OMB No. 0910-0810 Exp.
Date: 10/31/2021
Attachment F: Youth Questionnaire
FDA Tobacco Prevention Broad Quantitative Research Package
Youth Questionnaire
AGE CHECK
“Please answer each question as accurately as possible. Click on the “next” button at the bottom of the page to continue with the survey after you answer each question.”
1.A. How old are you?
Under 13 years old
13 years old
14 years old
15 years old
16 years old
17 years old
18 years old or older
[IF PARTICIPANT SELECTS B-F, CONTINUE TO PART A. IF PARTICIPANT SELECTS A or G, CONTINUE TO END PAGE.]
END PAGE
Thanks for your participation! Unfortunately, you are not eligible to complete the survey.
WELCOME PAGE
[TEXT FOR PARTICIPANTS]: “Please answer the questions on the following pages as accurately as possible. Remember to read the instructions carefully.”
[Each item on the Copy Testing Questionnaire will be presented in a separate page, separated by a “NEXT” button. There will also be a “BACK” button presented on each page in case youth accidentally skip a question.]
[Not all questions will be asked to all participants, participants will get questions based on how they screen into the study. All surveys will take no longer than 20 minutes to complete]
PART I
[Questions to be presented prior to showing rough-cut advertisements to ALL PARTICIPANTS – (Part 1 questions are only asked once]
A1. Does anyone who lives with you now… (Select all that apply)
Smoke cigarettes?
Use vapes, electronic cigarettes, e-cigs, vape pens, mods or a hookah pen?
Use smokeless tobacco (such as dip, spit, chewing tobacco, snus pouches, or moist snuff)?
Use any other form of tobacco?
No one who lives with me now uses any form of tobacco
[A1 = E is an exclusive response and cannot be selected in conjunction with option A, B, C, or D]
A2. How many of your four closest friends [vape/smoke a cigarette/use a cigar, cigarillo, or little cigar/ use smokeless/use hookah]?
0
1
2
3
4
A3. [RANDOMIZE ORDER. ALL ITEMS WILL BE PRESENTED ON THE SAME PAGE.]
A3_1. I like to explore strange places.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A3_2. I like to do frightening things.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A3_3. I like new and exciting experiences, even if I have to break the rules.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A3_4. I prefer friends who are exciting and unpredictable.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A3_5. My family and community are very important to me
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A3_6. My school life is an important aspect of my life
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
PART II
[(Questions to be provided after rough-cut advertisement) – AD VIEW PARTICIPANTS ONLY]
[TEXT FOR PARTICIPANTS]: “Please watch the video below. Please make sure your device volume is on so you can hear the audio.
To start watching the video, click on the video or press the play button. When the video ends, click on the button at the bottom of the page to continue with the survey.”
The ad will play twice before questions begin.
[Perceived Ad Effectiveness]
B1. What do you think is the main message of this advertisement? Please be as specific as possible.
[FREE RESPONSE BOX]
B2. What do you like about this advertisement? Please be as specific as possible.
[FREE RESPONSE BOX]
B3. What do you dislike about this advertisement? Please be as specific as possible.
[FREE RESPONSE BOX]
B4. Is there anything confusing, unclear, or hard to understand in this ad?
Yes
No
[If B4 = Yes, Ask B5. If B4 = No, Ask B6]
B5. What is confusing about this ad?
[FREE RESPONSE BOX]
B6. People sometimes have different emotional reactions when they see advertisements. On a scale from 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this ad made you feel:
Not at all Very
1 2 3 4 5
[RANDOMIZE ORDER]
Sad
Afraid
Irritated
Ashamed
Understood
Angry
Amused
Disgusted
Happy
Uneasy
Surprised
Informed
B7. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
[RANDOMIZE ORDER]
This ad is worth remembering
This ad grabbed my attention
This ad is powerful
This ad is informative
This ad is meaningful to me
This ad is convincing
This ad is terrible
This ad is silly
This ad is annoying
I trust the information in this ad
This ad told me things I never knew before about vapes
This ad is relevant to me
This ad gave me a reason not to use vapes
I can identify with what the ad says
This ad is different from other anti-tobacco ads I’ve seen or heard
B8. On a scale of 1 to 5, how would you rate the claims or arguments in this ad:
Not believable |
|
Believable |
|||
1 |
2 |
3 |
4 |
5 |
B9. On a scale of 1 to 5, indicate whether the ad made [smoking cigarettes/smoking little cigars/using hookah/vaping/using smokeless tobacco] look like something you would or would not want to do.
Makes me want to use vapes |
|
Makes me not want to use vapes |
||||
1 |
2 |
3 |
4 |
5 |
B10. If you saw this advertisement, on a scale from 1 to 5, where 1 is not at all likely and 5 is very likely, how likely would you be to do each of the following:
Not at all |
|
Very |
|||
1 |
2 |
3 |
4 |
5 |
Tell a friend about the ad
Look for more information online
Visit The Real Cost website or Facebook page
Share The Real Cost YouTube channel with a friend
Mention or like it on social media such as Facebook, Twitter, or Instagram
Do nothing
PART III
[Both ad exposure and control groups will see these questions]
[TEXT FOR PARTICIPANTS]: “Please answer each question as accurately as possible. Click on the button at the bottom of the page to continue with the survey.”
[Attitudes, Beliefs and Risk Perceptions]
How much do you agree or disagree with following statement:
C1. If I [vape/smoke a cigarette/use a cigar, cigarillo, or little cigar/ use smokeless/use hookah] I will…
C1_1. Damage my body
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_2. Damage my lungs
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_3. Vaping can change the way my brain works
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
C1_4. Become addicted to vaping
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_5. Be exposed to harmful chemicals (like formaldehyde and acrolein)
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_6. Develop serious health problems
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_7. Be exposed to metal particles (like nickel, tin, and aluminum)
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C2. [Vaping/smoking a cigarette/using a cigar, cigarillo, or little cigar/ using smokeless/using hookah] is . . .
Very Bad
Bad
Neither Good or Bad
Good
Very Good
C3. [Vaping/smoking a cigarette/using a cigar, cigarillo, or little cigar/ using smokeless/using hookah] . . .
Very Unenjoyable
Unenjoyable
Neither enjoyable or unenjoyable
Enjoyable
Very Enjoyable
C4. Out of every 10 people your age, how many do you think [vape/smoke a cigarette/use a cigar, cigarillo, or little cigar/ use smokeless/use hookah]? (Select one)
0 1 2 3 4 5 6 7 8 9 10
people people
[Attention-check items will be inserted randomly]
“Sometimes we ask different kinds of questions to make sure that our participants are reading the questions carefully and answering as accurately as possible.”
D1. Please select Tuesday and Friday from the list below. [RANDOMIZE ORDER]
Sunday
Tuesday
Thursday
Friday
“Sometimes we ask different kinds of questions to make sure that our participants are reading the questions carefully and answering as accurately as possible.”
D2. Jack’s favorite color is red. What is Jack’s favorite color?
Blue
Red
Green
Yellow
END PAGE
[TEXT FOR PARTICIPANTS]: “Thanks for completing the survey!
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 20 minutes per response to complete this survey (the time estimated to read and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Dana Wagner |
File Modified | 0000-00-00 |
File Created | 2021-08-26 |