1b - Questionnaire - English

Form Approved

OMB No. 0920-0910

Exp. Date 01/31/2015

National Tobacco Prevention and Control Public Education Campaign:

Rough Cut Testing of Television, Print/Digital Print and Radio Ads

Main Questionnaire

Public reporting burden of this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0910).

{PREAMBLE SHOWN DURING SCREENER}

On behalf of the Centers for Disease Control and Prevention (CDC), we're conducting a study about different health and smoking-specific advertising that you see in the media. Your opinions are very important to us! Please be assured that the purpose of this survey is to gather feedback regarding specific health-related advertising. We do not plan to report your answers individually. We plan to report results from this survey for the group as a whole. Thank you for taking the time to help us!

Your participation in this survey is voluntary.

Segments	Definition
Smokers	Smokers
Non-Smokers	Non-Smokers or Former Smokers
HIVSmokers (code also as Smoker)	Smokers with HIV
LGBTSmokers (code also as Smoker)	Smokers who are Lesbian, Gay, Bi-Sexual, or Transgender (LGBT)
TargetFemaleSmokers (code also as Smoker)	Smokers who are female and between the ages of 18-44

Section: Attitudes and Behaviors

Overall Health Impression

{Base = all respondents}

OH1. Would you say your health in general is excellent, very good, good, fair, or poor?

1. Excellent

2. Very Good

3. Good

4. Fair

5. Poor

Smoking Behavior

{Base = all smokers}

TS1. On average, how many cigarettes do you now smoke a day?

[1 PACK = 20 CIGARETTES]

[RANGE 1-100]

{Numeric response}

{Base = Respondents who SMOKE EVERY DAY (IF TS2 = 1)}

TS2. When do you typically have your first cigarette after waking up?

1. Within 5 minutes

2. 6-30 minutes

3. 31-60 minutes

4. After 60 minutes

{Base = all smokers}

TS3. How old were you when you first started to smoke cigarettes fairly regularly?

{Numeric response; mask 0-125}

E-Cigarette Use and Alternative forms Of Tobacco

{Base = all respondents}

E1. Have you ever used electronic cigarettes or e-cigarettes, such as Smoking Everywhere, NJOY, Blu or Vapor King, even one time?

1. Yes

2. No
   
   

{Base = all respondents}

E2. How likely are you to consider using electronic cigarettes or e-cigarettes, for any reason, in the future?

1. Very Likely

2. Likely

3. Neither Likely nor Unlikely

4. Unlikely

5. Very Unlikely
   
   

Subsegments	Definition
Used e-cigarettes	E1= E1_01
Open to using e-cigarettes	(E1 = E1_02 and E2 = E2_01 or E2_02 and is not categorized already as “used e-cigarettes”)}

{Base = all respondents}

E010. As far as you know or believe is the use of electronic cigarettes/e-cigarettes in combination with regular cigarettes less harmful than smoking only regular cigarettes, more harmful than smoking only regular cigarettes, or equally as harmful as smoking only regular cigarettes?

Please indicate your answer on a scale of 1 to 5, where one is much less harmful, 3 is the same as regular cigarettes, and 5 is much more harmful.

1 (much less harmful than smoking only regular cigarettes)

2

3 (equally as harmful as smoking only regular cigarettes)

4

5 (much more harmful than smoking only regular cigarettes)

{Base = used e-cigarettes and answers 02-07 to EU1b}

EU1a. Do you now use electronic cigarettes or e-cigarettes….

1. Every day

2. Some days

3. Not at all

{Base = all respondents}

E3. Have you ever used chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?

1. Yes

2. No

{Base = all respondents}

E4. Have you ever used dissolvable tobacco products, such as Camel Orbs, Sticks, or other brands?

1. Yes

2. No

{Base = all respondents}

E5. Snus is a smokeless tobacco usually sold in individual or pre-packaged small pouches that are placed under the lip against the gum. Have you ever used snus, such as Camel Snus or Marlboro Snus?

1. Yes

2. No

{Base = Smokers}

PA20. Do you believe there are health benefits to using electronic cigarettes/e-cigarettes even if you keep smoking cigarettes as well?

1. Yes

2. No

{Base = All respondents}

PA21. Is the following statement new information for you, “Using electronic cigarettes/e-cigarettes does not improve my health?”

1. Yes

2. No

Quit Attempts

{Base = smokers}

QA1. During the past 3 months, 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

{Base = smokers}

QA1d. 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

{Base = smokers who answered 1 or more to QA1 or QA1d}

QA3. When you last tried to quit smoking, did you do any of the following?

[PRESENT IN RANDOM ORDER]

1. YES

2. NO

QA3_A. Give up cigarettes all at once

QA3_B. Gradually cut back on cigarettes

QA3_C. Substitute some of your regular cigarettes with electronic cigarettes or e-cigarettes

QA3_D. Switch completely to electronic cigarettes or e-cigarettes such as Blu or NJOY

QA3_E. Switch to mild or some other brand of cigarettes

QA3_F. Use nicotine replacements like the nicotine patch or nicotine gum

QA3_G. Use medications like Zyban or Chantix

QA3_H. Get help from a telephone quit line

QA3_I. Get help from a website such as Smokefree.gov

QA3_J. Get help from a doctor or other health professional

QA3_H. Other specify

{Base = smokers}

QA4. Do you want to quit smoking cigarettes for good?

1. Yes

2. No

{Base = QA4_01}

QA5. How much do you want to quit smoking? Would you say you want to quit…

1. Not at all

2. A little

3. Somewhat

4. A lot

{Base = QA4_01}

QA6. Do you plan to quit smoking 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, or

5. More than 1 year from now

6. Not sure/Uncertain

Psychographic/Attitudinal

{Base = Current smokers}

PA1a. Please rank the top two reasons why you smoke cigarettes where “1” is the main reason and “2” is the second most important reason.

{RANDOMIZE}

1. Smoking cigarettes is a social thing to do when I’m out with friends

2. Smoking cigarettes is something to do at parties

3. I’m addicted to smoking

4. Smoking cigarettes goes well with/after meals

5. I like the taste of cigarettes

6. Smoking cigarettes helps me relax

7. Smoking cigarettes goes well when I’m drinking alcohol

8. Smoking cigarettes helps me stay awake

9. Smoking cigarettes helps when I’m stressed

10. Smoking cigarettes excites me

11. Smoking cigarettes is something to do when I’m bored

12. Smoking cigarettes helps me lose weight / not gain weight

13. I have tried to quit smoking cigarettes and cannot

14. Smoking cigarettes is something I can do with others while working

15. Other specify

{Base = All respondents}

PA8. Thinking about the last time you had a health issue or experienced any change in your physical health, where did you first look to get information?

1. Friends or family

2. Your doctor or healthcare professional

3. Internet

4. Pharmacy

5. Mobile App

6. Other Specify
   
   

{Base = All respondents}

PA2. How dangerous or safe do you think smoking cigarettes is?

1. Very dangerous

2. Dangerous

3. Neither dangerous nor safe

4. Safe

5. Very safe

{Base = All Smokers}

PA27. If you had to do it over again, would you have started smoking cigarettes? Would you say...

1. Definitely not

2. Probably not

3. Probably yes

4. Definitely yes

5. Not Sure

Demographic Information

{BASE for this section is all RESPONDENTS}

DEMO2. How many children (under age 18) live in your household:

1. None

2. 1-2 children

3. 3-4 children

4. 5 or more children

DEMO3. What is your marital status?

1. Now married

2. Living with my partner

3. Widowed

4. Divorced

5. Separated

6. Never married

7. Prefer not to answer

MILQ1. Have you ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard, or other military uniformed services?

01 Yes, now on active duty

02 Yes, on active duty during the past 12 months, but not now

03 Yes, was on active duty but not during the past 12 months

04 Am now training for Reserves or National Guard

05 No, never served in the military

{PREAMBLE}

Please indicate your race or ethnic background. Are you….?

SELECT ONE

DEMO6. Ethnicity

1. Hispanic or Latino

2. Not Hispanic or Latino

SELECT ONE OR MORE

DEMO7. Race:

1. White

1. Black or African American

2. American Indian or Alaska Native

3. Native Hawaiian or Other Pacific Islander

4. Asian

SES1. What is the highest level of education you have completed or the highest degree you have received? If you received your education in another country, please indicate the equivalent level below.

1. Less than high school

2. Completed high school or equivalent

3. Job-specific training program(s) after high school

4. Some college, but no degree

5. Associate Degree

6. College (such as B.A., B.S.)

7. Some graduate school, but no degree

8. Graduate degree (such as MBA, MS, M.D., Ph.D.)

9. Prefer not to answer

DEMO80. Which of the following income categories best describes your total 2012 household income before taxes?

1. Less than $15,000

2. $15,000 to $19,999

3. $20,000 to $24,999

4. $25,000 to $29,999

5. $30,000 to $34,999

6. $35,000 to $49,999

7. $50,000 to $74,999

8. $75,000 to $99,999

9. $100,000 or more

10. Prefer not to answer

DEMO9. Which statement best describes your current employment status?

01 Working – as a paid employee

02 Working – self-employed

03 Not working – on temporary layoff from a job

04 Not working – looking for work

05 Not working – retired

06 Not working – disabled

07 Not working – other

08 Prefer not to answer

Technology/Media

{BASE for this section is all RESPONDENTS}

T1. Think about the last time you went online to look for information...How did you begin looking?

Did you start at a search engine such as Google, Bing or Yahoo, at a site that specializes in topical information, like WebMD, at a more general site like Wikipedia, that contains information on all kinds of topics, or at a social network site like Facebook?

01 At a search engine such as Google, Bing or Yahoo

02 At a site that specializes in information, like WebMD

03 At a more general site like Wikipedia, that contains information on all kinds of topics

04 At a social network site like Facebook

05 Other specify

T2. Do you currently own a cell phone?

1. Yes

2. No

3. Don’t Know/Not Sure

{BASE = answers T2_01}
T3. Some cell phones are called "smartphones" because of certain features they have, such as Internet access and the ability to download apps. Is your cell phone a smartphone, such as an iPhone, Android, Blackberry or Windows phone?

1. Yes, I own a smartphone

2. I do not own a smartphone

Section: Overall Awareness of anti-smoking campaign and other campaign

{BASE for this section is all RESPONDENTS}

EAD2. Where have you seen or heard an advertisement for electronic cigarettes/e-cigarettes? (Select all that apply)

1. On the Internet

2. In newspapers or magazines

3. Convenience stores, supermarkets, gas stations, or shopping malls

4. On TV or at the movies

5. On the radio

6. On billboards or other outdoor ads

7. Other specify

8. None of the above

OAS1. Are you aware of any advertising or tobacco education campaigns against smoking, tobacco products, or tobacco companies that are now taking place?

1. Yes

2. No

{Base = recall anti-smoking advertising (OAS1/1)}

OAS2. Please comment on what you remember about these ads or tobacco education campaigns against smoking, tobacco products, or tobacco companies.

[OPEN END]

Section: Rough Cut Test

{Based on segment type, randomly select an eligible ad type, and randomly select an eligible ad}

Ad Type	Ad Title	Smokers	Non-Smokers	HIV Smokers	LGBT Smokers	Female Smokers
Print	“Brian’s Tip2”, Stroke/HIV consequences	300	100	0	200	0
Print	“Brian’s Tip1”, Stroke/HIV consequences	200	100	100	200	0
Print	“Amanda’s Tip”, maternal health	300	100	0	0	200
Print	“Felicita’s Tip”, periodontal disease	400	200	0	0	0
Print	“Rose’s Tip”, lung cancer	400	200	0	0	0
Radio	“Rose’s Tip”, 30 seconds, lung cancer	400	200	0	0	0
Radio	“Amanda’s Tip”, 60 seconds, maternal health	300	100	0	0	200
Radio	“Brett’s Tip”, 60 seconds, periodontal disease	400	200	0	0	0
TV	“Rose’s Tip" , 30 seconds, lung cancer	400	200	0	0	0
TV	“Amanda’s Tip”, 30 seconds, maternal health	300	100	0	0	200
TV	“Brett’s Tip", 30 seconds, periodontal disease	400	200	0	0	0
TV	“Rose’s Tip2", 30 seconds, lung cancer	400	200	0	0	0

{Assign hidden variable to Ad Type selected and Assign hidden variable to Ad selected}

{IF Ad Type is “TV”, use this language}

We would now like to show you a television ad and then gather your reactions to that ad. Please make sure the volume on your computer is turned up, so that you can both see and hear the video. Please click the forward arrow to continue. [Each respondent will review one TV ad]

{IF Ad Type is “Radio”, use this language}

Please make sure the volume on your computer is turned up, so that you may hear the audio. Please click the forward arrow at the bottom of the screen to continue. [Each respondent will review one radio ad]

{IF Ad Type is “Print”, use this language}

We would now like to show you an ad and then gather your reactions to that ad. Please click “Next” to continue. [Each respondent will review one print ad]

{For Ad Types = TV or Print: }

At top of page, before question, insert thumbnail image of ad for the rest of the questions in this survey}

{BASE = all RESPONDENTS and all Ad Types}

RC1. What do you believe is the main message of this ad?

[OPEN END]

{BASE = all RESPONDENTS and all Ad Types}

RC5. How believable or unbelievable was the person in the ad?

1. Extremely believable

2. Moderately believable

3. Slightly believable

4. Neither believable nor unbelievable

5. Slightly unbelievable

6. Moderately unbelievable

7. Extremely unbelievable

{BASE = all RESPONDENTS and all Ad Types}

RC3. People sometimes have different emotional reactions when they see or hear advertisements.

On a scale from 1 to 5, where 1 indicates not feeling any emotion, and 5 indicates feeling emotion extremely intensely, please indicate how much this advertisement made you feel:

1. Angry

2. Afraid

3. Ashamed

4. Sad

5. Hopeful

6. Understood

7. Surprised

8. Trusting

9. Motivated

10. Regretful

Scale for items RC3.A-J:

1. I do not feel this emotion

2. Slight emotion

3. Moderate emotion

4. Very intense emotion

5. Extreme and intense emotion

{BASE = all RESPONDENTS and all Ad Types}

RC4. On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please indicate how much you disagree or agree with the following statements.

1. This ad is convincing

2. This ad grabbed my attention

3. This ad was easy to understand

4. I learned something new by {TEXTFILL: if ad type = TV or Print, “viewing”; if ad type = Radio, “hearing”} this ad

5. I trust the information in this ad

6. This ad is believable

7. I would talk to someone else about this ad

8. This ad is annoying

9. The people in this ad are believable

10. This ad is worth remembering

11. This ad is powerful

12. This ad is informative

13. This ad is meaningful

14. I can identify with what the ad says

Scale for items RC4.A-N:

1. Strongly disagree

2. Somewhat disagree

3. Neither agree or disagree

4. Somewhat agree

5. Strongly agree

{BASE = all RESPONDENTS and all Ad Types}

RC5. Is there anything about the ad that is confusing, unclear, or hard to understand?

1. Confusing

2. Unclear

3. Hard to understand

4. None of the above

[Base = IF RC5 is any of 1, 2, or 3]

RC6. What was confusing, unclear or hard to understand? Please be as specific as possible.

{Open End}

{BASE = all RESPONDENTS and all Ad Types}

RC7. Was there anything about the ad that you liked?

1. Yes

2. No

{Base = ask only if Rc7.01}

RC8. What, if anything, do you like about this ad? Please be as specific as possible.

{Open End}

{BASE = all RESPONDENTS and all Ad Types}

RC9. Was there anything about the ad that you disliked?

1. Yes

2. No

{Base = ask only if Rc9.01}

RC10. What, if anything, do you dislike about this ad? Please be as specific as possible.

{Open End}

{BASE = Smokers and all Ad Types}

RC11. Does this ad make you want to quit smoking cigarettes?

1. Yes

2. No

{Base = ask only if Rc11.02}

RC12. Why doesn’t the ad make you want to quit smoking cigarettes? Please be as specific as possible.

{Open End}

{Base = ask only if Rc11.01}

RC13. What about the ad made you want to quit smoking cigarettes? Please be as specific as possible.

{Open End}

{BASE = Smokers and all Ad Types}

RC14. In the future, if you {TEXTFILL: if ad type = TV, “saw or heard this ad on television”; if ad type = Print, “saw this ad in a newspaper or magazine”; if ad type = Radio, “heard this ad on the radio”}, on a scale from 1 to 5, where 1 indicates not at all likely and 5 is extremely likely, how likely would you be to take the following actions in the next 6 months?

1. Call 1-800-QUIT-NOW for assistance in quitting smoking

2. Visit an informational government website, such as www.cdc.gov/tips for information on quitting

3. Talk with my doctor about quitting smoking

4. Not smoke around others

5. Visit the Twitter site for the campaign

6. Try to quit on your own

7. Use an e-cigarette to help quit smoking

8. Support smoke-free laws in your community

9. Do nothing

Scale for items RC14.A-H:

1. Not at all likely

2. A little likely

3. Moderately likely

4. Very likely

5. Extremely likely

{BASE = Non-Smokers and all Ad Types}

This question is about the possibility of encouraging someone you care about to quit smoking, based on the message you just {TEXTFILL: if ad type = TV or Print, “saw”; if ad type = Radio, “heard”} in the ad.

{BASE = Non-Smokers and all Ad Types}

RC15. Does the ad make you want to encourage someone to quit smoking cigarettes?

1. Yes

2. No

{Base = ask only if Rc15.02}

RC16. Why doesn’t the ad make you want to encourage someone to quit smoking? Please be as specific as possible.

{Open End}

{Base = ask only if Rc15.01}

RC17. What about the ad makes you want to encourage someone to quit smoking? Please be as specific as possible.

{Open End}

RC18. In the future, if you {TEXTFILL: if ad type = TV, “saw or heard this ad on television”; if ad type = Print, “saw this ad in a newspaper or magazine”; if ad type = Radio, “heard this ad on the radio”},, on a scale from 1 to 5, where 1 indicates not at all likely and 5 is extremely likely, how likely would you be to take the following actions in the next 6 months?

1. Call 1-800-QUIT-NOW for information to help someone you care about quit smoking

2. Visit an informational government website, such as www.cdc.gov/tips for information to help someone you care about quit smoking

3. Talk to my doctor about helping someone you care about quit smoking

4. Ask someone to not smoke around you or others

5. Encourage someone you care about to use e-cigarettes to help quit smoking

6. Visit the Twitter site for the campaign

7. Support smoke-free laws in your community

8. Encourage someone you care about to quit smoking

9. Do nothing

Scale for items RC18.A-H:

1. Not at all likely

2. A little likely

3. Moderately likely

4. Very likely

5. Extremely likely

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