5 Moderators Guide and Interview

Attachment E2: Moderator Guide

Alternative Tobacco Product Study

EYE TRACKING

OMB No.: 0925-0645

Expiration Date: 12/31/2014

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private under the Privacy Act. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all study participants and reported as summaries. You are being asked to complete this interview so that we can gather information about the study participants and their opinions about Snus.

Public reporting burden for this collection of information is estimated to average 35 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0645). Do not return the completed form to this address.

Time allocation

10 min	Introduction and Baseline Survey Completion (Attachment B)
15 min	Part 1: View Advertisements and Complete Eye Tracking Questionnaire (Attachment D)
35 min	Part 2: Individual Interviews (Attachment E2)

Introduction and preparation for the session

Thanks so much for taking the time to talk to us today. My name is [Name] and this is [Name] and we will be guiding you through the activities today. As you may know, we work with some investigators at the National Cancer Institute.

We want to understand how people like you perceive advertisements of new tobacco products. We are meeting with many people to ask them questions about their beliefs and perceptions of these tobacco products. This means there are no right or wrong answers. The way you can help us the most is to share your reactions with us: if you like something, don’t like it, find it interesting, we want to hear about your experience.

Today you will be participating in a study which should take about 1 hour. You will look at some magazine advertisements and discuss your thoughts about them. [Name] will be helping out and taking notes for me. And, there are some people who will be listening and observing the session but not in the room with us.

Please fill out this brief survey {Hand out Baseline Survey - Attachment B} and we will get started with the first part of the study. Some of this information we know you provided when you were first contacted, but this will help us keep all the information together.

For Moderator: Research Objectives

Better understand where smokers look on five different Snus advertisements.

Understand how where smokers look on each advertisement influences their beliefs and perceptions about Snus products.

Examine if smokers notice (read and process) the warning label on Snus advertisements.

Eye Tracking

I think they told you that we will record this session. The recording is primarily to help us take notes, but we might show anonymous clips to people working on the project. Is that all right with you?

On parts of today’s session we will be tracking where you are looking on the screen to help us understand how you read the information. To do this, I will need to set up the eye tracker.

• Calibrate eye tracker

I am going to show you five different advertisements for the tobacco product Snus (note: rhymes with moose).You have already read a little bit about this product in the first survey you completed. We want you to look at the advertisements as you would if you were flipping through a magazine. So, you will see each advertisement on the screen for 20 seconds and then I will ask you a few questions. Are you ready?

{After they view each advertisement (there will be 5 ads, each participant will receive them in a different order to account for any order effects),

• Part 2 Questionnaire: Verbally ask them the questions on the “Eye Tracking Questionnaire – Attachment D” form- be sure to put which ad viewed at the top of the page (Smokeless for Smokers, 0 Emissions, Without Matches, 2012, or Not all Snus) and fill in the answers- audio will capture open ended.

• Please be sure to put a participant ID at the top of the form so that we can link the answers back to the focus group, eye tracking, and other questionnaire data.}

If warning labels are not mentioned after the 5^th advertisement, ask:

• Did you notice a warning on this advertisement? (Yes or No)

• If yes, do you remember what the warning said?

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Question/Answer Period- relocate away from the computer

Materials

Copies of the 5 ads for each participant (print on gloss paper in color)

Pens

Now, we have an activity for you to do and we will discuss the advertisements. {Be sure to have the scale written somewhere- white board or on a flash card for them}

Individual Activity:

1. Assume you were interested in trying Snus. Each of you are now going to individually rank the ads by which one you would be most willing to try to least willing to try. Please look at each of the 5 ads and line them up from the one you would be MOST willing to try to the one you would be LEAST willing to try (so the one you would most be willing to try will be on the far left and the one you would be least willing to try would be on the far right).

   • Please put the rank number (1 most willing to try, 2, 3, 4, through 5 least willing to try) in the space provided at the bottom of the page next to “A”.

• Now, just look at your top ranked advertisement.

  • If you were offered a free package of the Snus you ranked as #1, what would be the likelihood that you would use it in the next 7 days? Would you be...

1. Extremely unlikely

2. Unlikely

3. Neither likely nor unlikely

4. Likely

5. Extremely likely

*Please write a, for extremely unlikely, b for unlikely, c for neither likely nor unlikely, d for likely or e for extremely likely in the area next to your 1 on line “A”*

• Still looking at your top ranked advertisement,

• If you were offered a free package of the Snus you ranked as #1 today, what would be the likelihood that you would use it instead of cigarettes in situations where you are not allowed to smoke (for instance, on an airplane or another public place where smoking was not allowed?). Would you be…

  1. Extremely unlikely

  2. Unlikely

  3. Neither likely nor unlikely

  4. Likely

  5. Extremely likely

*Please write a, for extremely unlikely, b for unlikely, c for neither likely nor unlikely, d for likely or e for extremely likely next to your last response on line “A”*

2. Now, please rank the ads by which one you believe to be least harmful to a person’s health to most harmful to a person’s health. Please look at each of the 5 ads and line them up from the one you think is the least harmful to a person’s health to the most harmful to a person’s health (so the one you think is least harmful will be on the far left and the one you think is most harmful will be on the far right).

   • Please put the rank number (1 for least harmful, 2, 3, 4, through 5 most harmful) in the space provided at the bottom of the page next to “B”.

3. Now, please rank the ads by which one you believe to be least addictive to most addictive. Please look at each of the 5 ads and line them up from the one you think is the least addictive to the most addictive (so the one you think is least addictive will be on the far left and the one you think is most addictive will be on the far right).

   • Please put the rank number (1 for least addictive, 2, 3, 4, through 5 most addictive) in the space provided at the bottom of the page next to “C”.

{Have participants keep the ads so that they may look at them during discussion}

{Please allow participants to talk as much as possible –probe with questions like ‘why do you think that’ as the discussion progresses- remember we are primarily interested in beliefs about the product, particularly health risks and perceptions compared to traditional tobacco products, like cigarettes}

Now, I will ask you some questions and hope that you will share your thoughts with me.

Beliefs about Snus- General Discussion

• Were you aware of the tobacco product “Snus” prior to today’s study?

• Where did you get information about Snus?

• Have you had any experience buying Snus?

• Have you had any experience using Snus?

• Do you know others who use Snus?

Discuss each advertisement individually- randomize the order of them

• What is the first thing you noticed about this advertisement?

• What do you think about the graphics/pictures on this advertisement?

• What do you think the graphic is trying to convey?

• What do you think about the text on the advertisement?

• Do you think there is meaning (or an underlying meaning) behind what the text says?

• What do you think about the colors used in the ad?

• Who do you think this advertisement is trying to target ?

• (who is the intended audience- men? Women? Young people? Older people?)

• Do you know what brand this ad was for? (brand awareness)

Warning Label

• Did you notice the warning on the advertisement?

  • Do you believe what the warning says?

  • How severe of a disease/health problem do you think mouth cancer is (do you think it leads to death)?

  • Who do you think puts the warnings on tobacco advertisements? (if needed give them prompts- government? Surgeon general? Physicians?

  • Have you seen any other health warnings about Snus or other smokeless tobacco products?

If you used Snus, would you be worried about the health outcomes?

How worried are you about the health outcomes of cigarette smoking?

Probe these items to see if participants will compare the health effects of Snus and Cigarettes.

Discussion about Snus- continued- speak generally about Snus products

What do you think are the negative things associated with using Snus?

If needed- Prompts:

Addictiveness?

Harm?

Bad breath?

Stigma?

Disease? (probe on what diseases they think Snus might cause, if any)

What do you think are the positive things associated with using Snus?

If needed- Prompts:

Enjoyable to use?

Buzz?

In general, safer than cigarettes?

In general, less addictive than cigarettes?

Compared to other forms of smokeless tobacco?

Less stigma than smoking?

No secondhand smoke?

Would you be willing to buy Snus in the future?

• Why (or why not)?

Would you be willing to use Snus in addition to smoking cigarettes?

• Why would you use in addition to smoking cigarettes? (or why not)

• When would you use Snus (if needed, prompt- at times when you can’t smoke)?

Would you be willing to switch to Snus completely and give up (quit) cigarette smoking?

• Why (or why not)?

Please put advertisements together and place them in the envelope.

Close and Debriefing

Thank you so much for participating in this study today. There is some information that we would like to share with you about the study.

• Distribute debriefing and other handouts.

• Read debriefing out loud.

• Ask if there are any questions.

• General thanks and give incentive.

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