OMB
No.: 0925-0945
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 survey 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
range from 15 to 50 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.
[The lengthier response is for participants in the focus group who will be individually viewing the advertisements and completing the eye tracking survey while others wait.]
Name of first advertisement shown ____________________________________
What is the main message you got from this advertisement? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Was there anything else about this advertisement you want to mention?
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you believe that the Snus product in THIS advertisement is less or more harmful to one’s health than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less harmful
less harmful
about the same
more harmful
much more harmful
Comments:
Do you believe that the Snus product in THIS advertisement is less or more addictive than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less addictive
less addictive
about the same
more addictive
much more addictive
Comments:
Name of second advertisement shown ____________________________________
What is the main message you got from this advertisement? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Was there anything else about this advertisement you want to mention?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you believe that the Snus product in THIS advertisement is less or more harmful to one’s health than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less harmful
less harmful
about the same
more harmful
much more harmful
Do you believe that the Snus product in THIS advertisement is less or more addictive than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less addictive
less addictive
about the same
more addictive
much more addictive
Name of third advertisement shown ____________________________________
What is the main message you got from this advertisement? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Was there anything else about this advertisement you want to mention?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you believe that the Snus product in THIS advertisement is less or more harmful to one’s health than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less harmful
less harmful
about the same
more harmful
much more harmful
Do you believe that the Snus product in THIS advertisement is less or more addictive than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less addictive
less addictive
about the same
more addictive
much more addictive
Name of fourth advertisement shown ____________________________________
What is the main message you got from this advertisement? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Was there anything else about this advertisement you want to mention?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you believe that the Snus product in THIS advertisement is less or more harmful to one’s health than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less harmful
less harmful
about the same
more harmful
much more harmful
Do you believe that the Snus product in THIS advertisement is less or more addictive than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less addictive
less addictive
about the same
more addictive
much more addictive
Name of fifth advertisement shown ____________________________________
What is the main message you got from this advertisement? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Was there anything else about this advertisement you want to mention?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you believe that the Snus product in THIS advertisement is less or more harmful to one’s health than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less harmful
less harmful
about the same
more harmful
much more harmful
Do you believe that the Snus product in THIS advertisement is less or more addictive than ordinary cigarettes? Would you say the Snus product in this advertisement is...
much less addictive
less addictive
about the same
more addictive
much more addictive
(If the participant has not mentioned a warning on this advertisement previously):
Did you notice a warning on this advertisement?
___Yes
___No
Did you notice a warning on any of the other advertisements?
___Yes
___No
If you did notice a warning, do you recall what the warning said? ______________________________________________________________________________________________________________________________________________________
| File Type | application/msword |
| Author | kaufmana |
| Last Modified By | Vivian Horovitch-Kelley |
| File Modified | 2013-05-31 |
| File Created | 2013-05-07 |