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
“Top 3 attention-grabbing statements” Worksheet

Adolescents – List B

Please put an X in the boxes next to the 3 statements that grabbed your attention the most. On the line under each of those three statements, please write a brief reason why that statement got your attention.

	Cigarettes cause cancer
	Smoking causes many forms of cancer such as lung, liver, stomach, oral, cervical, pancreatic, kidney, colorectal, bone marrow, blood, and bladder cancer
	Smoking causes bladder cancer which can lead to painful and frequent urination
	Cigarettes cause strokes and heart disease
	Smoking causes heart attacks and strokes by clogging your arteries
	Smoking causes gangrene, Buerger’s disease, and diabetes which can lead to amputation of limbs.
	Smoking causes blindness
	Secondhand smoke causes death in nonsmokers

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.