always be allowed

2. Be allowed only at some times or in some places

3. Never be allowed

7. DON’T KNOW/NOT SURE

9. REFUSED


general knowledge and attitudes


Now we have some general questions about smoking and tobacco use.


shsasknot

Rationale: Key Outcome Indicator 2.03.4


93. How likely would you be to ask a stranger not to smoke around you if you couldn’t move away from their smoke—…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Very likely

2. Somewhat likely

3. Not at all likely


7. DON’T KNOW/NOT SURE

9. REFUSED


shsharmopn

Rationale: Key Outcome Indicator 2.03.5


94. Do you think that breathing smoke from other people's cigarettes or from other tobacco products is…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Not at all harmful to one's health

2. Somewhat harmful to one's health

3. Very harmful to one's health


7. DON’T KNOW/NOT SURE

9. REFUSED


shspubopn

Rationale: Key Outcome Indicator 2.03.9


95. Should policies that don’t allow tobacco use in indoor or outdoor public places be strictly enforced?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


Demographic Items


Now I would like to ask you some questions about yourself and your family. Please remember that your answers will be strictly confidential and that no one will be able to identify you from any published reports.


marital2

Rationale: Key covariate


Interviewer: if respondent answers “single,” please verify that s/he was never married. if respondent is unsure between “living with a partner” and any other response category, code as “living with a partner.

96. Are you now…?


01. Married

02. Living with a partner

03. Divorced

04. Widowed

05. Separated

06. Single, that is, never married and not now living with a partner

07. Other (specify)


77. DON’T KNOW/NOT SURE

99. REFUSED



childle17

Rationale: To determine exposure to secondhand smoke.


97. How many children aged 17 or younger live in your household 6 months or more of the year?


_ _ Number of children


88. NONE


99. REFUSED


[RANGE: 01-30]

[Verification screen if number of children >= 08]


hispanic

Rationale: Key covariate


98. Are you Hispanic or Latino?


1. YES

2. NO à Go to Q100 RACEMULTI


7. DON’T KNOW/NOT SURE à Go to Q100 RACEMULTI

9. REFUSED à Go to Q100 RACEMULTI


hispgroup

Rationale: Key covariate


99. Which one or more of the following groups best describes you?


INTERVIEWER: Mark all that apply. CODE ANY HYPENATED RESPONSE ENDING IN “-AMERICAN” to the first group mentioned.

01. Mexican

02. Puerto Rican

03. Cuban

04. Central or South American

05. Dominican

06. Some other Hispanic or Latino group (SPECIFY)


77. DON’T KNOW/NOT SURE

99. REFUSED


iNTERVIEWER: IF A RESPONDENT MENTIONS A COUNTRY IN CENTRAL OR SOUTH AMERICA, CODE AS 04.

[PROGRAMMER: PROVIDE A LIST OF CENTRAL AND SOUTH AMERICAN COUNTRIES FOR THE INTERVIEWER TO SEE HERE.]


racemulti

Rationale: Key covariate


100. I’m going to read a list of racial categories. Which one or more of the following groups best describes you?


INTERVIEWER: Mark all that apply.

01. White

02. Black or African American

03. Asian

04. Native Hawaiian

05. Pacific Islander, other than Hawaiian

06. American Indian

07. Alaska Native


08. OTHER (SPECIFY)

09. NONE OF THE ABOVE


77. DON’T KNOW/NOT SURE

99. REFUSED


[IF Q100 RACEMULTI DOES NOT INCLUDE 03 GO TO Q102 EDUCA2


asian01

Rationale: Key covariate


101. Which one or more of the following groups best describes you?


01. Asian Indian

02. Chinese

03. Filipino

04 Japanese

05. Korean

06. Vietnamese

07. Other (SPECIFY)


77. DON’T KNOW/NOT SURE

99. REFUSED


educa2

Rationale: Key covariate


102. What is the highest level of school you have completed or the highest degree you have received?


INTERVIEWER: Read only if necessary.

01. 5TH GRADE OR LESS

02. 6TH GRADE

03. 7TH GRADE

04. 8TH GRADE

05. 9TH GRADE

06. 10TH GRADE

07. 11TH GRADE

08. 12TH GRADE, NO DIPLOMA

09. GED OR EQUIVALENT

10. HIGH SCHOOL DIPLOMA

11. SOME COLLEGE, NO DEGREE

12. CERTIFICATE, DIPLOMA, OR ASSOCIATE DEGREE: OCCUPATIONAL, TECHNICAL, OR VOCATIONAL PROGRAM

13. ASSOCIATE DEGREE: ACADEMIC PROGRAM

14. BACHELOR’S DEGREE

15. MASTER’S DEGREE

16. PROFESSIONAL SCHOOL DEGREE (EXAMPLES: MD, DDS, DVM, LLB, JD)

17. DOCTORAL DEGREE (EXAMPLES: PHD, EDD)


77. DON’T KNOW/NOT SURE

99. REFUSED


age

Rationale: Key covariate.


103. What is your age?


_ _ _ . Age in years


007. DON’T KNOW/NOT SURE

009. REFUSED


[RANGE: 018-130]

[VERIFICATION SCREEN IF AGE >=085]


gender

Rationale: Key covariate


INTERVIEWER: Ask only if necessary.

104. Are you male or female?


1. Male

2. Female

3. other (specify)


7. DON’T KNOW/NOT SURE

9. REFUSED


telnosgt1

Rationale: Needed for weighting.


105. Now I’m going to ask you about how many different telephone numbers your household has. Do not include numbers that are only used by a computer or fax machine. Also, do not include cell phone telephone numbers. Do you have more than one landline telephone number in your household?


1. YES

2. NO à Go to q107 STATERES


7. DON’T KNOW/NOT SURE à Go to q107 STATERES

9. REFUSED à Go to q107 STATERES


telnosres

Rationale: Needed for weighting.


106. How many of these are residential numbers?


INTERVIEWER: enter 6 if number of residential telephone numbers is 6 or more.

_. Number of residential telephone numbers


8. NONE


7. DON’T KNOW/NOT SURE

9. REFUSED


[RANGE: 0-6]


stateres

Rationale: To assign respondents to states.


107. What state do you live in?


01-56. State FIPS code


77. DON’T KNOW/NOT SURE

99. REFUSED


countyfips

Rationale: To allow states to make regional estimates.


108. What county do you live in?


NNN. County FIPS code


777. DON’T KNOW/NOT SURE

999. REFUSED



[CATI PROGRAMMER: THE RESPONSE CATEGORIES ABOVE INDICATE THAT COUNTY FIPS CODES SHOULD BE PUT ON THE DATA FILE TO INDICATE COUNTY OF RESIDENCE IF RESPONDENTS KNOW THE COUNTY THAT THEY LIVE IN, THEY WILL, OF COURSE, RESPOND WITH THE NAME OF THE COUNTY. THERE ARE A VARIETY OF WAYS THAT THE COUNTY FIPS CODE CAN BE DETERMINED. IF A STATE HAS NO MORE THAN 10-12 COUNTIES, THE INTERVIEWER MAY BE ABLE TO ENTER THE FIPS CODE FROM A LIST OF COUNTY NAMES AND FIPS CODES THAT APPEARS ON THE SCREEN FOR THIS QUESTION. IF A STATE HAS TOO MANY COUNTIES TO MAKE THIS WORK WELL, IT IS BEST TO HAVE THE INTERVIEWER JUST ENTER WHATEVER THE RESPONDENT SAYS. THEN, AT THE END OF THE SURVEY, DISPLAY THE TEXT TYPED AND HAVE THE INTERVIEWER LOOK UP (ON A PAPER LIST) THE NAME AND ENTER THE APPROPRIATE NUMBER. ASKING THE INTERVIEWER TO ENTER A CODE FROM A LIST WHILE THE RESPONDENT IS ON THE PHONE CAN CAUSE THE RESPONDENT TO BREAK OFF THE INTERVIEW IF THE INTERVIEWER TAKES TOO LONG OR THE INTERVIEWER TO COMMIT AN ERROR IF THE INTERVIEWER HURRIES TOO MUCH.]


zipcode

_ _ _ _ _ ZIP Code


77777 Don’t know/Not sure

99999 Refused

Existing chronic conditions and diseases


Now I want to ask you some questions about chronic conditions or diseases you might have.


heartdisease

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with heart disease.


109. Have you ever been told by a doctor or other health professional that you have heart disease?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


cancer

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with cancer.


110. (Have you ever been told by a doctor or other health professional that you have) cancer, other than skin cancer?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


diabetes

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with diabetes.


111. (Have you ever been told by a doctor or other health professional that you have) diabetes, or sugar diabetes?


interviewer: If “YES” and respondent is female, ask: “Was this only when you were pregnant?”

1. YES

2. YES, but female told only during pregnancy

3. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


respdisease

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with chronic lung disease.


112. (Have you ever been told by a doctor or other health professional that you have) a chronic lung disease, such as emphysema, chronic bronchitis, or chronic obstructive pulmonary disease, also known as c-o-p-d?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


asthma

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with asthma.


113. (Have you ever been told by a doctor or other health professional that you have) asthma?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


cholesterol

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with high cholesterol.


114. (Have you ever been told by a doctor or other health professional that you have) high cholesterol?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


hypertension

Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents with hypertension.


115. (Have you ever been told by a doctor or other health professional that you have) high blood pressure, or hypertension?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


opinions and attitudes related to tobacco


excise taxes


Now I would like to ask you a few more questions about your opinions and attitudes related to tobacco.


rskaddictopn2

Rationale: Programs try to communicate the addictive nature of tobacco. There are often important differences in this perception by sociodemographic categories.


116. How addictive do you think cigarette smoking is—…?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Not at all addictive

2. Moderately addictive

3. Very addictive


7. DON’T KNOW/NOT SURE

9. REFUSED


[RANGE: 1-5]


cigtaxopn2

Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)


117. Would you be in favor of an increase in the tax on a pack of cigarettes if the money were used to improve the public’s health?


1. YES

2. NO à Go to Q119 SLTTAXOPN


7. DON’T KNOW/NOT SURE à Go to Q119 SLTTAXOPN

9. REFUSED à Go to Q119 SLTTAXOPN


cigtaxopn3

Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)


interviewer: Pause between each response category to allow respondent to answer “yes” or “No” to each response alternative. enter the response code for the first “yes” and then continue to the next question.

118. For the next question, I’m going to read to you a set of possible answers. Please answer “Yes” or “No” to each answer. Current prices for a pack of cigarettes range from about four to six dollars. Would you be in favor of an additional tax on a pack of cigarettes of…


1. More than two dollars a pack?

2. Up to two dollars a pack?

3. Up to one dollar a pack?

4. Up to fifty cents a pack?


7. DON’T KNOW/NOT SURE

9. REFUSED


slttaxopn

Rationale: Key Outcome Indicators 1.06.5 (Core), 3.08.5 (Core)


119. Would you be in favor of an increase in the tax on chewing tobacco, snuff, dip, or snus if the money were used to improve the public’s health?


1. YES

2. NO


7. DON’T KNOW/NOT SURE

9. REFUSED


youth issues


teensellopn

Rationale: Key Outcome Indicator 1.06.4


120. How important is it to prevent sales of tobacco products to youth under 18— …?


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Not at all important

2. Somewhat important

3. Very important


7. DON’T KNOW/NOT SURE

9. REFUSED


schoolopn2

Rationale: Key Outcome Indicator 1.06.7, 2.03.10


121. Should tobacco use be completely banned on school grounds, including fields and parking lots, and at all school events, even for teachers and other adults?


1. Yes

2. No


7. DON’T KNOW/NOT SURE

9. REFUSED


IF Q103 AGE >= 30, GO TO Q123 PARENTING


sponsorship and marketing


weartobco

Asked of respondents 18-29.


Rationale: Key Outcome Indicator 1.06.3 (Youth)


122. How likely is it that you would ever use or wear something--such as a lighter, t-shirt, hat or sunglasses--that has a tobacco company name or picture on it—


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Very likely

2. Somewhat likely

3. Somewhat unlikely

4. Very unlikely


7. DON’T KNOW/NOT SURE

9. REFUSED


importance of discussing tobacco use with children


parenting

Asked of all respondents.


Rationale: Screener for Key Outcome Indicator 1.06.6


123. Now I want to ask you about the importance of discussing tobacco use with childen that you have a parental relationship with. Are you currently parenting any children aged 17 or younger?


1. Yes

2. No à IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR q6 smoklast <= 3, go to q126 HELPSMOKER, else go to q125 helpnonsmok



7. DON’T KNOW/NOT SURE à IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR q6 smoklast <= 3, go to q126 HELPSMOKER, else go to q125 helpnonsmok

9. REFUSED à IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR q6 smoklast <= 3, go to q126 HELPSMOKER, else go to q125 helpnonsmok


tobusediscuss

Asked of adults in a parental relationship with a child <=17.


Rationale: Key Outcome Indicator 1.06.6


124. Is talking with these children about not using tobacco


INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS QUESTION IS BEING RANDOMLY REVERSED

1. Not at all important to you

2. Somewhat important to you

3. Very important to you


7. DON’T KNOW/NOT SURE

9. REFUSED


IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR q6 smoklast <= 3,
go to q126 HELPSMOKER


smoker assistance


helpnonsmok

Asked of respondents (who have smoked fewer than 100 cigarettes in their life or who now smoke not at all) and (who have not puffed on a cigarette ever or in the last 30 days).


Rationale: To provide quitline telephone number and url for respondents who want to encourage someone else to quit smoking


125. In order to help a smoker you know to stop smoking, would you like the 1-800 quitline telephone number or the address for a website?


1. YES


The quitline number is 1-800-QUIT NOW.

A website that tells smokers about the help they can get to stop smoking is www.smokefree.gov.


2. NO


[GO TO Q127 INCOME2]


helpsmoker

Asked of respondents (who have smoked at least 100 cigarettes in their entire life and who now smoke every day or some days) or (who have at least puffed on a cigarette in the past 30 days).

Rationale: To provide national quitline telephone number and url for respondents who want to quit using tobacco


126. In order to get help to stop using tobacco for good, would you like the 1‑800 quitline telephone number or the address for a website?


1. YES


The quitline number is 1-800-QUIT NOW.

A website that tells you about help you can get to stop smoking is www.smokefree.gov.


2. NO


Sensitive sociodemograhpic Questions


I have two final questions that could be sometimes considered sensitive but that are important to the CDC to develop effective programs. We hope you will be willing to answer these questions. Please remember that all answers are confidential.


income2

Rationale: Key covariate


Note: 2006 median U.S. income = $48,201


127. Is your annual household income from all sources…?


04. Less than $50,000 If "no," ask 05; if "yes," ask 03
($40,000 to less than $50,000)

03. Less than $40,000 If "no," code 04; if "yes," ask 02
($30,000 to less than $40,000)

02. Less than $30,000 If "no," code 03; if "yes," ask 01
($20,000 to less than $30,000)

01. Less than $20,000 If "no," code 02

05. Less than $70,000 If "no," ask 06
($50,000 to less than $70,000)

06. Less than $100,000 If "no," ask 07
($70,000 to less than $100,000)

07. Less than $150,000 If "no," code 08
($100,000 to less than $150,000)

08. $150,000 or more


77. DON’T KNOW/NOT SURE

99. REFUSED


sexualpref

Rationale: Key covariate


INTERVIEWER: AS THE QUESTION IS READ, READ ALOUD THE NUMBERS, that is, "1. Heterosexual or straight; 2. Gay or lesbian; 3. Bisexual, 4. Transgendered." THIS ALLOWS THE RESPONDENT TO reply with A NUMBER IF, FOR WHATEVER REASON, THEY ARE UNCOMFORTABLE SAYING THE WORDS.

128. Do you consider yourself to be…?


1. Heterosexual, or straight

2. Gay or lesbian

3. Bisexual

4. Transgendered

5. OTHER (SPECIFY)


6. respondent Does not understand responses


7. DON’T KNOW/NOT SURE

9. REFUSED


Closing


That’s my last question. Everyone’s answers will be combined to give us information about tobacco in the U.S. The information will be used to help keep non-smokers from being exposed to tobacco smoke, to help young people make healthy choices about tobacco use, and to help smokers and users of other tobacco products stop using tobacco.


GIVE AMAZON.COM GIFT CODE TO RESPONDENT FOR COMPLETING THE INTERVIEW.


Thank you very much for your time and cooperation.


language

129. In what language was the interview conducted? If more than one, indicate the predominant language used.


01. English

02. Spanish



Page 2 of 92

File Typeapplication/msword
File TitleATS Questions 2008
AuthorPeter Mariolis
Last Modified Bycww6
File Modified2009-07-30
File Created2009-05-06

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