Qualitative Study on Cigarettes and Smoking: Knowledge, Beliefs, and Misperceptions about cigarettes and cigarette smoking

OMB No. 0910-0674

Exp: 3/31/16

Qualitative Study on Cigarettes and Smoking
“New Information” Worksheet

Adults – List A

Please place a check mark in the box next to the statements that taught you something new about cigarettes or smoking.

	Cigarettes cause fatal lung disease
	Smoking causes death from lung diseases such as emphysema and chronic bronchitis
	Smoking permanently damages your airways and lungs
	Smoking causes COPD, a serious lung disease, and permanently scars lung tissue
	Tobacco smoke can harm your children
	Secondhand smoke causes respiratory illness in children
	Secondhand smoke causes pneumonia and other lung infections in children
	Cigarettes are addictive
	Smoking causes sexual dysfunction in men

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 1 minute per response to complete the worksheet (the time estimated to read, review, and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.