OMB# 0910-0810
Exp. 12/31/2024
APPENDIX E
SURVEY
TITLE OF INFORMATION COLLECTION:
The Real Cost Campaign: Media Tracking Study
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 survey 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 a question is accidentally skipped.]
[Not all questions will be asked to all participants, participants will receive questions based on how they screen into the study. All surveys will take no longer than 17 minutes to complete]
SECTION A: DEMOGRAPHICS
[IF ETHNICITY (Hispanic/Latino) = 1 (YES)]
You indicated earlier that you identify as Hispanic or Latino/a. How much do you agree or disagree with the following statement?
A1. Being Hispanic or Latino/a is important to my sense of identity.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
SECTION B: TOBACCO USE
B1. Earlier you said that you use vapes. What are the reasons why you have used vapes? Select all that apply.
1. They are affordable
2. They are easy to get
3. A friend or family member uses them
4. They are easy to hide from parents and/or teachers
5. They might be less harmful to me than smoking cigarettes
6. They come in flavors I like
7. They don't smell
8. They help me fit in
9. They help me socialize/make friends
10. They help me manage my anxiety, stress, or depression
11. To get high or a buzz from nicotine.
12. To do tricks.
13. I was curious about using vapes/just wanted to try it
14. They satisfy my cravings for nicotine
15. To try to quit other tobacco products, such as cigarettes
16. Other [please specify]
99. Prefer not to answer
B2. In thinking about all tobacco products. which was the first product that you ever used (if any)?
1. Cigarettes
2. Vapes
3. Cigarillos (examples include Black & Mild, Backwoods, and Swisher Sweets) or little cigars (examples include Cheyenne, Djarum, Talon, and 305s) WITHOUT marijuana
4. Cigarillos (examples include Black & Mild, Backwoods, and Swisher Sweets) or little cigars (examples include Cheyenne, Djarum, Talon, and 305s) WITH marijuana
5. Hookah
6. Smokeless tobacco, such as chewing tobacco or snuff
7. Other (please specify)
8. I have never used any tobacco products
99. Prefer not to answer
[For those who have experimented with both ENDS and cigarettes]
B3. You indicated earlier that you have used vapes, and you just said that you’ve also tried cigarettes. Which of these two products did you try first?
1. Cigarettes
2. Vapes
3. I don’t remember
4. It was around the same time
99. Prefer not to answer
B4. Which product do you use most often?
1. Cigarettes
2. Vapes
3. I use both equally as often
4. I do not use either product
99. Prefer not to answer
[If cigarettes (1) for previous response in B2]
B5_a. Why do you use cigarettes more often than vapes?
[OPEN END]
[If vapes (2) for previous response in B8]
B5_b. Why do you use vapes more often than cigarettes?
[OPEN END]
B6. Which product do you prefer?
Cigarettes
Vapes
I prefer them equally
99. Prefer not to answer
B7. Why do you prefer [cigarettes/vapes]?
[OPEN END]
B8. What other tobacco products have you tried (if any)? Select all that apply.
1. Cigarillos (examples include Black & Mild, Backwoods, and Swisher Sweets) or little cigars (examples include Cheyenne, Djarum, Talon, and 305s) WITHOUT marijuana
2. Cigarillos (examples include Black & Mild, Backwoods, and Swisher Sweets) or little cigars (examples include Cheyenne, Djarum, Talon, and 305s) WITH marijuana
3. Hookah
4. Smokeless tobacco, such as chewing tobacco or snuff
5. Other (please specify)
6. I have never used any other tobacco products
99. Prefer not to answer
SECTION C: PSYCHOGRAPHICS
How much do you agree or disagree with the following statements?
C1. My family is important to me.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
C2. My school life is an important aspect of my life.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
C3. In the last month, how often have you felt...
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0. Never |
Almost Never |
2. Sometimes |
3. Fairly Often |
4. Very Often |
99. Prefer not to answer |
C3_a. that you were unable to control the important things in your life? |
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C3_b. confident about your ability to handle your personal problems? |
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C3_c. that things were going your way? |
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C3_d. difficulties were piling up so high that you could not overcome them? |
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C4. How much do you agree or disagree with the following statements?
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Strongly Disagree |
Disagree |
3. Neither Disagree nor Agree |
4. Agree |
5. Strongly Agree |
99. Prefer not to answer |
C4_a. I tend to bounce back quickly after hard times |
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C4_b. It does not take me long to recover from a stressful event |
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C4_c. I usually come through difficult times with little trouble |
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C4_d. I have a hard time making it through stressful events |
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C4_e. It is hard for me to snap back when something bad happens |
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C4_f. I tend to take a long time to get over setbacks in my life |
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The next questions ask about your current relationship with your parents or guardians.
C5. How close do you typically feel to the adult or adults you live with?
1. Not at all close
2. Not very close
3. Somewhat close
4. Quite close
5. Very close
99. Prefer not to answer
C6. In the past 12 months, have your parents or guardians talked with you, even once, about not vaping?
1. Yes
2. No
99. Prefer not to answer
SECTION D: TOBACCO-RELATED KABS
How much do you agree or disagree with following statements:
If I vape I will…
D1_a. Become addicted.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_b. Be controlled by nicotine.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
D1_c. Be a bad influence on others
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D1_d. Be more likely to smoke cigarettes
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_e. Inhale metal particles
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_f. Damage my body
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_g. Damage my lungs
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_h. Be exposed to harmful chemicals
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D1_i. Disappoint others around me
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D1_j. Inhale toxic chemicals (e.g., acrolein) that may damage my DNA
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2. How much do you agree or disagree with the following statements about vaping?
D2_a. Vaping just a little can make you crave more.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D2_b. Vaping can lead to anxiety.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D2_c. Vaping helps people reduce anxiety.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
D2_d. When people are not able to vape, their anxiety increases.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2_e. Vaping helps people relieve stress.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
D2_f. When people are not able to vape, their stress increases.
1. Strongly Disagree
2. Disagree
3. Neither Disagree nor Agree
4. Agree
5. Strongly Agree
99. Prefer not to answer
D2_g. Most vapes that teens use contain nicotine.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D2_h. The toxic metals in vapes can cause irreversible lung damage.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D2_i. Most vapes contain really addictive amounts of nicotine.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
D2_j. Vaping prevention ads are just trying to scare us about vapes.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2_k. If I vape, my family will be disappointed.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2_l. If I vape, my friends will be disappointed.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2_m. If you were to vape every day, how likely is it that you, personally, would not be able to stop vaping even if you wanted to?
Not at all likely
A little likely
Somewhat likely
Very likely
Extremely likely
99. Prefer not to answer
D2_o. If you were to vape every day, how likely is it that you, personally, would inhale chemicals that harm your body?
Not at all likely
A little likely
Somewhat likely
Very likely
Extremely likely
99. Prefer not to answer
How much do you agree or disagree with the following statements?
D2_p. A vaping addiction could cause major problems for people.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D2_q. The chemicals in vapes are extremely harmful to one’s body.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
D3. How much do you agree or disagree with the following statements about cigarettes?
D3_a. Cigarette cravings can lead to anxiety.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
99. Prefer not to answer
SECTION E: AD RECALL AND RECOGNITION
E1. Which of the following health-related advertising do you recall seeing or hearing in the past 3 months? Advertising can be on TV, on the radio, online or on billboards, magazines, or signs in public places.
Have you seen any advertising in the past 3 months that encourages you… (Select all that apply).
[RANDOMIZE ORDER]
Not to smoke cigarettes
Not to vape or use e-cigarettes
Not to dip or chew tobacco
Not to drink alcohol
Not to drink and drive
Not to bully others
Not to use drugs
None of the above
Prefer not to answer
[ASK AMONG THOSE WHO RECALL ENDS RELATED ADVERTISING]
[IF E1 DOES NOT INCLUDE 1, 2, OR 3, SKIP E2, E3]
E2. Do you recall seeing or hearing ads about the harmful effects vaping in these places? (Please choose all that apply).
On social media, such as Snapchat, Facebook, Instagram, or Reddit
On online video platforms, such as YouTube or Twitch
Online, on web pages other than social media and online video platforms
On music streaming services, such as Spotify or Pandora
Non-cable TV such as Hulu or Roku
Cable TV (e.g., ABC, FOX)
Somewhere else (Please write-in)
Don’t know
Prefer not to answer
E3. What, if anything, do you recall about the advertising that you saw? This may include images, characters, or situations in the advertising, themes or ideas, slogans, and more.
[OPEN END]
E4. Do you recognize these brands?
[MATRIX]
Yes
No
I’m not sure
Prefer not to answer
[RANDOMIZE ORDER - SHOW IMAGES OF LOGOS]
The Real Cost
The Truth Campaign
Tips from Former Smokers
Puff Bar
JUUL
Vuse
Posh
SMOK
Hyde
[IF E4_A = 2 OR 3, SKIP E5 AND E6]
E5. Which of the following do you associate with “The Real Cost” brand? (Select all that apply).
[RANDOMIZE ORDER]
Not to smoke cigarettes
Not to vape or use e-cigarettes
Not to dip or chew tobacco
Not to drink and drive
Not to eat sugary food or drink sugary drinks
None of the above
Prefer not to answer
E6. On the scales below, mark your impressions of The Real Cost Campaign about the risks of vaping. [EACH SCALE IS 1-5]
● Not scientific – Scientific
● Not truthful (or trustworthy/not trustworthy) – Truthful
● Not persuasive – Persuasive
● Doesn’t make me think – Makes me think
● I don’t know The Real Cost Campaign
E7. Which of these vaping or tobacco-related prevention advertising, if any, do you recall seeing any in the past 3 months? Please choose all that apply.
[RANDOMIZE ORDER]
[INCLUDE BOTH IMAGES AND DESCRIPTIONS OF IMAGES]
Images of metals that are inhaled by vaping
A guy on a movie set with a metal monster
An athlete missing the team bus because she can’t find her vape
A boy taking money from his mom’s purse to buy a vape
A girl dropping a vape into a toilet
A girl talking about how vaping caused her anxiety
Real teens sharing how vaping has negatively impacted their lives
A Little Lung character failing to skateboard with Tony Hawk
Animals demanding that JUUL not test on humans
A teen taking care of her vape baby as a result of nicotine addiction
None of these
Prefer not to answer
E8. In the last 3 months, do you recall seeing/hearing ads or promotions for vapes or vaping products in these places? E.g., Advertisements for Juul, Puffbar, or other brands (Please choose all that apply).
1. On social media, such as Snapchat, Facebook, Instagram, or Reddit
On online video platforms, such as YouTube or Twitch
Online, on web pages other than your social media sites
On music streaming services, such as Spotify or Pandora
Non-cable TV such as Hulu or Roku
Cable TV (i.e., ABC, FOX)
In a store, such as a convenience store, supermarket, or gas station
Somewhere else (Please write-in)
Don’t know
No, I haven’t seen any advertisements for vapes or vaping products
Prefer not to answer
[IF E8 = 8, 9, 10 or 11, SKIP E9]
E9. In the past week, how often do you see/hear ads or promotions for vapes or vaping products [insert selected response from above]? Please give us your best guess.
More than once a day
About once a day
A few times in the past week
About once in the past week
More than a week ago
[AD_INTRO]
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.
E10. Apart from this survey, how frequently have you seen this ad in the past 3 months?
Never
Rarely
Sometimes
Often
Very Often
Prefer not to answer
[IF E10 = 1 OR 99, SKIP E11]
E11. Do you recall seeing or hearing this ad in these places in the past 3 months? (Please choose all that apply).
On social media, such as Snapchat, Facebook, Instagram, or Reddit
On online video platforms, such as YouTube or Twitch
Online, on web pages other than your social media sites
On music streaming services, such as Spotify or Pandora
Non-cable TV such as Hulu or Roku
Cable TV (i.e., ABC, FOX)
Somewhere else (Please write-in)
Don’t know
99. Prefer not to answer
SECTION F: AD TRACKING
F1. If you were going to tell a friend what this ad was about, how would you describe the main message of the ad to them? Please be as specific as possible.
[OPEN END]
F2. How much do you agree with the following statement? I found this ad to be confusing, unclear, or hard to understand.
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
[IF F2 = 1, 2, 3 OR 99, SKIP F3]
F3. What is confusing, unclear, or hard to understand about this ad?
[ALLOW “PREFER NOT TO ANSWER”]
[OPEN END]
F4. 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:
[MATRIX]
[ALLOW “PREFER NOT TO ANSWER”]
Not at all Very
1 2 3 4 5
[RANDOMIZE ORDER]
Sad
Afraid
Irritated
Ashamed
Understood
Angry
Amused
Disgusted
Uneasy
Surprised
11. Sick
12. Regretful
13. Guilty
F5. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
[MATRIX]
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
[RANDOMIZE ORDER]
This ad grabbed my attention
This ad is believable
This ad is powerful
This ad is informative
This ad is meaningful to me
This ad is convincing
This ad is terrible
F6. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
[MATRIX]
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
[RANDOMIZE ORDER]
I trust the information in this ad
This ad is worth remembering
This ad is relevant to me
This ad told me things I never knew before about vapes
This ad told me things I never knew before about cigarettes
This ad gave me a reason not to use vapes
This ad gave me a reason not to smoke cigarettes
F7. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
[MATRIX]
Strongly Disagree
Disagree
Neither Disagree nor Agree
Agree
Strongly Agree
Prefer not to answer
[RANDOMIZE ORDER]
This ad is different from other anti-tobacco ads I’ve seen or heard
This ad discourages me from wanting to vape
This ad discourages me from wanting to smoke cigarettes
This ad makes me concerned about the health effects of vaping
This ad makes me concerned about the health effects of smoking cigarettes
This ad makes vaping seem unpleasant to me
This ad makes smoking cigarettes seem unpleasant to me
F8. On a scale of 1 to 5, indicate whether the ad made vaping look like something you would or would not want to do.
[ALLOW “PREFER NOT TO ANSWER”]
Makes me want to use vapes Makes me not want to use vapes
1 2 3 4 5
F9. On a scale of 1 to 5, indicate whether the ad made smoking cigarettes look like something you would or would not want to do.
[ALLOW “PREFER NOT TO ANSWER”]
Makes me want to smoke cigarettes Makes me not want to smoke cigarettes
1 2 3 4 5
F10. After seeing this ad, on a scale from 1 to 5, where 1 is not at all likely and 5 is very likely, how likely are you to do each of the following:
[MATRIX]
[ALLOW “PREFER NOT TO ANSWER”]
Not at all Very
1 2 3 4 5
Tell friends or family about the ad
Look for more information online about vaping
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
F11. What do you think this ad applies to? Select all that apply.
Vaping with nicotine from tobacco
Vaping with tobacco-free nicotine
Vaping without nicotine
Don’t Know
Prefer Not to Answer
Some vapes may contain tobacco-free nicotine.
F12. Before you took this survey, had you heard of “tobacco-free nicotine”?
Yes
No
Don’t Know
Prefer Not to Answer
F13. What kind of vapes do people your age use most often?
END PAGE
[TEXT FOR PARTICIPANTS]: “Thanks for completing the survey! Your incentive will be administered within 30 days of you completing the survey. If you have any questions or concerns about using vapes/e-cigarettes, please visit The Real Cost website for resources.”
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 17 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 | Jones, Bonnie |
File Modified | 0000-00-00 |
File Created | 2023-08-18 |