Media Tracking Questionnaire
Food and Drug Administration's Research and Evaluation Survey for the Public Education Campaign on Tobacco among LGBT (RESPECT)
Attacchment2_FollowUp_Instrument
Media Tracking Questionnaire
OMB: 0910-0808
Attachment 2: lgbt young adult follow-up Instrument
Form Approved
OMB No. 0910-0808
Exp. Date 01/31/2019
Research and Evaluation Survey for the Public Education Campaign on Tobacco among Lesbian Gay Bisexual Transgender (LGBT) (RESPECT) – Follow-Up Survey
Subjects for Questionnaire:
Section AA: Informed Consent
Section A: Demographic Items
Section B: Tobacco Use Behavior
Section C: Tobacco Use Intentions and Self-Efficacy
Section D: Cessation (Intention, Behavior, Motivation)
Section E: Attitudes, Beliefs & Risk Perceptions, Social Norm
Section F: Media Use and Awareness
Section G: Environment
Section H: LGBT Identity and Community
Notes: LGBT stands for Lesbian Gay Bisexual Transgender
The “Prefer not to answer” option will be available for all questions; however, it will not be visible on the screen. Rather respondents will have the option of continuing to the next question without answering the current question. If they do, they will be prompted to answer the question they skipped and “Prefer not to answer” will appear as an option.
Section AA: Informed consent
AA1. [THE INFORMED CONSENT TEXT WILL BE INSERTED HERE.]
Y_video [IF WEB] Please try to view this video to make sure you can see it.
[DISPLAY OCEAN VIDEO]
Y_video1 [IF WEB] Are you able to view this video?
Yes
No
[IF Y_video1 IS NO (=2), display this message:]
Viewing the videos in this survey is important. Try logging into the survey using a different computer or browser. If that doesn’t work, you will not be able to take the survey online.
[IF NO, NEED to BEGIN with the viewing of the VIDEO when the R comes back to the survey from a different device.]
LAND. [IF R IS ON MOBILE DEVICE]
It looks like you are viewing this survey on a cell phone. This survey works best in landscape mode.
Section A: Demographic Items
The first part of the survey asks you some general questions about yourself.
A1. What is your date of birth? (mm-dd-yyyy)? Select 99-9999 if you prefer not to answer.
A2. Are you Hispanic, Latino/a, or of Spanish origin? Check all that apply.
1 No, not of Hispanic, Latino/a, or Spanish origin
2 Yes, Mexican American, Chicano/a
3 Yes, Puerto Rican
4 Yes, Cuban
5 Yes, another Hispanic, Latino/a, or Spanish origin
9 Prefer not to answer
A3. What race or races do you consider yourself to be? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER or YOU MAY SKIP THIS QUESTION)
-
1
Yes
2
No
9
Prefer Not to Answer
A3_1. American Indian or Alaska Native
1
2
9
A3_2. Asian
1
2
9
A3_3. Black or African American
1
2
9
A3_4. Native Hawaiian or Other Pacific Islander
1
2
9
A3_5. White
1
2
9
A3_6. Other
1
2
9
A3_7. Prefer not to answer
A4. Which best describes your current job or paid employment status?
1 Work full-time at least 35 hours per week
2 Work part-time 15 to 34 hours per week
3 Work part-time less than 15 hours per week
4 I don't currently work for pay
5 Don’t know
9 Prefer not to answer
A5. What is the highest grade or level of school you have completed?
1 Less than high school
2 Some high school, no diploma
3 GED
4 High school graduate—diploma
5 Some college but no degree
6 Associate degree—occupational/vocational
7 Associate degree—academic program
8 Bachelor’s degree (ex: BA, AB, BS)
9 Master’s degree (ex: MA, MS, MEng, Med, MSW)
10 Professional school degree (ex: MD, DDS, DVM, JD)
11 Doctorate degree (ex: PhD, EdD)
12 Don’t know
99 Prefer not to answer
A6. Are you currently enrolled in a degree program?
1 Yes
2 No
3 Don’t know
9 Prefer not to answer
A8. Which of the following categories best describes your total household income in the past 12 months?
This is the total income before taxes of all persons in your household combined. Please include money from jobs, relatives, pensions, dividends, interest, social security payments or retirement benefits, net income from business, farm or rent, and any other money received by household members.
1 Less than $10,000
2 $10,000 to $14,999
3 $15,000 to $24,999
4 $25,000 to $34,999
5 $35,000 to $49,999
6 $50,000 to $74,999
7 $75,000 to $99,999
8 $100,000 to $149,999
9 $150,000 to $199,999
10 $200,000 or more
11 Don’t know
99 Prefer not to answer
Section B: Tobacco Use Behavior
The next section asks about your experiences with tobacco products.
Cigarette Use
B1. Have you ever tried cigarette smoking, even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
B2. [IF B1=1 or 9] During the past 30 days, on how many days did you smoke cigarettes? Enter 99 if you prefer not to answer.
|_|_| days [RANGE: 0-30, 99]
[PN: IF RESPONDENT DOESN’T ANSWER 0-30, FILL WITH 99]
B3. [IF B2=1 to 30] During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?
1 Fewer than 5 cigarettes
2 5-9 cigarettes
3 10 cigarettes (1/2 a pack)
4 11-19 cigarettes (more than 1/2 pack but less than 1 pack)
5 20 cigarettes (1 pack)
6 30 cigarettes (1 ½ packs)
7 40 cigarettes (2 packs)
8 More than 40 cigarettes (more than 2 packs)
9 Prefer not to answer
B4. [IF B2=1 to 30] On the days that you smoke, how soon after you wake up do you have your first cigarette? Would you say…
1 Within 5 minutes
2 6-30 minutes
3 31-60 minutes
4 After 60 minutes
9 Prefer not to answer
B5. [IF B2=1 to 30] Do you consider yourself a smoker?
1 Yes
2 No
9 Prefer not to answer
B6. [IF B2=1 to 30] Do you consider yourself a social smoker?
1 Yes
2 No
9 Prefer not to answer
B7. [IF B1=1] About how many cigarettes have you smoked in your entire life? Your best guess is fine.
1 1 or more puffs but never a whole cigarette
2 1 cigarette
3 2 to 5 cigarettes
4 6 to 15 cigarettes (about 1/2 a pack total)
5 16 to 25 cigarettes (about 1 pack total)
6 26 to 99 cigarettes (more than 1 pack, but less than 5 packs)
7 100 or more cigarettes (5 or more packs)
9 Prefer not to answer
B8. [IF B1=1 AND B2=0 OR 99] About how long has it been since you last smoked cigarettes?
1 More than 30 days ago but within the past 3 months
2 More than 3 months ago but within the past 12 months
3 More than 12 months ago but within the past 3 years
4 More than 3 years ago
9 Prefer not to answer
Other Tobacco and Substance Use
B9. Have you ever used smokeless tobacco, such as chewing tobacco, snuff, snus (rhymes with goose) or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal even just a small amount?
1 Yes
2 No
9 Prefer not to answer
B10. [IF B9=1]During the past 30 days, on how many days did you use chewing tobacco, snuff, snus or dip?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B11. Have you ever smoked cigars, cigarillos, or little cigars such as Swisher Sweets, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s, even one or two puffs?
1 Yes
2 No
9 Prefer not to answer
[IF B11=1, ASK B12]
B12. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars such as Swisher Sweets, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B13. Have you ever tried smoking tobacco out of a water pipe (also called “hookah”)?
1 Yes
2 No
9 Prefer not to answer
[IF B13=1, ASK B14]
B14. During the past 30 days, on how many days did you smoke tobacco out of a water pipe (also called “hookah”)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B15. These are examples of electronic nicotine products: e-cigarettes, e-cigars, e-hookahs, e-pipes, vape pens, hookah pens, mods, and personal vaporizers. These products are battery-powered, usually use nicotine fluid, and produce vapor instead of smoke. Some common brands include Fin, NJOY, Blu, e-GO, and Vuse. Have you ever tried these products, even once or twice?
1 Yes
2 No
9 Prefer not to answer
B16. [IF B15=1]During the past 30 days, on how many days did you use electronic nicotine products, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
B17. During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
Section C: Tobacco Use Intentions and Self-Efficacy[]
C1. [IF B1=2 OR B2= 0] Thinking about the future…
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
9 Prefer Not to Answer |
C1_1. |
Do you think that you will try a cigarette soon? |
1 |
2 |
3 |
4 |
9 |
C1_2. |
Do you think you will smoke a cigarette at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_3. |
If one of your best friends were to offer you a cigarette, would you smoke it? |
1 |
2 |
3 |
4 |
9 |
C2. How sure are you that, if you really wanted to, you could avoid smoking cigarettes if…
[RANDOMIZE C2_1-C2_4]
|
1 Not at all sure |
2 Slightly sure |
3 Somewhat sure |
4 Mostly sure |
5 Completely sure |
9 Prefer Not to Answer |
|
C2_1. You are at a party, bar or club? |
1 |
2 |
3 |
4 |
5 |
9 |
|
C2_2. You are in a place where most people are smoking? |
1 |
2 |
3 |
4 |
5 |
9 |
|
C2_2. Someone you know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
|
C2_3. Someone you want to get to know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
|
C2_4. Someone offers it to take a break? |
1 |
2 |
3 |
4 |
5 |
9 |
|
C2_5. Someone offers it to take a break? |
1 |
2 |
3 |
4 |
5 |
9 |
|
Section D: Cessation (Intention, Behavior, Motivation)
Cigarette Use
D1. [IF B2=1-30] How much do you want to stop smoking for good? Would you say…?
1 Not at all
2 A little
3 Somewhat
4 A lot
9 Prefer not to answer
D2. [IF B2=1-30]How much do you think your health would improve if you were to stop smoking for good?
1 Not at all
2 A little
3 Somewhat
4 A lot
9 Prefer not to answer
D3. [IF B2=1-30]How worried are you that smoking will damage your health in the future?
1 Not at all worried
2 A little worried
3 Somewhat worried
4 Very worried
9 Prefer not to answer
D4. [IF B2=1-30]How worried are you that smoking will damage your physical appearance or attractiveness?
1 Not at all worried
2 A little worried
3 Somewhat worried
4 Very worried
9 Prefer not to answer
[Ask ALL]
Section E: Attitudes, Beliefs & Risk Perceptions, Social Norms
The next set of questions asks for your opinions on cigarette use and other tobacco products.
Attitude
E1. How much do you agree or disagree with the following statements about people who are tobacco-free?
[RANDOMIZE ALL ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E1_1. |
People who are tobacco-free are confident. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_2. |
People who are tobacco-free are trendsetting. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_3. |
People who are tobacco-free are happy. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_4. |
People who are tobacco-free are judgmental. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_5. |
People who are tobacco-free are attractive. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_6. |
People who are tobacco-free are basic. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_7. |
People who are tobacco-free are boring. |
1 |
2 |
3 |
4 |
5 |
9 |
E1_8. |
People who are tobacco-free are predictable. |
1 |
2 |
3 |
4 |
5 |
9 |
E2. Smoking cigarettes is… (pick one)
[RANDOMIZE E2_1-E2_2]
E2_1. |
Bad |
|
|
|
|
|
|
|
Good |
E2_2. |
Unenjoyable |
|
|
|
|
|
|
|
Enjoyable |
E3A. [IF B1= 2 OR B2= 0 AND B9=2 OR B10= 1 AND B11= 2 OR B12= 1 AND B13= 2 OR B14= 1 AND B15= 2 OR B16= 1] How much do you agree or disagree with the following statements?
[RANDOMIZE E3A_1-E3A_5]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E3A_1. |
I am proud to live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E3A_2. |
Living tobacco-free is important to me. |
1 |
2 |
3 |
4 |
5 |
9 |
E3A_3. |
Tobacco use is harmful to the LGBT community. |
1 |
2 |
3 |
4 |
5 |
9 |
E3A_4. |
Being tobacco free when I go out makes me feel excluded. |
1 |
2 |
3 |
4 |
5 |
9 |
E3A_5. |
Using tobacco makes life harder. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B. [IF B2 NE 0 OR B10 NE 1 OR B12 NE 1 OR B14 NE 1 OR B16 NE 1] How much do you agree or disagree with the following statements?
[RANDOMIZE E3B_1-E3B_7]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E3B_1. |
I would be proud to live tobacco-free. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B_2. |
Living tobacco-free is important to me. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B_3. |
If I lived tobacco-free I would be proud to tell other people. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B_4. |
Using tobacco interferes with my life. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B_5. |
Tobacco use is harmful to the LGBT community. |
1 |
2 |
3 |
4 |
5 |
9 |
E3B_6. |
If I was tobacco free I would feel excluded when I go out. |
1 |
2 |
3 |
4 |
5 |
9 |
E3_7. |
Using tobacco makes life harder. |
1 |
2 |
3 |
4 |
5 |
9 |
E4. How much do you agree or disagree with the following statements? If I smoke cigarettes every day, I will…
[RANDOMIZE ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E4_1. |
Shorten my life |
1 |
2 |
3 |
4 |
5 |
9 |
E4_2. |
Be able to stop smoking when I want to |
1 |
2 |
3 |
4 |
5 |
9 |
E4_3. |
Damage my immune system |
1 |
2 |
3 |
4 |
5 |
9 |
E4_4. |
Turn off potential partners |
1 |
2 |
3 |
4 |
5 |
9 |
E4_5. |
Damage my teeth |
1 |
2 |
3 |
4 |
5 |
9 |
E4_6. |
Damage my skin |
1 |
2 |
3 |
4 |
5 |
9 |
E4_7. |
Develop lung cancer |
1 |
2 |
3 |
4 |
5 |
9 |
Social Norms
E5. How many of your four closest friends…
|
|
0 None |
1 One |
2 Two |
3 Three |
4 Four |
9 Prefer Not to Answer |
E5_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E5_2. |
Use a hookah or water pipe to smoke tobacco? |
0 |
1 |
2 |
3 |
4 |
9 |
E5_3. |
Use electronic nicotine products such as “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”,
Common brands are Blu, Njoy, Logic, Fin, Swisher, 21st Century Smoke, Vuse, Markten, V2 Cigs, Nicotek or Vapin Plus. |
0 |
1 |
2 |
3 |
4 |
9 |
E6. How many LGBT people who are your age...
|
|
0 None |
1 A few |
2 Some |
3 Most |
4 All |
9 Prefer Not to Answer |
E6_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_2. |
Use a hookah or water pipe to smoke tobacco? |
0 |
1 |
2 |
3 |
4 |
9 |
E6_3. |
Use electronic nicotine products such as “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?
Common brands are Blu, Njoy, Logic, Fin, Swisher, 21st Century Smoke, Vuse, Markten, V2 Cigs, Nicotek or Vapin Plus. |
0 |
1 |
2 |
3 |
4 |
9 |
E7. How do LGBT people your age feel about cigarette smoking? Would YOU say most LGBT people your age...
2 Strongly disapprove
3 Somewhat disapprove
4 Neither approve nor disapprove
4 Somewhat approve
4 Strongly approve
9 Prefer not to answer
E8. Compared to 3 months ago, people your age at LGBT bars, clubs and events are smoking...
1 More often
2 Less often
3 About the same
4 Not sure
9 Prefer not to answer
Perceived Approval
E9. How much do you agree or disagree with the following statements?
[RANDOMIZE E9_1-E9_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E9_1. |
According to my friends, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_2. |
According to most people who hang out where I hang out, it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E9_3. |
According to people my age in LGBT communities it is very important for me to not smoke cigarettes. |
1 |
2 |
3 |
4 |
5 |
9 |
E10. How much do you agree or disagree with the following statements? If I only smoke cigarettes on some days (for example, smoking only when I go out), I will…
[RANDOMIZE ROWS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E10_1. |
Shorten my life |
1 |
2 |
3 |
4 |
5 |
9 |
E10_2. |
Be able to stop smoking when I want to |
1 |
2 |
3 |
4 |
5 |
9 |
E10_3. |
Damage my immune system |
1 |
2 |
3 |
4 |
5 |
9 |
E10_4. |
Turn off potential partners |
1 |
2 |
3 |
4 |
5 |
9 |
E10_5. |
Damage my teeth |
1 |
2 |
3 |
4 |
5 |
9 |
E10_6. |
Damage my skin |
1 |
2 |
3 |
4 |
5 |
9 |
E10_7. |
Develop lung cancer |
1 |
2 |
3 |
4 |
5 |
9 |
APPROVAL OF SMOKING
E11. This next set of questions asks about how willing or unwilling you are to do things with people who smoke cigarettes. Would you:
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
9 Prefer Not to Answer |
E11_1. |
Go to a bar, club, party, concert or event where people are smoking cigarettes? |
1 |
2 |
3 |
4 |
9 |
E11_2. |
Hang out with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E11_3. |
Dance with someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E11_4. |
Kiss someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E11_5. |
Date someone who smokes cigarettes? |
1 |
2 |
3 |
4 |
9 |
E12. How much do you agree or disagree with the following statements about smoking cigarettes?
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E12_1. |
It is safe for me to smoke for only a year or two, as long as I quit after that. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_2. |
If I started to smoke occasionally I would not become addicted. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_3. |
Smoking cigarettes helps people relieve stress. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_4. |
Cigarette ingredients are harmful. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_5. |
Cigarette ingredients are dangerous. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_6. |
Smoking is a way to show my identity to others. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_7. |
Smoking cigarettes can help keep your weight down. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_8. |
Smoking can cause damage to every part of your body. |
1 |
2 |
3 |
4 |
5 |
9 |
E12_9. |
Smoking weakens your immune system. |
1 |
2 |
3 |
4 |
5 |
9 |
Section F: Media Use and Awareness
Next, we’d like to ask you about your use of TV and other media.
F1. How often do you…
|
1 Several times a day |
2 About Once a Day |
3 3-5 days a week |
4 1-2 days a week |
5 Every few weeks |
6 Less often |
7 Never |
9 Prefer Not to Answer |
F1_1. Watch TV shows or movies on any platform including a TV set, a computer, laptop or tablet, a smartphone or an iPod or MP3 player? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_2. Watch videos on YouTube? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_3. Listen to streaming radio? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_4. How often do you use dating websites or apps?
1 Several times a day
2 About once a day
3 3-5 days a week
4 1-2 days a week
5 Every few weeks
6 Less often
7 Never
9 Prefer not to answer
F2. Thinking about the social networking sites you use, about how often do you visit or use …
[RANDOMIZE ALL]
|
1 Several times a day |
2 About Once a Day |
3 3-5 days a week |
4 1-2 days a week |
5 Every few weeks |
6 Less often |
7 Never |
9 Prefer Not to Answer |
F2_1. Facebook |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F2_2. Instagram |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F2_3. Twitter |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F2_4. Tumblr |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F2_5. Snapchat |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F2_6. [IF F1_4 NE 7]Thinking about the dating websites and apps you use, about how often do you visit or use OkCupid?
1 Several times a day
2 About once a day
3 3-5 days a week
4 1-2 days a week
5 Every few weeks
6 Less often
7 Never
9 Prefer not to answer
F2_7. [IF Z3= 2 OR 4 AND Z6= 1 OR 3; IF A3= 2 OR 4 AND A6= 1 OR 3 AND F1_4 NE 7]
Thinking about the dating websites and apps you use, about how often do you visit or use HER?
1 Several times a day
2 About once a day
3 3-5 days a week
4 1-2 days a week
5 Every few weeks
6 Less often
7 Never
9 Prefer not to answer
F3. Think about the following websites... About how often do you visit or use the following…
[RANDOMIZE ALL]
|
1 Several times a day |
2 About Once a Day |
3 3-5 days a week |
4 1-2 days a week |
5 Every few weeks |
6 Less often |
7 Never |
9 Prefer Not to Answer |
F3_1. Queerty http://www.queerty.com/ |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
|
|
|
|
|
|
|
|
|
F3_2. Logo TV http://www.logotv.com/ |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F3_3. Out http://www.out.com/ |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F3_4. Autostraddle http://www.autostraddle.com/ |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F3_5. After Ellen http://www.afterellen.com |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F3_6. Gay.com http://www.gay.com/ |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F3_7. Towleroad http://www.towleroad.com |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F4. How often do you go to concerts, live shows, or other events at a store, local stage, community center, or music venue?
1 Once a week or more often
2 One or two times a month
3 Once every two or three months
4 One or two times a year
5 I do not attend concerts, live shows, or other events
9 Prefer not to answer
F5. In the past 30 days, on how many days did you go to an LGBT party, night, bar, club, or event?
1 0 days
2 1-3 days
3 4-6 days
4 7 or more days
5 Don’t remember how many days
9 Prefer not to answer
F6. How many LGBT celebrities, athletes, musicians, or artists do you follow on social media (e.g. Laverne Cox, Tegan & Sara, Ruby Rose, Angel Haze)?
1 0
2 1-2
3 3-4
4 5 or more
9 Prefer not to answer
BRAND AWARENESS
F7. We want to ask you about some brands that might or might not have appeared in the media around here, as part of ads or videos about tobacco or at concerts, live shows, or other events.
F7_1. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
COMMUNE
[DISPLAY CAMPAIGN LOGO]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F7_2. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
The Real Cost
[DISPLAY CAMPAIGN LOGO]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F7_3. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
This Free Life
[DISPLAY CAMPAIGN LOGO]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F7_4. In the past 3 months, that is since [FILL DATE], have you seen or heard the following brand?
Fresh Empire
[DISPLAY CAMPAIGN LOGO]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
AD AWARENESS OTHER TC CAMPAIGNS (TO USE AS CONTROLS)
F8. The next set of questions asks whether or not you’ve seen any of the following ads.
[RANDOMIZE F8_1-F8_3]
F8_1. In the past 3 months, that is since [FILL DATE], have you seen a Tips from Former Smokers (Tips) ad? Examples of some Tips from Former Smokers ads are shown below.
[DISPLAY Tips from Former Smokers PHOTO COLLAGE]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F8_2. In the past 3 months, that is since [FILL DATE], have you seen a truth® campaign ad? Examples of some truth® campaign ads are shown below.
[DISPLAY truth® PHOTO COLLAGE]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F8_3. In the past 3 months, that is since [FILL DATE], have you seen a The Real Cost campaign ad? Examples of some The Real Cost campaign ads are shown below.
[DISPLAY The Real Cost PHOTO COLLAGE]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F8_4. In the past 3 months, that is since [FILL DATE], have you seen a Fresh Empire campaign ad? Examples of some Fresh Empire campaign ads are shown below.
[DISPLAY Fresh Empire PHOTO COLLAGE]
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
CHANNELS OF This Free Life AWARENESS
F9. [IF F7_3= 1 or 3, Ask F9]Where have you seen or heard about This Free Life? Check all that apply
[RANDOMIZE; ALL APPEAR ON SCREEN AT ONCE (IF NOT ABLE TO DISPLAY ALL, MAKE ITEM SKIPPABLE AND REMOVE F9_h)]
F9_a. On TV
F9_b. On the Internet or anywhere online
F9_c. Billboards or other out-of-home ads (e.g., subways, bars, events)
F9_d. At an event
F9_e. Local LGBT magazines (e.g., NEXT magazine, Frontiers, Metro Weekly)
F9_f. National LGBT magazines (e.g., Out magazine, Curve, Original Plumbing)
F9_g. Some other place (please specify____________)
F9_h. Prefer not to answer
F10. The This Free Life campaign is online. Have you ever seen This Free Life or [DISPLAY LGBT CAMPAIGN LOGO]
on… Check all that apply
[RANDOMIZE; ALL APPEAR ON SCREEN AT ONCE (IF NOT ABLE TO DISPLAY ALL, MAKE ITEM SKIPPABLE AND REMOVE F10_9)]
F10_1. Twitter?
F10_2. Instagram?
F10_3. Facebook?
F10_4. YouTube?
F10_5. Pandora?
F10_6. Tumblr?
F10_7. LGBT websites (e.g., Autostraddle, After Ellen, Queerty, Towleroad)
F10_8. Other websites with LGBT content (e.g., Buzzfeed)F10_9. Dating websites or apps (e.g., OK Cupid, HER)
F10_10. Other (please specify____________)
F10_11. Prefer not to answer
EVENTS AWARENESS, CHANNEL OF AWARENESS
F11_1. In the past 3 months, that is since [FILL DATE], have you heard of an event in your area sponsored by, or associated with, This Free Life? (DISPLAY LOGO)
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
[IF F11_1=1,3, or 9 ASK F12]
This Free Life
F12. [IF F11_1=1 OR 3 OR 9] How did you hear about the This Free Life event?
1__ Poster
2__ Flyer or promotional materials
3__ Email
4__ Text message
5__ Friend
6__ Social media (Facebook, Instagram)
7__ Local LGBT magazines
8__ Other (please specify_______________)
9__ Not sure
99__ Prefer not to answer
EVENT ATTENDANCE AND REACTIONS
F13_1. [IF F11_1=1 OR 3 OR 9] Have you ever attended an event sponsored by, or associated with This Free Life ?
1 Yes
2 No
9 Prefer not to answer
[IF F13=2 GO TO VIDEO AWARENESS (F11_2)]
F13_2. [IF F13_1=1 OR 9] How many events in your area sponsored by, or associated with, This Free Life have you attended in the past 3 months, that is since [FILL DATE]?
1 None
2 One
3 Two
4 Three
5 Four or more
9 Prefer not to answer
F14. [IF F13_1 =1 OR 9]How would you describe the event(s)? [RANDOMIZE F14_1-F14_2] [MAKE THIS ITEM SKIPPABLE]
F14_1. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F14_2. |
Unenjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
F15. [IF F13_1=1 OR 9]How much do you agree or disagree with the following statements?
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F15_1. |
The event(s) was worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F15_2. |
The event(s) grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F15_3. |
The event(s) was powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F15_4. |
The event(s) was informative |
1 |
2 |
3 |
4 |
5 |
9 |
F15_5. |
The event(s) was meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F15_6. |
The event(s) was convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F15_7. |
The event(s) was terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F15_8. |
The event(s) told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F15_9. |
The event(s) gave me good reasons NOT to smoke cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
F15_10. |
The event(s) gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F16_a. [IF F13_1 =1 OR 9]On a scale of 1 to 5, indicate whether the event(s) made smoking cigarettes seem like something you would or wouldn’t want to do.
1 The event(s) makes me want to smoke cigarettes
2
3
4
5 The event(s) makes me want to NOT smoke cigarettes
9 Prefer not to answer
F16_b. [IF F13_1 =1 OR 9]On a scale of 1 to 5, indicate whether the event(s) made using tobacco seem like something you would or wouldn’t want to do.
1 The event(s) makes me want to use tobacco
2
3
4
5 The event(s) makes me want to NOT use tobacco
9 Prefer not to answer
VIDEO AWARENESS
F11_2. In the past 3 months, that is since [FILL DATE], have you seen a This Free Life video online? (DISPLAY LOGO)
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F17. Now we would like to show you some videos that have been shown in the U.S. Once you have viewed the video, please click on the forward arrow below to continue with the survey.
[DISPLAY VIDEOS OR SCREENSHOTS IN RANDOM ORDER. Use VIDEO for This Free Life ads and fake ad if relevant. Use SCREENSHOTS for truth® and Tips from Former Smokers ads if relevant. Each participant will view the video or screenshot then answer F18-F23, then watch the next video and answer the same questions for that video and so on until all videos/screenshots have been viewed]
[RANDOMIZE BLOCKS OF QUESTIONS ABOUT EACH VIDEO (F18_1 – F23_1_h) AND (F18_2 – F23_2_h) AND (F18_3 – F23_3_h]
F18_1. [DISPLAY OUR STORY VIDEO] Apart from this survey, how frequently have you seen this video in the past 3 months, that is since [FILL DATE]?
PROGRAMMER: ALLOW ANSWER TO BE MADE ONLY AFTER VIDEO PLAY FOR 15 SECONDS.
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
REACTIONS TO VIDEOS
[Ask all items for each video]
F19_1. What is the main message of this video?
[RANDOMIZE ORDER OF CHECKBOX LIST]
1 Addiction to cigarettes is expensive
2 Smoking can hurt nearly every part of you
3 3 out of 4 people who start smoking as teens will continue smoking as adults
4 Many LGBT lives are cut short by tobacco each year
5 Tobacco gets in the way of your health and happiness
6 Carbon monoxide is a chemical found in both cigarette smoke and car exhaust
7 Smoking tobacco can make you smell bad
8 Life is better when you’re tobacco-free
9 Smoking tobacco messes with your appearance
10 You don’t need tobacco to express who you are
11 Smoking tobacco puts poisons in your body
12 Even casual smoking can do you damage
13 Many LGBT people are proud to live tobacco-free
98 Not sure
99 Prefer not to answer
F20_1. How would you describe this video? [RANDOMIZE F20_1_a-F20_1_b] [MAKE THIS ITEM SKIPPABLE]
F20_1_a. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F20_1_b. |
Unenjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
F21_1. How much do you agree or disagree with the following statements?
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F21_1_a. |
This video is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_b. |
This video grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_c. |
This video is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_d. |
This video is informative |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_e. |
This video is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_f. |
This video is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_g. |
This video is terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_h. |
This video told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_i |
This video gave me good reasons NOT to smoke cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
F21_1_j. |
This video gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F22_1_a. On a scale of 1 to 5, indicate whether the video made using tobacco look like something you would or wouldn’t want to do.
1 The video makes me want to use tobacco
2
3
4
5 The video makes me want to NOT use tobacco
9 Prefer not to answer
F22_1_b. On a scale of 1 to 5, indicate whether the video made using tobacco look like something you would or wouldn’t want to do.
1 The video makes me want to use tobacco
2
3
4
5 The video makes me want to NOT use tobacco
9 Prefer not to answer
F23_1. [RANDOMIZE RESPONSE OPTIONS]On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this video made you feel…
1 2 3 4 5
Not at all Very
F23_a. Afraid
F23_b. Irritated
F23_c. Understood
F23_d. Uneasy
F23_e. Happy
F23_f. Accepted
F23_g.Inspired
F23_h. Confident
LOOP BACK TO PLAY THEN ASK ALL QUESTIONS ABOUT NEXT VIDEO HERE. SHOW ALL VIDEOS.
F18_2. [DISPLAY FLAWLESS VIDEO] Apart from this survey, how frequently have you seen this video in the past 3 months that is since [FILL DATE]?
PROGRAMMER: ALLOW ANSWER TO BE MADE ONLY AFTER VIDEO PLAY FOR 15 SECONDS.
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
REACTIONS TO VIDEOS
F19_2. What is the main message of this video?
[RANDOMIZE ORDER OF CHECKBOX LIST]
1 Addiction to cigarettes is expensive
2 Smoking can hurt nearly every part of you
3 3 out of 4 people who start smoking as teens will continue smoking as adults
4 Many LGBT lives are cut short by tobacco each year
5 Tobacco gets in the way of your health and happiness
6 Carbon monoxide is a chemical found in both cigarette smoke and car exhaust
7 Smoking tobacco can make you smell bad
8 Life is better when you’re tobacco-free
9 Smoking tobacco messes with your appearance
10 You don’t need tobacco to express who you are
11 Smoking tobacco puts poisons in your body
12 Even casual smoking can do you damage
13 Many LGBT people are proud to live tobacco-free
98 Not sure
99 Prefer not to answer
F20_2. How would you describe this video? [RANDOMIZE F20_2_a-F20_2_b]
F20_2_a. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F20_2_b. |
Unenjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
PROGRAMMER: PROGRAMMER: DETERMINE HOW TO ADD AN OVERT PREFER NOT TO ANSWER OPTION
F21_2. How much do you agree or disagree with the following statements?
|
|
Strongly Disagree |
Disagree |
Neither Agree or Disagree |
Agree |
Strongly Agree |
Prefer Not to Answer |
F21_2_a. |
This video is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_b. |
This video grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_c. |
This video is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_d. |
This video is informative |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_e. |
This video is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_f. |
This video is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_g. |
This video is terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_h. |
This video told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_i |
This video gave me good reasons NOT to smoke cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
F21_2_j. |
This video gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F22_2_a.
On a scale of 1 to 5, indicate whether the video made using tobacco look like something you would or wouldn’t want to do.
1 The video makes me want to use tobacco
2
3
4
5 The video makes me want to NOT use tobacco
9 Prefer not to answer
F22_2_b.
On a scale of 1 to 5, indicate whether the video made smoking cigarettes look like something you would or wouldn’t want to do.
1 The video makes me want to smoke cigarettes
2
3
4
5 The video makes me want to NOT smoke cigarettes
9 Prefer not to answer
F23_2.
[RANDOMIZE RESPONSE OPTIONS] On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this video made you feel…
|
1 Not at all |
2 |
3 |
4 |
5 Very |
Prefer not to answer |
F23_2_a. Afraid
|
|
|
|
|
|
|
F23_2_b. Irritated
|
|
|
|
|
|
|
F23_2_c. Understood
|
|
|
|
|
|
|
F23_2_d. Uneasy
|
|
|
|
|
|
|
F23_2_e. Happy
|
|
|
|
|
|
|
F23_2_f. Accepted
|
|
|
|
|
|
|
F23_2_g. Inspired
|
|
|
|
|
|
|
F23_2_h. Confident
|
|
|
|
|
|
|
F18_3. [DISPLAY TIP THE SCALE VIDEO] Apart from this survey, how frequently have you seen this video in the past 3 months, that is since [FILL DATE]?
[SHOW FEMALE VIDEO IF Z3= 2 OR 4 AND Z6= 1 OR 3; IF A3= 2 OR 4 AND A6= 1 OR 3; ELSE RANDOMLY ASSIGN TO SEE EITHER MALE OR FEMALE VIDEO]
[SHOW MALE VIDEO IF Z3= 1 OR 3 AND Z5= 1 OR 3 ; IF A3= 1 OR 3 AND A5= 1 OR 3; ELSE RANDOMLY ASSIGN TO SEE EITHER MALE OR FEMALE VIDEO]
PROGRAMMER: ALLOW ANSWER TO BE MADE ONLY AFTER VIDEO PLAY FOR 15 SECONDS.
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
REACTIONS TO VIDEOS
F19_3. What is the main message of this video?
[RANDOMIZE
ORDER OF CHECKBOX LIST]
1 Addiction to cigarettes is expensive
2 Smoking can hurt nearly every part of you
3 3 out of 4 people who start smoking as teens will continue smoking as adults
4 Many LGBT lives are cut short by tobacco each year
5 Tobacco gets in the way of your health and happiness
6 Carbon monoxide is a chemical found in both cigarette smoke and car exhaust
7 Smoking tobacco can make you smell bad
8 Life is better when you’re tobacco-free
9 Smoking tobacco messes with your appearance
10 You don’t need tobacco to express who you are
11 Smoking tobacco puts poisons in your body
12 Even casual smoking can do you damage
13 Many LGBT people are proud to live tobacco-free
98 Not sure
99 Prefer not to answer
F20_3. How would you describe this video? [RANDOMIZE F20_3_a-F20_3_b]
F20_3_a. |
Bad |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Good |
F20_3_b. |
Unenjoyable |
-3 |
-2 |
-1 |
0 |
+1 |
+2 |
+3 |
Enjoyable |
PROGRAMMER: PROGRAMMER: DETERMINE HOW TO ADD AN OVERT PREFER NOT TO ANSWER OPTION
F21_3. How much do you agree or disagree with the following statements?
|
|
Strongly Disagree |
Disagree |
Neither Agree or Disagree |
Agree |
Strongly Agree |
Prefer Not to Answer |
F21_3_a. |
This video is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_b. |
This video grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_c. |
This video is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_d. |
This video is informative |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_e. |
This video is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_f. |
This video is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_g. |
This video is terrible |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_h. |
This video told me things I never knew before about tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_i |
This video gave me good reasons NOT to smoke cigarettes |
1 |
2 |
3 |
4 |
5 |
9 |
F21_3_j. |
This video gave me good reasons NOT to use tobacco |
1 |
2 |
3 |
4 |
5 |
9 |
F22_3_a.
On a scale of 1 to 5, indicate whether the video made using tobacco look like something you would or wouldn’t want to do.
1 The video makes me want to use tobacco
2
3
4
5 The video makes me want to NOT use tobacco
9 Prefer not to answer
F22_3_b.
On a scale of 1 to 5, indicate whether the video made smoking cigarettes look like something you would or wouldn’t want to do.
1 The video makes me want to smoke cigarettes
2
3
4
5 The video makes me want to NOT smoke cigarettes
9 Prefer not to answer
F23_3.
[RANDOMIZE RESPONSE OPTIONS] On scale of 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this video made you feel…
|
1 Not at all |
2 |
3 |
4 |
5 Very |
Prefer not to answer |
F23_3_a. Afraid
|
|
|
|
|
|
|
F23_3_b. Irritated
|
|
|
|
|
|
|
F23_3_c. Understood
|
|
|
|
|
|
|
F23_3_d. Uneasy
|
|
|
|
|
|
|
F23_3_e. Happy
|
|
|
|
|
|
|
F23_3_f. Accepted
|
|
|
|
|
|
|
F23_3_g. Inspired
|
|
|
|
|
|
|
F23_3_h. Confident
|
|
|
|
|
|
|
STREAMING RADIO AWARENESS
F24. In the past 3 months, that is since [FILL DATE], have you heard about This Free Life on Pandora? (DISPLAY LOGO)
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
F25. [RANDOMIZE – 2 clips: Randomize presentation of clips and F25_A AND F25_B. ALLOW ANSWER TO BE RECORDED AFTER 10 SECONDS OF PLAY TIME]Now we would like to play you some radio clips that have aired in the U.S.
F25_a. [PLAY SCIENTIFIC MALE CLIP] Apart from this survey, how frequently have you heard this on the radio in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
F25_b. [PLAY NON SCIENTIFIC FEMALE CLIP] Apart from this survey, how frequently have you heard this on the radio in the past 3 months, that is since [FILL DATE]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
DIGITAL CONTENT AWARENESS
Now we would like to show you some digital content that you may have seen online.
[DISPLAY SCREENSHOT OF MATERIALS]
F26a. Now we would like to show you some digital content that you may have seen online.
Apart from this survey, have you seen this content online in the past 3 months, that is since [FILL DATE]?
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
[IF F26a=1,3, or 9 ASK F27b]
F27b. [IF F26a=1,3, or 9] How frequently have you seen this content online in the past 3 months, that is since [FILL DATE]? [DISPLAY CONTENT AGAIN]
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
PROMOTIONAL MATERIALS AWARENESS
F28a. Now we would like to show you some materials that have been circulating in some cities in the U.S.
[DISPLAY SCREENSHOT OF MATERIALS]
Apart from this survey, have you seen promotional materials like this in the past 3 months, that is since [FILL DATE]?
1 Yes
2 No
3 Not Sure
9 Prefer not to answer
[IF F28a=1,3, or 9 ASK F28b]
F28b. [IF F28a=1 OR 3 OR 9] How frequently have you seen materials like this in the past 3 months, that is since [FILL DATE]? [DISPLAY CONTENT AGAIN]
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
BRAND EQUITY
F29. [IF F7_3 = 1 OR 3 OR 9]How much do you agree or disagree with the following statements about This Free Life?
[RANDOMIZE F29_1- F29_3]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F29_1. |
I want to help promote This Free Life |
1 |
2 |
3 |
4 |
5 |
9 |
F29_2. |
I’d defend This Free Life if someone was making fun of it |
1 |
2 |
3 |
4 |
5 |
9 |
F29_3. |
I’d wear a This Free Life T-shirt |
1 |
2 |
3 |
4 |
5 |
9 |
[RANDOMIZE ITEMS BELOW WITH F29_5/ F29_6 ASKED TOGETHER IN THAT ORDER]
F29_4. |
I talk to my friends about This Free Life |
1 |
2 |
3 |
4 |
5 |
9 |
F29_5. |
If I had the chance, I would tell people I know to watch This Free Life videos |
1 |
2 |
3 |
4 |
5 |
9 |
F29_6. |
If I had the chance, I would tell people I know to check out This Free Life at events |
1 |
2 |
3 |
4 |
5 |
9 |
F29_7. |
If I see anything from This Free Life, I check it out |
1 |
2 |
3 |
4 |
5 |
9 |
[RANDOMIZE ITEMS BELOW WITH F29_10/ F29_11 AND F29_12/ F29_13 ASKED TOGETHER IN THAT ORDER]
F29_8. |
This Free Life is popular with people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F29_9. |
People are talking about This Free Life |
1 |
2 |
3 |
4 |
5 |
9 |
F29_10. |
This Free Life videos are becoming more popular with the people who hang out where I hang out |
1 |
2 |
3 |
4 |
5 |
9 |
F29_11. |
Checking out This Free Life at events is becoming more popular with the people who hang out where I hang out |
1 |
2 |
3 |
4 |
5 |
9 |
F29_12. |
This Free Life videos are for people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F29_13. |
This Free Life events are for people like me |
1 |
2 |
3 |
4 |
5 |
9 |
F30. [IF F7_3 = 1 OR 3 OR 9]To what extent do you agree that each of the traits or statements listed below describe This Free Life?
[RANDOMIZE RESPONSE OPTIONS]
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F30_1. |
Trendsetting |
1 |
2 |
3 |
4 |
5 |
9 |
F30_2. |
Motivating |
1 |
2 |
3 |
4 |
5 |
9 |
F30_3. |
Confident |
1 |
2 |
3 |
4 |
5 |
9 |
F30_4. |
Outgoing |
1 |
2 |
3 |
4 |
5 |
9 |
F30_5. |
Hosts the best parties |
1 |
2 |
3 |
4 |
5 |
9 |
F30_6. |
Always looks good |
1 |
2 |
3 |
4 |
5 |
9 |
F31. [IF F7_3 = 1 OR 3 OR 9]How much do you agree or disagree with the following statements?
When I think of This Free Life, I think…
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F31_1. |
I have the freedom to be tobacco-free |
1 |
2 |
3 |
4 |
5 |
9 |
F31_2. |
Using tobacco can undo some of the progress I have made |
1 |
2 |
3 |
4 |
5 |
9 |
F31_3. |
Tobacco use is not attractive |
1 |
2 |
3 |
4 |
5 |
9 |
Section G: Environment
The next section asks some questions about your household and peers.
G1. Other than you, has anyone who lives with you used any of the following during the past 30 days…? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER)
1 cigarettes
3 cigars, cigarillos, or little cigars such as Swisher Sweets, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s
4 tobacco out of a water pipe (also called “hookah”)
7 No, no one who lives with me has used any form of tobacco during the past 30 days
9 Prefer not to answer
G2. How often do you attend church or religious services? Would you say…
1 Never
2 Less than once a month
3 About once a month
4 About 2 or 3 times a month
5 Once a week
6 More than once a week
9 Prefer not to answer
Please tell us if you strongly disagree, disagree, agree, or strongly agree with the following statements.
G3. I would like to explore strange places. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly Agree
9 Prefer not to answer
G4. I like to do frightening things. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly Agree
9 Prefer not to answer
G5. I like new and exciting experiences, even if I have to break the rules. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly Agree
9 Prefer not to answer
G6. I prefer friends who are exciting and unpredictable. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly Agree
9 Prefer not to answer
G7. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
_____ Number of days
2 None
3 Don’t know
9 Prefer not to answer
G8. In the last month, how often have you
|
|
0 Never |
1 Almost never |
2 Sometimes |
3 Fairly often |
4 Very often |
9 Prefer Not to Answer |
G8_1. |
Felt that you were unable to control the important things in your life. |
1 |
2 |
3 |
4 |
5 |
9 |
G8_2. |
Felt confident about your ability to handle your personal problems. |
1 |
2 |
3 |
4 |
5 |
9 |
G8_3. |
Felt that things were going your way. |
1 |
2 |
3 |
4 |
5 |
9 |
G8_4. |
Felt difficulties were piling up so high that you could not overcome them. |
1 |
2 |
3 |
4 |
5 |
9 |
Section H: LGBT Identity and Community
Discrimination
H1. Have you ever experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following seven situations because of your sexual identity (lesbian, gay, bisexual, transgender)?
-
1
Yes
2
No
9
Prefer not to answer
H1_1.
In your family
1
2
9
H1_2.
At school
1
2
9
H1_3.
Getting a job
1
2
9
H1_4.
At work
1
2
9
H1_5.
At home
1
2
9
H1_6.
Getting medical care
1
2
9
H1_7
On the street or in a public setting
1
2
9
LGBT Community Involvement
H2_1. Have you ever attended a LGBT pride event?
1 Yes
2 No
9 Prefer not to answer
[IF H2_1= 1 SKIP TO H3]
H2_2. Have you attended a LGBT pride event in the past 12 months?
1 Yes
2 No
9 Prefer not to answer
LGBT Identity Development
H3. For each of the following questions, please mark the response that best indicates your current experience as an LGBT person. Please be as honest as possible: Indicate how you really feel now, not how you think you should feel. There is no need to think too much about any one question. Answer each question according to your initial reaction and then move on to the next.
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
H3_1. |
I am glad to be an LGBT person. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_2. |
My sexual identity is an insignificant part of who I am. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_3. |
I’m proud to be part of the LGBT community. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_4. |
My sexual identity is a central part of my identity. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_5. |
To understand who I am as a person, you have to know that I’m LGBT. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_6. |
Being an LGBT person is a very important aspect of my life. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_7. |
I believe being LGBT is an important part of me. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_8. |
I am proud to be LGBT. |
1 |
2 |
3 |
4 |
5 |
9 |
H3_9. |
I feel part of the LGBT community |
1 |
2 |
3 |
4 |
5 |
9 |
H3_10. |
I feel accepted by the LGBT community |
1 |
2 |
3 |
4 |
5 |
9 |
WEBTH Within 2 business days, we will send an email containing information about how to access and redeem your digital gift card. This information must be sent via email to the email address you supplied before starting this survey. Check your spam, junk or clutter folder(s) if you don’t see our email in your email inbox.
RECON Thank you for your responses! We will be conducting additional rounds of this survey. The next round will take place in about 6 months. At that time, we may contact you to participate. Your participation in these next rounds is really important so that we can measure what has changed over time. Should we contact you, you will be able to decide if you want to take part in the survey at that time, and you can change your mind at any point.
Thank you for taking time to complete this survey. You may close this window now.
OMB No: 0910-0808 Expiration Date: 01/31/2019
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