D, Hookah Moderator's Guide

HOOKAH FOCUS GROUP MODERATOR GUIDE – IN PERSON
PATH ad hoc – E-cig and hookah formative research

A. OVERVIEW

Thank
 you
 for
 agreeing
 to
 participate
 in
 a
 discussion
 about
 hookah
 use
 .
 My
 name
 is

____________________
 and
 I
 will
 be
 leading
 the
 session
 tonight.

 With
 me
 is
 _____________,
 who
 will

be
 taking
 notes
 and
 helping
 me
 with
 the
 discussion.
 _________
 and
 I
 both
 work
 for
 Westat,
 a
 company

based
 in
 Rockville,
 MD.

 Through
 a
 contract
 from
 the
 National
 Institutes
 of
 Health
 (NIH)
 and
 the
 Food

and
 Drug
 Administration
 (FDA),
 Westat
 is
 developing
 materials
 and
 questionnaire
 items
 for
 a
 study

known
 as
 the
 Population
 Assessment
 of
 Tobacco
 and
 Health
 or
 PATH
 Study.
 The
 PATH
 Study
 is
 a
 large

national
 study

 to
 understand
 tobacco
 use
 and
 health
 among
 Americans.

Our
 interest
 is
 in
 being
 sure
 that
 people
 can
 understand
 and
 answer
 the
 questions
 we
 ask
 in
 the
 PATH

Study.

 Because
 hookah
 use
 is
 fairly
 new,
 people
 may
 think
 about
 it
 or
 talk
 about
 hookah
 use
 in
 different

ways.

 The

 questions
 and
 materials
 in
 the
 PATH
 Study
 need
 to

 reflect
 how
 people
 talk
 and
 think
 about

hookah
 use
 .
 We
 hope
 to
 learn
 from
 you
 how
 we
 should
 ask
 about
 this
 product
 in
 the
 study

questionnaires.

Today/tonight,
 we’ll
 ask
 you
 questions
 about
 your
 experiences
 using

 hookah,
 such
 as
 when
 you
 first

started
 using
 hookah,
 what
 you
 like
 about
 using

 hookah,
 how
 often
 you
 use

 hookah,
 and
 why
 you
 use

hookah.

Before
 we
 start,
 we’d
 like
 to
 make
 a
 few
 things
 clear.
 This
 is
 a
 research
 project,
 and
 your
 participation
 is

voluntary.
 The
 focus
 group
 will
 last
 about
 an
 hour
 and
 a
 half.

 We
 will
 provide
 you
 $40.00
 after
 the
 focus

group
 as
 a
 thank
 you
 for
 your
 participation.
 You
 may
 choose
 not
 to
 answer
 any
 question.
 You
 may
 leave

at
 any
 time
 during
 the
 session.

Your
 participation
 is
 anonymous.

 Findings
 from
 the
 focus
 group
 will
 include
 the
 ideas
 that
 you
 all
 share

with
 us
 today,
 but
 not
 your
 names.
 Sometimes
 we
 will
 quote
 what
 the
 group
 says,
 but
 we
 will
 not
 use

anyone’s
 names
 in
 the
 findings.

 This
 study
 is
 interested
 in
 what
 gets
 said,
 not
 who
 said
 what.

 On

occasion,
 researchers
 from
 NIH
 and
 FDA
 may
 listen
 to
 this
 discussion
 today/tonight.

[WALK
 PARTICIPANTS
 THROUGH
 THE
 INFORMED
 CONSENT
 DOCUMENT]

Does
 anyone
 have
 any
 questions?

 [ANSWER
 ALL
 QUESTIONS]

I’d
 like
 to
 start
 the
 audio
 recording
 now.

[TURN
 ON
 RECORDER]

I
 will
 call
 on
 you
 by
 your
 first
 name
 when
 appropriate.
 However,
 you
 don’t
 have
 to
 wait
 for
 me
 to
 call
 on

you.
 Feel
 free
 to
 speak
 naturally
 and
 interact
 with
 the
 other
 focus
 group
 participants.
 Please
 use
 each

other’s
 first
 names
 so
 that
 we
 know
 who
 you’re
 speaking
 to
 on
 the
 tape.
 When
 studying
 the
 transcripts

from
 today’s
 session,
 it
 is
 also
 helpful
 for
 me
 to
 know
 when
 we
 change
 speakers.
 So,
 please
 identify

yourself
 by
 first
 name
 when
 you
 speak
 so
 that
 we
 have
 that
 on
 tape.
 Also,
 please
 try
 to
 speak
 one
 at
 a

time.

 If
 you
 have
 a
 cell
 phone,
 we
 would
 appreciate
 if
 you
 would
 silence
 the
 ringer;
 if
 you
 need
 to
 take
 a

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HOOKAH FOCUS GROUP MODERATOR GUIDE – IN PERSON
PATH ad hoc – E-cig and hookah formative research

call,
 please
 step
 out
 and
 return
 as
 soon
 as
 you
 are
 done.

 If
 you
 need
 a
 restroom,
 they
 are
 located

___________.

 Please
 feel
 free
 to
 step
 out
 if
 you
 need
 to,
 but
 don’t
 all
 leave
 at
 once!

Does
 anyone
 have
 any
 other
 questions?

 [ANSWER
 ALL
 QUESTIONS]

B. INTRODUCTIONS

Let’s
 start
 off
 by
 going
 around
 the
 room:
 state
 just
 your
 first
 name,
 approximately
 how
 long
 you’ve
 been

using
 hookah,
 and
 then
 tell
 us
 something
 unique
 about
 yourself
 –
 an
 interesting
 hobby,
 famous
 relative

or
 ancestor,
 something
 like
 that.

C. HOOKAH
 USE

[GENERAL
 DISCUSSION
 –
 NO
 NEED
 TO
 ASK
 EVERYONE
 INDIVIDUALLY]

a. When
 did
 you
 first
 use
 a
 hookah?

b. Why
 did
 you
 start
 using
 a
 hookah?

c. How
 often
 do
 you
 use
 hookah?

d. When
 was
 the
 last
 time
 you
 used
 a
 hookah?

 Could
 you
 describe
 it
 to
 me?

i.
PROBE
 AS
 NEEDED:
 Where
 were
 you?
 How
 many
 people
 were
 you
 with?
 How

typical
 is
 this
 of
 your
 usual
 hookah
 use?

[SHOW
 PICTURE
 OF
 HOOKAH]

A. ANATOMY
 OF
 THE
 HOOKAH

a. Can
 anyone
 tell
 me
 about
 the
 different
 parts
 of
 the
 hookah
 and
 what
 they
 are
 for?

 You
 can
 use

the
 letters
 in
 the
 picture
 to
 refer
 to
 specific
 parts
 if
 you
 would
 like.

CHARCOAL

Many
 people
 use
 charcoal
 to
 heat
 the
 hookah.

[REFER
 TO
 LETTER
 POINTING
 TO
 WHERE
 CHARCOAL
 GOES]

a. Do
 you
 use/Have
 you
 used
 natural
 charcoal?

 Is
 it
 quick
 light
 or
 non-­‐quick
 light?

b. Have
 you
 heard
 of
 or
 used
 electric
 charcoal?

c. What
 do
 you
 think
 about
 electric
 charcoal?

BOWL

[REFER
 TO
 LETTER
 POINTING
 TO
 BOWL]

d. What
 goes
 in
 that
 part?

e. What
 do
 you
 typically
 put
 in
 there?

f. Have
 you
 heard
 of
 or
 ever
 put
 anything
 else
 in
 there?

 (PROBE
 ONLY
 IF
 ABSOLUTELY
 NEEDED

with
 “such
 as
 juice,
 Kool-­‐Aid,
 or
 anything
 else?”)

g. Does
 that
 change
 the
 experience?

VENT

[REFER
 TO
 LETTER
 POINTING
 TO

 VENT]

h. Does
 anyone
 know
 what
 this
 is?

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HOOKAH FOCUS GROUP MODERATOR GUIDE – IN PERSON
PATH ad hoc – E-cig and hookah formative research

[IF
 NEEDED:

 Tell
 them
 that
 it
 is
 the
 vent
 for
 hookah]

i. Why
 do
 you
 think
 there
 is
 a
 vent
 there?

 What
 do
 you
 think
 it
 does?

[Many
 of
 you
 already
 know
 this,
 but]
 Typically
 people
 use
 something
 called
 shisha
 or
 mu’assel
 in
 a

hookah.

[SHOW
 PICTURE
 OF
 SHISHA]

j. Have
 you
 seen
 this
 before?

k. What
 is
 shisha?
 (What
 is
 it
 made
 of?)

l. What
 kind
 or
 flavors
 of
 shisha
 have
 you
 used?

a. Is
 it
 herbal?

 Fruit?

 Tobacco?

 Candy?

 Some
 combination
 of
 those?

m. Does
 all
 shisha
 contain
 tobacco?

n. Does
 shisha
 contain
 nicotine?

[PROBE
 AS
 NEEDED]

i.
How
 would
 you
 recommend
 we
 ask
 about
 other
 changes
 people
 might
 make
 to
 a

hookah?

ii.
For
 example,
 how
 would
 you
 ask
 someone
 what
 they
 use
 in
 the
 bowl
 for
 the
 liquid

in
 a
 hookah?

iii.
How
 would
 you
 ask
 them
 what
 they
 use
 in
 a
 hookah?

B. HOOKAH
 USE
 BEHAVIOR

a. When
 you
 use
 a
 hookah,
 how
 many
 puffs
 do
 you
 usually
 take?

b. How
 long
 does
 it
 usually
 take
 you
 to
 use
 one
 hookah?

c. How
 often
 do
 you
 use
 your
 hookah
 in
 a
 day?

d. Is
 there
 a
 certain
 time
 of
 day
 that
 you
 usually
 use
 a
 hookah?

e. Where
 do
 you
 usually
 use
 a
 hookah?

f. Are
 you
 usually
 alone
 or
 do
 you
 usually
 use
 with
 friends?

g. How
 many
 hoses
 do
 you
 usually
 have
 coming
 off
 the
 hookah?

h. How
 many
 people
 do
 you
 usually
 share
 the
 hookah
 with?

i. Do
 you
 own
 a
 hookah?

 Do
 you
 live
 with
 someone
 who
 owns
 a
 hookah?

j. For
 how
 long
 have
 you
 been
 using
 hookahs
 this
 way?

 Would
 you
 describe
 this
 as
 how
 you

“typically”
 use
 a
 hookah?

k. Do
 you
 consider
 hookah
 a
 “tobacco
 product”?

i.
PROBE
 AS
 NEEDED:
 Tell
 me
 more
 about
 that.
 Is
 this
 what
 you
 usually
 do?

C. USE
 BEHAVIORS

a. What
 do
 YOU
 usually
 use
 in
 a
 hookah?

b. Have
 you
 ever
 used
 anything
 else
 in
 a
 hookah?

 Do
 you
 know
 anyone
 who
 has
 used
 anything

other
 than
 [responses
 provided]
 in
 a
 hookah?

c. Do
 you
 prepare
 the
 hookah
 yourself
 or
 does
 someone
 else
 prepare
 it
 for
 you?

d. Where
 do
 you
 buy
 the
 shisha?

e. How
 do
 you
 decide
 which
 one
 to
 buy?

f. How
 much
 do
 you
 usually
 pay
 for
 it?

 Is
 it
 expensive?

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HOOKAH FOCUS GROUP MODERATOR GUIDE – IN PERSON
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g. If
 you
 purchase
 shisha
 yourself,
 how
 long
 does
 it
 usually
 last?
 How
 do
 you
 think
 the
 price
 of

the
 shisha
 compare
 to
 other
 tobacco
 products?

i.
PROBE
 AS
 NEEDED:
 How
 do
 you
 know
 that?/How
 can
 you
 tell?
 Do
 you
 have
 a
 typical

brand
 that
 you
 like
 to
 use?

In
 our
 surveys,
 we
 often
 want
 to
 learn
 how
 many
 cigarettes
 smokers
 are
 using.

 We
 thus
 typically
 ask
 a

question
 like
 the
 following
 [SHOW
 TO
 PARTICIPANTS]:

On
 average,
 about
 how
 many
 cigarettes
 do
 you
 now
 smoke
 each
 day?

 A
 pack
 usually
 has
 20

cigarettes
 in
 it.

If
 we
 were
 to
 ask
 about
 using
 a
 hookah,
 does
 asking
 [SHOW]
 “On
 average,
 about
 how
 many
 times
 do

you
 use
 a
 hookah
 in
 a
 day?”
 make
 sense
 to
 you?

 What
 time
 period
 makes
 sense—day,
 week,
 month,
 3

months?

 Explain.

[IF
 THE
 ABOVE
 WORKS]

 How
 meaningful
 would
 it
 be
 for
 us
 to
 then
 ask
 [SHOW]:

“Each
 time
 you
 use
 a
 hookah,
 how
 many
 puffs
 do
 you
 take?”

Does
 this
 question
 make
 sense
 to
 you
 [SHOW]:

“On
 average,
 how
 long
 [is/was]
 one
 hookah
 session
 for
 you
 [and
 the
 people
 you
 share/d
 it

with]?
 A
 session
 is
 one
 sitting
 in
 which
 you
 use
 hookah,
 whether
 alone
 or
 with
 others.”

[IF
 ABOVE
 QUESTIONS
 DO
 NOT
 WORK]
 What
 would
 be
 a
 better
 way
 to
 ask
 these
 types
 of
 questions?

Would
 you
 say
 a
 hookah
 ‘session’
 or
 a
 ‘time’
 that
 you
 used
 a
 hookah
 or
 something
 else?

D. DUAL
 USE

We’re
 also
 interested
 in
 how
 people
 use
 tobacco
 products
 in
 the
 same
 day.

a. Other
 than
 hookah,
 can
 you
 tell
 me
 what
 tobacco
 products
 you
 usually
 smoke
 or
 use?

b. Describe
 how
 you
 use
 hookah
 and
 __________
 in
 a
 typical
 day.

c. When
 do
 you
 use
 hookah
 and
 when
 do
 you
 use________
 in
 a
 typical
 day?

d. Which
 one
 do
 you
 use
 the
 most?

e. Which
 one
 did
 you
 start
 using
 first?

f. Why
 do
 you
 sometimes
 use
 hookah
 and
 sometimes
 use
 __________?

i.
PROBE
 AS
 NEEDED
 about
 environment,
 social
 context,
 subjective
 experience
 from

different
 products.

g. Do
 these
 patterns
 stay
 the
 same
 month
 to
 month,
 or
 does
 how
 you
 use
 hookah
 and
 _______

vary
 a
 lot
 from
 month
 to
 month?

h. Are
 you
 planning
 on
 cutting
 back
 on
 one
 of
 these
 products?
 Switching
 completely
 to
 one

product?

i. Do
 you
 think
 using
 a
 hookah
 is
 bad
 for
 you?

 How
 about
 compared
 to
 other
 tobacco
 products?

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HOOKAH FOCUS GROUP MODERATOR GUIDE – IN PERSON
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CLOSE

Those
 are
 all
 the
 questions
 I
 have
 for
 you,
 but
 let
 me
 check
 with
 my
 colleagues
 to
 see
 if
 there
 are
 issues

you
 all
 raised
 about
 which
 they
 have
 additional
 questions.

[CHECK
 WITH
 OBSERVERS,
 RETURN
 AND
 ASK
 ADDITIONAL
 QUESTIONS,
 AS
 APPROPRIATE]

Thank
 you
 for
 your
 thoughts
 and
 your
 time
 today.

 We
 will
 now
 give
 you
 $40
 as
 a
 thank
 you
 for
 your

participation.

 Do
 you
 have
 any
 other
 questions?

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