Longitudinal Cohort Youth Assent/Consent Process and Post-Tests 1-5 – Outcome Survey

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Attachment 01_Post Campaign Instrument_FU4

Longitudinal Cohort Youth Assent/Consent Process and Post-Tests 1-5 – Outcome Survey

OMB: 0910-0788

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0910-0788 can be found here:

2019-02-12 - No material or nonsubstantive change to a currently approved collection

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ATTACHMENT 1: POST-CAMPAIGN INSTRUMENT (EFECT)

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

RIHSC No. 15-052CTP

Evaluation of the Fresh Empire Campaign on Tobacco –

Post-test Instrument (EFECT-FU)

Programming conventions and specifications notes

Abbreviations used include ‘R’ for ‘respondent’ and ‘PNTA’ for ‘prefer not to answer.’
Prefer Not To Answer/Don’t Know/Refused/None of these are not allowed in combination with other responses.
Variable names and section headings are not displayed on screen.
Response options should not be labeled with numbers.
A previous button will only be offered to respondents in select instances.
Bolding conveys emphasis while capital letters convey instructions for programmers or interviewers.
Questionnaire will include a progress bar.
All items are required.
“Next” buttons will be displayed on every survey screen as appropriate.
All images should be arranged in such a way that focus on usability and layout. Images should be aligned and of similar sizes as one another.
Where response options are arranged vertically, the PNTA response should be set farther apart from the other responses.

FIID [IF CAPI] [DISPLAY DATE OF INSTRUMENT RELEASE]

ENTER YOUR FIID. [6 DIGIT ENTRY]

ASK: All CAPI interviewers.

RAVAIL [IF CAPI]

THE SELECTED RESPONDENT IS [YOUTHFNAME]

IS THE SELECTED RESPONDENT AVAILABLE?

INTERVIEWER: IF R IS NOT AVAILABLE, PLEASE BREAKOFF AND SCHEDULE A TIME FOR THE INTERVIEW WHEN THE SELECTED RESPONDENT WILL BE HOME

1 Yes

ASK: CAPI respondents.

DISPLAY: YOUTHFNAME is the respondent’s name from the contact information survey that the respondent completed during intercept.

LDOBC [IF CAPI]

What is your date of birth?

PROGRAMMER: PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007.

IF STARTWAVE NE WAVE5 CHECK LDOBC AGAINST MOST RECENTLY KNOWN DOB FROM THE MOST RECENT WAVE, WHETHER FROM WAVE4 OR WAVE3 OR WAVE2 OR FROM BASELINE. IF WAVE4 DOB IS BLANK, THEN USE WAVE3 DOB. IF WAVE3 DOB IS BLANK, THEN USE WAVE2 DOB. IF WAVE2 DOB IS BLANK, THEN USE BASELINE DOB. IF THE TWO DOBS MATCH, GO TO CONAGE. IF THE DOBS DO NOT MATCH, GO TO LDOB2C.

IF STARTWAVE=WAVE5 CALCAGE NEEDS TO EQUAL 12 TO 17. ELSE GO TO LDOB2C.

ASK: All CAPI respondents.

GO TO: If DOB matches last known DOB from any prior wave, go to CONAGE. If DOB doesn’t match last known DOB from WAVE4 OR WAVE3 OR WAVE2 or from BASELINE, go to next question LDOB2C.

LDOB2C [IF CAPI AND DOBS DON’T MATCH OR LDOBC NE 12-17]

So that we can ask you the right questions, we need your correct age. Again, what is your date of birth?

PROGRAMMER: PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007.

ASK: CAPI respondents who have different LDOBC from last known DOB (WAVE4 OR WAVE3 OR WAVE2 OR BASELINE) OR CAPI RESPONDENTS WHERE STARTWAVE=5 AND LDOBC DOES NOT EQUAL 12-17.

INELIG [IF CAPI AND STARTWAVE=5 AND (LDOB2C <12 OR >17)] Thank you, but you must be between 12 and 17 to take this survey.

ASK: CAPI respondents where STARTWAVE = 5 and LDOB2C NOT EQUAL 12 - 17

CONAGE [IF CAPI]

PROGRAMMER: DEFINE CONAGE. CALCULATE AGE BASED ON LDOBC IF LDOB2C IS NOT BLANK. OTHERWISE USE LDOB2C. IF AGE CALCULATED BASED ON CURRENT DATE IS 18 OR OLDER, CONAGE = 1. OTHERWISE, CONAGE =2.

ASK: CAPI respondents

PAVAIL [IF CAPI AND CONAGE =2]

IS THE SELECTED RESPONDENT’S PARENT OR GUARDIAN PRESENT?

1 Yes

2 No

INTERVIEWER: IF PARENT IS NOT AVAILABLE, PLEASE BREAKOFF AND SCHEDULE A TIME FOR THE INTERVIEW WHEN A PARENT OR GUARDIAN WILL BE HOME.

ASK: CAPI respondents who are less than 18 years old, according to CONAGE.

PERMISS [IF CAPI AND CONAGE=2]

PROGRAMMER: INSERT ATTACHMENT 5A

ASK: CAPI respondents who are less than 18 years old, according to CONAGE.

ASSENT [IF CAPI AND CONAGE=2 AND STARTWAVE NE WAVE5]

PROGRAMMER: INSERT ATTACHMENT 5A

[IF CAPI AND CONAGE=2 AND STARTWAVE = WAVE5]

PROGRAMMER: INSERT ATTACHMENT 5

ASK: CAPI respondents who are less than 18 years old, according to CONAGE.

CONSENT [IF CAPI AND CONAGE=1]

PROGRAMMER: INSERT ATTACHMENT 5B

ASK: CAPI respondents who are 18 years old or older, according to CONAGE.

TUTOR [IF CAPI]

INTERVIEWER: POINT TO TOUCHPAD

You will use the touchpad here to answer each survey question. Each question has an option for “Prefer not to answer.” You can use that option if you don’t know the answer to a question, or if you choose to not answer a question. Remember that your answers will be kept private. I will not be able to see them. Your parents and school will not be able to see them either.

NEXT

ASK: CAPI respondents.

TUTOR2 [IF CAPI]

Some screens have more than one question. In this case, you will need to scroll down to view all of the questions on a screen. To scroll, use the Page Up and Page Down buttons. Those buttons are here. POINT TO BUTTONS

I will now give you the computer and you can answer the questions on your own. Please let me know if you have questions or need help with anything.

INTERVIEWER: HAND R COMPUTER

NEXT

ASK: CAPI respondents.

S0a/LOGIN PAGE. [IF WEB]

Thank you for logging in to the Evaluation of the Fresh Empire Campaign on Tobacco (EFECT) study! Please enter your ID Number and password. Your ID Number is 8 characters such as XXX11111. If you can't find your ID Number, please call 800-845-6708.

ID Number: ___________________

Password: ____________________

The ID Number and password are CASE SENSITIVE, so please type carefully.

PROGRAMMER: IF ENTRIES DON’T AGREE “Invalid ID Number and/or password. Please verify your ID Number and password and try again. Please remember passwords are CASE SENSITIVE.”

ASK: Web respondents.

CONAGEW [IF WEB]

INSTRUMENT CHECK POINT - IS THE RESPONDENT AGE 18 OR OLDER?

PROGRAMMER: REVIEW FLAG TO DETERMINE IF R IS 18 OR OLDER BASED ON DOB IN BASELINE OR WAVE 2 OR WAVE 3 OR WAVE 4

1 YES

2 NO

CHECKPOINT: IF THE CASE IS COMING IN VIA A LEAD LETTER AND IS UNDER THE AGE OF 18 ACCORDING TO DOB, GO TO WID AND PERMISS. ELSE GO TO ASSENT.

CALCULATE CALCAGE: CALCULATE CURRENT AGE AS OF DATE OF INTERVIEW BASED ON THE DOB OF RESPONDENT

PROGRAMMER: ADMINISTER WID, WIDFP AND PERMISS IF PARENTAL PERMISSION IS NOT WAIVED OR COLLECTED OVER THE PHONE.

ASK: Web respondents.

WID [IF CONAGEW=2 AND WEB AND LONGITUDINAL=YES AND SOCIAL MEDIA=NO]

Our records indicate that a [CALCAGE] year old named [YouthFname] participated in a previous wave of our study. Before we begin with the interview, we need the parent or guardian of [YouthFname] to review some information. Are you the parent or guardian of [YouthFname]?

1 Yes

2 No – GO TO WIDFP

ASK: Web respondents who are less than 18 years old.

DISPLAY: CALCAGE is the respondent’s age based on the intercept screener. Prefill YouthFname is the respondents name from the preload.

WIDFP [IF WID=NO AND CONAGEW =2 AND WEB AND LONGITUDINAL=YES AND SOCIAL MEDIA=NO]

Is [YouthFname]’s parent available to review this information? If not, please log back in to the website when the parent or guardian is available.

1 Yes, parent is available

2 No, I will log back in when parent is available

ASK: Web respondents who are less than 18 years old.

DISPLAY: YouthFname is the respondents name from the contact information survey that the respondent completed during intercept.

PERMISS [IF LONGITUDINAL=YES AND CALCAGE = 12-17 AND SOCIALMEDIA=NO AND WEB]

PROGRAMMER: INSERT ATTACHMENT 5C

ASK: Longitudinal web respondents age 12 to 17 who are not recruited through social media

ASSENT

[IF LONGITUDINAL=NO AND SOCIALMEDIA=YES AND CALCAGE =15-17 AND WEB]

PROGRAMMER: INSERT ATTACHMENT 5E

[IF LONGITUDINAL=YES AND CALCAGE = 12-17 AND SOCIALMEDIA=NO AND WEB]

PROGRAMMER: INSERT ATTACHMENT 5C

[IF LONGITUDINAL = YES AND SOCIALMEDIA=YES AND

((CALCAGE=13-17 AND STARTWAVE = WAVE1) OR

(AGE AT FU1=13-14 AND STARTWAVE=WAVE2) OR

(CALCAGE=13-14 AND SOCIALMEDIA=YES AND STARTWAVE=WAVE3))]

(CALCAGE=13-14 AND SOCIALMEDIA=YES AND STARTWAVE=WAVE4))]

PROGRAMMER: INSERT ATTACHMENT 5G

[IF LONGITUDINAL=NO AND CALCAGE=13-14 AND WEB]

PROGRAMMER: INSERT ATTACHMENT 5F

[IF (LONGITUDINAL =YES AND AGE AT FU1= 15-17 AND STARTWAVE=WAVE2 AND SOCIAL MEDIA=YES AND WEB) OR OR (STARTWAVE=WAVE3 AND CALCAGE=15-17 AND SOCIAL MEDIA = YES) OR (STARTWAVE=WAVE4 AND CALCAGE=15-17 AND SOCIAL MEDIA = YES)]

PROGRAMMER: INSERT ATTACHMENT 5I

ASK: Longitudinal web respondents age 12 to 17 who require assent

CONSENT [IF LONGITUDINAL= YES AND WEB AND CALCAGE=18]

PROGRAMMER: INSERT ATTACHMENT 5D

ASK: Longitudinal web respondents age 18.

PRIV [IF WEB]

Please make sure that you can answer the questions in private where no one can see your answers.

ASK: Web respondents.

DRIV [IF WEB]

We care about your safety. Do not attempt to answer these questions while driving.

ASK: Web respondents.

TUTOR3 [IF WEB]

Please click on the answer to each survey question, using a mouse or a touchscreen. Each question has an option for “Prefer not to answer.” You can use that option if you don’t know the answer to a question, or if you choose to not answer a question. Remember that your answers will be kept private. We will not share the answers to your questions with your parents or anyone else outside the research team.

NEXT

ASK: Web respondents.

WEB DOB SERIES

DOB [IF (LONGITUDINAL = NO) AND WEB]

What is your date of birth? (mm-dd-yyyy)

PROGRAMMER: PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1920 – 2015.

PROGRAMMER: CALCULATE RAGE BASED ON CURRENT DATE MINUS DOB.

ASK: Web respondents who are not longitudinal.

AGE [IF (LONGITUDINAL = NO) AND WEB]

That would make you [RAGE] years old, is that correct?

1 Yes

1 No

ASK: Web respondents who are not longitudinal.

DISPLAY: Prefill RAGE is the respondent’s age calculated from DOB.

GOTO: If RAGE is age 13 to 17 years old and AGE = Yes, go to Y_video. If RAGE is less than 13 years old or more than than 17 years old and AGE = Yes, go to next question WINELIG.

WINELIG [IF RAGE IS <13 OR >=18 AND (LONGITUDINAL = NO) AND WEB]

Thank you, but you are not eligible to take this survey.

PROGRAMMER: CODE AS 2390

ASK: Web respondents who are not longitudinal and who are younger than 13 years old or older than 17 years old, according to RAGE.

LDOBW [IF (LONGITUDINAL = YES) AND WEB]

What is your date of birth?

PROGRAMMER: PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007.

CHECK LDOBW AGAINST BLDOB. IF THE TWO DOBS MATCH, GO TO Y_Video. IF THE DOBS DO NOT MATCH, CHECK AGAINST FU1_DOB AND FU2_DOB AND FU3_DOB. IF LDOBW AND FU1_DOB OR FU2_DOB OR FU3_DOB MATCH, GO TO Y_Video. IF THOSE DOBS DO NOT MATCH, GO TO LDOB2W.

ASK: Longitudinal Web respondents.

GOTO: If LDOBW matches BLDOB or LDOBW matches FU1_DOB or FU2_DOB or FU3_DOB, go to Y_video. If LDOBW does not match BLDOB and LDOBW does not match FU1_DOB OR FU2_DOB or FU3_DOB, go to next question LDOB2W.

LDOB2W [IF ((LONGITUDINAL = YES) AND WEB AND (LDOBW NE BL_DOB OR FU1_DOB OR FU2_DOB OR FU3_DOB)) OR (LONGITUDINAL=NO AND AGE =NO AND WEB)]

So that we can ask you the right questions, we need your correct age. Again, what is your date of birth?

PROGRAMMER: PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007. MONTH SOULD BE WRITTEN IN FULL IE “JANUARY”

IF LONGITUDINAL = NO UPDATE RAGE WITH LDOB2W BIRTHDAY.

ASK: Longitudinal web respondents where LDOBW does not match BLDOB and LDOBW does not match FU1_DOB OR FU2_DOB OR FU3_DOB.

GOTO: If LDOB2W matches BLDOB or LDOB2W matches FU1_DOB, OR FU2_DOB OR FU3_DOB go to Y_video. If LDOB2W does not match BLDOB OR FU2_DOB OR FU3_DOB and LDOB2W does not match FU1_DOB, go to next question INELIGAGE.

INELIGAGE [IF (LONGITUDINAL = YES) AND (LDOB2W NE BLDOB OR FU1_DOB OR FU2_DOB OR FU3_DOB) AND WEB]

We’re sorry, but we are not able to locate your file in our records. For this reason, you will not be able to take this survey online at this time.

Thank you for your time.

PROGRAMMER: EXIT PROGRAM AND CODE AS 2390

ASK: Longitudinal web respondents where LDOB2W does not match BLDOB and LDOB2W does not match FU1_DOB OR FU2_DOB OR FU3_DOB.

WINELIG2 [IF RAGE IS <13 OR >17 AND (LONGITUDINAL = NO) AND WEB]

Thank you, but you are not eligible to take this survey.

PROGRAMMER: CODE AS 2390

ASK: Web respondents who are not longitudinal and who are not 13-17 years old

Y_video [IF WEB] Please try to view this video to make sure you can see it.

PROGRAMMER: DISPLAY OCEAN VIDEO

ASK: Web respondents who are not longitudinal.

Y_video1 [IF WEB]

Are you able to view and hear this video?

1 Yes

2 No

PROGRAMMER: IF Y_video1 IS NO (=2), DISPLAY THIS MESSAGE:

Viewing and hearing the videos in this survey is important. Please turn up on the volume on your device. If you cannot view the video, 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.

PROGRAMMER: IF NO, NEED TO BEGIN WITH THE VIEWING OF THE VIDEO WHEN R COMES BACK TO THE SURVEY FROM A DIFFERENT DEVICE.

ASK: Eligible web respondents.

IBSE. [IF LONGITUDINAL=YES]

First we have some questions about you and your friends. You have seen these questions before, but we are asking them again to see if things have changed or stayed the same. Click Next to continue.

ASK: Eligible longitudinal respondents.

S5a. [IF LONGITUDINAL=YES]

Rank the three people that would BEST FIT in your main group of friends, starting with the best fit. Click on the picture to make a selection.

ASK: Longitudinal respondents.

S5b. [IF LONGITUDINAL=YES]

Rank the three people that would LEAST FIT in your main group of friends, starting with the worst fit. Click on the picture to make a selection.

ASK: Longitudinal respondents.

S6a. [IF LONGITUDINAL=YES]

Rank the three people that would BEST FIT in your main group of friends, starting with the best fit. Click on the picture to make a selection.

ASK: Longitudinal respondents.

S6b. [IF LONGITUDINAL=YES]

Rank the three people that would LEAST FIT in your main group of friends, starting with the worst fit. Click on the picture to make a selection.

ASK: Longitudinal respondents.

S7. [IF LONGITUDINAL=YES AND WEB]

What is your zip code?

□ Don’t know

□ Prefer not to answer

PROGRAMMER: IDENTIFY LAST AVAILABLE ZIP. IF FU2S7 NE BLANK, THEN LAZ IS FU2S7. ELSE LAZ IS SCREENER ZIP. COMPARE ZIP TO LAST AVAILABLE ZIP FROM SAMPLE LIST. IF LAST AVAILABLE ZIP=ZIP, CONTINUE TO A3. IF THE LAST AVAILABLE ZIP IS IN AN INTERVENTION GROUP AND ZIP IS IN CONTROL GO TO ZIPCHK. IF THE LAST AVAILABLE ZIP IS IN A CONTROL ZIP AND THE ZIP IS IN INTERVENTION GO TO ZIPCHK. IF ZIP IS NOT IN SAMPLE GO TO ZIPCHK. ELSE GO TO A3.

ADD A POP UP BOX CHECK IF S7=DK OR PNTA. IF S7=DK OR PNTA, POP UP BOX SHOULD SAY: “Please enter a valid zip code to continue with the survey. If you don’t know or prefer not to enter your zip code, you will exit the survey. Choose Change Answer to enter a valid zip code or Keep Answer if you wish to exit.” THE POP UP BOX WILL HAVE TWO OPTIONS: ‘CHANGE ANSWER’ OR ‘KEEP ANSWER AND CONTINUE.’

ASK: Longitudinal web respondents.

GOTO: If last available zip=S7, go to A3. If the last available zip is in an intervention group and S7 is in a control zip, go to ZIPCHK. If the last available zip is in a control zip and S7 is in an intervention group, go to ZIPCHK. If S7 is not in sample, go to ZIPCHK.

ZIPCHK [IF LONGITUDINAL=YES AND WEB AND ((LAST AVAILABLE ZIP IS IN AN INTERVENTION GROUP AND ZIP IS IN CONTROL ZIP) OR (LAST AVAILABLE ZIP IS IN A CONTROL ZIP AND ZIP IS IN AN INTERVENTION GROUP))]

You have entered [FILL S7]. Is this correct?

1 Yes

2 No

NEXT

PROGRAMMER: IF THE LAST AVAILABLE ZIP IS IN AN INTERVENTION GROUP AND ZIP IS IN CONTROL AND ZIPCHK=YES GO TO INELIG. IF THE LAST AVAILABLE ZIP IS IN A CONTROL ZIP AND THE ZIP IS IN INTERVENTION AND ZIPCHK=YES GO TO INELIG. IF ZIP IS NOT IN SAMPLE AND ZIPCHK=YES GO TO INELIG. IF ZIPCHK = NO, GO BACK TO S7.

ASK: Longitudinal web respondents where last available zip is in an intervention group and S7 is in control zip or last available zip is in a control zip and S7 is in an intervention group.

DISPLAY: Prefill S7 is the respondent’s zip.

GOTO: If the last available zip is in an intervention group and ZIP is in control and ZIPCHK = Yes, go to INELIG. If the last available zip is in a control zip and the ZIP is in intervention and ZIPCHK=Yes, go to INELIG. If ZIP is not in sample and ZIPCHK=yes go to INELIG. If ZIPCHK = No, go back to S7.

INELIG [IF S7=PNTA OR DK OR IS NOT IN STUDY AREA OR IS NOT IN THE SAME TYPE OF DMA AS AT BASELINE OR WAVE1]

Thank you for your interest in this study. Unfortunately, you are no longer located in the study area.

PROGRAMMER: CODE AS 2320

ASK: Longitudinal web respondents where S7 = PNTA or DK or is not in study area or is not in the same type of DMA as at BASELINE or WAVE1 or WAVE2.

Section A: Demographics

A1. [IF LONGITUDINAL=NO]

Are you of Hispanic, Latino/a, or Spanish origin?

PROGRAMMER: PROGRAM SO THAT RESPONDENTS CAN SELECT MORE THAN ONE RESPONSE ON 2-5

1 No, not of Hispanic, Latino, Latina, or Spanish origin

2 Yes, Mexican, Mexican American, Chicano or Chicana

3 Yes, Puerto Rican

4 Yes, Cuban

5 Yes, Another Hispanic, Latino/a or Spanish origin

9 Prefer not to answer

ASK: Eligible respondents who are not longitudinal.

A2. [IF LONGITUDINAL=NO]

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 American Indian or Alaska Native

2 Asian

3 Black or African American

4 Native Hawaiian or Other Pacific Islander

5 White

6 Other (specify_____________)

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

A3. In general, do you usually speak…

1 Only Spanish

2 Spanish more than English

3 Spanish and English equally

4 English more than Spanish

5 English only

6 Some other language (please specify___________)

9 Prefer not to answer

ASK: All eligible respondents.

A4. What grade are you currently in? If school is not in session, what grade are you going into?

1 6th grade or lower

2 7th grade

3 8th grade

4 9th grade

5 10th grade

6 11th grade

7 12th grade

8 In college

9 Ungraded or other grade

10 Out of school

99 Prefer not to answer

ASK: All respondents.

A5. During the past 30 days, about how much money did you have each week to spend any way you wanted to?

1 None

2 $5 or less

3 $6 to $10

4 $11 to $20

5 $21 to $35

6 $36 to $50

7 $51 to $75

8 $76 to $125

9 $126 or more

99 Prefer not to answer

ASK: All respondents.

Section B: Tobacco Use Behavior

B1. [IF BASELINE B1 NE 1 AND FU1 B1 NE 1 AND FU2 B1 NE 1 AND FU3 B1 NE 1]

Have you ever tried cigarette smoking, even one or two puffs?

1 Yes

2 No – GO TO B10

9 Prefer not to answer

ASK: Respondents who did not report having ever tried cigarette smoking during BASELINE or FU1 or FU2 or FU3.

GOTO: If B1 = 2, go to B10. If B1 = 1 or 9, go to next question B2.

B2.

[IF B1=1 OR 9] How old were you when you first tried cigarette smoking, even one or two puffs?

1 8 years old or younger

2 9 years old

3 10 years old

4 11 years old

5 12 years old

6 13 years old

7 14 years old

8 15 years old

9 16 years old

10 17 years old

11 18 years old or older

99 Prefer not to answer

CHECK : IF AGE ENTERED IS GREATER THAN AGE CALCULATED FROM DOB THEN DISPLAY: Please provide an age as old as or younger than you are currently.

ASK: Respondents who had ever smoked cigarettes or preferred not to answer whether they smoked cigarettes in B1.

B3. [IF BASELINE B1 = 1 OR 9 OR FU1 B1 =1 OR 9 OR FU2 B1 = 1 OR 9 OR FU3 B1=1 OR 9 OR (CURRENT B1=1 OR 9)]

During the past 30 days, on how many days did you smoke cigarettes?

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

7 All 30 days

9 Prefer not to answer

ASK: Respondents who had ever smoked cigarettes or preferred not to answer whether they smoked cigarettes in B1 or reported having ever smoked cigarettes in BASELINE or FU1 or FU2 or FU3.

GOTO: If B3 = 1, go to B6. If B3 NE 1, go to next question B4.

B4. [IF B3 NE 1]

Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who had smoked one or more cigarettes during the past 30 days or preferred not to answer whether they smoked cigarettes during the past 30 days, according to B3.

B5. [IF B3 NE 1]

During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?

1 Less than 1 cigarette per day

2 1 cigarette per day

3 2 to 5 cigarettes per day

4 6 to 10 cigarettes per day

5 11 to 20 cigarettes per day

6 More than 20 cigarettes per day

9 Prefer not to answer

ASK: Respondents who had smoked one or more cigarettes during the past 30 days or preferred not to answer whether they smoked cigarettes during the past 30 days, according to B3.

B6. [IF BASELINE B1 = 1 OR 9 OR FU1 B1 =1 OR 9 OR FU2 B1=1 OR 9 OR FU3 B1=1 OR 9 OR (CURRENT B1=1 OR 9)]

About how many cigarettes have you smoked in your entire life? Your best guess is fine.

1 I have never smoked cigarettes, not even one or two puffs

2 1 or more puffs but never a whole cigarette

3 1 cigarette

4 2 to 5 cigarettes

5 6 to 15 cigarettes (about 1/2 a pack total)

6 16 to 25 cigarettes (about 1 pack total)

7 26 to 99 cigarettes (more than 1 pack, but less than 5 packs)

8 100 or more cigarettes (5 or more packs)

9 Prefer not to answer

ASK: Respondents who had ever smoked cigarettes or preferred not to answer whether they smoked cigarettes in B1 or reported having ever smoked cigarettes in BASELINE or FU1 or FU2 or FU3.

B7. [IF BASELINE B1 = 1 OR 9 OR FU1 B1 =1 OR 9 OR FU2 B1=1 OR 9 OR FU3 B1=1 OR 9 OR (CURRENT B1=1 OR 9)]

Do you consider yourself a smoker?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who had ever smoked cigarettes or preferred not to answer whether they smoked cigarettes in B1 or reported having ever smoked cigarettes in BASELINE or FU1 or FU2 or FU3.

B10. [IF BASELINE B10 NE 1 OR FU1 B10 NE 1 OR FU2 B10 NE 1 OR FU3 B10 NE 1]

Have you ever tried smoking cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s, even one time?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who did not report having ever tried smoking cigars, cigarillos, or little cigars during BASELINE or FU1 or FU2 or FU3.

GOTO: If B10 = 2, go to B12. If B10 = 1 or 9, go to next question B11b.

B11b. [IF BASELINEB10=1 OR FU1B10=1 OR FU2B10=1 OR FU3B10=1 OR (CURRENT B10=1 OR 9)]

During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars without added marijuana? Common brands are Swisher Sweets, Black & Mild, 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

7 All 30 days

9 Prefer not to answer

ASK: Respondents who had ever smoked cigars, cigarillos, or little cigars or preferred not to answer whether they smoked cigars, cigarillos, or little cigars in B10 or reported having ever smoked cigars, cigarillos, or little cigars in BASELINE or FU1 or FU2 or FU3.

B12. [IF BASELINE B12 NE 1 OR FU1 B12 NE 1 OR FU2 B12 NE 1 OR FU3 B12 NE 1]

Have you ever tried smoking tobacco out of a water pipe (also called “hookah”), even one time?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who did not report having ever tried smoking tobacco out of a water pipe during BASELINE or FU1 OR FU2 OR FU3.

GOTO: If B12 = 2, go to B14. If B12 = 1 or 9, go to next question B13.

B13. [IF BASELINE B12 = 1 OR FU1B12 = 1 OR FU2B12=1 OR FU3 B12=1 OR (CURRENT B12 = 1 OR 9)]

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

7 All 30 days

9 Prefer not to answer

ASK: Respondents who had ever smoked tobacco out of a water pipe or preferred not to answer whether they smoked tobacco out of a water pipe in B12 or reported having ever smoked tobacco out of a water pipe in BASELINE or FU1 or FU2 or FU3.

B14. [IF BASELINE B14 NE 1 OR FU1 B14 NE 1 OR FU2 B14 NE 1 OR FU3 B14 NE 1]

These are examples of electronic nicotine products: e-cigarettes, e-cigars, e-hookahs, epipes, vape pens, hookah pens and personal vaporizers. These products are battery-powered, use nicotine fluid rather than tobacco leaves, and produce vapor instead of smoke. Some common brands include Fin, NJOY, Blu, e-Go and Vuse. Have you ever tried these products, even one or two puffs?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who did not report having ever tried electronic nicotine products during BASELINE or FU1 or FU2 or FU3.

GOTO: If B14 = 2, go to C1. If B14 = 1 or 9, go to next question B15.

B15. [IF BASELINE B14=1 OR FU1B14=1 OR FU2B14=1 OR FU3B14=1 OR (CURRENT B14 = 1 OR 9)]

During the past 30 days, on how many days did you use electronic nicotine products, such as “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

7 All 30 days

9 Prefer not to answer

ASK: Respondents who have ever used electronic nicotine products or preferred not to answer whether they used electronic nicotine products in B1 or reported having ever used electronic nicotine products in BASELINE or FU1 or FU2 or FU3.

Section C: Tobacco Use Intentions and Self-Efficacy

C1. Thinking about the future…

		Definitely Yes	Probably Yes	Probably Not	Definitely Not	Prefer Not to Answer
C1_1.	Do you think that you will smoke 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

ASK: All respondents.

C2. How sure are you that, if you really wanted to, you could say no to a cigarette offer if…

PROGRAMMER: RANDOMIZE C2_1-C2_3

		Not at all sure	Slightly sure	Somewhat sure	Mostly sure	Completely sure	Prefer Not to Answer
C2_1.	You are at a party where most people are smoking?	₁	₂	₃	₄	₅	₉
C2_2.	A very close friend offers it?	₁	₂	₃	₄	₅	₉
C2_3.	Someone you know offers it?	₁	₂	₃	₄	₅	₉

ASK: All respondents.

Section D: Cessation (Intention, Behavior, Motivation)

D2. [IF B3 = 2-9]

How much do you want to stop smoking cigarettes for good?

1 Not at all

2 A little

3 Somewhat

4 A lot

9 Prefer not to answer

ASK: Respondents who had smoked between 1 and 30 days in the past 30 days or preferred not to answer how many of the past 30 days they had smoked.

D4. [IF B3=2-9]

During the past 3 months, did you stop smoking cigarettes for one day or longer because you were trying to quit smoking cigarettes for good?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who had smoked between 1 and 30 days in the past 30 days or preferred not to answer how many of the past 30 days they had smoked.

Section E: Attitudes, Beliefs, Risk Perceptions and Social Norms

The next set of questions asks for your opinions on cigarette use and other tobacco products.

Attitudes, Beliefs and Risk Perceptions

E1. How much do you agree or disagree with the following statements about people who are tobacco-free?

PROGRAMMER: RANDOMIZE ALL ROWS

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	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 fresh.	₁	₂	₃	₄	₅	₉
E1_3.	People who are tobacco-free are trendsetters.	₁	₂	₃	₄	₅	₉
E1_4.	People who are tobacco-free are in control.	₁	₂	₃	₄	₅	₉
E1_5.	People who are tobacco-free are real.	₁	₂	₃	₄	₅	₉
E1_6.	People who are tobacco-free are attractive.	₁	₂	₃	₄	₅	₉
E1_7.	People who are tobacco-free are lame.	₁	₂	₃	₄	₅	₉
E1_9.	People who are tobacco-free are fake.	₁	₂	₃	₄	₅	₉
E1_10.	People who are tobacco-free are annoying.	₁	₂	₃	₄	₅	₉
E1_12.	People who are tobacco-free are followers.	₁	₂	₃	₄	₅	₉

ASK: All respondents.

E3. Please enter the number that best fits your response. Smoking cigarettes is… (pick one)

PROGRAMMER: RANDOMIZE E3_1-E3_2

MAKE THIS ITEM SKIPPABLE

DISPLAY IMAGE OF SCALE LABELED 1 THROUGH 7 AND A NUMERIC ENTRY FIELD FOR RESPONSE.

E3_1.	Bad	₁	₂	₃	₄	₅	₆	₇	Good
E3_2.	Not enjoyable	₁	₂	₃	₄	₅	₆	₇	Enjoyable

________________ (Range 1-7)

ASK: All respondents.

E4. How much do you agree or disagree with the following statements?

PROGRAMMER: RANDOMIZE E4_1-E4_3

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
E4_1.	I am proud to live tobacco-free.	₁	₂	₃	₄	₅	₉
E4_2.	Living tobacco-free is important to me.	₁	₂	₃	₄	₅	₉
E4_3.	I am proud to tell other people I live tobacco-free.	₁	₂	₃	₄	₅	₉

ASK: All respondents.

E5. How much do you agree or disagree with the following statements? If I smoke cigarettes, I will…

PROGRAMMER: RANDOMIZE E5_1 to E5_23. Keep E5_22 as the last item.

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
E5_1.	Damage my body	₁	₂	₃	₄	₅	₉
E5_3.	Shorten my life	₁	₂	₃	₄	₅	₉
E5_6.	Be able to stop smoking when I want to	₁	₂	₃	₄	₅	₉
E5_7.	Become addicted to smoking	₁	₂	₃	₄	₅	₉
E5_9.	Be less attractive to others	₁	₂	₃	₄	₅	₉
E5_11.	Have bad breath	₁	₂	₃	₄	₅	₉
E5_14.	Be a bad influence on my younger brothers, sisters, cousins, family or friends	₁	₂	₃	₄	₅	₉
E5_18.	Be able to reach my goals	₁	₂	₃	₄	₅	₉
E5_19.	Be less successful	₁	₂	₃	₄	₅	₉
E5_20.	Be less physically fit	₁	₂	₃	₄	₅	₉
E5_21.	Not perform at my best	₁	₂	₃	₄	₅	₉
E5_22.	Please select the option labeled ‘Disagree’ as your answer.	₁	₂	₃	₄	₅	₉
E5_23.	Lose my teeth	₁	₂	₃	₄	₅	₉

ASK: All respondents.

Social Norms

E6. How many of your four closest friends…

		None	One	Two	Three	Four	Prefer Not to Answer
E6_1.	Smoke cigarettes?	₀	₁	₂	₃	₄	₉
E6_4.	Use marijuana?	₀	₁	₂	₃	₄	₉
E6_5.	Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)?	₀	₁	₂	₃	₄	₉
E6_6.	Smoke cigars, cigarillos, or little cigars without added marijuana? Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s.	₀	₁	₂	₃	₄	₉
E6_7.	Use electronic nicotine products, such as “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?	₀	₁	₂	₃	₄	₉
E6_8.	Smoke tobacco out of a water pipe (also called “hookah”)?	₀	₁	₂	₃	₄	₉

ASK: All respondents.

E7. How many of the people who hang out where you hang out…

		None	A few	Some	Most	All	Prefer Not to Answer
E7_1.	Smoke cigarettes?	₀	₁	₂	₃	₄	₉
E7_4.	Use marijuana?	₀	₁	₂	₃	₄	₉
E7_5.	Smoke blunts (cigars, cigarillos, or little cigars with marijuana added)?	₀	₁	₂	₃	₄	₉
E7_6.	Smoke cigars, cigarillos, or little cigars without added marijuana? Common brands are Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s.	₀	₁	₂	₃	₄	₉
E7_7.	Use electronic nicotine products, such as “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”?	₀	₁	₂	₃	₄	₉
E7_8.	Smoke tobacco out of a water pipe (also called “hookah”)?	₀	₁	₂	₃	₄	₉

ASK: All respondents.

E8. Thinking about the people who hang out where you hang out, do you think tobacco use is…

1 Increasing

2 Decreasing

3 Staying the same

4 Not sure

9 Prefer not to answer

ASK: All respondents.

Perceived Approval

E9. How much do you agree or disagree with the following statements?

PROGRAMMER: RANDOMIZE E9_1-E9_4

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
E9_1.	According to my family, it is very important for me to not smoke cigarettes.	₁	₂	₃	₄	₅	₉
E9_2.	According to my friends, it is very important for me to not smoke cigarettes.	₁	₂	₃	₄	₅	₉
E9_3.	According to most people my age, it is very important for me to not smoke cigarettes.	₁	₂	₃	₄	₅	₉
E9_4.	According to the people who hang out where I hang out, it is very important for me to not smoke cigarettes.	₁	₂	₃	₄	₅	₉

ASK: All respondents.

Approval Of Smoking

E10. This next set of questions asks about things you would or would not do with people who smoke cigarettes. Would you…

		Definitely Yes	Probably Yes	Probably Not	Definitely Not	Prefer Not to Answer
E10_1.	Go to a party, concert or event where people are smoking cigarettes?	₁	₂	₃	₄	₉
E10_2.	Hang out with someone who smokes cigarettes?	₁	₂	₃	₄	₉
E10_4.	Kiss someone who smokes cigarettes?	₁	₂	₃	₄	₉
E10_5.	Go out with someone who smokes cigarettes?	₁	₂	₃	₄	₉

ASK: All respondents.

Perceived Popularity

E12. How much do you agree or disagree with the following statements?

PROGRAMMER: RANDOMIZE E12_1-E12_4

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
E12_1.	Most successful people smoke cigarettes.	₁	₂	₃	₄	₅	₉
E12_2.	More fresh people smoke cigarettes than people who are not fresh.	₁	₂	₃	₄	₅	₉
E12_3.	Rich and famous people are more likely to smoke cigarettes than people who aren’t rich and famous.	₁	₂	₃	₄	₅	₉
E12_4.	My favorite hip hop artists smoke cigarettes.	₁	₂	₃	₄	₅	₉

ASK: All respondents.

Section F: Media Use and Awareness

F1. These next questions ask about your use of TV and other media.

In the past 6 months, that is since [FILL DATE], about how often did you…

PROGRAMMER: CALCULATE 6 MONTHS FROM THE DATE OF CURRENT INTERVIEW.

		Several times a day	About once a day	3-5 days a week	1-2 days a week	Every few weeks	Less often	Never	Prefer Not to Answer
F1_1.	Watch TV shows or movies on any platform including a TV, computer, tablet, or smartphone?	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 music on DatPiff, Pandora, Spotify, Apple Music, SoundCloud or others?	₁	₂	₃	₄	₅	₆	₇	₉
F1_4.	Listen to the radio (local radio stations)?	₁	₂	₃	₄	₅	₆	₇	₉
F1_6.	Browse any other type of website, like news or entertainment?	₁	₂	₃	₄	₅	₆	₇	₉

ASK: All respondents.

DISPLAY: FILL DATE will calculate the date 6 months prior to the current date.

F1a. Thinking about the social media sites you use, about how often do you visit or use …

PROGRAMMER: RANDOMIZE ALL

		Several times a day	About once a Day	3-5 days a week	1-2 days a week	Every few weeks	Less often	Never	Prefer Not to Answer
F1a_1.	Facebook	₁	₂	₃	₄	₅	₆	₇	₉
F1a_2.	Instagram	₁	₂	₃	₄	₅	₆	₇	₉
F1a_3.	Twitter	₁	₂	₃	₄	₅	₆	₇	₉

ASK: All respondents.

F2. Think about the following websites. In the past 6 months, that is since [FILL DATE], about how often did you visit or use…

PROGRAMMER: RANDOMIZE ALL

		Several times a day	About once a day	3-5 days a week	1-2 days a week	Every few weeks	Less often	Never	Prefer Not to Answer
F2_2.	XXL http://www.xxlmag.com	₁	₂	₃	₄	₅	₆	₇	₉
F2_4.	Complex http://www.complex.com	₁	₂	₃	₄	₅	₆	₇	₉
F2_7.	Global Grind http://www.globalgrind.com	₁	₂	₃	₄	₅	₆	₇	₉
F2_8.	Spin http://www.spin.com	₁	₂	₃	₄	₅	₆	₇	₉
F2_9.	Worldstar Hip Hop http://worldstarhiphop.com	₁	₂	₃	₄	₅	₆	₇	₉

ASK: All respondents.

DISPLAY: FILL DATE will calculate the date 6 months prior to the current date.

F3. How often do you go to the movies at a movie theater?

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 see movies at a movie theater

9 Prefer not to answer

ASK: All respondents.

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

ASK: All respondents.

Home Environment

[IF LONGITUDINAL=NO]

These next questions ask about your parent(s) or guardian(s). Some people your age have parents who they do not live with. As you answer these questions, please think only about the parent(s) or guardian(s) you live with.

ASK: Respondents who are not longitudinal.

F9. [IF LONGITUDINAL=NO]

Do your parent(s) or guardian(s) have rules about how much time you can spend using media, such as TV, computer, video games, cell phones, and music?

1 Yes, my parent(s) or guardian(s) have lots of rules about it.

2 Yes, my parent(s) or guardian(s) have a few rules about it.

3 No, my parent(s) or guardian(s) don’t have any rules about it.

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

F10. [IF LONGITUDINAL=NO]

Do your parent(s) or guardian(s) have rules about what you are allowed to do on the computer, which video games you are allowed to play, or what music you’re allowed to listen to?

1 Yes, my parent(s) or guardian(s) have lots of rules about it.

2 Yes, my parent(s) or guardian(s) have a few rules about it.

3 No, my parent(s) or guardian(s) don’t have any rules about it.

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

F11. [IF LONGITUDINAL=NO]

In general, how often do your parent(s) or guardian(s) make sure you follow the rules they have about using media, such as TV, computers, video games, and music?

1 Most of the time

2 Some of the time

3 A little of the time

4 Never

5 My parent(s) or guardian(s) don’t have rules about using media

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

F12. [IF LONGITUDINAL=NO]

How often do your parent(s) or guardian(s) let you watch movies or videos that are rated R?

1 Never

2 Once in awhile

3 Sometimes

4 All the time

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

F13. [IF LONGITUDINAL=NO]

How often do your parent(s) or guardian(s) let you go to concerts, live shows, or other events?

1 Never

2 Once in awhile

3 Sometimes

4 All the time

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

F14. To show us that you are paying attention, please select ‘Never’ as your response to this item.

1 Never

2 Once in awhile

3 Sometimes

4 All the time

9 Prefer not to answer

ASK: All respondents.

Brand Awareness

F5. 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.

PROGRAMMER: RANDOMIZE F5_1-F5_5

F5_1. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard the following brand?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY1] months, have you seen or heard the following brand?

Truth®

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_2. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard the following brand?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU2_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard the following brand?

Digital Youth Against Tobacco (DYAT)

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_3. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard the following brand?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU2_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard the following brand?

The Real Cost

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_4. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard the following brand?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard the following brand?

Fresh Empire

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_5. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard the following brand?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard the following brand?

Drop Vape

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_6. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4] In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard an ad saying "Keep it fresh. Live tobacco-free."?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard an ad saying "Keep it fresh. Live tobacco-free."?

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F5_7. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4] In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen or heard about any rappers or other hip hop celebrities promoting a tobacco-free life?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen or heard about any rappers or other hip hop celebrities promoting a tobacco-free life?

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

Channels of FE Awareness

F6. [IF F5_4= 1 or 3]

Where have you seen or heard about Fresh Empire? Check all that apply.

PROGRAMMER: RANDOMIZE RESPONSE OPTIONS. KEEP ‘OTHER’ AND ‘PNTA’ AT THE END

1 On TV

2 On the radio

3 On the Internet or anywhere online

4 Billboards or other out-of-home ads (e.g., bus stops, at the movies, malls)

5 At a concert, club, festival, or event (e.g., SneakerCon or BETx Experience)

6 Hip Hop magazines (e.g., Slam, XXL, or Fader)

7 Some other place (please specify____________)

9 Prefer not to answer

ASK: Respondents who reported in F5_4 seeing or hearing Fresh Empire or were unsure if they had seen or heard Fresh Empire.

F7. [IF F5_4= 1 or 3]

Fresh Empire is online. Have you ever seen Fresh Empire on… Check all that apply

PROGRAMMER: RANDOMIZE KEEP ‘OTHER’ AND ‘I HAVE NOT SEEN’ AND ‘PNTA’ AT THE END; ALL APPEAR ON SCREEN AT ONCE

1 Twitter?

2 Instagram?

3 Facebook?

4 YouTube?

5 Pandora?

6 Spotify?

7 Sound Cloud?

8 Hip Hop websites (e.g., World Star, XXL, Complex, Global Grind, etc)?

9 Other (please specify____________)?

10 I have not seen Fresh Empire online

99 Prefer not to answer

ASK: Respondents who reported in F5_4 seeing or hearing Fresh Empire or were unsure if they had seen or heard Fresh Empire.

F7a. [IF F7 1-9 = YES]

Have you ‘liked’, shared, or commented on any social media posts about Fresh Empire?

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: Respondents who reported in F7 seeing Fresh Empire online.

F8. [IF F5_4= 1 or 3]

Do you know or know of anyone who is part of Fresh Empire?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who reported in F5_4 seeing or hearing Fresh Empire or were unsure if they had seen or heard Fresh Empire.

F50_5a. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

In the past [FILL MONTHS SINCE LAST SURVEY] months, have you seen Fresh Empire at an event, concert, or club?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)]

In the past [FILL MONTHS SINCE JANUARY 1] months, have you seen Fresh Empire at an event, concert, or club?

1 Yes

2 No

3 Not Sure

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE LAST SURVEY will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

Event Attendance And Reactions

F25. [IF F50_5a=1, 3, or 9]

Did you talk to anyone from Fresh Empire at an event, concert, or club?

1 Yes

2 No

9 Prefer not to answer

ASK: Respondents who reported in F50_5a hearing about a Fresh Empire event or were unsure or preferred not to answer if they had heard about a Fresh Empire.

F26. [IF F50_5a=1, 3, or 9] 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
F26_1.	I would go to another Fresh Empire event in the future	₁	₂	₃	₄	₅	₆
F26_2.	The event was fun	₁	₂	₃	₄	₅	₆

ASK: Respondents who reported in F50_5a hearing about a Fresh Empire event or were unsure or preferred not to answer if they had heard about a Fresh Empire.

Video Awareness And Engagement

F29. Now we would like to show you some videos and ads that have been shown in the U.S. Once you have viewed the video or ads, please click on the next arrow below to continue with the survey.

PROGRAMMER: RANDOMIZE ORDER OF SCREENSHOTS AND VIDEOS- VIDEOS ARE 4 FRESH EMPIRE VIDEOS, SCREENSHOTS ARE COLLAGES OF REAL COST, TRUTH, AND TIPS ADS

ASK: All respondents.

PROGRAMMER: DISPLAY KEEP IT MOVING VIDEO (SEE KEEP IT MOVING STORYBOARD IN ATTACHMENT 1A)

F29_1. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)]

Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: INSERT KEEP IT MOVING SCREENSHOT

F30_1. What is the main message of this video?

1 The legal age for buying cigarettes is going up

2 Cigarette smoke contains more than 7,000 chemicals

3 Smoking causes many kinds of cancer

4 Living tobacco-free keeps you healthy so you can get to where you want to be in life

5 If I smoke cigarettes, I won’t be able to get 100 percent out of my body

6 Smoking can damage nearly every part of your body

98 Not sure

99 Prefer not to answer

ASK: All respondents.

PROGRAMMER: INSERT KEEP IT MOVING SCREENSHOT

F32_1. 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
F32_1.	This video is worth remembering	₁	₂	₃	₄	₅	₉
F32_2.	This video grabbed my attention	₁	₂	₃	₄	₅	₉
F32_3.	This video is powerful	₁	₂	₃	₄	₅	₉
F32_4.	This video is informative	₁	₂	₃	₄	₅	₉
F32_5.	This video is meaningful to me	₁	₂	₃	₄	₅	₉
F32_6.	This video is convincing	₁	₂	₃	₄	₅	₉

ASK: All respondents.

PROGRAMMER: INSERT KEEP IT MOVING SCREENSHOT

F33_1. [IF F29_1 = 2-5]

Have you ‘liked’, shared, or commented on any social media posts about this video?

1 Yes

2 No

3 Not sure

9 Prefer not to answer

ASK: Respondents who report seeing the video more than ‘Never.’

PROGRAMMER: DISPLAY BARBERSHOP VIDEO (SEE BARBERSHOP STORYBOARD IN ATTACHMENT 1A)

F29_9.

[IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: INSERT BARBERSHOP SCREENSHOT

F30_9. What is the main message of this video?

1 The legal age for buying cigarettes is going up

2 Cigarette smoke contains more than 7,000 chemicals

3 Smoking causes many kinds of cancer

4 Smoking can ruin your look

5 Live tobacco free to stay fresh

98 Not sure

99 Prefer not to answer

ASK: All respondents.

PROGRAMMER: INSERT BARBERSHOP SCREENSHOT

F32_9. 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
F32_11.	This video is worth remembering	₁	₂	₃	₄	₅	₉
F32_12.	This video grabbed my attention	₁	₂	₃	₄	₅	₉
F32_13.	This video is powerful	₁	₂	₃	₄	₅	₉
F32_14.	This video is informative	₁	₂	₃	₄	₅	₉
F32_15.	This video is meaningful to me	₁	₂	₃	₄	₅	₉
F32_16.	This video is convincing	₁	₂	₃	₄	₅	₉

ASK: All respondents.

PROGRAMMER: INSERT BARBERSHOP SCREENSHOT

F33_9. [IF F29_9=2-5]

Have you ‘liked’, shared, or commented on any social media posts about this video?

1 Yes

2 No

3 Not sure

9 Prefer not to answer

ASK: Respondents who have seen the video more than ‘never.’

PROGRAMMER: DISPLAY LEVEL UP VIDEO (SEE LEVEL UP STORYBOARD IN ATTACHMENT 1A)

F29_10.

[IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: INSERT LEVEL UP SCREENSHOT

F30_10. What is the main message of this video?

1 The legal age for buying cigarettes is going up

2 Cigarette smoke contains more than 7,000 chemicals

3 Smoking causes many kinds of cancer

4 Tobacco gets in the way of your rise to the top

5 Don’t let tobacco control you

6 Addiction to cigarettes keeps you from being successful

98 Not sure

99 Prefer not to answer

ASK: All respondents.

PROGRAMMER: INSERT LEVEL UP SCREENSHOT

F32_10. 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
F32_101.	This video is worth remembering	₁	₂	₃	₄	₅	₉
F32_102.	This video grabbed my attention	₁	₂	₃	₄	₅	₉
F32_103.	This video is powerful	₁	₂	₃	₄	₅	₉
F32_104.	This video is informative	₁	₂	₃	₄	₅	₉
F32_105.	This video is meaningful to me	₁	₂	₃	₄	₅	₉
F32_106.	This video is convincing	₁	₂	₃	₄	₅	₉

ASK: All respondents.

PROGRAMMER: INSERT LEVEL UP SCREENSHOT

F33_10. [IF F29_10=2-5]

Have you ‘liked’, shared, or commented on any social media posts about this video?

1 Yes

2 No

3 Not sure

9 Prefer not to answer

ASK: Respondents who have seen the video more than ‘never’

PROGRAMMER: DISPLAY BE NEXT VIDEO (SEE BE NEXT STORYBOARD IN ATTACHMENT 1A)

F29_11.

[IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] Apart from this survey, how frequently have you seen this video in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: INSERT BE NEXT SCREENSHOT

F30_11. What is the main message of this video?

1 The legal age for buying cigarettes is going up

2 Cigarette smoke contains more than 7,000 chemicals

3 Smoking causes many kinds of cancer

4 Don’t let tobacco control you

5 Addiction to tobacco holds you back

6 Live tobacco free to stay fresh

98 Not sure

99 Prefer not to answer

ASK: All respondents.

PROGRAMMER: INSERT BE NEXT SCREENSHOT

F32_110. 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
F32_110.	This video is worth remembering	₁	₂	₃	₄	₅	₉
F32_120.	This video grabbed my attention	₁	₂	₃	₄	₅	₉
F32_130.	This video is powerful	₁	₂	₃	₄	₅	₉
F32_140.	This video is informative	₁	₂	₃	₄	₅	₉
F32_150.	This video is meaningful to me	₁	₂	₃	₄	₅	₉
F32_160.	This video is convincing	₁	₂	₃	₄	₅	₉

ASK: All respondents.

PROGRAMMER: INSERT BE NEXT SCREENSHOT

F33_11. [IF F29_11=2-5]

Have you ‘liked’, shared, or commented on any social media posts about this video?

1 Yes

2 No

3 Not sure

9 Prefer not to answer

ASK: Respondents who have seen the video more than ‘never’

PROGRAMMER: DISPLAY SCREENSHOT 1

FE_Truth1.png

F29_5a. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)]

Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: DISPLAY TIPS2017.JPG [RANDOMIZE]

F29_6.

F29_6. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)] Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

PROGRAMMER: DISPLAY ADS4.JPG [RANDOMIZE]

F29_7. [IF (LONGITUDINAL = YES AND FU3_DATE NE BLANK) OR STARTWAVE = WAVE4]

Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE FU_3 COMPLETION] months?

[IF (LONGITUDINAL = NO) OR (IF LONGITUDINAL = YES AND FU3_DATE = BLANK)]

Apart from this survey, how frequently have you seen these ads in the past [FILL MONTHS SINCE JANUARY 1] months?

1 Never

2 Rarely

3 Sometimes

4 Often

5 Very Often

9 Prefer not to answer

ASK: All respondents.

DISPLAY: FILL MONTHS SINCE FU_3 COMPLETION will be calculated from the current date. FILL MONTHS SINCE JANUARY 1 will be calculated from the current date.

F39. [IF F5_4=1 OR 3 OR 9]

How much do you agree or disagree with the following statements about Fresh Empire?

PROGRAMMER: RANDOMIZE F39_1-F39_3

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
F39_1.	I want to help promote Fresh Empire	₁	₂	₃	₄	₅	₉
F39_2 .	I’d defend Fresh Empire if someone was hating on it	₁	₂	₃	₄	₅	₉
F39_3.	I’d wear a Fresh Empire T-shirt	₁	₂	₃	₄	₅	₉

PROGRAMMER: RANDOMIZE ITEMS BELOW

F39_6.	I talk to my friends about Fresh Empire	₁	₂	₃	₄	₅	₉
F39_9 .	If I see anything from Fresh Empire, I check it out	₁	₂	₃	₄	₅	₉
F39_10.	If I had the chance, I would tell people I know to watch Fresh Empire videos.	₁	₂	₃	₄	₅	₉
F39_11.	If I had the chance, I would tell people to check out Fresh Empire events	₁	₂	₃	₄	₅	₉

PROGRAMMER: RANDOMIZE ITEMS BELOW

F39_12.	Fresh Empire is popular with people like me	₁	₂	₃	₄	₅	₉
F39_13.	People are buzzing about Fresh Empire	₁	₂	₃	₄	₅	₉
F39_14.	Fresh Empire is becoming more popular with the people who hang out where I hang out	₁	₂	₃	₄	₅	₉
F39_15.	Checking out Fresh Empire at events is becoming more popular with the people who hang out where I hang out	₁	₂	₃	₄	₅	₉
F39_16.	Fresh Empire videos are for people like me	₁	₂	₃	₄	₅	₉
F39_17.	Fresh Empire events are for people like me	₁	₂	₃	₄	₅	₉

ASK: Respondents who reported in F5_4 seeing or hearing Fresh Empire or were unsure or preferred not to answer if they had seen or heard Fresh Empire.

F40_x. To what extent do you agree that each of the traits or statements listed below describe Fresh Empire?

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
F40_1.	Trendy	₁	₂	₃	₄	₅	₉
F40_2.	Fresh	₁	₂	₃	₄	₅	₉
F40_3.	In control	₁	₂	₃	₄	₅	₉
F40_4.	Keeps it 100	₁	₂	₃	₄	₅	₉

ASK: All respondents.

Section G: Environment

[IF LONGITUDINAL = NO]

The next section asks some questions about your household and peers.

ASK: Respondents who are not longitudinal.

G1. [IF LONGITUDINAL = NO]

Other than you, has anyone who lives with you used any of the following during the past 30 days…? Select all that apply.

1 Cigarettes

2 Cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s

3 Tobacco out of a water pipe (also called “hookah”)

4 Electronic nicotine products, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”

5 Any other form of tobacco

6 No, no one who lives with me has used any form of tobacco during the past 30 days

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

G1a. [IF G1=5 AND LONGITUDINAL = NO]

What other form of tobacco has anyone who lives with you used during the past 30 days?

___________________________

ASK: Respondents who are not longitudinal and who reported living with someone who used ‘any other form of tobacco’ during the last 30 days in G1.

G2. [IF LONGITUDINAL = NO]

Have any of your brother(s) and/or sister(s) smoked cigarettes during the past 30 days?

1 Yes

2 No

3 I don’t know

4 I don’t have any brothers or sisters

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

G3. [IF LONGITUDINAL = NO]

Which statement best describes the rules about smoking in your home? Would you say…

1 Smoking is not allowed anywhere inside your home

2 Smoking is allowed in some places or at some times

3 Smoking is allowed anywhere inside the home

4 There are no rules about smoking inside the home

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

G4. [IF LONGITUDINAL = NO]

How well would you say you have done in school? Would you say…

1 Much better than average

2 Better than average

3 Average

4 Below average

5 Much worse than average

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

G5. [IF LONGITUDINAL = NO]

How much do you agree or disagree with the following statements?

PROGRAMMER: RANDOMIZE G5_1-G5_3

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
G5_1.	I feel close to people at my school.	₁	₂	₃	₄	₅	₉
G5_2.	I am happy to be at my school.	₁	₂	₃	₄	₅	₉
G5_3.	I feel like I am a part of my school.	₁	₂	₃	₄	₅	₉

ASK: Respondents who are not longitudinal.

G6. [IF LONGITUDINAL = NO]

How far do you think you will go in school?

1 I don’t plan to go to school anymore

2 6th grade

3 7th grade

4 8th grade

5 9th grade

6 10th grade

7 11th grade

8 12th grade or GED

9 Some college or technical school but no degree

10 Technical school degree

11 College degree

12 Graduate school, medical school, or law school

99 Prefer not to answer

ASK: Respondents who are not longitudinal.

G7. [IF LONGITUDINAL = NO]

How many close friends do you have? Close friends include people whom you feel at ease with, can talk to about private matters, and can call on for help.

__________ MIN 0 MAX 7

Prefer not to answer

ASK: Respondents who are not longitudinal.

G8. [IF LONGITUDINAL = NO]

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

ASK: Respondents who are not longitudinal.

G9. How much do you agree or disagree with the following statements?

PROGRAMMER: RANDOMIZE G9_1-G9_4

		Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Prefer Not to Answer
G9_1.	I would like to explore strange places.	₁	₂	₃	₄	₅	₉
G9_2.	I like to do frightening things.	₁	₂	₃	₄	₅	₉
G9_3.	I like new and exciting experiences, even if I have to break the rules.	₁	₂	₃	₄	₅	₉
G9_4.	I prefer friends who are exciting and unpredictable.	₁	₂	₃	₄	₅	₉

ASK: All respondents.

G10. [IF LONGITUDINAL = NO]

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 (Range: 1-30)

33 None

44 Don’t know

99 Prefer not to answer

Hard error: Please enter a number between 1 and 30 or select "None"

Hard Error: Please either enter a number or select None, Don’t know, or Prefer not to answer, but not both.

ASK: Respondents who are not longitudinal.

G11. [IF LONGITUDINAL = NO]

The next question asks about your relationship with your parent(s) or guardian(s). Some people your age have parents who they do not live with. As you answer this question, please think only about the parent(s) or guardian(s) you live with.

Thinking about the parent(s) or guardian(s) you live with, how satisfied are you with the way you communicate with each other?

1 Not at all satisfied

2 Not very satisfied

3 Somewhat satisfied

4 Quite satisfied

5 Very satisfied

9 Prefer not to answer

ASK: Respondents who are not longitudinal.

FINAL [IF CAPI]

That was the last question. Once you move past this screen, your responses will be locked. They cannot be seen by your interviewer. Please tell your interviewer that you are finished.

ASK: CAPI Respondents.

CODE [IF CAPI]

INTERVIEWER - ENTER 3 DIGIT CODE TO LOCK RESPONSES

[IN PERSON INTERVIEW ONLY]

ASK: CAPI interviewers.

RECON Thank you for your responses! We will be conducting another round of this survey in 6 months. Your participation in the next round is really important so that we can measure what has changed over time and what has stayed the same. When we contact you again in the future, 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.

Can we contact you to invite you to take the next round of the survey?

1 YES

2 NO

ASK: All respondents.

RECONREF [IF RECON=NO]

Your participation is important for the success of this study. We will find a time that works for you to be interviewed, and you will receive another $25 after you complete the interview. Can we contact you for the next survey?

1 YES

2 NO - - GO TO INCENT01

ASK: Respondents who answered ‘NO’ to RECON.

GOTO: If RECONREF = YES, go to next question MOVE. If RECONREF = NO, go to INCENT01.

MOVE Do you plan to move in the next 6 months?

1 YES

2 NO

3 DON’T KNOW

ASK: Respondents who agreed to participate in the next survey in RECON or RECONREF.

MOVEL

[IF (FU3_FAMFRNM NE BLANK AND FU3_FAMFRNPH NE BLANK) OR (FU2_FAMFRNM NE BLANK AND FU2_FAMFRNPH NE BLANK) OR (FU1_FAMFRNM NE BLANK AND FU1_FAMFRNPH NE BLANK) OR (BL_FAMFRNM NE BLANK AND BL_FAMFRPH NE BLANK)]

PROGRAMMER: LOOK AT VALUES FROM FU3 (most recent survey). IF BOTH ARE NOT BLANK, STORE THE VALUES IN FAMFRNM AND FAMFRPH; ELSE STORE THE VALUES FOR THE FU2 OR FU1 IF NOT BLANK OR BASELINE IN FAMFRNM AND FAMFRPH.

During your last interview, you said that [FILL FAMFRNM] would know how to contact you and provided the following phone number [FILL FAMFRPH].

Is this information still correct or would you like to update this information?

1 INFORMATION IS CORRECT

2 UPDATE INFORMATION

DISPLAY: FAMFRNM and FAMFRPH are the most recently provided contact information for a family member or friend. These should be filled based on the most recently completed survey, whether that be FU3, FU2, FU1, or Baseline.

ASK: Respondents who responded to FAMFRNM and FAMFRNPH in any prior wave.

FRIFAM [IF MOVEL=2 OR ((BL_FAMFRNM IS BLANK OR BL_FAMFRPH IS BLANK) AND (FU1_FAMFRNM IS BLANK OR FU1_FAMFRPH IS BLANK)) AND (FU2_FAMFRNM IS BLANK OR FU2_FAMFRPH IS BLANK)) AND (FU3_FAMFRNM IS BLANK OR FU3_FAMFRPH IS BLANK))]

[IF CAPI] Just in case we have a hard time finding you, can you please give me the name and number of a close family member who does not live here, but who will know how to reach you?

[IF WEB] Just in case we have a hard time finding you, can you please give me the name and number of a close family member who does not live with you, but who will know how to reach you?

Name __________________________________

Phone Number ___________________________

ASK: Respondents who wanted to update information in MOVEL or didn’t respond to FAMFRNM or FAMFRPH in prior waves.

RECONTH Thanks for providing this information. NEXT

ASK: All respondents.

INCENT01 [IF CAPI AND CONAGE=2]

PROGRAMMER: DISPLAY CASE ID FROM IFMS ON SCREEN.

INTERVIEWER: 1) OFFER THE YOUTH THE CASH. ONE $20 BILL AND ONE $5 BILL

2) RECORD THE ABOVE CASE ID ON THE INCENTIVE RECEIPT

3) MARK THE APPROPRIATE BOX TO INDICATE WHETHER THE YOUTH ACCEPTED OR DECLINED THE CASH

4) SIGN AND DATE THE INCENTIVE RECEIPT

5) GIVE THE PINK COPY OF THE RECEIPT TO THE YOUTH

I have signed this form to indicate that I have given you $25 for completing this interview. Thanks again!

NEXT

ASK: CAPI respondents.

S01. [IF CAPI AND CONAGE=2 AND (RECONREF=1 OR BLANK) AND STARTWAVE=WAVE5] Next I have some questions about the people who live in this home. I would like to ask these questions to one of your parents. Please ask one of your parents to join us.

ONCE PARENT HAS JOINED, READ REMAINING QUESTIONS TO PARENT

Thank you for joining us. Your child has completed his/her portion of the interview. I have just a few questions for you about other children in the household.

Please think about all of the people who live in this home who are 17 years old or younger. Not including your child who just completed the interview, how many people live in this home who are 17 years old or younger?

__________ MIN 0 MAX 7

Prefer not to answer

ASK: CAPI respondents who are under the age of 18 and who said either ‘yes’ to RECONREF or who skipped RECONREF.

____________________________________________________________________

S02. [IF CAPI AND S01>=1 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] Please tell me more about these people, starting with the oldest. How old is this person?

__________ MIN 0 MAX 17

Prefer not to answer

ASK: CAPI respondents who are under the age of 18 and who said either ‘yes’ to RECONREF or who skipped RECONREF and who report at least one additional minor in the household in S01.

_____________________________________________________________________

S02a. [IF CAPI AND S02=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S03. [IF CAPI AND S01>=2 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5]. How old is the next oldest person in the household who is 17 years old or younger?

__________ MIN 0 MAX 17

₉ Prefer not to answer

S03a. [IF CAPI AND S03=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S04. [IF CAPI AND S01>=3 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] How old is the next oldest person in the household who is 17 years old or younger?

__________ MIN 0 MAX 17

₉ Prefer not to answer

S04a. [IF CAPI AND S04=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S05. [IF CAPI AND S01>=4AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5]. How old is the next oldest person in the household who is 17 years old or younger?

__________ MIN 0 MAX 17

₉ Prefer not to answer

S05a. [IF CAPI AND S05=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S06. [IF CAPI AND S01>=5 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] How old is the next oldest person in the household who is 17 years old or younger?

__________ MIN 0 MAX 17

₉ Prefer not to answer

S06a. [IF CAPI AND S06=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S07. [IF CAPI AND S01>=6 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] How old is the next oldest person in the household who is 17 years old or younger?

__________ MIN 0 MAX 17

₉ Prefer not to answer

S07a. [IF CAPI AND S07=12-17 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] What is this person’s name?

__________

₉ Prefer not to answer

S08. [IF CAPI AND AT LEAST ONE KID AGE 12-17 ROSTERED AND CONAGE=2 AND RECONREF=1 OR BLANK AND STARTWAVE=WAVE5] We would like to invite [FILL S02A THROUGH S07A NAMES WHERE AGE = 12-17] to see if he/she qualifies for this study.

[IF CAPI AND AT LEAST ONE KID AGE 12-17 ROSTERED AND CONAGE=1] We would like to invite [FILL S02A THROUGH S07A NAMES WHERE AGE = 12-17] to see if he/she qualifies for this study. But first we need parental permission. Is there a parent who is available to provide that permission?

INCENT02 [IF CAPI AND CONAGE=1] PROGRAMMER: DISPLAY CASE ID FROM IFMS ON SCREEN.

SIGN COMPENSATION RECEIPT AND HAND MONEY TO R I have signed this form to indicate that I have given you $25 for completing this interview. Thanks again!

S08a. [IF CAPI AND AT LEAST ONE KID AGE 12-17 ROSTERED AND CONAGE=1 AND RECONREF=1 OR BLANK] ONCE PARENT HAS JOINED, READ REMAINING QUESTIONS TO PARENT.

[IF CAPI AND AT LEAST ONE KID AGE 12-17 ROSTERED AND CONAGE=1] Thank you for joining us. Your child has completed his/her portion of the interview. I have just a few questions for you about other children in the household.

S08b. [IF CAPI AND AT LEAST ONE KID AGE 12-17 ROSTERED AND CONAGE=1 AND RECONREF=1 OR BLANK] Is [FILL NAMES OF 12-17 YEAR OLDS] available to answer a few questions to determine whether they qualify? If he/she/they are eligible, we can conduct the survey here and they will receive $25.

S09. [IF CAPI]

INTERVIEWER: ASK ITEM OF PARENT

Finally, RTI may contact you by phone or mail to ask a few questions about the quality of my work. Can you please give me your name and phone number?

Name __________________________________

Phone Number ___________________________

NEXT

PROGRAMMER: CODE AS 2690

ASK: CAPI respondents.

WEBTH [IF WEB] Thank you for your responses. Within 3 business days, we will send an email containing information about how to access and redeem your digital gift card. The email will come from Reward@VirtualRewardCenter. This information must be sent via email. What is the email address where we should send your gift card?

________________ PROGRAMMER: MAKE ENTRY MANDATORY. NO SKIPS ACCEPTED.

Note: You can participate only once and are eligible to receive only one gift card.

PROGRAMMER: CODE AS 2691

NEXT

END

Thank you again for your help. That was my last question.

Thank you for taking time to complete this survey.

OMB No: 0910-0788 Expiration Date: 05/31/2018

Paperwork Reduction Act Statement: The public reporting burden for this collection of information has been estimated to average 45 minutes per response to complete the assent/consent and survey (the time estimated to read, review and respond). Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov.

ASK: All respondents

MIEND. You may now close your browser or navigate away from this page.

ASK: Web respondents

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Rao, Pamela *
File Modified	0000-00-00
File Created	2021-01-20