Att 4b Example Main Questionnaire

Form Approved

OMB No. 0920-0910

Exp. Date 01/31/2015

EXAMPLE

National Tobacco Prevention and Control Public Education Campaign:

Copy testing of television ads

Main Questionnaire for current or former cigarette smokers
who use or are open to using electronic cigarettes or e-cigarettes

Public reporting burden of this collection of information is estimated to average xx 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.

Categories of Qualified Respondents from Screener

Qualified Respondent Category
Current Smoker	AND	USED	Electronic cigarettes
Current Smoker	AND	MAY USE	Electronic cigarettes
Former Smoker	AND	USED	Electronic cigarettes
Former Smoker	AND	MAY USE	Electronic cigarettes

Section: Attitudes and Behaviors

Overall Health Impression

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

Tobacco Smoking Behavior

{Base = all qualified 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 respondents}

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

{Numeric response; mask 0-125}

{Base = all respondents}

TS4. Where do you smoke most often?

5. At home

6. At work

7. Friend’s or family’s house

8. In my car or other type of vehicle

9. Someone else’s car or other type of vehicle

10. At a party

11. At a restaurant

12. At a bar

13. Outdoors

14. Somewhere else (other specify)

{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 just feel like smoking cigarettes

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 = Former smokers}

PA1b. Please rank the top two reasons why you used to smoke cigarettes where “1” was the main reason you smoked and “2” was the second most important reason you smoked.

{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 just feel like smoking cigarettes

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}

PA9. How much do you agree or disagree with each of the following statements?

1. I know everything there is to know about the physical effects of smoking cigarettes

2. I wish I knew more about the physical effects of smoking cigarettes

3. I think that smoking cigarettes is addictive

4. Nicotine Replacement Therapy, such as nicotine gum or patch, makes it easier to quit

PA10b. How much do you agree or disagree with each of the following statements?

1. There’s nothing wrong with smoking cigarettes

2. Smoking cigarettes is not such a big deal, it’s just a lot of negative hype

3. I would consider quitting smoking cigarettes because I don’t want to harm my family or friends with second-hand smoke

4. Smoking cigarettes seems acceptable because I see it all the time in movies

5. When someone quits smoking cigarettes, the risk of getting a tobacco-related illness goes away

6. Smoking cigarettes is a reward

7. I have more respect for people who have quit smoking cigarettes than for people who have never smoked

8. Non-smokers don’t want to date someone who smokes

9. People who smoke cigarettes have more friends

10. There is nothing wrong with using electronic cigarettes/e-cigarettes

Scale for each of the items in PA10b:

1. Strongly agree

2. Somewhat agree

3. Neither agree nor disagree

4. Somewhat disagree

5. Strongly disagree

{Base = All respondents}

PA4. How much does smoking cigarettes relieve stress for you?

1. Extremely stress-relieving

2. Very stress-relieving

3. Somewhat stress-relieving

4. Slightly stress-relieving

5. Not at all stress-relieving

{Base=current smokers}

PA24. Would quitting smoking cigarettes positively impact your relationship with family or friends?

1. Yes, it would positively impact my relationship with family or friends

2. It would neither positively or negatively impact my relationship

3. It would negative impact my relationship with family or friends

{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

E-Cigarette Behavior

{PREAMBLE}

The next questions are about electronic cigarettes, often called e-cigarettes. An e-cigarette looks like a regular cigarette, but it runs on a battery and produces vapor instead of smoke. There are many types of 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)

E-Cigarette Behavior (USES)

{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 = used e-cigarettes}

EU1c. Do you usually use disposable electronic cigarettes/e-cigarettes ,an electronic cigarette/e-cigarette that uses cartridges, or an electronic cigarette/e-cigarette that uses tanks?

Please indicate the type of e-cigarette that you use the most.

1. Disposable electronic cigarettes/e-cigarettes

2. Electronic cigarette/e-cigarette that uses cartridges

3. Electronic cigarette/e-cigarette that uses tanks

{Base = responded to EU1c)

B9b. On average, about how many [FILL “disposable e-cigarettes” IF EU1c =1]; [FILL “e-cigarette cartridges” if EU1c =2]; [FILL “e-cigarette tanks” if EU1c =3] do you now use each week?

                ________________ [ENTER NUMBER]

{Base = used e-cigarettes}

EU3. Do you use electronic cigarettes/e-cigarettes in places where smoking regular cigarettes is not allowed?

1. Yes

2. No

{Base = used e-cigarettes and is current smoker}

EU5. Which do you enjoy more, using electronic cigarettes/e-cigarettes or smoking cigarettes?

1. I enjoy using electronic cigarettes/e-cigarettes more than smoking cigarettes

2. I enjoy smoking cigarettes more than using electronic cigarettes/e-cigarettes

3. I don’t enjoy using electronic cigarettes/e-cigarettes and I don’t enjoy smoking cigarettes

4. I enjoy both equally

{Base = used e-cigarettes and is current smoker}

EU6. Has the number of cigarettes you smoke increased, decreased, or stayed about the same since you started using electronic cigarettes/e-cigarettes?

1. The number of cigarettes I smoke has increased since I started using electronic cigarettes/e-cigarettes

2. The number of cigarettes I smoke has decreased since I started using electronic cigarettes/e-cigarettes

3. The number of cigarettes I smoke has stayed about the same since I started using electronic cigarettes/e-cigarettes

{Base = used e-cigarettes and is former smoker}

EU7. As a former smoker, when you smoked cigarettes, did you also use electronic cigarettes/e-cigarettes at that time?

1. I used electronic cigarettes/e-cigarettes when I smoked cigarettes

2. I did not use electronic cigarettes/e-cigarettes until after I quit smoking cigarettes

{Base = used e-cigarettes and is former smoker and answered 01 to EU7}

EU7b. Did you use e-cigarettes as a way to quit smoking regular cigarettes?

1. Yes, I used electronic cigarettes/e-cigarettes to quit smoking regular cigarettes

2. I did not use electronic cigarettes/e-cigarettes to quit smoking regular cigarettes

{Base = used e-cigarettes and is former smoker and answered 01 to EU7b}

EU7c. Do you plan to continue to use e-cigarettes as a replacement for regular cigarettes?

1. Yes, I will continue to use e-cigarettes as a replacement for regular cigarettes

2. I plan to stop using e-cigarettes

3. I have stopped using e-cigarettes

{Base = used e-cigarettes}

B12a. Do you use electronic/e-cigarettes in any of the following places?

1. Yes

2. No

[ANSWER ALL, RANDOMIZE ORDER]

B12a_1. Restaurants or bars

B12a_2. Stores or shopping malls

B12a_3. Airplanes

B12a_4. Beaches, parks, or other outdoor places

B12a_5. In your car or other type of vehicle

B12a_6. In your home

B12a_7. Somewhere else, specify

{Base = used e-cigarettes}

EU21. Have you considered using electronic cigarettes/e-cigarettes in any of the following locations? (Select all that apply)

1. Restaurants or bars

2. Stores or shopping malls

3. Airplanes

4. Beaches, parks, or other outdoor places

5. In your car or other type of vehicle

6. In your home

7. Somewhere else, specify _______________

8. I have not thought about using electronic cigarettes/e-cigarettes in any of the above locations {Exclusive; ANCHOR}

{Base = used e-cigarettes}

EU9. Do you use electronic cigarettes/e-cigarettes more indoors, outdoors, or about the same?

1. Outdoors

2. Indoors

3. About the same

{Base = used e-cigarettes}

EU10. Do you usually use electronic cigarettes/e-cigarettes when you are alone, or when you are with other people?

1. I usually use electronic cigarettes/e-cigarettes when I am alone

2. I usually use electronic cigarettes/e-cigarettes when I am with other people

3. I usually use electronic cigarettes/e-cigarettes about the same when I am alone and when I am with other people

{Base = used e-cigarettes}

EU11. Do you think using electronic cigarettes/e-cigarettes is more socially acceptable than smoking cigarettes?

1. Yes, using electronic cigarettes/e-cigarettes is more socially acceptable

2. No, using electronic cigarettes/e-cigarettes is equally as socially acceptable as smoking cigarettes

3. No, using electronic cigarettes/e-cigarettes is less socially acceptable than smoking cigarettes

{Base = used e-cigarettes and is current smoker}

EU12. Are you embarrassed to use electronic cigarettes/e-cigarettes in front of other people?

1. Yes, I am embarrassed to use electronic cigarettes/e-cigarettes in front of other people

2. No I am not embarrassed to use electronic cigarettes/e-cigarettes in front of other people

{Base = used e-cigarettes}

EC13. Are any of the following a reason why you [IF EU1A=3, FILL: first tried; IF EU1A =1 or 2, FILL: currently use] electronic cigarettes/e-cigarettes?

1. Yes

2. No

EC13_1. They cost less than other forms of tobacco

EC13_2. They can be used in places where smoking cigarettes isn’t allowed

EC13_3. They might be less harmful to me than regular cigarettes

EC13_4. They might be less harmful to people around me than regular cigarettes

EC13_5. Electronic cigarettes/e-cigarettes come in flavors I like

EC13_6. Electronic cigarettes/e-cigarettes can help me quit smoking regular cigarettes

EC13_7. Electronic cigarettes/e-cigarettes can help me reduce the number of regular cigarettes I smoke.

EC13_8. Electronic cigarettes/e-cigarettes don’t smell

EC13_9. Using an electronic cigarette/e-cigarette feels like smoking a regular cigarette

EC13_10. Electronic cigarettes/e-cigarettes don’t bother people who don’t use tobacco

EC13_11. The advertising for electronic cigarettes/e-cigarettes appeals to me.

EC13_12. They help me deal with cravings to smoke.

EC13_13. I have a friend or family member who suggested I use electronic cigarettes/e-cigarettes as a way to quit smoking.

EC13_14. I was curious about electronic cigarettes/e-cigarettes

EC13_15. Other, specify________________________

EC21. Which of those is the main reason you might want to use electronic cigarettes/e-cigarettes?

{IF MORE THAN ONE ITEM SELECTED IN EC13, DISPLAY LIST OF ALL REASONS SELECTED IN EC13. IF ONLY ONE ITEM SELECTED IN EC13, FILL FOR EC21}

[BASE = IF EU1A = 3, ASK EC21a]

EC21a. You indicated previously that you have tried electronic cigarettes/e-cigarettes before but do not currently use them. Using the text box below, tell us in a few words why you do not use electronic cigarettes/e-cigarettes now.

OPEN-ENDED________________________

[BASE = IF EU1A = 1 or 2, ASK EC21b]

EC21b. You indicated previously that you currently smoke cigarettes and also currently use electronic cigarettes/e-cigarettes. Using the text box below, tell us in a few words why your reasons for not switching completely from regular cigarettes to electronic cigarettes/e-cigarettes.

OPEN-ENDED________________________

{Base = used e-cigarettes}

EC14. Where have you purchased electronic cigarettes/e-cigarettes and/or the nicotine refill packs?

1. Over the Internet

2. Convenience stores

3. Drug stores or pharmacies

4. Gas stations

5. Specialty e-cigarette shops (sometimes called vape shops)

6. Shopping malls

7. Other specify

E-Cigarette Behavior (Open to Using)

{Base = open to using e-cigarettes}

EO1. Are you thinking about using electronic cigarettes/e-cigarettes…

1. within the next 30 days

2. within the next 6 months

3. within the year

4. longer than a year

{Base = open to using e-cigarettes and is current smoker}

EO3. Do you think you will use electronic cigarettes/e-cigarettes for those times when you are unable to smoke cigarettes?

1. Yes

2. No

{Base = open to using e-cigarettes and is current smoker}

EO4. Do you think if you start using electronic cigarettes/e-cigarettes, the number of cigarettes you smoke will probably increase, decrease, or stay the same?

1. The number of cigarettes I smoke will probably decrease if I use electronic cigarettes/e-cigarettes

2. The number of cigarettes I smoke will probably increase if I use electronic cigarettes/e-cigarettes

3. The number of cigarettes I smoke will probably stay the same if I use electronic cigarettes/e-cigarettes

{Base = open to using e-cigarettes}

EO6. If you started using electronic cigarettes/e-cigarettes, where do you think you would use e-cigarettes most often?

1. In an airplane

1. At home

2. At work

3. Friend’s or family’s house

4. In my car or other type of vehicle

5. Someone else’s car or other type of vehicle

6. At a party

7. At a restaurant

8. At a bar

9. Outdoors

10. Somewhere else (other specify) {ANCHOR}

{Base = open to using e-cigarettes}

E08. Do you think using electronic cigarettes/e-cigarettes is more socially acceptable than smoking cigarettes?

1. Yes, using electronic cigarettes/e-cigarettes is more socially acceptable than smoking cigarettes

2. No, using electronic cigarettes/e-cigarettes is equally as socially acceptable as smoking cigarettes

3. No, using electronic cigarettes/e-cigarettes is less socially acceptable than smoking cigarettes

{Base = open to using e-cigarettes}

EO13. Are any of the following a reason why you might want to use electronic cigarettes/e-cigarettes?

1. Yes

2. No
   
   

EO13_1. They cost less than other forms of tobacco

EO13_2. They can be used in places where smoking cigarettes isn’t allowed

EO13_3. They might be less harmful to me than regular cigarettes

EO13_4. They might be less harmful to people around me than regular cigarettes

EO13_5. Electronic cigarettes/e-cigarettes come in flavors I like

EO13_6. Electronic cigarettes/e-cigarettes can help me quit smoking regular cigarettes

EO13_7. Electronic cigarettes/e-cigarettes can help me reduce the number of regular cigarettes I smoke.

EO13_8. Electronic cigarettes/e-cigarettes don’t smell

EO13_9. Using an electronic cigarette/e-cigarette feels like smoking a regular cigarette

EO13_10. Electronic cigarettes/e-cigarettes don’t bother people who don’t use tobacco

EO13_11. The advertising for electronic cigarettes/e-cigarettes appeals to me.

EO13_12. They help me deal with cravings to smoke.

EO13_13. I have a friend or family member who suggested I use electronic cigarettes/e-cigarettes as a way to quit smoking.

EO13_14. I was curious about electronic cigarettes/e-cigarettes

EO13_15. Other, specify________________________

EO21. Which of those is the main reason you might want to use electronic cigarettes/e-cigarettes?

{IF MORE THAN ONE ITEM SELECTED IN EO13, DISPLAY LIST OF ALL REASONS SELECTED IN EO13. IF ONLY ONE ITEM SELECTED IN EO13, FILL FOR EO21}

{Base = All respondents}

E010. Compared to cigarettes, how harmful do you think electronic cigarettes/e-cigarettes are to a person’s health?

1. A lot less harmful

2. A little less harmful

3. About the same

4. A little more harmful

5. A lot more harmful

Other forms of tobacco/nicotine use

{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

E7. Do you think there are health risks associated with using smokeless tobacco products, such as chewing tobacco, snuff, dip, dissolvable tobacco products, or snus, or are there no health risks from using them?

1. There are definitely health risks associated with using smokeless tobacco products

2. There are probably health risks associated with using smokeless tobacco products

3. There are probably some non-serious health risks associated with using smokeless tobacco products

4. There are probably no health risks associated with using smokeless tobacco products

5. There are definitely no health risks associated with using smokeless tobacco products

Quit Attempts

{Base = Current 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 = Current 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 = Current smokers}

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

QA3_D. Substitute some of your regular cigarettes with electronic cigarettes or e-cigarettes

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

{Base = Current 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

Attitudinal

{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}

PA10a. How much do you agree or disagree with each of the following statements?

1. I hope good things happen in my life, but I often feel that I don’t have much control

2. I make things happen in my life

3. I set goals for my future

4. I believe a person should take life as it comes – whatever happens, happens

5. Life has been good to me so far

6. I believe in my ability to make important changes in the world

7. Spirituality and/or religion play a big part in my life

8. I am confident that I have the ability to achieve my dreams

Scale for each of the items in PA10a:

6. Strongly agree

7. Somewhat agree

8. Neither agree nor disagree

9. Somewhat disagree

10. Strongly disagree

{Base = used e-cigarettes}

PA13. How much is using electronic cigarettes/e-cigarettes a social activity to do with friends?

1. Extremely social

2. Very social

3. Somewhat social

4. Slightly social

5. Not at all social

{Base = used e-cigarettes}

PA14a. Which of the following statements best describes your usage of e-cigarettes?

1. I feel comfortable using my e-cigarettes in all locations or places

2. There are some locations or places where I feel uncomfortable using e-cigarettes
   
   

{Base = used e-cigarettes and answers PA14a_01}

PA14b. What specific locations or places would you NOT use electronic cigarettes/e-cigarettes?

{OPEN-END}

{Base = used e-cigarettes and answers PA14a_01}

PA15. Why would you not use electronic cigarettes/e-cigarettes in those locations or places?

{OPEN-END}

{Base = All respondents}

PA19. Do you think using electronic cigarettes/e-cigarettes keeps you from quitting smoking cigarettes, for good?

1. Yes

2. No

{Base = All respondents}

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

{Base = open to using e-cigarettes}

PA22. Why are you thinking about using electronic cigarettes/e-cigarettes?

{OPEN-END}

{Base=all respondents}

PA26. Did a friend or family member tell you about health benefits of electronic cigarettes/e-cigarettes when compared to cigarette smoking?

1. Yes

2. No

Demographics

{Base for this section is all respondents}

DEMO1. What is your gender?

1. Male

2. Female

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

DEMO4. Do you consider yourself to be (Select all that apply):

01 Heterosexual / Straight

02 Lesbian

03 Gay (male)

04 Bisexual

05 Transgender

06 Something else – please specify ______________

07 Prefer not to answer

MILQ1 Have you ever served on active duty in the U.S. Armed Forces, Military Reserves, 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

2. Black or African American

3. American Indian or Alaska Native

4. Native Hawaiian or Other Pacific Islander

5. 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

DEMO8. 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

{BASE = answers T3_01}

T11. Is the smartphone you use most often …?

1. An iPhone

2. An Android device (e.g. Motorola Droid, Samsung Galaxy, etc.)

3. A Blackberry

4. A Windows Phone

5. Something else

{BASE = answers T2_01}

T4. How often do you access the Internet on your smartphone?

1. More than once per day

2. Once per day

3. A few times per week

4. Once per week

5. Less than once per week

6. Rarely

7. Never

T5. During a typical month in the past year, how often did you read a newspaper in print or on the Internet?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Not at all

T7. During a typical month in the past year, how often did you watch television or television Internet sites?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Not at all

T8. During a typical month in the past year, how often did you listen to the radio?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Not at all

T9. During a typical month in the past year, how often did you obtain information from Internet sources such as blogs, chat rooms, or independent news services?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Not at all

Section: Overall Awareness of Publicly Available Ads

{Base = All respondents}

EAD1. Have you seen or heard one or more ads for electronic cigarettes/e-cigarettes in the past three months?

1. Yes

2. No

{Base = EAD1_01}

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

{Base = EAD2=01}

EAD3. When you are using the Internet, how often do you see ads or promotions for electronic cigarettes/e-cigarettes?

1. I do not use the Internet

2. Never

3. Rarely

4. Sometimes

5. Most of the time

6. Always

{Base = EAD2_02}

EAD4. When you read newspapers or magazine, how often do you see ads or promotions for electronic cigarettes/e-cigarettes?

1. I do not read newspapers or magazines

2. Never

3. Rarely

4. Sometimes

5. Most of the time

6. Always

 

{Base = EAD2=03}

EAD5a. When you go to a convenience store, supermarket, gas station, or shopping mall, how often do you see ads or promotions for electronic cigarettes/e-cigarettes?

1. I do not go to convenience stores, supermarkets, gas stations, or shopping malls

2. Never

3. Rarely

4. Sometimes

5. Most of the time

6. Always

 

{Base = EAD2_04}

EAD5b. When you watch television or go to the movies, how often do you see ads or promotions for electronic cigarettes/e-cigarettes?

1. I do not watch TV or go to the movies

2. Never

3. Rarely

4. Sometimes

5. Most of the time

6. Always

EAD6. After you seen or heard an ad for electronic cigarettes/e-cigarettes, have you ever had an urge to smoke a cigarette?

1. Yes

2. No

{Base = All respondents}

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

3. Yes

4. 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: Copy Test

{Base in this section = all respondents or as indicated}

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 “Next” to continue.

[Respondent will review one of three ads}

{Image of ad should be at top of page when the rest of the questions are asked}

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

[OPEN END]

RC2. 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

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 with extreme intensity, 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 did not feel this emotion

2. Slight emotion

3. Moderate emotion

4. Very intense emotion

5. Extreme and intense emotion

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 viewing or 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

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}

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

1. Yes

2. No

{Base = answered Rc7.01}

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

{Open End}

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 = Current smokers}

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 = All respondents}

RC14. In the future, if you saw or heard this ad on television, on a scale from 1 to 5, where 1 indicates not at all likely and 5 is very 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 my own

7. Use an electronic cigarette/ e-cigarette to help quit smoking

8. Support smoke-free laws in my community

9. Do nothing

Scale for items RC14.A-H:

1. Very Unlikely

2. Unlikely

3. Neither Likely Nor Unlikely

4. Likely

5. Very Likely

{UNAIDED}

{Base = All respondents}

U2. What do you remember of the URL (web address) listed (even if you remember only parts of the URL, list those parts)

[OPEN END]

{Base = All respondents}

U3. Imagine you are at a search engine site, like Google, Yahoo or Bing. Please type in the words or phrases you would use to get more information on quitting smoking, given the ad that you just saw.

{OPEN-END – make the open-end box look like Google’s Search Engine}

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