Form 1 Extended Interview

Population Assessment of Tobacco and Health (PATH) Study (NIDA)

Attachment 3c - English
PATH Study Data Collection Instruments:
Adult Extended Interview
June 18, 2013

THIS INSTRUMENT IMMEDIATELY FOLLOWS THE LAST QUESTION OF THE
INDIVIDUAL SCREENER FOR THOSE RESPONDENTS WHO ARE SELECTED FOR
THE PATH STUDY.

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Adult Extended Questionnaire
Version 7.5

Table of Contents

CIGARETTE SECTION ..................................................................................................... 5
E-CIGARETTE SECTION ................................................................................................ 25
CIGAR SECTION ............................................................................................................. 44
PIPE SECTION ................................................................................................................ 63
HOOKAH SECTION ........................................................................................................ 77
SMOKELESS TOBACCO SECTION ............................................................................... 96
DISSOLVABLE TOBACCO SECTION .......................................................................... 115
POLYUSE SECTION ..................................................................................................... 130
NICOTINE DEPENDENCE SECTION ........................................................................... 134
PACKAGING AND HEALTH WARNINGS SECTION .................................................... 169
PRODUCT REGULATION - MODIFIED RISK TOBACCO PRODUCTS ...................... 180
MEDIA USE SECTION .................................................................................................. 189
SECONDHAND SMOKE EXPOSURE SECTION ......................................................... 193
PEER AND FAMILY INFLUENCES ............................................................................... 196
HEALTH EFFECTS OUTCOME SECTION ................................................................... 197
INDUSTRY ADVERTISING AND PROMOTION SECTION .......................................... 246
ADDITIONAL DEMOGRAPHICS ................................................................................... 251
CONTACT INFORMATION SECTION .......................................................................... 265
APPENDIX A: LOGIC CHECKS AND CONFIRMATIONS ............................................. 272
APPENDIX B: USER GROUP DEFINITIONS ................................................................ 275

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Adult Extended Questionnaire
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Section

Number of questions

Cigarettes

56

E-Cigarette

55

Cigar, Cigarillo and Filtered Cigar

47

Pipe Tobacco

41

Hookah

53

Smokeless Tobacco

51

Dissolvable Tobacco

47

Polyuse

5

Nicotine Dependence

72

Packaging and Health Warnings

27

Product Regulation-Modified Risk Tobacco Products

29

Media Use

13

Secondhand Smoke Exposure

8

Peer and Family Influences

3

Health Effects Outcome

148

Industry Advertising and Promotion

16

Additional Demographics

17

Contact Information

22

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Adult Extended Questionnaire
Version 7.5
OMB Control Number: 0925-0664

Expiration Date: 11/30/2015

Public reporting burden for this collection of information is estimated to average 54 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance
Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (XXXX-XXXX). Do
not return the completed form to this address.

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CIGARETTE SECTION
DISPLAY TRANSITION TEXT: The following questions ask about your experience with cigarettes.
PATH ID:

AC1005

Screen ID:

How many cigarettes have you smoked in your entire life? A pack usually has 20 cigarettes in it.
1 1 or more puffs but never a whole cigarette
2 1 to 10 cigarettes (about ½ pack total)
3 11 to 20 cigarettes (about ½ pack to 1 pack)
4 21 to 50 cigarettes (more than 1 pack but less than 3 packs)
5 51 to 99 (more than 2 ½ packs but less than 5 packs)
6 100 or more cigarettes (5 packs or more)
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked a cigarette (EVER USER CIG =1)
PATH ID:

AC1006

Screen ID:

How old were you the first time you smoked part or all of a cigarette?
1 I___I___I years old
GO TO AC1100
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked a cigarette (EVER USER CIG =1)
GO TO: If AC1006=-8 or -7, GO TO AC1120.
If EVER USER CIG = 1 AND AC1005 = 5, GO TO AC1100.
Else GO TO Box AC1
PATH ID:

AC1120

Screen ID:

The first time you smoked part or all of a cigarette, were you…
1 Less than 18 years old,
2 18 to 24 years old,
3 25 to 34 years old,
4 35 to 44 years old,
5 45 to 54 years old, or
6 55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who refused to give or did not know age (AC1006 = -8 or -7).
GO TO: If EVER USER CIG = 1 AND AC1005 = 5) GO TO AC1100.
Else GO TO BOX AC1.

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PATH ID:

AC1100

Screen ID:

Have you ever smoked cigarettes fairly regularly?
1
Yes
2
No
GO TO BOX AC1
-8
DON’T KNOW
GO TO BOX AC1
-7
REFUSED
GO TO BOX AC1
ASK: Respondents who have ever smoked a cigarette and have smoked 100 or more cigarettes (EVER
USER CIG =1 AND AC1005 = 5)
PATH ID:

AC1007

Screen ID:

How old were you when you first started smoking fairly regularly?
1 I___|___|
GO TO BOX AC1
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked fairly regularly (AC1100=1)
PATH ID:

AC1121

Screen ID:

When you first started smoking fairly regularly, were you…
1 Less than 18 years old,
2 18 to 24 years old,
3 25 to 34 years old,
4 35 to 44 years old,
5 45 to 54 years old, or
6 55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who refused to give or did not know age (AC1007 = -8 or -7).
BOX AC1
PROGRAM: Define the following variables (see Appendix B):
CURRENT USER CIGS
EVERY DAY USER CIGS
SOME DAY USER CIGS
EXPERIMENTAL CURRENT USER CIGS
EXPERIMENTAL FORMER USER CIGS
FORMER USER CIGS
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
IF EVERY DAY USER, GO TO AC1020
IF (SOME DAY USER OR EXPERIMENTAL CURRENT USER) AND AGE 18-24, GO TO AC9022

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IF ((SOME DAY USER OR EXPERIMENTAL CURRENT USER) AND AGE > 24) OR EXPERIMENTAL
FORMER USER OR FORMER USER, GO TO AC9020
PATH ID:

AC1020

Screen ID:

How old were you when you first started smoking cigarettes every day?
1

GO TO AC9022

I___I___I years old

-8
DON’T KNOW
-7
REFUSED
ASK: Everyday users
GO TO: If Age 18-24, go to AC9022.
If AC1020=-8 or -7, go to AC1122.
Else go to AC9020.
PATH ID:

AC1122

Screen ID:

When you first started smoking cigarettes every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AC1020 (AC1020 = -8, -7).
GO TO: If Age 18-24, go to AC9022.
Else go to AC9020.
PATH ID:

AC9022

Screen ID:

Do you consider yourself a smoker?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Experimental Current users who are 18-24 years old (AM0003=2).

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PATH ID:

AC9020

Screen ID:

When you first started smoking cigarettes, did you start with cigarettes flavored to taste like menthol or
mint?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Former users, Experimental Current users, and Experimental Former users
GO TO: If Current user AND AC9020=1, go to BOX AC6.
If Experimental Current user AND AC9020=1, go to BOX AC2
If Former user or Experimental Former user AND AC9020=1, go to AC1009
Else if AC9020=2, DK RF, go to AC9021
PATH ID:

AC9021

Screen ID:

When you first started smoking cigarettes, did you start with cigarettes flavored to taste like clove, spice,
candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Former users, Experimental Current users, and Experimental Former users who did not
start smoking with menthol flavored cigarettes (AC9020=2, DK, RF)
GO TO: If Current user, go to AC9002
Else if Experimental Current user, go to BOX AC2
Else go to AC1009
PATH ID:

AC1009

Screen ID:

About how long has it been since you completely quit smoking cigarettes?
1
2
3
-8

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS
DON’T KNOW

-7
REFUSED
ASK: Former users and Experimental Former users
GO TO: If Former user, BOX AC6
Else go to next section

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BOX AC6
PROGRAM: Define the following variables (see Appendix B) :
FORMER USER 12 MONTH CIGS
FORMER USER 12 MONTH PLUS CIGS
After defining the variables, then:
If FORMER USER 12 MONTH PLUS CIG, go to next section
Else if AC1100 = 1, go to AC9002
Else if former user 12 month, go to AC1025
Else go to BOX AC2
PATH ID:

AC9002

Screen ID:

About how long [have you been smoking | did you smoke] fairly regularly? Do not count any time you may
have stayed off cigarettes.
I___I___I
I___I___I
Years
Months
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users that have ever smoked fairly regularly (AC1100=1)
GO TO: If Former user, go to AC9003
Else go to BOX AC2
1

PATH ID:

AC9003

Screen ID:

On average, about how many cigarettes did you smoke per day while you were smoking fairly regularly? A
pack usually has 20 cigarettes in it.
|__|__|
Cigarettes per day
|__|__|
2
Packs per day
-8
DON’T KNOW
-7
REFUSED
ASK: Former users that have ever smoked fairly regularly (AC1100=1)
1

BOX AC2
EVERY DAY USER CIG GO TO AC1021
SOME DAY USER CIG OR EXPERIMENTAL CURRENT USER CIG GO TO AC1022
FORMER USER 12 MONTH CIG AND AC9003 NOT IN (0, DK, RF) GO TO BOX AC5
ELSE IF FORMER USER 12 MONTH CIG GO TO AC1025

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PATH ID:

AC1021

Screen ID:

On average, about how many cigarettes do you now smoke each day? A pack usually has 20 cigarettes in
it.
1

I___I___I
Cigarettes per day

2

I___I___I
Packs per day
-8
DON’T KNOW
-7
REFUSED
ASK: Everyday users
GO TO: If AC1021 = 0, go to AC1024
Else if AC1021 IN (DK, RF), go to AC1090
Else go to BOX AC5
PATH ID:

GO TO AC1090
GO TO AC1090

AC1090

Screen ID:

Would you say that, on average, you now smoke more than 20 cigarettes, about 20 cigarettes, or less than
20 cigarettes each day? A pack usually has 20 cigarettes in it.
1
More than 20 cigarettes each day
GO TO BOX AC5
2
About 20 cigarettes each day
GO TO BOX AC5
3
Less than 20 cigarettes each day
GO TO BOX AC5
-8
DON’T KNOW
GO TO AC1024
-7
REFUSED
GO TO AC1024
ASK: Everyday users who don’t know or refused to report how many cigarettes they smoke each day
(AC1021=-8,-7)
PATH ID:

AC1022

Screen ID:

On how many of the past 30 days did you smoke cigarettes?
1

|__|__|

Days
-8
DON’T KNOW
-7
REFUSED
ASK: Some Day users and Experimental Current users
PROGRAM: Range check: 1-30 days
GO TO: If AC1022 = 0 and some day user, go to AC1024
Else if AC1022 = 0 and experimental current user, go to AC1025
Else go to AC1023

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PATH ID:

AC1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AC1022 days I days you smoked], how many
cigarettes did you usually smoke each day? A pack usually has 20 cigarettes in it.
I___I___I
Cigarettes per day
I___I___I
2
Packs per day
-8
DON’T KNOW
-7
REFUSED
ASK: Some Day users and Experimental Current users who smoked at least one day in past 30 or did not
provide the number of days smoked in the past 30 (AC1022>0 OR AC1022 IN ((DK, R)
PROGRAM: If AC1022=1, DK or RF, display “days you smoked”. Else display “# days” where # = number of
days reported in AC1022.
GO TO: IF EXPERIMENTAL CURRENT USER CIG, GO TO AC1025
Else if AC1023 IN (0, DK, R), go to AC1024
Else go to BOX AC5
1

BOX AC5
Create variables:
Create CIGSPERDAY if respondent selected ‘cigarette’ unit when reporting number.
For everyday users and AC1021 <> -7, -8, CIGSPERDAY = AC1021
For someday users, CIGSPERDAY = AC1023
For former 12 month users, CIGSPERDAY = AC9003
Create PCKSPERDAY if respondent selected ‘pack’unit when reporting number.
For everyday users and AC1021 <> -7, -8, PCKSPERDAY = AC1021
For someday users, PCKSPERDAY = AC1023
For former 12 month users, PCKSPERDAY = AC9003
GO TO: If Everyday user and AC1090 in (1, 2, 3), GO TO AC9009
Else if AC1100 = 1, go to AC9004
Else go to AC1024

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PATH ID:

AC9004

Screen ID:

You mentioned that you [smoked | smoke ] [#] [[cigarette[s] I pack[s]] per day. [Did you smoke I Have you
smoked] about this many [cigarettes I packs] per day [during the time you smoked I since you started
smoking] fairly regularly?
1
Yes
2
No
GO TO AC9005
-8
DON’T KNOW
GO TO AC9005
-7
REFUSED
GO TO AC9005
ASK: Current and former 12 month users who provided the number of cigarettes smoked per day AND
have ever smoked fairly regularly (AC1100=1)
PROGRAM: For 12 month former smokers display “smoked”, “Did you smoke”, “during the time you
smoked”; For current smokers display “smoke”, “Have you smoked”, “since you started smoking”. If
CIGSPERDAY=1, display ‘cigarette’; if CIGSPERDAY>1, display ‘cigarettes’. If PCKSPERDAY=1, display
‘pack’; if PCKSPERDAY>1, display ‘packs’.
AUTOFILL [#] with CIGSPERDAY or PCKSPERDAY
GO TO: If current user AND AC9004 = 1, GO TO AC1024
Else if former 12 month user and AC9004 = 1, GO TO AC1025
PATH ID:

AC9009

Screen ID:

You mentioned that you smoke [CIGSPERDAY2]. Have you smoked about this many cigarettes per day
since you started smoking fairly regularly?
1
Yes
GO TO AC1024
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Everyday users who indicated an average number of cigarettes smoked per day (AC1090 IN (1, 2, 3))
AND have ever smoked fairly regularly (AC1100=1)
PROGRAM: Fill CIGSPERDAY2 with “more than 20 cigarettes each day” if AC1090 = 1, “about 20
cigarettes each day” if AC1090 = 2, and “less than 20 cigarettes each day” if AC1090 = 3
PATH ID:

AC9005

Screen ID:

On average, about how many cigarettes did you smoke per day when you smoked fairly regularly in the
past? A pack usually has 20 cigarettes in it.
I___I___I
Cigarettes per day
I___I___I
2
Packs per day
-7
REFUSED
-8
DON’T KNOW
ASK: Current users and Former users 12 Month who reported that they have smoked fairly regularly
(AC1100=1) AND who say they now smoke a different amount than they used to (AC9004=2)
GO TO: If Current User, go to AC1024
Else go to AC1025
1

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PATH ID:

AC1024

Screen ID:

[On the days that you smoke, how | How] soon after you wake up do you typically smoke your first cigarette
of the day? Please enter the number of minutes or hours.
1
|__|__| MINUTES after waking
GO TO AC1025
2
|__|__| HOURS after waking
GO TO AC1025
-8
DON’T KNOW
-7
REFUSED
ASK: Current users.
PROGRAM: For Every day smokers, display “How”. For Some day smokers, display “On the days that you
smoke, how”
PATH ID:

AC1092

Screen ID:

[On the days that you smoke, would | Would] you say you smoke your first cigarette of the day within the
first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AC1024=-8,-7)
PROGRAM: For Every day smokers, display “Would”. For Some day smokers, display “On the days that
you smoke, would”
PATH ID:

AC1025

Screen ID:

Around this time 12 months ago, were you smoking cigarettes every day, some days, or not at all?
1
Every day
2
Some days
GO TO AC1097
3
Not at all
GO TO AC1097
-8
DON’T KNOW
GO TO AC1097
-7
REFUSED
GO TO AC1097
ASK: Current Users, Experimental Current users, and Former users 12 Month
GO TO: Experimental Current CIG user GO TO NEXT SECTION

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PATH ID:

AC9006

Screen ID:

Around this time 12 months ago, on average, about how many cigarettes did you smoke each day? A pack
usually has 20 cigarettes in it.
1

I___I___I
Cigarettes per day

GO TO AC1097

2

I___I___I
Packs per day

GO TO AC1097

-8
DON’T KNOW
GO TO AC9140
-7
REFUSED
GO TO AC1097
ASK: Everyday users around this time 12 months ago (AC1025=1)
PATH ID:

AC9140

Screen ID:

Would you say that, around this time 12 months ago, on average, you smoked more than 20 cigarettes,
about 20 cigarettes, or less than 20 cigarettes each day? A pack usually has 20 cigarettes in it.
1
More than 20 cigarettes each day
2
About 20 cigarettes each day
3
Less than 20 cigarettes each day
-8
DON’T KNOW
-7
REFUSED
ASK: Everyday users around this time 12 months ago (AC1025=1) who refused or did not know how many
cigarettes they smoked each day 12 months ago (AC9006=DK/R)
GO TO: If Current user, go to AC1097
Else if Former User 12 month, go to AC9007
PATH ID:

AC1097

Screen ID:

The next questions ask about your experience buying cigarettes.
In the past 30 days, did you use a coupon when buying cigarettes?
1
Yes
2
No
3
I did not buy cigarettes in the past 30 days
-8
DON’T KNOW
-7
REFUSED
ASK: Current users

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GO TO AC9007
GO TO AC9007
GO TO AC9007
GO TO AC9007

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PATH ID:

AC1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy cigarettes?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy cigarettes in the last 30 days (AC1097=1)

PATH ID:

AC9007

Screen ID:

When you [buy I bought] cigarettes for yourself, [do I did] you usually buy manufactured cigarettes or a
pouch of tobacco to roll-your-own cigarettes? Choose all that apply.
1
Manufactured cigarettes
2
Roll-your-own tobacco
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month
PROGRAM: For current smokers, display “buy” and “do”; For 12 month former smokers, display “bought”
and “did”
PROGRAM:
If respondent provides more than one response in AC9007, create and repeat AC1030 TO AC1051 once for
each cigarette type, following appropriate skip patterns.
If AC9007 = DK or R, go through AC1030 TO AC1051 following the display instructions for manufactured
cigarettes.
PATH ID:

AC1030

Screen ID:

How [do I did] you usually buy [cigarettes | a pouch of roll-your-own cigarette tobacco] for yourself? Is it…
1
In person
2
From the internet
GO TO AC1039
3
By telephone
GO TO AC1039
4
I [do I did] not buy my own [cigarettes I cigarette tobacco] GO TO AC1039
-8 DON’T KNOW
GO TO AC1039
-7 REFUSED
GO TO AC1039
ASK: Current users and Former users 12 Month
PROGRAM: Display instruction for question and response option 4 fills: for Current smokers, display “do”.
For 12 month former smokers, display “did”. For Current smokers or 12 month former smokers who smoke
manufactured cigarettes (AC9007=1) display “cigarettes”. For Current smokers or 12 month former smokers
who smoke roll-your-own cigarettes (AC9007=2) display “a pouch of roll-your-own cigarette tobacco” (and
“cigarette tobacco” in response option 4).

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PATH ID:

AC1032

Screen ID:

[Do/Did] you usually buy [cigarettes | roll-your-own cigarette tobacco]...?
1
In your own state
2
In another state
3
Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who usually buy cigarettes in person (AC1030=1)
PROGRAM: For current smokers display “Do”; For 12 month former smokers display “Did”. For Current
smokers or 12 month former smokers who smoke manufactured cigarettes (AC9007=1) display “cigarettes”.
For Current smokers or 12 month former smokers who smoke roll-your-own cigarettes (AC9007=2) display
“a roll-your-own cigarette tobacco”.
PATH ID:

AC1033

Screen ID:

Where [ do | did ] you buy your [cigarettes | roll-your-own cigarette tobacco] most of the time?
1
A convenience store or gas station
2
A supermarket, grocery store, or drug store
3
A warehouse club, such as Sam’s or Costco
4
A smoke shop, tobacco specialty store or tobacco outlet store
5
A duty free shop or military commissary
6
A bar, pub, restaurant or casino
7
A friend or relative
8
A swap meet or flea market
9
A store on an Indian reservation
10
A liquor store
11
Or from somewhere else
SPECIFY: ____________________________
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 Month who usually buy in person (AC1030=1)
PROGRAM: For current smokers display “do”. For 12 month former smokers display “did”. For those who
smoke manufactured cigarettes (AC9007=1) display “cigarettes”. For those who smoke roll-your-own
cigarettes (AC9007=2) display “roll-your-own cigarette tobacco”.
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
GO TO: If former user 12 month, go to AC1047
Else go to BOXAC3

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BOXAC3
Current smokers who smoke roll-your-own cigarettes (AC9007=2) GO TO AC1047
PATH ID:

AC1039

Screen ID:

Do you usually buy cigarettes by the carton, pack or as single cigarettes?
1 Carton
GO TO AC1040
2 Pack
GO TO AC1042
3 Single cigarettes
GO TO AC1043
-8 DON’T KNOW
GO TO AC1047
-7 REFUSED
GO TO AC1047
ASK: Current users who usually purchase manufactured cigarettes (AC9007=1)
PATH ID:

AC1040

Screen ID:

How many packs of cigarettes are in the carton you usually buy?
1

I___I___I packs

-7

REFUSED

-8

DON’T KNOW

ASK: Current users whose usual purchase was by the carton (AC1039=1) and who smoke manufactured
cigarettes (AC9007=1)
PATH ID:

AC1041

Screen ID:

How much do you usually pay for a carton of cigarettes?
$I___I___I___I . I___I___|
GO TO AC1047
Dollars
Cents
-8 DON’T KNOW
GO TO AC1047
-7 REFUSED
GO TO AC1047
ASK: Current users whose usual purchase was by the carton (AC1039=1) and who smoke manufactured
cigarettes (AC9007=1)
1

PATH ID:

AC1042

Screen ID:

How much do you usually pay for a pack of cigarettes?
$ I___I___I___I . I___I___I
GO TO AC1047
Dollars
Cents
-8 DON’T KNOW
GO TO AC1047
-7 REFUSED
GO TO AC1047
ASK: Current users whose usual purchase was by the pack (AC1039=2) and who smoke manufactured
cigarettes (AC9007=1)
1

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PATH ID:

AC1043

Screen ID:

How much do you usually pay for a single cigarette?
$ I___I___I___I . I___I___I
Dollars
Cents
-8 DON’T KNOW
-7 REFUSED
ASK: Current users whose usual purchase was a single cigarette (AC1039=3) and who smoke
manufactured cigarettes (AC9007=1)
1

PATH ID:

AC1047

Screen ID:

[Do I Did] you have a regular brand of [cigarettes | roll-your-own cigarette tobacco] that you usually [smoke I
smoked]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month
PROGRAM: For current smokers display “Do” and “smoke”; for 12 month former smokers display “Did” and
“smoked”. For current smokers and 12 month former smokers who smoke manufactured cigarettes
(AC9007=1) display “cigarettes”. For current smokers and 12 month former smokers who smoke roll-yourown cigarettes (AC9007=2) display “roll-your-own cigarette tobacco”.
PATH ID:

AC1048

Screen ID:

What brand of [cigarettes | roll-your-own cigarette tobacco] [do I did] you [usually I last] smoke? Please
select it from the choices below by touching the screen. [If you do not see it below, touch the button marked
“NEXT”. I If you do not see it below, touch the box marked “Something else.”]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AC1070]
1 Something else
GO TO AC1049
-8 DON’T KNOW
GO TO AC1050
-7 REFUSED
GO TO AC1050
ASK: Current users and Former users 12 Month
PROGRAM: For current smokers who have regular brand (AC1047=1), display “do” and “usually”; For
current smokers who do not have a regular brand (AC1047=2, DK, RF), display “did” and “last”. For 12
month former smokers who had a regular brand (AC1047=1), display “did” and “usually”; For 12 month
former smokers who did not have a regular brand (AC1047=2, DK, RF), display “did” and “last”. For current
smokers and 12 month former smokers who smoke manufactured cigarettes (AC9007=1) display
“cigarettes”. For current smokers and 12 month former smokers who smoke roll-your-own cigarettes

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(AC9007=2) display “roll-your-own cigarette tobacco”. For current smokers and 12 month former smokers
who smoke manufactured cigarettes (AC9007=1) display only brands of manufactured cigarettes. For
current smokers and 12 month former smokers who smoke roll-your-own cigarettes (AC9007=2) display
only brands of roll-your-own cigarette tobacco.
PATH ID:

AC1070

Screen ID:

You selected [CIGBRANDFILL | RYOBRANDFILL] as your brand. What kind of [CIGBRANDFILL |
RYOBRANDFILL] [do I did] you [usually I last] smoke? Please select it from the choices below by touching
the screen. [If you do not see it below, touch the button marked “NEXT”. I If you do not see it below, touch
the box marked “Something else.”]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AC1048]
1 Something else
GO TO AC1071
-8 DON’T KNOW
GO TO AC1050
-7 REFUSED
GO TO AC1050
ASK: Current users and Former users 12 Month
PROGRAM: if manufactured user, fill CIGRANDFILL with AC1048; if roll-your-own user, fill
RYOBRANDFILL with AC1048. For current smokers who have regular brand (AC1047=1), display “do” and
“usually”; For current smokers who do not have a regular brand (AC1047=2, DK, RF), display “did” and
“last”. For 12 month former smokers who had a regular brand (AC1047=1), display “did” and “usually”; For
12 month former smokers who did not have a regular brand (AC1047=2, DK, RF), display “did” and “last”.
PATH ID:

AC1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AC1050
-8 DON’T KNOW
GO TO AC1050
-7 REFUSED
GO TO AC1050
ASK: Current users and Former users 12 month who did not select an image of their regular brand
(AC1048=1)

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PATH ID:

AC1071

Screen ID:

You said that the type of [CIGBRANDFILL | RYOBRANDFILL]s that you [smoke I smoked] is not pictured.
What type is it?
1
__________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who did not select the type of product they use
(AC1070=”Something else”) but who DID select a brand (AC1048<>1, -8, -7). Do not ask of respondents
who wrote a brand into AC1049.
PROGRAM: For current smokers, display “smoke”; for 12 month former smokers, display “smoked”.
PATH ID:

AC1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [smoke I smoked] flavored to taste like menthol or mint?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who smoke manufactured cigarettes (AC9007=1)
PROGRAM: For current smokers who have regular brand (AC1047=1), display “Is” and “your regular brand”
and “smoke”; For current smokers who do not have a regular brand (AC1047=2, DK, RF), display “Was” and
“the last brand” and “smoked”. For former smokers 12 month who had a regular brand (AC1047=1), display
“Was” and “your regular brand” and “smoked”; For former smokers 12 month who did not have a regular
brand (AC1047=2, DK, RF), display “Was” and “the last brand” and “smoked”.
GO TO: If AC9007 IN (1, DK, R), go to AC1051
Else go to AC1052
PATH ID:

AC1052

Screen ID:

[Is / was] [your regular brand I the last brand] of roll-your-own cigarette tobacco [you smoked] flavored to
taste like menthol or mint?
1
Yes
GO TO AC1051
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month who smoke roll-your-own cigarettes (AC9007=2)
PROGRAM: For current smokers who have a regular brand (AC1047=1), display “Is”, “your regular brand”.
For current smokers who do not have a regular brand (AC1047=2, DK, RF), display "Was", "the last brand"
and "you smoked". For 12 month former smokers who had a regular brand (AC1047=1), display "Was",
"your regular brand". For 12 month former smokers who did not have a regular brand (AC1047=2, DK, RF),
display "Was", "the last brand" and "you smoked".

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PATH ID:

AC1053

Screen ID:

[Is / was] [your regular brand I the last brand] of roll-your-own cigarette tobacco [you smoked] flavored to
taste like clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month who smoke roll-your-own cigarettes only (AC9007=2)
whose current or last brand was not mint/menthol (AC1052=2)
PROGRAM: For current smokers who have a regular brand (AC1047=1), display “Is”, “your regular brand”.
For current smokers who do not have a regular brand (AC1047=2, DK, RF), display "Was", "the last brand"
and "you smoked". For 12 month former smokers who had a regular brand (AC1047=1), display "Was",
"your regular brand". For 12 month former smokers who did not have a regular brand (AC1047=2, DK, RF),
display "Was", "the last brand" and "you smoked".
GO TO: if current user AND AC1047 = 1, go to AC1051
Else If former user 12 month AND AC9007 = 1 AND AC1047 = 1, go to AC9010
Else if (current user for former user 12 month) AND AC9007 = 1 AND AC1047 <> 1, go to AC9019
Else go to next section
PATH ID:

AC1051

Screen ID:

About how long have you been smoking your regular brand of [cigarettes | roll-your-own cigarette tobacco]?
Please choose whether you've been smoking your regular brand for years, months, or days. Then enter the
number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have a regular brand (AC1047=1). For Current users who smoke manufactured
cigarettes (AC9007=1) display “cigarettes”. For Current users who smoke roll-your-own cigarettes
(AC9007=2) display “roll-your-own cigarette tobacco”.
GO TO: If AC9007 = 1, go to AC9010
Else go to AC9019
1

Box AC3
Display question AC9010, AC9011, AC9012, AC9013, AC9014, AC9015, AC9016, AC9017, on one screen.
Show the intro/transition text from AC9010 first, then show each item with a Y/N response. As each item is
answered, show the next one.
PROGRAM: Randomize order of AC9010 through AC9017.

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PATH ID:

AC9010

Screen ID:

In choosing your regular brand of cigarettes [when you smoked], was part of your decision based on any of
the following?
It [is/was] less expensive.
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PROGRAM: For current smokers, display “is”. For 12 month former smokers, display “when you last
smoked” and “was”
PATH ID:

AC9011

Screen ID:

The tar and nicotine levels.
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who have a regular brand (AC1047=1) and who smoke
manufactured cigarettes (AC9007=1)
PATH ID:

AC9012

Screen ID:

The design of the pack.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PATH ID:

AC9013

Screen ID:

It may not be as bad for your health.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)

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PATH ID:

AC9014

Screen ID:

The taste.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PATH ID:

AC9015

Screen ID:

As a way to help you quit.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PATH ID:

AC9016

Screen ID:

The amount of satisfaction it [gives | gave] you.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PROGRAM: For current smokers display “it gives”. For 12 month former smokers display “gave”
PATH ID:

AC9017

Screen ID:

People who are important to you [smoke I smoked] this brand.
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 Month who have a regular brand AC1047=1 and who smoke
manufactured cigarettes (AC9007=1)
PROGRAM: For current smokers display “smoke”. For 12 month former smokers display “smoked”

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PATH ID:

AC9019

Screen ID:

Do you think the brand of cigarettes you [usually smoke I usually smoked | last smoked] might be less
harmful, no different, or more harmful, compared to other cigarette brands?
1
Less harmful
2
No different
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 Month who smoke manufactured cigarettes (AC9007=1)
PROGRAM: If current user with a regular brand (AC1047=1), fill with “usually smoke”; If current user that
does not have regular brand (AC1047=2, DK, RF), fill with “last smoked”. If former user with a regular brand
(AC1047=1), fill with “usually smoked”; if former user that did not have a regular brand (AC1047=2, DK, RF),
fill with “last smoked”.
PATH ID:

AC0104

Screen ID:

We just have one more question about [your regular brand I the last brand] of cigarettes[ you
smoked].
You said earlier that you smoked a cigarette [TIME OF LAST USE]. Think about the very last
cigarette you smoked. Was the brand [NEQBRAND]?
1

Yes

2

No

-8

DON’T KNOW

-7

REFUSED

ASK: Respondents who have smoked a cigarette today, yesterday or the day before yesterday
(AC0100=1, 2 or 3 or 4) AND who selected a valid brand (AC1048<>1, -8, -7) AND valid sub
brand (AC1070<>1, -8, -7).
DISPLAY:
For smokers who have a regular brand (AC1047=1), display “your regular brand”. For smokers
who do not have a regular brand (AC1047=2, DK, RF), display "the last brand" and "you smoked".
For ‘TIME OF LAST USE’,
If AC0100=1, display “in the past hour”
If AC0100=2, display “sometime today”
If AC0100=3, display “yesterday”
If AC0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AC1070

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E-CIGARETTE SECTION
PATH ID:

Screen ID:

The next questions are about electronic or e-cigarettes. E-cigarettes look like regular cigarettes, but are
battery-powered and produce vapor instead of smoke.
E-cigarettes can be bought as one-time, disposable products, or can be bought as re-usable kits with a
cartridge. Some people refill their own cartridges with nicotine fluid, sometimes called “e-juice” or “e-liquid”.
Disposable e-cigarettes, e-cigarette cartridges and e-liquid come in many different flavors and nicotine
concentrations.
SHOW GENERIC IMAGES OF E-CIGARETTES, CARTRIDGES AND JUICE.
PATH ID:

AE1090

Screen ID:

Do you own an e-cigarette?
1
Yes
2
No
GO TO AE1005
-8
DON’T KNOW
GO TO AE1005
-7
REFUSED
GO TO AE1005
ASK: Respondents who have used an e-cigarette (AE1002=1)
PATH ID:

AE9002

Screen ID:

What brand of e-cigarette do you own? Please select it from the choices below by touching the screen. [If
you do not see it below, touch the button marked “NEXT”. I If you do not see it below, touch the box marked
“Something else”.]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AE9004]
1
Something else
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who own an e-cigarette (AE1090=1)

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GO TO AE9004
GO TO AE9004

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PATH ID:

AE9003

Screen ID:

You said that the brand of e-cigarette you own was not pictured. What brand is it?
1
__________________________
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who did not select an image of their regular brand (AE9002=1)
PATH ID:

AE9004

Screen ID:

About how much did you pay for your e-cigarette? Do not include the cost of additional cartridges or
accessories unless they were included in a starter kit.
1
Less than $10
2
$10 to $20
3
$21 to $100
4
More than $100
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who own an e-cigarette (AE1090=1)
PATH ID:

AE1005

Screen ID:

How many disposable e-cigarettes or e-cigarette cartridges have you used in your entire life?
1
1 or more puffs but never a whole one
2
1 to 10
3
11 to 20
4
21 to 50
5
51 to 99
6
100 or more
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used an e-cigarette (AE1002=1)
PATH ID:

AE1006

Screen ID:

How old were you when you first used an e-cigarette, even one or two times?
1

I___I___I years old

GO TO AE1100

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used an e-cigarette (AE1002=1)

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PATH ID:

AE1120

Screen ID:

When you first used an e-cigarette, even one or two times, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AE1006 (AE1006 = -8, -7).
PATH ID:

AE1100

Screen ID:

Have you ever used e-cigarettes fairly regularly?
1
Yes
2
No
GO TO AE1008
-8
DON’T KNOW
GO TO AE1008
-7
REFUSED
GO TO AE1008
ASK: Respondents who have used an e-cigarette (AE1002=1)
PATH ID:

AE1007

Screen ID:

How old were you when you first started using e-cigarettes fairly regularly?
1

GO TO AE1020

I___I___I years old

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever used fairly regularly (AE1100=1)
GO TO: If AE1003 = 1, go to AE1020
Else, go to AE1008

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PATH ID:

AE1121

Screen ID:

When you first started using e-cigarettes fairly regularly, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AE1007 (AE1007 = -8, -7).
GO TO: If AE1003 = 1, go to AE1020
Else, go to AE1008
PATH ID:

AE1020

Screen ID:

How old were you when you first started using e-cigarettes every day?
1
I___I___I years old
GO TO AE1008
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who use an e-cigarette every day (AE1003=1)
PATH ID:

AE1122

Screen ID:

When you first started using e-cigaretes every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AE1020 (AE1020 = -8, -7).

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PATH ID:

AE1008

Screen ID:

When you first started using e-cigarettes, did you use cartridges or disposable e-cigarettes flavored to taste
like menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have used an e-cigarette (AE1002=1)
GO TO: If AE1003 <> 1, go to AE1009
If AE1003=2 AND AE0100=5, go to AE1009.
Else go to BOX AE2
PATH ID:

AE1009

Screen ID:

About how long has it been since you last took a puff from an e-cigarette? (If it was earlier today, enter 1
day).
1
2
3

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used e-cigarettes (AE1002=1) AND do not use every day (AE1003<>1)
PROGRAM: EXCLUDE Some day users (AE1003=2) who previously reported they last used in the past
hour, sometime today, yesterday, or the day before yesterday (AE0100=1 or 2 or 3 or 4).
GO TO: If AE1003 = 3, go to AE1010
Else go to BOX AE2
PATH ID:

AE1010

Screen ID:

Have you completely quit using e-cigarettes?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used e-cigarettes (AE1002=1) AND currently use not at all (AE1003=3)

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Screen ID:

BOX AE2
PROGRAM: Define the following variables (see Appendix B):
EVER USER ECIG
CURRENT USER ECIG
EVERY DAY USER ECIG
SOME DAY USER ECIG
EXPERIMENTAL CURRENT USER ECIG
EXPERIMENTAL FORMER USER ECIG
FORMER USER 12 MONTH ECIG
Former user 12 month plus ECIG
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
EVERY DAY USER ECIG GO TO AE9005
SOME DAY USER ECIG GO TO AE9005
EXPERIMENTAL CURRENT USER ECIG GO TO AE9005
EXPERIMENTAL FORMER USER ECIG GO TO NEXT SECTION
FORMER USER 12 MONTH ECIG GO TO AE9005
FORMER USER 12 MONTH PLUS ECIG GO TO AG1005
PATH ID:

AE9005

Screen ID:

Please think about the e-cigarette you [use/used] most of the time.
[Is/Was] your e-cigarette rechargeable?
1
Yes
2
No
GO TO AE9009
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, 12 month former users and experimental current users.
PROGRAM: For current and experimental current users, display “use” and “Is”; For 12 month former users,
display “used” and “Was”.
PATH ID:

AE9008

Screen ID:

[Does I Did] your e-cigarette use cartridges?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, 12 month former users and experimental current users whose e-cigarettes are
rechargeable (AE9005=1, -8 or -7).
PROGRAM: For current and experimental current users, display “Does”; For 12 month former users,
display “Did”.

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PATH ID:

AE9009

Screen ID:

Can you refill your [e-cigarette I e-cigarette cartridges] with “e-liquid”?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, 12 month former users and experimental current users.
PROGRAM: If AE9008=2, -8 or -7, display “e-cigarette”; if AE9008=1, display “e-cigarette cartridges”
PROGRAM: [ECIGFILL] Series
If respondent reports using disposable/non-rechargeable (AE9005=2 AND AE9009=2) OR uses
rechargeable that does not use cartridges but is refillable with e-liquid (AE9005=1 AND AE9008=2 AND
AE9009=1), fill [ECIGFILL] with “e-cigarettes”.
If respondent reports using rechargeable with cartridges or is refillable ((AE9005=1) AND (AE9008=1 OR
AE9009=1)), fill [ECIGFILL] with “e-cigarette cartridges”.
Screen ID:

BOX AE4
EVERY DAY USER ECIG GO TO AE1021
SOME DAY USER ECIG GO TO AE1022
EXPERIMENTAL CURRENT USER ECIG GO TO AE1022
FORMER USER 12 MONTH ECIG GO TO AE1025
PATH ID:

AE1021

Screen ID:

On average, about how many [ECIGFILL] do you now use each day?
1
Less than 1 each day
2
I___I___I
-8 DON’T KNOW
-7 REFUSED
ASK: Everyday users

PATH – Wave 1
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GO TO AE9006
GO TO AE9006
GO TO AE9006

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PATH ID:

AE1022

Screen ID:

On how many of the past 30 days did you use an e-cigarette?
1

|__|__|
-8 DON’T KNOW
-7 REFUSED
ASK: Some day users and Experimental Current users
GO TO: If AE1022 = 0 and some day user, go to AE9006
Else if AE1022 = 0 and experimental current user, go to AE1025
Else go to AE1023
PROGRAM: Range check: 1-30 days
PATH ID:

AE1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AE1022 days I days you used], how many
[ECIGFILL] did you usually use each day? Please enter a number.
1

Less than 1 each day

2

|__|__|__|
-8 DON’T KNOW
-7 REFUSED
ASK: Some day users and Experimental Current Users who have used at least one day in past 30 or did not
provide the number of days used in the past 30 (AE1022>0 OR AE1022 IN (DK, R)).
PROGRAM: If AE1022=1, DK or RF, display “days you used”. Else display “# days” where # = number of
days reported in AE1022.
GO TO: EXPERIMENTAL CURRENT USER E-CIG GO TO AE1025
PATH ID:

AE9010

Screen ID:

Do the [ECIGFILL] you usually use contain nicotine?
1
2
-8
-7

Yes
No
DON’T KNOW
REFUSED

GO TO AE1024
GO TO AE1024
GO TO AE1024

ASK: Current users

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PATH ID:

AE9006

Screen ID:

What concentration of nicotine do you usually use in your [ECIGFILL]?
1
I don’t know the concentration
2
0mg or 0%
3
1-12mg or 0.1-0.6%
4
13-17mg or 0.7-1.2%
5
18-24mg or 1.3-1.8%
6
25+mg or 1.9+%
-8 DON’T KNOW
-7 REFUSED
ASK: Current users whose e-cigarettes contain nicotine (AE9010=1)
PATH ID:

AE1024

Screen ID:

(On the days that you use e-cigarettes,) {how/How} soon after you wake up do you typically take your first
puff of the day? Please enter the number of minutes or hours.
I___I___I___I
GO TO AE1025
Minutes after waking
I___I___I___I
GO TO AE1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: For Every Day e-cigarette users display “How”; For Some Day e-cigarette users display ‘On the
days that you use e-cigarettes, how’
1

PATH ID:

AE1092

Screen ID:

(On the days that you use e-cigarettes, would | Would) you say you take your first puff of the day within the
first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AE1024=-8,-7)
PROGRAM: For Every day e-cigarette users, display “Would”. For Some day e-cigarette users, display “On
the days that you use e-cigarettes, would”

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Adult Extended Questionnaire
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PATH ID:

AE1025

Screen ID:

Around this time 12 months ago, were you using e-cigarettes…?
1

Every day

2

Some days

3

Not at all

-8

DON’T KNOW

-7

REFUSED

ASK: Current e-cigarette users, 12 month former e-cigarette users, and experimental current e-cigarette
users
GO TO: If Experimental Current user, go to AE1060.
Else if AE1025 IN (1, 2), go to AE9007
Else if current user go to AE1097
Else go to AE1030
PATH ID:

AE9007

Screen ID:

Around this time 12 months ago, what concentration of nicotine did you usually use in your [ECIGFILL]?
1

I don’t know the concentration

2

0mg or 0%

3

1-12mg or 0.1-0.6%

4

13-17mg or 0.7-1.2%

5

18-24mg or 1.3-1.8%

6

25+mg or 1.9+%

-8

DON’T KNOW

-7

REFUSED

ASK: Every day e-cigarette smokers around this time 12 months ago (AE1025=1, 2)
PATH ID:

AE1097

Screen ID:

The next questions ask about your experience buying [ECIGFILL].
In the past 30 days, did you use a coupon when buying [ECIGFILL] [and e-liquid]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: If AE9009=1, display “and e-liquid”.

PATH – Wave 1
Adult Extended Questionnaire

GO TO AE1030
GO TO AE1030
GO TO AE1030

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Adult Extended Questionnaire
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PATH ID:

AE1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy [ECIGFILL] [and e-liquid]?
1
I__I__I__I
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy e-cigarettess in the last 30 days (AE1097=1)
PROGRAM: If AE9009=1, display “and e-liquid”.
PATH ID:

AE1030

Screen ID:

How [do/did] you usually buy [ECIGFILL] [and e-liquid] for yourself? Is it…
1 In person
2 From the internet
GO TO AE1047
3 By telephone
GO TO AE1047
4 I [do I did] not buy my own [ECIGFILL] [and e-liquid]
GO TO AE1047
-8 DON’T KNOW
GO TO AE1047
-7 REFUSED
GO TO AE1047
ASK: Current users and Former users 12 month
PROGRAM: If AE9009=1, display “and e-liquid”.
Display instruction for question and response option 4 fill: for current e-cigarette users display “do”; For 12
month former e-cigarette users display “did”. If AE9009=1, display “and e-liquid”.
PATH ID:

AE1032

Screen ID:

[Do/Did] you usually buy [ECIGFILL] [and e-liquid]…
1

In your own state

2

In another state

3

Outside the US

-8

DON’T KNOW

-7

REFUSED

ASK: Current users and Former users 12 month who usually buy e-cigarettes in person (AE1030=1)
PROGRAM: If AE9009=1, display “and e-liquid”. For current e-cigarette users display “Do”; For 12 month
former e-cigarette users display “Did”

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Adult Extended Questionnaire
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PATH ID:

AE1033

Screen ID:

Where [do/did ] you buy your [ECIGFILL] [and e-liquid] most of the time?
1

A mall kiosk

2

A convenience store or gas station

3

A supermarket, grocery store, or drug store

4

A warehouse club, such as Sam’s or Costco

5

A smoke shop, tobacco specialty store or tobacco outlet store

6

A duty free shop or military commissary

7
8

A bar, pub, restaurant or casino
A friend or relative

9

A swap meet or flea market

10
11

A liquor store
Or from somewhere else

-8

DON’T KNOW

-7

REFUSED

SPECIFY: ____________________________

ASK: Current users and Former users 12 month who usually buy e-cigarettes in person (AE1030=1)
PROGRAM: If AE9009=1, display “and e-liquid”. For current e-cigarette users display “do”; For 12 month
former e-cigarette users display “did”
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
PATH ID:

AE1047

Screen ID:

[Do I Did] you have a regular brand of e-cigarettes that you usually [use I used]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current users display “Do” and “use”; for 12 month former users display “Did” and “used”.

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Adult Extended Questionnaire
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PATH ID:

AE1048

Screen ID:

What brand of e-cigarette [do I did] you [usually I last] use? Please select it from the choices below by
touching the screen. [If you do not see it below, touch the button marked “NEXT”. I If you do not see it
below, touch the box marked “Something else”.]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AE1050]
1
Something else
GO TO AE1049
-8 DON’T KNOW
GO TO AE1050
-7 REFUSED
GO TO AE1050
ASK: Current users and Former users 12 month
PROGRAM: For current users who have regular brand (AE1047=1), display “do” and “usually”; For current
users who do not have a regular brand (AE1047=2, DK, RF), display “did” and “last”. For 12 month former
users who had a regular brand (AE1047=1), display “did” and “usually”; For 12 month former users who did
not have a regular brand (AE1047=2, DK, RF), display “did” and “last”.
PATH ID:

AE1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month who did not select an image of their regular brand
(AE1048=1)

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Adult Extended Questionnaire
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PATH ID:

AE1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [use I used] flavored to taste like menthol, mint, clove,
spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current users who have a regular brand (AE1047=1), display “Is”, “your regular brand” and
“use.” For current users who do not have a regular brand (AE1047=2, DK, RF), display "Was", "the last
brand" and " used ". For 12 month former users who had a regular brand (AE1047=1), display "Was", "your
regular brand" and " used ". For 12 month former users who did not have a regular brand (AE1047=2, DK,
RF), display "Was", "the last brand" and " used ".
GO TO: If current user or former user 12 month AND AE1047 = 1, go to AE1051
Else go to AE0104
PATH ID:

AE1051

Screen ID:

About how long (did you use/have you been using) your regular brand of e-cigarette? Please choose
whether (you used/you've been using) your regular brand for years, months, or days. Then enter the
number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who have a regular brand (AE1047=1)
PROGRAM: For current users, display “have you been using” and “you’ve been using.” For former users 12
months, display “did you use” and “you used.”
1

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AE0104

Screen ID:

You said earlier that you last used an e-cigarette [TIME OF LAST USE]. Think about the very last
puff you took. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have used an e-cigarette today, yesterday or the day before yesterday
(AE0100=1, 2 or 3 or 4) AND who selected a valid brand (AE1048<>1, -8, -7).
DISPLAY:
For ‘TIME OF LAST USE’,
If AE0100=1, display “in the past hour”
If AE0100=2, display “sometime today”
If AE0100=3, display “yesterday”
If AE0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AE1048
Box AE3
Display question AE1060, AE1061, AE1085, AE1062, AE1075, AE1063, AE1064, AE1065, AE1066,
AE1067, AE1068, AE1069, AE1072 on one screen. Show the intro/transition text from AE1060 first, then
show each item with responses. As each item is answered, show the next one.
PROGRAM: Randomize order of AE1060 through AE1072.
PATH ID:

AE1060

Screen ID:

The next questions are about the reasons people use e-cigarettes. Please select which reasons [apply to
you I applied to you when you used to use e-cigarettes].
I [use I used] e-cigarettes because…
They [are I were] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “apply to you”, “use” and “are”; for former users, display “applied to
you when you used to use e-cigarettes”, “used” and “were”.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AE1061

Screen ID:

People in the media or other public figures [use I used] e-cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.
PATH ID:

AE1085

Screen ID:

I [can I could] use e-cigarettes at times when or in places where smoking cigarettes [isn’t I wasn’t] allowed.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “can” and ”isn’t”; for former users, display “could” and “wasn’t”.
PATH ID:

AE1062

Screen ID:

They might [be I have been] less harmful to me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AE1075

Screen ID:

They might [be I have been] less harmful to people around me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.

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Adult Extended Questionnaire
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PATH ID:

AE1063

Screen ID:

[ECIGFILL] [come I came] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “come” and “like”; for former users, display “came” and “liked”.
PATH ID:

AE1064

Screen ID:

Using e-cigarettes helps people to quit smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AE1065

Screen ID:

E-cigarettes don’t smell
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AE1066

Screen ID:

Using an e-cigarette [feels I felt] like smoking a regular cigarette.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “feel”; for former users, display “felt”.

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Adult Extended Questionnaire
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PATH ID:

AE1067

Screen ID:

E-cigarettes [are I were] more acceptable to non-tobacco users.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “are”; for former users, display “were”.
PATH ID:

AE1068

Screen ID:

People who are important to me [use I used] e-cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.
PATH ID:

AE1069

Screen ID:

I [like I liked] socializing while using an e-cigarette.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “like”; for former users, display “liked”.
PATH ID:

AE1072

Screen ID:

The advertising for e-cigarettes [appeals I appealed] to me.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current Users, Experimental Current users, and Former users 12 Month
PROGRAM: For current users, display “appeals”; for former users, display “appealed”.
GO TO: If (Current user OR Experimental Current user) AND Current user cig, go to AE1086
Else If ((Current user OR Experimental Current user) AND Former user 12 month cig) OR (former user 12
months AND (current user cig or former user 12 months cig)), go to AE1080
Else go to next section

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AE1086

Screen ID:

In the past 30 days, have you used an e-cigarette at times when or in places where you could not smoke
regular cigarettes?
1
Yes
2
No
GO TO AE 1080
-8
DON’T KNOW
GO TO AE 1080
-7
REFUSED
GO TO AE 1080
ASK: Current users and Experimental Current users who are also Current users of cigarettes
PATH ID:

AE1087

Screen ID:

How often do you use e-cigarettes at times when or in places where you could not smoke regular
cigarettes?
1
Every day
2
Some days
3
Rarely
-8
DON’T KNOW
-7
REFUSED
ASK: Current cigarette smokers and Experimental Current users who have used e-cigarettes when could
not smoke regular cigarettes (AE1086=1)
PATH ID:

AE1080

Screen ID:

[Do | Did] you use e-cigarettes as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month who are also Current or
Former users 12 month of cigarettes
PROGRAM: For current e-cig users or experimental current e-cig users display “do”; For 12 month former ecig users display “did”
PATH ID:

AE1081

Screen ID:

[Do | Did] you use e-cigarettes as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current e-cig users display “do”; For 12 month former e-cig users display “did”

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Adult Extended Questionnaire
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CIGAR SECTION
PATH ID:

Screen ID:

CREATE NEW VARIABLES:
BLUNT_ONLY_GRILLO – respondents that report never smoking a cigar, but report smoking cigarillos as
blunts
BLUNT_ONLY_GRILLO=1 YES, if AG9004=2 AND AG9107=1 AND AG9009=1 OR 3.
Else BLUNT_ONLY_GRILLO=2 NO.
BLUNT_ONLY_GFC – respondents that report never smoking a cigar, but report smoking filtered cigars as
blunts
BLUNT_ONLY_GFC=1 YES, if AG9004=2 AND AG9107=1 AND AG9009=2.
Else BLUNT_ONLY_GFC=2 NO.
REPEAT THE REST OF THE SECTION ONCE FOR EACH TYPE OF CIGAR THE RESPONDENT HAS
USED (TRADITIONAL CIGARS, CIGARILLOS, FILTERED CIGARS). IF BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1, ONLY ASK ITEMS: AG1095, AG1008, AG1030, AG1032, AG1033, AG1039,
AG1040, AG1042, AG1043, AG1047, AG1048, AG1070, AG1049, AG1071, and AG1050, following skips
appropriately.
DISPLAY TEXT BELOW AS FOLLOWS:
FOR RESPONDENTS WHO HAVE USED TRADITIONAL CIGARS:
The next questions are about traditional cigars.
Traditional cigars contain tightly rolled tobacco that is wrapped in a tobacco leaf.
[SHOW GENERIC IMAGE FOR TRADITIONAL CIGAR]
FOR RESPONDENTS WHO HAVE USED CIGARILLOS OR FILTERED CIGARS, EXCLUDING BLUNT
ONLY USERS (BLUNT_ONLY_GRILLO=2 OR BLUNT_ONLY_GFC=2), DISPLAY THE FOLLOWING
TEXT EACH TIME THEY REPEAT THE REST OF THE SECTION. ADD THE LAST SENTENCE ONLY IF
THEY STILL HAVE ANOTHER CIGARFILL TO ANSWER QUESTIONS ABOUT:
The next questions are about [CIGARFILL]s.
[IF CIGARFILL=cigarillos] Cigarillos are medium-sized cigars and sometimes come with plastic or wood
tips.
[IF CIGARFILL=filtered cigars] Filtered cigars are usually brown and have a filter like a cigarette.
As you answer these questions, please think only about your use of [CIGARFILL]s like those shown
below. [SHOW GENERIC IMAGE FOR CIGARFILL]. [ONLY IF THIS IS NOT THE LAST TIME
THROUGH THE SECTION]. There will be a separate section later about other kinds of cigars.
FOR RESPONDENTS WHO HAVE USED CIGARILLOS OR FILTERED CIGARS ONLY AS
BLUNTS (BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1), DISPLAY THE FOLLOWING TEXT
EACH TIME THEY REPEAT THE REST OF THE SECTION. ADD THE LAST SENTENCE ONLY IF THEY
STILL HAVE ANOTHER CIGARFILL TO ANSWER QUESTIONS ABOUT.
The next questions are about [CIGARFILL]s smoked as blunts.
[IF CIGARFILL=cigarillos] Cigarillos are medium-sized cigars and sometimes come with plastic
or wood tips. Sometimes people take tobacco out of a cigarillo and replace it with marijuana. This is
sometimes called a blunt.

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Adult Extended Questionnaire
Version 7.5
[IF CIGARFILL=filtered cigars] Filtered cigars are usually brown and have a filter like a cigarette.
Sometimes people take tobacco out of a filtered cigar and replace it with marijuana. This is sometimes
called a blunt.
As you answer these questions, please think only about your use of [CIGARFILL]s smoked as blunts
like those shown below. [SHOW GENERIC IMAGE FOR CIGARFILL].
[ONLY IF THIS IS NOT THE LAST TIME THROUGH THE SECTION].
separate section later about other kinds of cigars.

There will be a

PROGRAM: If BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1, go to AG1095
Else go to AG1005.
PATH ID:

AG1005

Screen ID:

How many [CIGARFILL]s have you smoked in your entire life?
1
1 or more puffs but never a whole one
2
1 to 10
3
11 to 20
4
21 to 50
5
51 to 99
6
100 or more
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked at least one type of cigar where traditional cigar (AG9003=1) and/or
cigarillo (AG9009=1 OR 3) and/or LFC (AG9009=2)
PATH ID:

AG1095

Screen ID:

Please look at this picture. Which group is most like the [[CIGARFILL] I cigarillo I filtered cigar] you usually
smoke[ as a blunt]?
1
Group 1
2
Group 2
3
Group 3
4
Group 4
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked at least one type of cigar where traditional cigar (AG9003=1) and/or
cigarillo (AG9009=1 OR 3) and/or LFC (AG9009=2) OR are blunt-only cigar smokers
(BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1).
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillo” and “ as a blunt”. If BLUNT_ONLY_GFC=1,
display “filtered cigar” and “as a blunt”. Else, display “[CIGARFILL]”.
DISPLAY IMAGE OF CIGARS WITH SCALE

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Adult Extended Questionnaire
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PATH ID:

AG1006

Screen ID:

How old were you the first time you smoked part or all of a [CIGARFILL], even one or two puffs?
1
I___I___I years old
GO TO AG1100
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked at least one type of cigar where traditional cigar (AG9003=1) and/or
cigarillo (AG9009=1 OR 3) and/or FC (AG9009=2)
PATH ID:

AG1120

Screen ID:

The first time you smoked part or all of a [CIGARFILL], even one or two puffs, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AG1006 (AG1006 = -8, -7).
PATH ID:

AG1100

Screen ID:

Have you ever smoked [CIGARFILL]s fairly regularly?
1
Yes
2
No
GO TO AG1008
-8
DON’T KNOW
GO TO AG1008
-7
REFUSED
GO TO AG1008
ASK: Respondents who have smoked at least one type of cigar where traditional cigar (AG9003=1) and/or
cigarillo (AG9009=1 OR 3) and/or FC (AG9009=2)
PATH ID:

AG1007

Screen ID:

How old were you when you first started smoking [CIGARFILL]s fairly regularly?
1

GO TO AG1020

I___I___I years old

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked fairly regularly (AG1100=1)
GO TO: If AG1003 = 1, go to AG1020
Else, go to AG1008

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AG1121

Screen ID:

When you first started smoking [CIGARFILL]s fairly regularly, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AG1007 (AG1007 = -8, -7).
GO TO: If AG1003 = 1, go to AG1020
Else, go to AG1008
PATH ID:

AG1020

Screen ID:

How old were you when you first started smoking [CIGARFILL]s every day?
1
I___I___I years old
GO TO AG1008
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who a [CIGARFILL] every day (AG1003=1)
PATH ID:

AG1122

Screen ID:

When you first started smoking [CIGARFILL]s every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AG1020 (AG1020 = -8, -7).

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Version 7.5
PATH ID:

AG1008

Screen ID:

When you first started smoking [[CIGARFILL]s I cigarillos as blunts I filtered cigars as blunts], did you smoke
[[CIGARFILL]s I blunts] flavored to taste like menthol, mint, clove, spice, candy, fruit, chocolate, alcohol
(such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have smoked [CIGARFILL]s OR are blunt-only cigar smokers
(BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1)
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillos as blunts” and “blunts”. If
BLUNT_ONLY_GFC=1, display “filtered cigars as blunts” and “blunts”.
GO TO: If AG1003 <> 1, go to AG1009
If AG1003=2 AND AG0100=5, go to AG1009
If BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1, go to AG1030
Else go to BOX AG2
PATH ID:

AG1009

Screen ID:

About how long has it been since you last smoked [CIGARFILL]s? (If it was earlier today, enter 1 day)
1
2
3

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked [CIGARFILL]s and do not smoke every day (AG1003<>1)
PROGRAM: EXCLUDE Some day smokers (AG1003=2) who previously reported they last smoked in the
past hour, sometime today, yesterday, or the day before yesterday (AG0100=1 or 2 or 3 or 4).
GO TO: If AG1003 = 3, go to AG1010
Else go to BOX AG2
PATH ID:

AG1010

Screen ID:

Have you completely quit smoking [CIGARFILL]s?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked [CIGARFILL]s and currently smoke not at all (AG1003=3)

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Adult Extended Questionnaire
Version 7.5
Screen ID:

BOX AG2
PROGRAM: Define the following variables (see Appendix B).
EVER USER [CIGARFILL]
CURRENT USER [CIGARFILL]
EVERY DAY USER [CIGARFILL]
SOME DAY USER [CIGARFILL]
EXPERIMENTAL CURRENT USER [CIGARFILL]
EXPERIMENTAL FORMER USER [CIGARFILL]
FORMER USER 12 MONTH [CIGARFILL]
FORMER USER 12 MONTH PLUS [CIGARFILL]
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
EVERY DAY USER [CIGARFILL] GO TO AG1021
SOME DAY [CIGARFILL] USER GO TO AG1022
EXPERIMENTAL CURRENT USER [CIGARFILL] GO TO AG1022
EXPERIMENTAL FORMER USER [CIGARFILL] GO TO NEXT SECTION
IF FORMER USER 12 MONTH [CIGARFILL] GO TO AG1025
IF FORMER USER 12 MONTH PLUS [CIGARFILL] GO TO NEXT SECTION
PATH ID:

AG1021

Screen ID:

On average, about how many [CIGARFILL]s do you now smoke each day?
1
Less than 1 each day
2
I___I___I
-8 DON’T KNOW
-7 REFUSED
ASK: Every day users
PATH ID:

GO TO AG1023
GO TO AG1023
GO TO AG1023
GO TO AG1023

AG1022

Screen ID:

On how many of the past 30 days did you smoke [CIGARFILL]s?
1

|__|__|

Days
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users
PROGRAM: Range check: 1-30 days
GO TO: If AG1022 = 0 and some day user, go to AG1024
Else if AG1022 = 0 and experimental current user, go to AG1025
Else go to AG1023

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PATH ID:

AG1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AG1022 days I days you smoked], how many
[CIGARFILL]s did you usually smoke each day?
1

Less than 1 each day

2

|__|__|
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users who have smoked at least one day in past 30 or did
not provide the number of days smoked in the past 30 (AG1022>0 OR AG1022 IN (DK, R))
PROGRAM: If AG1022=1, DK or RF, display “days you smoked”. Else display “# days” where # = number of
days reported in AG1022.
GO TO: EXPERIMENTAL CURRENT USER E-CIG GO TO AG1025
PATH ID:

AG1024

Screen ID:

(On the days that you smoke [CIGARFILL]s,) {how/How} soon after you wake up do you typically smoke
your first [CIGARFILL] of the day? Please enter the number of minutes or hours.
I___I___I___I
GO TO AG1025
Minutes after waking
I___I___I___I
GO TO AG1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: For Every Day Users [CIGARFILL] display “How”; For Some Day [CIGARFILL] smokers display
‘On the days that you smoke [CIGARFILL]s, how’
1

PATH ID:

AG1092

Screen ID:

(On the days that you smoke [CIGARFILL]s, would | Would) you say you smoke your first [CIGARFILL] of
the day within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AG1024=-8,-7)
PROGRAM: For Every day Users [CIGARFILL], display “Would”. For Some day Users [CIGARFILL],
display “On the days that you smoke [CIGARFILL]s, would”

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PATH ID:

AG1025

Screen ID:

Around this time 12 months ago, were you smoking [CIGARFILL]s…?
1

Every day

2

Some days

3

Not at all

-8

DON’T KNOW

-7

REFUSED

ASK: Current users, Experimental Current users, and Former users 12 month
GO TO: If Former user 12 month, go to AG1030
If Experimental current user, go to AG1060
Else go to AG1097
PATH ID:

AG1097

Screen ID:

The next questions ask about your experience buying [CIGARFILL]s.
In the past 30 days, did you use a coupon when buying [CIGARFILL]s?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PATH ID:

GO TO AG1030
GO TO AG1030
GO TO AG1030

AG1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy [CIGARFILL]s?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy [CIGARFILL]s in the last 30 days (AG1097=1)

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PATH ID:

AG1030

Screen ID:

How [do/did] you usually buy [[CIGARFILL]s I cigarillos I filtered cigars] for yourself[ when you smoke
blunts]? Is it…
1 In person (such as at a store or cigar bar)
2 From the internet
GO TO AG1047
3 By telephone
GO TO AG1047
4 I [do I did] not buy my own [CIGARFILL]s
GO TO AG1047
-8 DON’T KNOW
GO TO AG1047
-7 REFUSED
GO TO AG1047
ASK: Current users and Former users 12 month OR blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1
OR BLUNT_ONLY_GFC=1)
PROGRAM: For current [CIGARFILL] smokers display “do” and [CIGARFILLs]; For 12 month former
[CIGARFILL] smokers display “did” and [CIGARFILLs]. IF BLUNT_ONLY_GRILLO=1, display “do”,
“cigarillos” and “when you smoke blunts”; and fill response option 4 with “do” and “cigarillos for blunts”. If
BLUNT_ONLY_GFC=1 display “do”, “filtered cigars” and “when you smoke blunts”; and fill response option
4 with “do” and “filtered cigars for blunts”.
Display instruction for question and response option 4 fill: for current [CIGARFILL] smokers display “do”; For
12 month former [CIGARFILL] smokers display “did”
PATH ID:

AG1032

Screen ID:

[Do/Did] you usually buy [[CIGARFILL]s I cigarillos for blunts I filtered cigars for blunts]...?
1 In your own state
2 In another state
3 Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1) who usually buy [CIGARFILL]s in person (AG1030=1)
PROGRAM: For current [CIGARFILL] smokers display “Do” and “[CIGARFILL]s”; For 12 month former
[CIGARFILL] smokers display “Did” and “[CIGARFILL]s”. If BLUNT_ONLY_GRILLO=1, display “Do” and
“cigarillos for blunts”. If BLUNT_ONLY_GFC=1, display “Do” and “filtered cigars for blunts”.

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Version 7.5
PATH ID:

AG1033

Screen ID:

Where [do/did ] you buy your [[CIGARFILL]s I cigarillos for blunts I filtered cigars for blunts] most of the
time?
[PROGRAM: If OS field selected and additional OS screen is shown, display question text and add the
following text: “Please type your answer using the computer keyboard.”]
1 A cigar bar
2 A convenience store or gas station
3 A supermarket, grocery store, or drug store
4 A warehouse club, such as Sam’s or Costco
5 A smoke shop, tobacco specialty store or tobacco outlet store
6 A duty free shop or military commissary
7 A bar, pub, restaurant or casino
8 A friend or relative
9 A swap meet or flea market
10 A liquor store
11 Or from somewhere else
SPECIFY: ____________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users,Former users 12 month, and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1) who usually buy [CIGARFILL]s in person (AG1030=1)
PROGRAM: For current [CIGARFILL] smokers display “do” and “[CIGARFILLs]; For 12 month former
[CIGARFILL] smokers display “did” and “[CIGARFILLs]. If BLUNT_ONLY_GRILLO=1, display “Do” and
“cigarillos for blunts”. If BLUNT_ONLY_GFC=1, display “Do” and “filtered cigars for blunts”.
GO TO: If former user 12 month, go to AG1047
Else go to AG1039
PATH ID:

AG1039

Screen ID:

Do you usually buy [[CIGARFILL]s I cigarillos for blunts I filtered cigars for blunts] by the box or as single
[[CIGARFILL]s I cigarillos I filtered cigars?
1 Box
GO TO AG1040
2 Single [[CIGARFILL]s I cigarillos I filtered cigars] GO TO AG1043
-8 DON’T KNOW
GO TO AG1047
-7 REFUSED
GO TO AG1047
ASK: Current users and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1)
who buy in person (AG1030=1)
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillos for blunts” and “cigarillos” in question and
option 2. If BLUNT_ONLY_GFC=1, display “filtered cigars for blunts” and “filtered cigars” in question and
option 2. Else display [CIGARFILL]s.

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Version 7.5
PATH ID:

AG1040

Screen ID:

How many [[CIGARFILL]s I cigarillos I filtered cigars] come in the box that you usually buy[ for blunts]?
1

I___I___I [[CIGARFILL]s I cigarillos I filtered cigars]

-7

REFUSED

-8

DON’T KNOW

ASK: Current users and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1)
who buy [CIGARFILL]s by the box (AG1039=1)
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillos” (in question and option 1) and “for blunts”. If
BLUNT_ONLY_GFC=1, display “filtered cigars” (in question and option 1) and “for blunts”. Else display
[CIGARFILL]s.
PATH ID:

AG1042

Screen ID:

How much do you usually pay for a box of [[CIGARFILL]s I cigarillos for blunts I filtered cigars for blunts]?
$ I___I___I___I
Amount
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1)
who usually buy [CIGARFILL]s by the box (AG1039=1)
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillos for blunts”. If BLUNT_ONLY_GFC=1, display
“filtered cigars for blunts”. Else display [CIGARFILLs].
1

PATH ID:

AG1043

Screen ID:

How much do you usually pay for a single [[CIGARFILL] I cigarillo for a blunt I filtered cigar for a blunt]?
$ I___I___I___I
Amount
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1)
who usually buy [CIGARFILL]s as single [CIGARFILL]s (AG1039=2)
PROGRAM: If BLUNT_ONLY_GRILLO=1, display “cigarillo for a blunt”. If BLUNT_ONLY_GFC=1, display
“filtered cigar for a blunt”. Else display [CIGARFILL].
1

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PATH ID:

AG1047

Screen ID:

[Do I Did] you have a regular brand of [[CIGARFILL]s I cigarillo I filtered cigar] that you usually [smoke I
smoked I use for blunts]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users,Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1)
PROGRAM: For current [CIGARFILL] smokers display “Do”, “smoke” and “[CIGARFILL]s”; for 12 month
former [CIGARFILL] smokers display “Did”, “smoked”, and “[CIGARFILL]s”. PROGRAM: If
BLUNT_ONLY_GRILLO=1, display “Do”, cigarillo” and “use for blunts”. If BLUNT_ONLY_GFC=1, display
“Do”, “filtered cigar” and “use for blunts”.
PATH ID:

AG1048

Screen ID:

What brand of [[CIGARFILL] I cigarillo for blunts I filtered cigar for blunts] [do I did] you [usually I last]
smoke? Please select it from the choices below by touching the screen. [If you do not see it below, touch
the button marked “NEXT”. I If you do not see it below, touch the box marked “Something else.”]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AG1070]
1
Something else
GO TO AG1049
-8 DON’T KNOW
GO TO AG1050
-7 REFUSED
GO TO AG1050
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1)
PROGRAM: For current smokers who have regular brand (AG1047=1), display [CIGARFILL], “do” and
“usually”; For current smokers who do not have a regular brand (AG1047=2, DK, RF), display [CIGARFILL],
“did” and “last”. For 12 month former smokers who had a regular brand (AG1047=1), display [CIGARFILL],
“did” and “usually”; For 12 month former smokers who did not have a regular brand (AG1047=2, DK, RF),
display [CIGARFILL], “did” and “last”. If BLUNT_ONLY_GRILLO=1 and has regular brand (AG1047=1),
display “cigarillos for blunts”, “do” and “usually”. If BLUNT_ONLY_GRILLO=1 and does not have regular
brand (AG1047=2, DK, RF), display “cigarillo for blunts”, “did” and “last”. If BLUNT_ONLY_GFC=1 and has
regular brand (AG1047=1), display “filtered cigar for blunts”, “do” and “usually”. If BLUNT_ONLY_GFC=1
and does not have regular brand (AG1047=2, DK, RF), display “filtered cigar for blunts”, “did” and “last”.
GO TO: If AG1048 NOT IN (1, DK, RF), go to AG1070

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AG1070

Screen ID:

You selected [BRANDFILL] as your brand. What kind of [BRANDFILL] [do I did] you [usually I last] smoke[
as a blunt]? Please select it from the choices below by touching the screen. [If you do not see it below,
touch the button marked “NEXT”. I If you do not see it below, touch the box marked “Something else”.]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AG1048]
1
-8
-7

Something else
GO TO AG1071
DON’T KNOW
GO TO AG1050
REFUSED
GO TO AG1050
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1) who selected a brand image in AG1048.
PROGRAM: For current smokers who have regular brand (AG1047=1), display “do” and “usually”; For
current smokers who do not have a regular brand (AG1047=2, DK, RF), display “did” and “last”. For 12
month former smokers who had a regular brand (AG1047=1), display “did” and “usually”; For 12 month
former smokers who did not have a regular brand (AG1047=2, DK, RF), display “did” and “last”. If
BLUNT_ONLY_GRILLO=1 and has regular brand (AG1047=1), display “do”, “usually” and “as a blunt”; If
BLUNT_ONLY_GRILLO=1 and does not have a regular brand (AG1047=2, DK, RF), display “did”, “last”,
and “as a blunt”. If BLUNT_ONLY_GFC=1 and has regular brand (AG1047=1), display “do”, “usually” and
“as a blunt”; If BLUNT_ONLY_GFC=1 and does not have a regular brand (AG1047=2, DK, RF), display
“did”, “last”, and “as a blunt”.
PATH ID:

AG1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AG1050
-8 DON’T KNOW
GO TO AG1050
-7 REFUSED
GO TO AG1050
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1)who did not select an image of their regular brand (AG1048=1)

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Version 7.5
PATH ID:

AG1071

Screen ID:

You said that the type of [BRANDFILL]s that you [smoke I smoked][ as blunts] is not pictured. What type is
it?
1
-8
-7

__________________________
DON’T KNOW
REFUSED
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1) who did not select the type of product they use (AG1070=”Something else”) but
who DID select a brand (AG1048<>1, -8, -7). Do not ask of respondents who wrote a brand into AG1049.
PROGRAM: For current smokers, display “smoke”; for 12 month former smokers, display “smoked”. If
BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1, display “smoke” and “as blunts”.
PATH ID:

AG1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [smoke I smoked][ as blunts] flavored to taste like
menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Former users 12 month and blunt-only cigar smokers (BLUNT_ONLY_GRILLO=1 OR
BLUNT_ONLY_GFC=1)
PROGRAM: For current smokers who have a regular brand (AG1047=1), display “Is”, “your regular brand”
and “smoke”. For current smokers who do not have a regular brand (AG1047=2, DK, RF), display "Was",
"the last brand" and "smoked". For 12 month former smokers who had a regular brand (AG1047=1), display
"Was", "your regular brand" and "smoked". For 12 month former smokers who did not have a regular brand
(AG1047=2, DK, RF), display "Was", "the last brand" and "smoked". If BLUNT_ONLY_GRILLO=1 and has
a regular brand (AG1047=1), display “Is”, “your regular brand”, “smoke” and “as blunts”. If
BLUNT_ONLY_GRILLO=1 and does not have a regular brand (AG1047=2, DK, RF), display "Was", "the last
brand","smoked", “as blunts”. If BLUNT_ONLY_GFC=1 and has a regular brand (AG1047=1), display “Is”,
“your regular brand”, “smoke” and “as blunts”. If BLUNT_ONLY_GFC=1 and does not have a regular brand
(AG1047=2, DK, RF), display "Was", "the last brand","smoked", “as blunts”.
GO TO: If current user or former user 12 month AND AG1047 = 1, go to AG1051
If BLUNT_ONLY_GRILLO=1 OR BLUNT_ONLY_GFC=1, go to next section.
Else go to AG0104

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Version 7.5
PATH ID:

AG1051

Screen ID:

About how long (did you smoke/have you been smoking) your regular brand of [CIGARFILL]? Please
choose whether (you smoked/you've been smoking) your regular brand for years, months, or days. Then
enter the number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who have a regular brand (AG1047=1)
PROGRAM: For current users, display “have you been smoking” and “you’ve been smoking.” For 12 month
former users, display “did you smoke” and “you smoked.”
1

PATH ID:

AG0104

Screen ID:

You said earlier that you smoked a [CIGARFILL] [TIME OF LAST USE]. Think about the very last
[CIGARFILL] you smoked. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have smoked a CIGARFILL today, yesterday or the day before yesterday
(AG0100=1, 2 or 3 or 4) AND who selected a valid brand (AG1048<>1, -8, -7) AND valid sub
brand (AG1070<>1, -8, -7).
DISPLAY:
For ‘TIME OF LAST USE’,
If AG0100=1, display “in the past hour”
If AG0100=2, display “sometime today”
If AG0100=3, display “yesterday”
If AG0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AG1070

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Version 7.5
Box AG6
Display question AG1060, AG1061, AG1085, AG1062, AG1063, AG1064, AG1066, AG1068, AG1069,
AG1072 on one screen. Show the intro/transition text from AG1060 first, then show each item with
responses. As each item is answered, show the next one.
PROGRAM: Randomize order of AG1060 through AG1072.
PATH ID:

AG1060

Screen ID:

The next questions are about the reasons people smoke [CIGARFILL]s. Please select which reasons
[apply to you I applied to you when you used to smoke [CIGARFILL]s].
I [smoke I smoked] [CIGARFILL]s because…
They [are I were] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “apply to you”, “smoke” and “are”; for former users, display “applied
to you when you used to smoke [CIGARFILL]s”, “smoked” and “were”.
PATH ID:

AG1061

Screen ID:

People in the media or other public figures [smoke I smoked] [CIGARFILL]s.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “smoke”; for former users, display “smoked”.
PATH ID:

AG1085

Screen ID:

I [can I could] smoke [CIGARFILL]s at times when or in places where smoking cigarettes [isn’t I wasn’t]
allowed.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “can” and ”isn’t”; for former users, display “could” and “wasn’t”.

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Version 7.5
PATH ID:

AG1062

Screen ID:

They might [be I have been] less harmful than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AG1063

Screen ID:

[CIGARFILL]s [come I came] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “come” and “like”; for former users, display “came” and “liked”.
PATH ID:

AG1064

Screen ID:

Smoking [CIGARFILL]s helps people to quit smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AG1066

Screen ID:

Smoking a [CIGARFILL] [feels I felt] like smoking a regular cigarette.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “feel”; for former users, display “felt”.

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Version 7.5
PATH ID:

AG1068

Screen ID:

People who are important to me [smoke I smoked] [CIGARFILL]s.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “smoke”; for former users, display “smoked”.
PATH ID:

AG1069

Screen ID:

I [like I liked] socializing while smoking a [CIGARFILL].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “like”; for former users, display “liked”.
PATH ID:

AG1072

Screen ID:

The advertising for [CIGARFILL]s [appeals I appealed] to me.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “appeals”; for former users, display “appealed”.
PATH ID:

AG1080

Screen ID:

[Do | Did] you smoke [CIGARFILL]s as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month who are also Current or
Former users 12 month of cigarettes
PROGRAM: For current [CIGARFILL] smokers display “do”; For 12 month former [CIGARFILL] smokers
display “did”

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PATH ID:

AG1081

Screen ID:

[Do | Did] you smoke [CIGARFILL]s as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current [CIGARFILL] smokers display “do”; For 12 month former [CIGARFILL] smokers
display “did”

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PIPE SECTION
The next questions are about smoking tobacco in pipes.
Pipes come in many shapes and sizes. They all have a bowl that holds the tobacco and a stem. Pipe
tobacco is often sold loose in packages or tins. In the following section, we are only asking about smoking
pipes filled with tobacco. The picture below shows a typical pipe and some pipe tobacco.
[SHOW IMAGES OF PIPES AND PIPE TOBACCO – BOTH LOOSE AND IN TINS]
PATH ID:

AP1005

Screen ID:

How many bowls filled with pipe tobacco have you smoked in your entire life?
1
2
3
4
5
6
-8
-7

1 or more puffs but never a whole one
1 to 10
11 to 20
21 to 50
51 to 99
100 or more
DON’T KNOW
REFUSED

ASK: Respondents who have smoked a pipe (AP1002=1)
PATH ID:

AP1006

Screen ID:

How old were you the first time you smoked part or all of a pipe filled with tobacco, even one or two puffs?
1
I___I___I years old
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked a pipe (AP1002=1)
PATH ID:

AP1120

GO TO AP1100

Screen ID:

The first time you smoked part or all of a pipe filled with tobacco, even one or two puffs, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AP1006 (AP1006 = -8, -7).

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PATH ID:

AP1100

Screen ID:

Have you ever smoked a pipe filled with tobacco fairly regularly?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked a pipe (AP1002=1)
PATH ID:

GO TO AP1008
GO TO AP1008
GO TO AP1008

AP1007

Screen ID:

How old were you when you first started smoking a pipe filled with tobacco fairly regularly?
1

GO TO AP1020

I___I___I years old

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents that have ever smoked fairly regularly (AP1100=1)
GO TO: If AP1003 = 1, go to AP1020
Else, go to AP1008
PATH ID:

AP1121

Screen ID:

When you first started smoking a pipe filled with tobacco fairly regularly, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AP1007 (AP1007 = -8, -7).
GO TO: If AP1003 = 1, go to AP1020
Else, go to AP1008

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PATH ID:

AP1020

Screen ID:

How old were you when you first started smoking a pipe filled with tobacco every day?
1
I___I___I years old
GO TO AP1008
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who smoke a pipe every day (AP1003=1)
PATH ID:

AP1122

Screen ID:

When you first started smoking a pipe filled with tobacco every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AP1020 (AP1020 = -8, -7).
PATH ID:

AP1008

Screen ID:

When you first started smoking a pipe, did you smoke pipe tobacco flavored to taste like menthol, mint,
clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have used a pipe (AP1002=1)
GO TO: If AP1003 <> 1, go to AP1009
If AP1003=2 AND AP0100=5, go to AP1009.
Else go to BOX AP1

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PATH ID:

AP1009

Screen ID:

About how long has it been since you last smoked a pipe filled with tobacco? (If it was earlier today, enter 1
day)
1
2
3

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked a pipe (AP1002=1) and do not smoke every day (AP1003<>1)
PROGRAM: EXCLUDE Some day smokers (AP1003=2) who previously reported they last smoked in the
past hour, sometime today, yesterday, or the day before yesterday (AP0100=1 or 2 or 3 or 4).
GO TO: If AP1003 = 3, go to AP1009
Else go to BOX AP1
PATH ID:

AP1010

Screen ID:

Have you completely quit smoking pipes filled with tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have smoked a pipe (AP1002=1) and currently smoke not at all (AP1003=3)
Screen ID:

BOX AP1
PROGRAM: Define the following variables (see Appendix B):
EVER USER PIPE
CURRENT USER PIPE
EVERY DAY USER PIPE
SOME DAY USER PIPE
EXPERIMENTAL CURRENT USER PIPE
EXPERIMENTAL FORMER USER PIPE
FORMER USER 12 MONTH PIPE
FORMER USER 12 MONTH PLUS PIPE
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
EVERY DAY USER PIPE GO TO AP1021
SOME DAY USER PIPE OR EXPIERMENTAL CURRENT USER PIPE GO TO AP1022
FORMER USER 12 MONTH PIPE GO TO AP1025

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FORMER USER 12 MONTH PLUS PIPE OR EXPERIMENTAL FORMER USER PIPE
GO TO NEXT SECTION
PATH ID:

AP1021

Screen ID:

On average, about how many bowls filled with pipe tobacco do you now smoke each day?
1
Less than 1 each day
2
I___I___I
-8 DON’T KNOW
-7 REFUSED
ASK: Every day users
PATH ID:

GO TO AP1024
GO TO AP1024
GO TO AP1024
GO TO AP1024

AP1022

Screen ID:

On how many of the past 30 days did you smoke a pipe filled with tobacco?
1

|__|__|

Days
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users
PROGRAM: Range check: 1-30 days
GO TO: If AP1022 = 0 and some day user, go to AP1024
Else if AP1022 = 0 and experimental current user, go to AP1025
Else go to AP1023
PATH ID:

AP1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AP1022 days I days you smoked], how many bowls
filled with pipe tobacco did you usually smoke each day?
1
2

Less than 1 each day
|__|__|

-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users who have smoked at least one day in past 30 or did
not provide the number of days smoked in past 30 (AP1022>0 OR AP1022 IN (DK, R))
PROGRAM: If AP1022=1, DK or RF, display “days you smoked”. Else display “# days” where # = number of
days reported in AP1022.
GO TO: EXPERIMENTAL CURRENT USER PIPE GO TO AP1025

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PATH ID:

AP1024

Screen ID:

(On the days that you smoke pipes filled with tobacco,) [how/How] soon after you wake up do you typically
take your first puff from a pipe? Please enter the number of minutes or hours.
I___I___I___I
GO TO AP1025
Minutes after waking
I___I___I___I
GO TO AP1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: For Every Day pipe smokers display “How”; For Some Day pipe smokers display ‘On the days
that you smoke a pipe filled with tobacco, how’
1

PATH ID:

AP1092

Screen ID:

(On the days that you smoke pipes filled with tobacco,would | Would) you say you take your first puff from a
pipe within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AP1024=-8,-7)
PROGRAM: For Every day pipe smokers, display “Would”. For Some day pipe smokers, display “On the
days that you smoke pipes filled with tobacco, would”
PATH ID:

AP1025

Screen ID:

Around this time 12 months ago, were you smoking a pipe filled with tobacco every day, some days, or not
at all?
1

Every day

2

Some days

3

Not at all

-8

DON’T KNOW

-7

REFUSED

ASK: Current users, Experimental Current users, and Former users 12 month
GO TO: If EXPERIMENTAL CURRENT USER PIPE, GO TO AP1060
If Former users 12 month, go to AP1030
Else go to AP1097

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PATH ID:

AP1097

Screen ID:

The next questions ask about your experience buying pipe tobacco.
In the past 30 days, did you use a coupon when buying pipe tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PATH ID:

GO TO AP1030
GO TO AP1030
GO TO AP1030

AP1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy pipe tobacco?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy pipe tobacco in the last 30 days (AP1097=1)
PATH ID:

AP1030

Screen ID:

How [do/did] you usually buy pipe tobacco for yourself? Is it…
1 In person
2 From the internet
GO TO AP1047
3 By telephone
GO TO AP1047
4 I [do I did] not buy my own pipe tobacco
GO TO AP1047
-8 DON’T KNOW
GO TO AP1047
-7 REFUSED
GO TO AP1047
ASK: Current users and Former users 12 month
PROGRAM: Display instruction for question and response option 4 fill: for current pipe smokers display “do”;
For 12 month former pipe smokers display “did”
PATH ID:

AP1032

Screen ID:

[Do/Did] you usually buy pipe tobacco...?
1 In your own state
2 In another state
3 Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users or Former users 12 month who usually buy pipe tobacco in person (AP1030=1)
PROGRAM: For current pipe smokers display “Do”; For 12 month former pipe smokers display “Did”

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PATH ID:

AP1033

Screen ID:

Where [do/did ] you buy your pipe tobacco most of the time?
1 A convenience store or gas station
2 A supermarket, grocery store, or drug store
3 A warehouse club, such as Sam’s or Costco
4 A smoke shop, tobacco specialty store or tobacco outlet store
5 A duty free shop or military commissary
6 A bar, pub, restaurant or casino
7 A friend or relative
8 A swap meet or flea market
9 A liquor store
10 Or from somewhere else
SPECIFY: ____________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users or Former users 12 month who usually buy pipe tobacco in person (AP1030=1)
PROGRAM: For current pipe smokers display “do”; For 12 month former pipe smokers display “did”
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
PATH ID:

AP1047

Screen ID:

[Do I Did] you have a regular brand of pipe tobacco that you usually [smoke I smoked]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current smokers display “Do” and “smoke”; for 12 month former smokers display “Did” and
“smoked”.

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PATH ID:

AP1048

Screen ID:

What brand of pipe tobacco [do I did] you [usually I last] smoke? Please select it from the choices below by
touching the screen. [ If you do not see it below, touch the button marked “NEXT”. I If you do not see it
below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AP1070]
1
Something else
GO TO AP1049
-8 DON’T KNOW
GO TO AP1050
-7 REFUSED
GO TO AP1050
ASK: Current users and Former users 12 month
PROGRAM: For current smokers who have regular brand (AP1047=1), display “do” and “usually”; For
current smokers who do not have a regular brand (AP1047=2, DK, RF, DK, RF), display “did” and “last”.
For 12 month former smokers who had a regular brand (AP1047=1), display “did” and “usually”; For 12
month former smokers who did not have a regular brand (AP1047=2, DK, RF, DK, RF), display “did” and
“last”.
GO TO: If AP1050 NOT IN (1, DK, RF), go to AP0170
PATH ID:

AP1070

Screen ID:

You selected [BRANDFILL] as your brand. What kind of [BRANDFILL] [do I did] you [usually I last] smoke?
Please select it from the choices below by touching the screen. [ If you do not see it below, touch the button
marked “NEXT”. I If you do not see it below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AP1048]
1
-8
-7

Something else
GO TO AP1071
DON’T KNOW
GO TO AP1050
REFUSED
GO TO AP1050
ASK: Current users and Former users 12 month who selected a brand image in AP1048.
PROGRAM: For current smokers who have regular brand (AP1047=1), display “do” and “usually”; For
current smokers who do not have a regular brand (AP1047=2, DK, RF, DK, RF), display “did” and “last”. For
12 month former smokers who had a regular brand (AP1047=1), display “did” and “usually”; For 12 month
former smokers who did not have a regular brand (AP1047=2, DK, RF, DK, RF), display “did” and “last”.

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PATH ID:

AP1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AP1050
-8 DON’T KNOW
GO TO AP1050
-7 REFUSED
GO TO AP1050
ASK: Current users and Former users 12 month who did not select an image of their regular brand
(AP1048=1)
PATH ID:

AP1071

Screen ID:

You said that the type of [BRANDFILL]s that you [smoke I smoked] is not pictured. What type is it?
1
-8
-7

__________________________
DON’T KNOW
REFUSED
ASK: : Current users and Former users 12 month who did not select the type of product they use
(AP1070=”Something else”) but who DID select a brand (AP1048<>1, -8, -7). Do not ask of respondents
who wrote a brand into AP1049.
PROGRAM: For current smokers, display “smoke”; for 12 month former smokers, display “smoked”.
PATH ID:

AP1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [smoke I smoked] flavored to taste like menthol, mint,
clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current smokers who have a regular brand (AP1047=1), display “Is”, “your regular brand”
and “smoke”. For current smokers who do not have a regular brand (AP1047=2, DK, RF), display "Was",
"the last brand" and "smoked". For 12 month former smokers who had a regular brand (AP1047=1), display
"Was", "your regular brand" and "smoked". For 12 month former smokers who did not have a regular brand
(AP1047=2, DK, RF), display "Was", "the last brand" and "smoked".
GO TO: If current user or former user 12 month AND AP1047 = 1, go to AP1051
Else go to AP0104

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PATH ID:

AP1051

Screen ID:

About how long (did you smoke/have you been smoking) your regular brand of pipe tobacco? Please
choose whether (you smoked/you've been smoking) your regular brand for years, months, or days. Then
enter the number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who have a regular brand (AP1047=1)
PROGRAM: For current users, display “have you been smoking” and “you’ve been smoking.” For 12 month
former users, display “did you smoke” and “you smoked.”
1

PATH ID:

AP0104

Screen ID:

You said earlier that you last smoked a pipe [TIME OF LAST USE]. Think about the very last bowl
of pipe tobacco you smoked. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have smoked a pipe today, yesterday or the day before yesterday
(AP0100=1, 2 or 3 or 4) AND who selected a valid brand (AP1048<>1, -8, -7) AND valid sub
brand (AP1070<>1, -8, -7).
DISPLAY:
For ‘TIME OF LAST USE’,
If AP0100=1, display “in the past hour”
If AP0100=2, display “sometime today”
If AP0100=3, display “yesterday”
If AP0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AP1070

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Box AP2
Display question AP1060, AP1061, AP1062, AP1063, AP1064, , AP1068, AP1069, AP1072 on one screen.
Show the intro/transition text from AP1060 first, then show each item with responses. As each item is
answered, show the next one.
PROGRAM: Randomize order of AP1060 through AP1072.
PATH ID:

AP1060

Screen ID:

The next questions are about the reasons people smoke pipes. Please select which reasons [apply to you I
applied to you when you used to smoke pipes].
I [smoke I smoked] a pipe filled with tobacco because…
It [is I was] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “apply to you”, “smoke” and “is”; for former users, display “applied to
you when you used to smoke pipes”, “smoked” and “was”.
PATH ID:

AP1061

Screen ID:

People in the media or other public figures [smoke I smoked] pipes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “smoke”; for former users, display “smoked”.
PATH ID:

AP1085

Screen ID:

I [can I could] smoke pipes at times when or in places where smoking cigarettes [isn’t I wasn’t] allowed.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “can” and ”isn’t”; for former users, display “could” and “wasn’t”.

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PATH ID:

AP1062

Screen ID:

It might [be I have been] less harmful than smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AP1063

Screen ID:

Pipe tobacco [comes I came] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “come” and “like”; for former users, display “came” and “liked”.
PATH ID:

AP1064

Screen ID:

Smoking a pipe helps people to quit smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AP1068

Screen ID:

People who are important to me [smoke I smoked] pipes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “smoke”; for former users, display “smoked”.

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PATH ID:

AP1069

Screen ID:

I [like I liked] socializing while smoking a pipe.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “like”; for former users, display “liked”.
PATH ID:

AP1072

Screen ID:

The advertising for pipes [appeals I appealed] to me.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “appeals”; for former users, display “appealed”.
GO TO: If NOT current user or Former user 12 month cig, go to next section
Else go to AP1080
PATH ID:

AP1080

Screen ID:

[Do | Did] you smoke pipes filled with tobacco as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month who are also Current or
Former users 12 month of cigarettes
PROGRAM: For current smokers or experimental current pipe users display “do”; For 12 month former
smokers display “did”
PATH ID:

AP1081

Screen ID:

[Do | Did] you smoke pipes as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current smokers or experimental current pipe users display “do”; For 12 month former
smokers display “did”

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HOOKAH SECTION
[AHINTRO_1]
The next few questions are about smoking tobacco in a hookah. A hookah pipe is a type of water pipe that
is sometimes also called a narghile pipe. From now on, we will use hookah to refer to a water pipe or
narghile pipe that is often used to smoke tobacco.
There are many types of hookahs. People often smoke tobacco in hookahs in groups at cafes or in hookah
bars.
SHOW GENERIC IMAGES OF HOOKAH
[AHINTRO_2]
People smoke shisha or hookah tobacco in a hookah. Some shisha contains tobacco and some does not.
Shisha comes in many flavors.
SHOW GENERIC IMAGES OF SHISHA
PATH ID:

AH1005

Screen ID:

How many times have you smoked hookah in your entire life? Count each sitting or session where you
smoked tobacco in a hookah, whether alone or with others.
1
2
3
4
5
-8
-7

1 to 10
11 to 20
21 to 50
51 to 99
100 or more
DON’T KNOW
REFUSED

ASK: Respondents who have ever smoked hookah (AH1002=1)
PATH ID:

AH1006

Screen ID:

How old were you the first time you smoked hookah, even one or two puffs?
1

I___I___I years old

GO TO AH1100

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever smoked hookah (AH1002=1)

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PATH ID:

AH1120

Screen ID:

The first time you smoked hookah, even one or two puffs, were you …
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AH1006 (AH1006 = -8, -7).
PATH ID:

AH1100

Screen ID:

Have you ever smoked hookah fairly regularly?
1
Yes
2
No
GO TO AH1008
-8
DON’T KNOW
GO TO AH1008
-7
REFUSED
GO TO AH1008
ASK: Respondents who have ever smoked hookah (AH1002=1)
PATH ID:

AH1007

Screen ID:

How old were you when you first started smoking hookah fairly regularly?
1

I___I___I years old

GO TO AH1020

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked fairly regularly (AH1100=1)
PATH ID:

AH1121

Screen ID:

When you first started smoking hookah fairly regularly, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AH1007 (AH1007 = -8, -7).
GO TO: If AH1003 = 1, go to AH1020
Else, go to AH1008

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH1020

Screen ID:

How old were you when you first started smoking hookah every day?
1
I___I___I years old
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who smoke every day (AH1003 = 1)
PATH ID:

GO TO AH1008

AH1122

Screen ID:

When you first started smoking hookah every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AH1020 (AH1020 = -8, -7).
PATH ID:

AH1008

Screen ID:

When you first started smoking hookah, did you smoke shisha or hookah tobacco flavored to taste like
menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked hookah (AH1002=1)
GO TO: If AH1003 <> 1, go to AH1009
If AH1003=2 AND AH0100=5, go to AH1009.
Else go to BOX AH3

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH1009

Screen ID:

About how long has it been since you last smoked hookah? (If it was earlier today, enter 1 day)
1
2
3

I___I___I
DAYS
I___I___I
MONTHS

GO TO BOX AH3

I___I___I
YEARS

GO TO BOX AH3

GO TO BOX AH3

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever smoked hookah (AH1002=1) and do not smoke every day (AH1003<>1)
PROGRAM: EXCLUDE Some day smokers (AH1003=2) who previously reported they last smoked in the
past hour, sometime today, yesterday, or the day before yesterday (AH0100=1 or 2 or 3 or 4).
PATH ID:

AH9001

Screen ID:

Have you smoked hookah at least once in the past 30 days?
1
Yes
GO TO BOX AH3
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who did not provide the amount of time that has passed sinced they had last smoked
hookah (AH1009 IN (DK,R)
PATH ID:

AH9002

Screen ID:

Have you smoked hookah at least once in the past three months?
1
Yes
GO TO BOX AH3
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who did not provide the amount of time that has passed sinced they had last smoked
hookah AND have not smoked hookah at least once in the past 30 days (AH1009 IN (DK,R) AND AH9001
IN (2, DK, R))

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH9010

Screen ID:

Have you smoked hookah at least once in the past twelve months?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who did not provide the amount of time that has passed sinced they had last smoked
hookah AND have not smoked hookah at least once in the past 3 months (AH1009 IN (DK,R) AND AH9001
IN (2, DK, R) AND AH9002 IN (2, DK, R))

BOX AH3
If AH9002<>1 OR AH1009>90 DAYS or 3 MONTHS, go to AH1010
PATH ID:

AH1010

Screen ID:

Have you completely quit smoking hookah?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have not smoked hookah in the last three months (AH9002<>1 OR AH1009>90
DAYS or 3 MONTHS)
GO TO: If AH1009 <=12 Months OR AH9001=1 OR AH9002=1, go to AH9003
Else go to BOX AH1
PATH ID:

AH9003

Screen ID:

Which of the following choices best describes your hookah smoking? Usually I smoke hookah…
1

Every day

PROGRAM: DISPLAY RESPONSE OPTION 1
ONLY IF AH1003=DK/R

GO TO AH9006

GO TO AH9005
2 Weekly
3 Monthly
GO TO AH9004
4 Every couple of months
GO TO BOX AH1
5 About once a year
GO TO BOX AH1
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have ever smoked hookah (AH1002=1) AND do not smoke every day (AH1003<>1)
AND smoked hookah in the past 12 months (AH1009 <=12 Months Ago OR AH9001=1 OR AH9002=1)

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PATH ID:

AH9004

Screen ID:

On average, about how many times do you smoke hookah in a month? Count each sitting or session where
you smoked tobacco in a hookah, whether alone or with others.
1
_________________
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who smoke hookah monthly (AH9003=3)
PATH ID:

GO TO BOX AH1
GO TO BOX AH1
GO TO BOX AH1

AH9005

Screen ID:

On average, about how many times do you smoke hookah in a week? Count each sitting or session where
you smoked tobacco in a hookah, whether alone or with others.
1
_________________
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who smoke hookah weekly (AH9003=2)
PATH ID:

GO TO BOX AH1
GO TO BOX AH1
GO TO BOX AH1

AH9006

Screen ID:

On average, about how many times do you smoke hookah each day? Count each sitting or session where
you smoked tobacco in a hookah, whether alone or with others.
1
_________________
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who smoke hookah every day (AH1003 = 1 OR AH9003 = 1)
Screen ID:

BOX AH1
PROGRAM: Define the following variables (see Appendix B):
EVER USER HOOK
CURRENT USER HOOK
EVERY DAY USER HOOK
30 DAY USER HOOK
EXPERIMENTAL CURRENT USER HOOK
EXPERIMENTAL FORMER USER HOOK
FORMER USER 12 MONTH HOOK
FORMER USER 12 MONTH PLUS HOOK

AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
CURRENT USER HOOK OR EXPERIMENTAL CURRENT USER HOOK, GO TO AH1024
FORMER USER 12 MONTH HOOK, GO TO AH1025
FORMER USER 12 MONTH PLUS HOOK OR EXPERIMENTAL FORMER USER HOOK GO TO NEXT
SECTION

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PATH ID:

AH1024

Screen ID:

(On the days that you smoke hookah,) {how/How} soon after you wake up do you typically take your first
puff from a hookah? Please enter the number of minutes or hours.
I___I___I___I
GO TO AH1025
Minutes after waking
I___I___I___I
GO TO AH1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users and 30 Day User HOOK
PROGRAM: For Every Day hookah smokers display “How”; Else display ‘On the days that you smoke
hookah, how’
1

PATH ID:

AH1092

Screen ID:

(On the days that you smoke hookah, would | Would) you say you typically take your first puff from a hookah
within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users and 30 Day User HOOK who don’t know or refuse to
answer how soon after waking up (AH1024=-8,-7)
PROGRAM: For Every day hookah smokers, display “Would”. Else, display “On the days that you smoke
hookah, would”
PATH ID:

AH1025

Screen ID:

Around this time 12 months ago, were you smoking hookah every day, some days, or not at all?
1

Every day

2

Some days

3

Not at all

-8

DON’T KNOW

-7

REFUSED

ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH1090

Screen ID:

[Do / Did] you own a hookah?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current and 30 Day hookah smokers display “Do”; For 12 month
former hookah smokers display “Did”.
PATH ID:

AH9011

Screen ID:

Where [do / did] you usually smoke hookah? Choose all that apply.
[PROGRAM: If OS field selected and additional OS screen is shown, display question text and add the
following text: “Please type your answer using the computer keyboard.”]
1
At home
2
In a hookah bar or cafe
3
At a friend’s house
4
Somewhere else (SPECIFY:__________)
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current and 30 Day hookah smokers display “Do”; For 12 month
former hookah smokers display “Did”.
PATH ID:

AH9012

Screen ID:

[Do/Did] you usually share the same hookah with others when you [smoke/smoked]?
1
Yes
2
No
GO TO AH1097
-8
DON’T KNOW
GO TO AH1097
-7
REFUSED
GO TO AH1097
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current and 30 Day hookah smokers display “Do” and “smoke”; For
12 month former hookah smokers display “Did” and “smoked”

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PATH ID:

AH9013

Screen ID:

How many people [do/did] you usually share hookah with?
1
None
2
1 other person
3
2 other people
4
3 other people
-8
4 or more other people
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month that
share hookah with others (AH9012=1)
PROGRAM: For current, experimental current and 30 Day hookah smokers display “do”; for 12 month
former hookah smokers display “did”
PATH ID:

AH9014

Screen ID:

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 smoke hookah, whether alone or with others.
1
Less than 30 minutes
2
30-60 minutes
3
1-2 hours
4
More than 2 hours
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current and 30 Day hookah smokers display “is”; for 12 month
former hookah smokers display “was”. If current, experimental current or 30 Day smoker and shares with
other people (AH9012=1 and AH9013 NE 1), display “and the people you share it with”. If 12 month former
hookah smoker and shared with other people (AH9012=1 and AH9013 NE 1), display “and the people you
shared it with”

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH9015

Screen ID:

On average, when you [smoke I smoked I share I shared] hookah, how many times [do I did] you refill it with
tobacco?
1
0 times
2
1 time
3
2 to 3 times
4
4 or more times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: If current, experimental current or 30 Day smoker and does not share with other people
(AH9012=2), display “smoke” and “do”. If current, experimental current or 30 Day smoker and does share
with other people (AH9012=1), display “share” and “do”. If 12 month former hookah smoker and does not
share with other people (AH9012=2), display “smoked” and “did”. If 12 month former hookah smoker and
does share with other people (AH9012=1), display “shared” and “did”.
GO TO: If Experimental current user or Former user 12 month, go to AH1030
If Current or 30 Day User HOOK, go to AH1097.
PATH ID:

AH1097

Screen ID:

The next questions ask about your experience buying shisha or hookah tobacco.
In the past 30 days, did you use a coupon when buying shisha or hookah tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current and 30 Day HOOK users
PATH ID:

GO TO AH1030
GO TO AH1030
GO TO AH1030

AH1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy shisha or hookah tobacco?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current and 30 Day HOOK users who have used a coupon to buy shisha tobacco in the last 30 days
(AH1097=1)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AH1030

Screen ID:

How [do/did] you usually buy shisha or hookah tobacco for yourself? Is it…
1
In person (such as at a store or hookah bar)
2
From the internet
GO TO AH1047
3
By telephone
GO TO AH1047
4
I [do I did] not buy my own shisha or hookah tobacco
GO TO AH1047
-8
DON’T KNOW
GO TO AH1047
-7
REFUSED
GO TO AH1047
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: Display instruction for question and response option 4 fill: for current, experimental current or
30 Day hookah smokers display “do”; For 12 month former hookah smokers display “did”
PATH ID:

AH1032

Screen ID:

[Do/Did] you usually buy shisha or hookah tobacco...?
1 In your own state
2 In another state
3 Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, or Former users 12 month who
usually buy shisha tobacco in person (AH1030=1) PROGRAM: For current, experimental current or 30
Day hookah smokers display “Do”; For 12 month former hookah smokers display “Did”
PATH ID:

AH1033

Screen ID:

Where [do/did ] you buy your shisha or hookah tobacco most of the time?
1 A hookah bar or cafe
2 A convenience store or gas station
3 A supermarket, grocery store, or drug store
4 A warehouse club, such as Sam’s or Costco
5 A smoke shop, tobacco specialty store or tobacco outlet store
6 A duty free shop or military commissary
7 A bar, pub, restaurant or casino
8 A friend or relative
9 A swap meet or flea market
10 A liquor store
11 Or from somewhere else
SPECIFY: ____________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, or Former users 12 month who
usually buy shisha tobacco in person (AH1030=1)

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Adult Extended Questionnaire
Version 7.5
PROGRAM: For current, experimental current or 30 Day hookah smokers display “do”; For 12 month former
hookah smokers display “did”
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
PATH ID:

AH1047

Screen ID:

[Do I Did] you have a regular brand of shisha or hookah tobacco that you usually [smoke I smoked]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day hookah smokers display “Do” and “smoke”; for 12
month former hookah smokers display “Did” and “smoked”
PATH ID:

AH1048

Screen ID:

What brand of shisha or hookah tobacco [do I did] you [usually I last] smoke? Please select it from the
choices below by touching the screen. [ If you do not see it below, touch the button marked “NEXT”. I If
you do not see it below, touch the box marked “Something else.” ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AH1070]
1
Something else
GO TO AH1049
-8 DON’T KNOW
GO TO AH1060
-7 REFUSED
GO TO AH1060
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day smokers who have regular brand (AH1047=1),
display “do” and “usually”; For current, experimental current or 30 Day smokers who do not have a regular
brand (AH1047=2, DK, RF), display “did” and “last”. For 12 month former smokers who had a regular brand
(AH1047=1), display “did” and “usually”; For 12 month former smokers who did not have a regular brand
(AH1047=2, DK, RF), display “did” and “last”.
GO TO: If AH1048 NOT IN (1, DK, R), go to AH1070

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Version 7.5
PATH ID:

AH1070

Screen ID:

You selected [BRANDFILL] as your brand. What kind of [BRANDFILL] [do I did] you [usually I last] smoke?
Please select it from the choices below by touching the screen. [ If you do not see it below, touch the button
marked “NEXT”. I If you do not see it below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AH1048]
1
-8
-7

Something else
GO TO AH1071
DON’T KNOW
GO TO AH1060
REFUSED
GO TO AH1060
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who
selected a brand image in AH1048 (AH1048<>1, DK, R)
GO TO: If AH1070 NOT IN (1, DK, R), go to AH9018
PROGRAM: For current, experimental current or 30 Day smokers who have regular brand (AH1047=1),
display “do” and “usually”; For current, experimental current or 30 Day smokers who do not have a regular
brand (AH1047=2, DK, RF, DK, RF), display “did” and “last”. For 12 month former smokers who had a
regular brand (AH1047=1), display “did” and “usually”; For 12 month former smokers who did not have a
regular brand (AH1047=2, DK, RF, DK, RF), display “did” and “last”.
PATH ID:

AH1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AH9108
-8 DON’T KNOW
GO TO AH1060
-7 REFUSED
GO TO AH1060
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who did
not select an image of their regular brand (AH1048=1)
PATH ID:

AH1071

Screen ID:

You said that the type of [BRANDFILL]s that you [smoke I smoked] is not pictured. What type is it?
1
-8
-7

__________________________
DON’T KNOW
GO TO AH1060
REFUSED
GO TO AH1060
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who did
not select the type of product they use (AH1070=”Something else”) but who DID select a brand
(AH1048<>1, DK, R). Do not ask of respondents who wrote a brand into AH1049.
PROGRAM: For current, experimental current or 30 Day smokers, display “smoke”; for 12 month former
smokers, display “smoked”.

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Version 7.5
PATH ID:

AH9108

Screen ID:

Does this brand of shisha contain tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who DID
select a brand (AH1048<>1, -8, -7)
PATH ID:

AH1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [smoke I smoked] flavored to taste like menthol, mint,
clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day smokers who have a regular brand (AH1047=1),
display “Is”, “your regular brand” and “smoke”. For current, experimental current or 30 Day smokers who do
not have a regular brand (AH1047=2, DK, RF), display "Was", "the last brand" and " smoked ". For 12
month former smokers who had a regular brand (AH1047=1), display "Was", "your regular brand" and "
smoked ". For 12 month former smokers who did not have a regular brand (AH1047=2, DK, RF), display
"Was", "the last brand" and " smoked ".
GO TO: If current user, experimental current or 30 Day or former user 12 month AND AH1047 = 1, go to
AH1051
Else go to AH1060
PATH ID:

AH1051

Screen ID:

About how long (did you smoke/ have you been smoking) your regular brand of shisha or hookah tobacco?
Please choose whether (you smoked/you've been smoking) your regular brand for years, months, or days.
Then enter the number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who
have a regular brand (AH1047=1)
PROGRAM: If current, experimental current or 30 Day user, display “have you been smoking” and “you’ve
been smoking”. If former user 12 month, display “did you smoke” and “you smoked”.
1

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Version 7.5
PATH ID:

AH0104

Screen ID:

You said earlier that you last smoked hookah [TIME OF LAST USE]. Think about the very last
puff you took. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have smoked hookah today, yesterday or the day before yesterday
(AH0100=1, 2 or 3 or 4) AND who selected a valid brand (AH1048<>1, -8, -7) AND valid sub
brand (AH1070<>1, -8, -7).
DISPLAY:
For ‘TIME OF LAST USE’,
If AH0100=1, display “in the past hour”
If AH0100=2, display “sometime today”
If AH0100=3, display “yesterday”
If AH0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AH1070
Box AH2
Display question AH1060, AH1061, AH1085, AH1062, AH1063, AH1064, AH1066, AH1068, AH1069,
AH1072, AH1073 on one screen. Show the intro/transition text from AH1060 first, then show each item with
responses. As each item is answered, show the next one.
PROGRAM: Randomize order of AH1060 through AH1073.

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Version 7.5
PATH ID:

AH1060

Screen ID:

The next questions are about the reasons people smoke hookah. Please select which reasons [apply to
you I applied to you when you used to smoke hookah].
I [smoke I smoked] hookah because…
It [is I was] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users, display “apply to you”, “smoke” and “is”; for
former users, display “applied to you when you used to smoke hookah”, “smoked” and “was”.
PATH ID:

AH1061

Screen ID:

People in the media or other public figures [smoke I smoked] hookah.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “smoke”; for former users,
display “smoked”.
PATH ID:

AH1085

Screen ID:

I [can I could] smoke hookah at times when or in places where smoking cigarettes [isn’t I wasn’t] allowed.
1
Yes
2
No
-8
DON”T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “can” and ”isn’t”; for former
users, display “could” and “wasn’t”.

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Version 7.5
PATH ID:

AH1062

Screen ID:

It might [be I have been] less harmful than smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “be”; for former users, display
“have been”.
PATH ID:

AH1063

Screen ID:

Shisha or hookah tobacco [comes I came] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “come” and “like”; for former
users, display “came” and “liked”.
PATH ID:

AH1064

Screen ID:

Smoking hookah helps people to quit smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PATH ID:

AH1068

Screen ID:

People who are important to me [smoke I smoked] hookah.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “smoke”; for former users,
display “smoked”.

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Version 7.5
PATH ID:

AH1069

Screen ID:

I [like I liked] socializing while smoking hookah.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “like”; for former users, display
“liked”.
PATH ID:

AH1072

Screen ID:

The advertising for hookah [appeals I appealed] to me.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current or 30 Day users users, display “appeals”; for former users,
display “appealed”.
PATH ID:

AH1073

Screen ID:

Smoking hookah is part of my cultural tradition.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
GO TO: If NOT current user, Experimental Current user, 30 Day User HOOK, Former user 12 month or
Former user 12 month CIG, go to next section
Else go to AG1080
PATH ID:

AH1080

Screen ID:

[Do | Did] you smoke hookah as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month who are
also Current or Former users 12 month of cigarettes
PROGRAM: For current, experimental current, and 30 Day hookah smokers display “do”; For 12 month
former hookah smokers display “did”

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PATH ID:

AH1081

Screen ID:

[Do | Did] you smoke hookah as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, 30 Day User HOOK, and Former users 12 month
PROGRAM: For current, experimental current, and 30 Day hookah smokers display “do”; For 12 month
former hookah smokers display “did”

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SMOKELESS TOBACCO SECTION
If SMKLSSTYPE[1]=1 and SMKLSSTYPE[2]=null (respondents who use smokeless BUT not snus), display
the following text:
The next questions ask about smokeless tobacco which you put in your mouth and chew, suck or spit.
There are many kinds of smokeless tobacco, such as loose snus, moist snuff, dip, spit, and chewing
tobacco.
Common brands include Redman, Levi Garrett, Beechnut, Skoal, Grizzly and Copenhagen, but there are
many others.
[SHOW GENERIC IMAGE OF SMOKELESS PRODUCTS, EXCLUDING SNUS TIN AND POUCHES]
If SMKLSSTYPE[1]=null and SMKLSSTYPE[2]=2 (respondents who use snus BUT not smokeless), display
the following text:
The next questions ask about snus pouches, a type of smokeless tobacco that comes in a small pouch that
you put under your lip.
Common brands of snus pouches include Camel snus, General snus, Marlboro snus, and Nordic Ice, but
there are many others.
[SHOW GENERIC IMAGE OF SNUS TIN AND POUCHES]
If SMKLSSTYPE[1]=1 and SMKLSSTYPE[2]=2 (respondents who use both snus and other smokeless)
FIRST TIME THROUGH, display the following text:
The next questions ask about snus pouches, a type of smokeless tobacco that comes in a small pouch that
you put under your lip.
Common brands of snus pouches include Camel snus, General snus, Marlboro snus, and Nordic Ice, but
there are many others.
Please think about your use of snus pouches as you answer these questions. There will be a separate
section later about other kinds of smokeless tobacco.
[SHOW GENERIC IMAGE OF SNUS TIN AND POUCHES]
If SMKLSSTYPE[1]=1 and SMKLSSTYPE[2]=2, SECOND TIME THROUGH, display the following text:
You just answered questions about snus pouches. The next questions are about your use of other kinds of
smokeless tobacco, such as loose snus, moist snuff, dip, spit, and chewing tobacco.
Common brands include Redman, Levi Garrett, Beechnut, Skoal, Grizzly and Copenhagen, but there are
many others.
The questions will use the phrase “smokeless tobacco” to refer to these products. Please think about your
use of smokeless tobacco products, not including snus pouches, as you answer these questions.
[SHOW GENERIC IMAGE OF SMOKELESS PRODUCTS, EXCLUDING SNUS TIN AND POUCHES]

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PATH ID:

AS1005

Screen ID:

How many [times I snus pouches] have you used [smokeless tobacco] in your entire life?
1
1 to 10
2
11 to 20
3
21 to 50
4
51 to 99
5
100 or more
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used [SMKLSSFILL]
PROGRAM: If SMKLSSTYPE[1]=1, display “times” and “smokeless tobacco”; if SMKLSSTYPE[2]=2, display
“snus pouches”.
PATH ID:

AS1006

Screen ID:

How old were you when you first used [SMKLSSFILL], even one or two times?
1

I___I___I years old

GO TO AS1100

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used [SMKLSSFILL]
PATH ID:

AS1120

Screen ID:

When you first used [SMKLSSFILL], even one or two times, were you…
1
2

Less than 18 years old,
18 to 24 years old,

3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AS1006 (AS1006 = -8, -7).
PATH ID:

AS1100

Screen ID:

Have you ever used [SMKLSSFILL] fairly regularly?
1
Yes
2
No
GO TO AS1008
-8
DON’T KNOW
GO TO AS1008
-7
REFUSED
GO TO AS1008
ASK: Respondents who have used [SMKLSSFILL] (AS1002=1)

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PATH ID:

AS1007

Screen ID:

How old were you when you first started using [SMKLSSFILL] fairly regularly?
1

GO TO AS1020

I___I___I years old

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents that have ever used [SMKLSSFILL] fairly regularly (AS1100=1)
GO TO: If AS1003 = 1, go to AS1020
Else go to AS1008
PATH ID:

AS1121

Screen ID:

When you first started using [SMKLSSFILL] fairly regularly, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AS1007 (AS1007 = -8, -7).
GO TO: If AS1003 = 1, go to AS1020
Else, go to AS1008
PATH ID:

AS1020

Screen ID:

How old were you when you first started using [SMKLSSFILL] every day?
1
I___I___I years old
GO TO AS1008
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who use [SMKLSSFILL] every day (AS1003=1)

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PATH ID:

AS1122

Screen ID:

When you first started using [SMKLSSFILL] every day, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AS1020 (AS1020 = -8, -7).
PATH ID:

AS1008

Screen ID:

When you first started using [SMKLSSFILL], did you use [smokeless tobacco I snus pouches] flavored to
taste like menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other
sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have used [SMKLSSFILL]
PROGRAM: If SMKLSSTYPE[1]=1, display “smokeless tobacco”; if SMKLSSTYPE[2]=2, display “snus
pouches”.
GO TO: If AS1003 <> 1, go to AS1009
If AS1003=2 AND AS0100=5, go to AS1009.
Else go to BOX AS2

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PATH ID:

AS1009

Screen ID:

About how long has it been since you last used [SMKLSSFILL]? (If it was earlier today, enter 1 day)
1
2
3

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used [SMKLSSFILL] and do not use every day (AS1003<>1)
PROGRAM: EXCLUDE Some day users (AS1003=2) who previously reported they last used in the past
hour, sometime today, yesterday, or the day before yesterday (AS0100=1 or 2 or 3 or 4).
GO TO: If AS1003 = 3, go to AS1010
Else go to BOX AS2
PATH ID:

AS1010

Screen ID:

Have you completely quit using [SMKLSSFILL]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have use [SMKLSSFILL] and currently use not at all (AS1003=3)

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Screen ID:

BOX AS2

PROGRAM: Define the following variables (see Appendix B):
EVER USER SMKLS
CURRENT USER SMKLS
EVERY DAY USER SMKLS
SOME DAY USER SMKLS
EXPERIMENTAL CURRENT USER SMKLS
EXPERIMENTAL FORMER USER SMKLS
FORMER USER 12 MONTH SMKLS
FORMER USER 12 MONTH PLUS SMKLS
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
EVERY DAY USER SMKLS GO TO AS1021
SOME DAY USER SMKLS OR EXPIERMENTAL CURRENT USER SMKLS GO TO AS1022
FORMER USER 12 MONTH SMKLS GO TO AS1025
FORMER USER 12 MONTH PLUS SMKLS OR EXPERIMENTAL FORMER USER SMKLS
GO TO NEXT SECTION
PATH ID:

AS1021

Screen ID:

On average, about how many [times do you now use smokeless tobacco each day I snus pouches do you
now use each day]?
1
I___I___I
GO TO AS1024
-8 DON’T KNOW
GO TO AS1024
-7 REFUSED
GO TO AS1024
ASK: Everyday users
PROGRAM: If display SMKLSSFILL[1]=1, “times do you now use smokeless tobacco each day; if
SMKLSSFILL[2]=2, display “snus pouches do you now use each day”
PATH ID:

AS1022

Screen ID:

On how many of the past 30 days did you use [SMKLSSFILL]?
|__|__|
Days
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users
PROGRAM: Range check: 1-30 days
GO TO: If AS1022 = 0 and some day user, go to AS1024
Else if AS1022 = 0 and experimental current user, go to AS1025
Else go to AS1023
1

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PATH ID:

AS1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AS1022 days I days you used], [how many times
did you usually use smokeless tobacco each day I how many snus pouches did you usually use each day]?
1

|__|__|

-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users who have used [SMKLSSFILL] at least one day in
past 30 or did not provide the number of days used in the past 30 (AS1022>0 OR AS1022 IN (DK, R))
If DK/RF, FILL=[days you used].
PROGRAM: If AS1022=1, DK or RF, display “days you used”; else display “# days” where # = number of
days reported in AS1022. If SMKLSSFILL[1]=1, display “how many times did you usually use smokeless
tobacco each day; if SMKLSSFILL[2]=2, display “how many snus pouches did you usually use each day”
GO TO: EXPERIMENTAL CURRENT USER [SMKLSSFILL] GO TO AS1025
PATH ID:

AS1024

Screen ID:

(On the days that you use [SMKLSSFILL],) {how/How} soon after you wake up do you typically use your first
[smokeless tobacco product I snus pouch] of the day? Please enter the number of minutes or hours.
I___I___I___I
GO TO AS1025
Minutes after waking
I___I___I___I
GO TO AS1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: For Every Day [SMKLSSFILL] users display “How”; For Some Day [SMKLSSFILL] users
display ‘On the days that you use [SMKLSSFILL], how’. If [SMKLSSFILL]=1, display ‘smokeless tobacco
product’; if [SMKLSSFILL]=2 display ‘snus pouch’
1

PATH ID:

AS1092

Screen ID:

(On the days that you use [SMKLSSFILL], would | Would) you say you use your first [smokeless tobacco
product I snus pouch] of the day within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AS1024=-8,-7)
PROGRAM: For Every day [SMKLSSFILL] users, display “Would”. For Some day [SMKLSSFILL] users,
display “On the days that you use [SMKLSSFILL], would”. If [SMKLSSFILL]=1, display ‘smokeless tobacco
product’; if [SMKLSSFILL]=2 display ‘snus pouch’

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PATH ID:

AS1025

Screen ID:

Around this time 12 months ago, were you using [SMKLSSFILL] every day, some days, or not at all?
1
Every day
2
Some days
3
Not at all
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
GO TO: If EXPERIMENTAL CURRENT USER [SMKLSSFILL] GO TO AS1060
If Former users 12 month, go to AS1030
Else go to AS1097
PATH ID:

AS1097

Screen ID:

The next questions ask about your experience buying [SMKLSSFILL].
In the past 30 days, did you use a coupon when buying [SMKLSSFILL]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PATH ID:

GO TO AS1030
GO TO AS1030
GO TO AS1030

AS1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy [SMKLSSFILL]?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy smokeless tobacco in the last 30 days (AS1097=1)

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PATH ID:

AS1030

Screen ID:

How [do/did] you usually buy [SMKLSSFILL] for yourself? Is it…
1 In person
2 From the internet
GO TO AS1047
3 By telephone
GO TO AS1047
4 I [do I did] not buy my own [SMKLSFILL]
GO TO AS1047
-8 DON’T KNOW
GO TO AS1047
-7 REFUSED
GO TO AS1047
ASK: Current users and Former users 12 month
PROGRAM: Display instruction for question and response option 4 fill: for current [SMKLSSFILL] users
display “do”; For 12 month former [SMKLSSFILL] users display “did”
GO TO: If AS1030 = 1, go to AS1032
Else go to AS1047
PATH ID:

AS1032

Screen ID:

[Do/Did] you usually buy [SMKLSSFILL]...?
1 In your own state
2 In another state
3 Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users or Former users 12 month who usually buy smokeless tobacco in person (AS1030=1)
PROGRAM: For current [SMKLSSFILL] users display “Do”; For 12 month former [SMKLSSFILL] users
display “Did”
PATH ID:

AS1033

Screen ID:

Where [do/did ] you buy your [SMKLSSFILL] most of the time?
1
2
3
4
5
6
7
8
9
10
-8
-7

A convenience store or gas station
A supermarket, grocery store, or drug store
A warehouse club, such as Sam’s or Costco
A smoke shop, tobacco specialty store or tobacco outlet store
A duty free shop or military commissary
A bar, pub, restaurant or casino
A friend or relative
A swap meet or flea market
A liquor store
Or from somewhere else
DON’T KNOW
REFUSED

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ASK: Current users or Former users 12 month who usually buy smokeless tobacco in person (AS1030=1)
PROGRAM: For current [SMKLSSFILL] users display “do”; For 12 month former [SMKLSSFILL] users
display “did”
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
GO TO: If former user 12 months, go to AS1047
Else go to AS1042
PATH ID:

AS1042

Screen ID:

How much do you usually pay for a container of [SMKLSSFILL]?
1

$ I___I___I___I
Amount
DON’T KNOW
REFUSED

-8
-7
ASK: Current users
GO TO: If SMKLSSFILL[2]=2, go to AU9001
Else go to AS147
PATH ID:

AU9001

Screen ID:

How many pouches are in the container of snus that you usually buy?
1
I___I___I___I
-8
DON’T KNOW
GO TO AS1047
-7
REFUSED
GO TO AS1047
ASK: Current users snus
PROGRAM: This is only asked of snus users where SMKLSSFILL[2]=2; This is not asked of smokeless
tobacco users where SMKLSSFILL[1]=1.
PATH ID:

AU9002

Screen ID:

About how many days does it take you to use up this size container?
I___I___I___I
Number of days
-8
DON’T KNOW
-7
REFUSED
ASK: Current users snus who provided the number of pouches in the container of snus they usually buy
(AU9001 NOT IN (DK, R)
PROGRAM: This is only asked of snus users where SMKLSSFILL[2]=2; This is not asked of smokeless
tobacco users where SMKLSSFILL[1]=1.
1

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PATH ID:

AS1047

Screen ID:

[Do I Did] you have a regular brand of [SMKLSSFILL] that you usually [use I used]?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current users display “Do” and “use”; for 12 month former users display “Did” and “used”.
PATH ID:

AS1048

Screen ID:

What brand of [SMKLSSFILL] [do I did] you [usually I last] use? Please select it from the choices below by
touching the screen. [ If you do not see it below, touch the button marked “NEXT”. I If you do not see it
below, touch the box marked “Something else.” ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AS1070]
1
Something else
GO TO AS1049
-8 DON’T KNOW
GO TO AS1050
-7 REFUSED
GO TO AS1050
ASK: Current users and Former users 12 month
PROGRAM: For current users who have regular brand (AS1047=1), display “do” and “usually”; For current
users who do not have a regular brand (AS1047=2, DK, RF), display “did” and “last”. For 12 month former
users who had a regular brand (AS1047=1), display “did” and “usually”; For 12 month former users who did
not have a regular brand (AS1047=2, DK, RF), display “did” and “last”.
GO TO: If AS1050 NOT IN (1, DK, RF), go to AS0170
PATH ID:

AS1070

Screen ID:

You selected [BRANDFILL] as your brand. What kind of [BRANDFILL] [do I did] you [usually I last] use?
Please select it from the choices below by touching the screen. [ If you do not see it below, touch the button
marked “NEXT”. I If you do not see it below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AS1048]

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1
-8
-7

Something else
GO TO AS1071
DON’T KNOW
GO TO AS1050
REFUSED
GO TO AS1050
ASK: Current users and Former users 12 month who selected a brand image in AS1048.
PROGRAM: For current users who have regular brand (AS1047=1), display “do” and “usually”; For current
users who do not have a regular brand (AS1047=2, DK, RF, DK, RF), display “did” and “last”. For 12 month
former users who had a regular brand (AS1047=1), display “did” and “usually”; For 12 month former users
who did not have a regular brand (AS1047=2, DK, RF, DK, RF), display “did” and “last”.
PATH ID:

AS1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AS1050
-8 DON’T KNOW
GO TO AS1050
-7 REFUSED
GO TO AS1050
ASK: Current users and Former users 12 month who did not select an image of their regular brand
(AS1048=1)
PATH ID:

AS1071

Screen ID:

You said that the type of [BRANDFILL]s that you [use I used] is not pictured. What type is it?
1
-8
-7

__________________________
DON’T KNOW
REFUSED
ASK: Current users and Former users 12 month who did not select the type of product they use
(AS1070=”Something else”) but who DID select a brand (AS1048<>1, -8, -7). Do not ask of respondents
who wrote a brand into AS1049.
PROGRAM: For current users, display “use”; for 12 month former users, display “used”.

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PATH ID:

AS1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [use I used] flavored to taste like menthol, mint, clove,
spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month
PROGRAM: For current users who have a regular brand (AS1047=1), display “Is”, “your regular brand” and
“use.” For current users who do not have a regular brand (AS1047=2, DK, RF), display "Was", "the last
brand" and " used ". For 12 month former users who had a regular brand (AS1047=1), display "Was", "your
regular brand" and " used ". For 12 month former users who did not have a regular brand (AS1047=2, DK,
RF), display "Was", "the last brand" and " used ".
GO TO: If current user or former user 12 month AND AS1047 = 1, go to AS1051
Else if SMKLSSFILL[1]=1 go to AS0104
Else if SMKLSSFILL[2]=2, go to AU0104.
PATH ID:

AS1051

Screen ID:

About how long (did you use/have you been using) your regular brand of [SMKLSSFILL]? Please choose
whether (you used/you've been using) your regular brand for years, months, or days. Then enter the
number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who have a regular brand (AS1047=1)
PROGRAM: For current users, display “have you been using” and “you’ve been using.” For former users 12
months, display “did you use” and “you used.”
1

PATH ID:

AS0104

Screen ID:

You said earlier that you used smokeless tobacco [TIME OF LAST USE]. Think about the very
last time you used it. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have used smokeless tobacco (SMKLSSFILL[1]=1) today, yesterday or

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the day before yesterday (AS0100=1, 2 or 3 or 4) AND who selected a valid brand (AS1048<>1, 8, -7) AND valid sub brand (AS1070<>1, -8, -7). This question is limited to smokeless tobacco
users; it is not asked for snus users.
DISPLAY:
For ‘TIME OF LAST USE’,
If AS0100=1, display “in the past hour”
If AS0100=2, display “sometime today”
If AS0100=3, display “yesterday”
If AS0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AS1070
PATH ID:

AU0104

Screen ID:

You said earlier that you last used snus [TIME OF LAST USE]. Think about the very last pouch
you used. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have used snus (SMKLSSFILL[2]=2) today, yesterday or the day before
yesterday (AS0100=1, 2 or 3 or 4) AND who selected a valid brand (AS1048<>1, -8, -7) AND valid
sub brand (AS1070<>1, -8, -7). This question is limited to snus users; it is not asked for
smokeless tobacco users.
DISPLAY:
For ‘TIME OF LAST USE’,
If AS0100=1, display “in the past hour”
If AS0100=2, display “sometime today”
If AS0100=3, display “yesterday”
If AS0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AS1070
Box AS3
Display question AS1060, AS1061, AS1085, AS1062, AS1075, AS1063, AS1064, AS1065, AS1067,
AS1068, AU1076, AU1070, AS1072 on one screen. Show the intro/transition text from AS1060 first, then
show each item with responses. As each item is answered, show the next one.
PROGRAM NOTE: Items AU1076 and AU1070 are only shown for snus users; they are not shown for
smokeless tobacco users.
PROGRAM: Randomize order of AS1060 through AS1072.

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PATH ID:

AS1060

Screen ID:

The next questions are about the reasons people use [SMKLSSFILL]. Please select which reasons [apply
to you I applied to you when you used to use [SMKLSSFILL]].
I [use I used] [SMKLSSFILL] because…
It [is I was] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “apply to you”, “use” and “is”; for former users, display “applied to
you when you used to use [SMKLSSFILL]”, “used” and “was”.
PATH ID:

AS1061

Screen ID:

People in the media or other public figures [use I used] [SMKLSSFILL].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.
PATH ID:

AS1085

Screen ID:

I [can I could] use [SMKLSSFILL] at times when or in places where smoking cigarettes [isn’t I wasn’t]
allowed.
1
Yes
2
No
-8
DON”T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “can” and ”isn’t”; for former users, display “could” and “wasn’t”.

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PATH ID:

AS1062

Screen ID:

It might [be I have been] less harmful to me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AS1075

Screen ID:

[It I They] might [be I have been] less harmful to people around me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
DISPLAY: If smokeless tobacco (SMKLSSFILL[1]=1), display ‘It’; If snus pouches (SMKLSSFILL[2]=2,
display “They”. For current users, display “be”; for former users, display “have been”.
PATH ID:

AS1063

Screen ID:

[[Smokeless tobacco [comes I came]] [[Snus pouches [come I came]] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: If SMKLSSFILL[1]=1, display “Smokeless tobacco”. If current user, display “comes” and “like”;
if former user, display “came” and “liked”. If SMKLSSFILL[2]=2, display “Snus pouches”. If current user,
display “come” and “like”; if former user, display “came” and “liked”.
PATH ID:

AS1064

Screen ID:

Using [SMKLSSFILL] helps people to quit smoking cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month

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PATH ID:

AS1065

Screen ID:

[Smokeless tobacco doesn’t I Snus pouches don’t] smell.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: IF SMKLSSFILL[1]=1, DISPLAY “Smokeless tobacco doesn’t”; IF SMKLSSFILL[2]=2,
DISPLAY “Snus pouches don’t”
PATH ID:

AS1067

Screen ID:

[[Smokeless tobacco] [is I was]] [[Snus pouches] [are I were]] more acceptable to non-tobacco users.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: IF SMKLSSFILL[1]=1, DISPLAY “Smokeless tobacco”. If current user, display “is”, if former
user, display “was”. IF SMKLSSFILL[2]=2, DISPLAY “Snus pouches”. If current user, display “are”, if
former user, display “were”.
PATH ID:

AS1068

Screen ID:

People who are important to me [use I used] [SMKLSSFILL].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.
GO TO: If SMKLSSFILL[2]=2, go to AU1076
Else go to AS1072

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PATH ID:

AU1076

Screen ID:

No one can tell when I [am I was] using a snus pouch.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month of snus
PROGRAM: This is only asked of snus users where SMKLSSFILL[2]=2; This is not asked of smokeless
tobacco users where SMKLSSFILL[1]=1. If current user, display “am”, if former user, display “was”.
GO TO: If current user cig, go to AU1070
Else go to AS1072
PATH ID:

AU1070

Screen ID:

The sensations [are I were] stronger or more pleasurable than cigarettes.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month of snus who are also Current
or Former users 12 month of cigarettes
PROGRAM: This is only asked of snus users where SMKLSSFILL[2]=2 AND dual users of cigarettes; This is
not asked of smokeless tobacco users where SMKLSSFILL[1]=1. If current user, display “am”, if former
user, display “were”.
PATH ID:

AS1072

Screen ID:

The advertising for [SMKLSSFILL] [appeals I appealed] to me.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “appeals”; for former users, display “appealed”.
GO TO: If (Current user OR Experimental Current user) AND Current user cig, go to AS1086
Else If ((Current user OR Experimental Current user) AND Former user 12 month cig) OR (former user 12
months AND (current user cig or former user 12 months cig)), go to AS1080
Else go to next section

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PATH ID:

AS1086

Screen ID:

In the past 30 days have you used [SMKLSSFILL] at times when or in places where you could not smoke
regular cigarettes?
1
Yes
2
No
GO TO AS1080
-8
DON’T KNOW
GO TO AS1080
-7
REFUSED
GO TO AS1080
ASK: Current users and Experimental Current users who are also Current users of cigarettes
PATH ID:

AS1087

Screen ID:

How often do you use [SMKLSSFILL] at times when or in places where you could not smoke regular
cigarettes?
1
Every day
2
Some days
3
Rarely
-8
DON’T KNOW
-7
REFUSED
ASK: Experiemental Current users and respondents who used [SMKLSSFILL] when could not smoke
regular cigarettes (AS1086=1)
PATH ID:

AS1080

Screen ID:

[Do | Did] you use [SMKLSSFILL] as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month who are also Current users or
Former users 12 month of cigarettes
PROGRAM: For current users or experimental current users display “do”; For 12 month former users
display “did”
PATH ID:

AS1081

Screen ID:

[Do | Did] you use [SMKLSSFILL] as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current [SMKLSSFILL] users or experimental current display “do”; For 12 month former
[SMKLSSFILL] users display “did”

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DISSOLVABLE TOBACCO SECTION
The next questions ask about another type of tobacco called dissolvable tobacco. You don’t smoke
dissolvable tobacco products – they are made of finely ground flavored tobacco that dissolves in your
mouth.
Dissolvable tobacco products come in a variety of shapes, including small round pellets, thin sticks and flat
strips. Some common brands are Ariva, Stonewall, or Camel Orbs, Sticks or Strips.
SHOW GENERIC IMAGES OF DISSOLVABLES
PATH ID:

AD1005

Screen ID:

How many pieces of dissolvable tobacco have you used in your entire life?
1
2
3
4
5
-8
-7

1 to 10
11 to 20
21 to 50
51 to 99
100 or more
DON’T KNOW
REFUSED

ASK: Respondents who have used dissolvable tobacco (AD1002=1)
PATH ID:

AD1006

Screen ID:

How old were you when you first used dissolvable tobacco, even one or two times?
1
I___I___I years old
GO TO AD1100
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used dissolvable tobacco (AD1002=1)
PATH ID:

AD1120

Screen ID:

When you first used dissolvable tobacco, even one or two times, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AD1006 (AD1006 = -8, -7).

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PATH ID:

AD1100

Screen ID:

Have you ever used dissolvable tobacco fairly regularly?
1
Yes
2
No
GO TO AD1008
-8
DON’T KNOW
GO TO AD1008
-7
REFUSED
GO TO AD1008
ASK: Respondents who have used dissolvable tobacco (AD1002=1)
PATH ID:

AD1007

Screen ID:

How old were you when you first started using dissolvable tobacco fairly regularly?
1

GO TO AD1020

I___I___I years old

-8 DON’T KNOW
-7 REFUSED
ASK: Respondents that have ever used dissolvable tobacco fairly regularly (AD1100=1)
GO TO: If AD1003 = 1, go to AD1020
Else go to AD1008
PATH ID:

AD1121

Screen ID:

When you first started using dissolvable tobacco fairly regularly, were you…
1

Less than 18 years old,

2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: ASK: Respondents who refused to give or did not know age in AD1007 (AD1007 = -8, -7).
GO TO: If AD1003 = 1, go to AD1020
Else, go to AD1008
PATH ID:

AD1020

Screen ID:

How old were you when you first started using dissolvable tobacco every day?
1
I___I___I years old
GO TO AD1008
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who use dissolvable tobacco every day (AD1003=1)

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PATH ID:

AD1122

Screen ID:

When you first started using dissolvable tobacco every day, were you…
1
2
3

Less than 18 years old,
18 to 24 years old,
25 to 34 years old,

4

35 to 44 years old,

5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AD1020 (AD1020 = -8, -7).
PATH ID:

AD1008

Screen ID:

When you first started using dissolvable tobacco, did you use dissolvable tobacco flavored to taste like
menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have used dissolvable tobacco (AD1002=1)
GO TO: If AD1003 <> 1, go to AD1009
If AD1003=2 AND AD0100=5, go to AD1009.
Else go to BOX AD2
PATH ID:

AD1009

Screen ID:

About how long has it been since you last used dissolvable tobacco? (If it was earlier today, enter 1 day)
1
2
3

I___I___I
DAYS
I___I___I
MONTHS
I___I___I
YEARS

-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used dissolvable tobacco (AD1002=1) and do not use every day
(AD1003<>1)
PROGRAM: EXCLUDE Some day users (AD1003=2) who previously reported they last used in the past
hour, sometime today, yesterday, or the day before yesterday (AD0100=1 or 2 or 3 or 4).
GO TO: If AD1003 = 3, go to AD1010
Else go to BOX AD2

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PATH ID:

AD1010

Screen ID:

Have you completely quit using dissolvable tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have use dissolvable tobacco (AD1002=1) and currently use not at all (AD1003=3)
Screen ID:

BOXAD2

PROGRAM: Define the following variables (see Appendix B):
EVER USER DISSBL
CURRENT USER DISSBL
EVERY DAY USER DISSBL
SOME DAY USER DISSBL
EXPERIMENTAL CURRENT USER DISSBL
EXPERIMENTAL FORMER USER DISSBL
FORMER USER 12 MONTH DISSBL
FORMER USER 12 MONTH PLUS DISSBL
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
EVERY DAY USER DISSBL GO TO AD1021
SOME DAY USER DISSBL OR EXPIERMENTAL CURRENT USER DISSBL GO TO ADS1022
FORMER USER 12 MONTH DISSBL GO TO AD1025
FORMER USER 12 MONTH PLUS DISSBL OR EXPERIMENTAL FORMER USER DISSBL
GO TO NEXT SECTION
PATH ID:

AD1021

Screen ID:

On average, about how many pieces of dissolvable tobacco do you now use each day?
1
I___I___I
-8 DON’T KNOW
-7 REFUSED
ASK: Everyday users
PATH ID:

GO TO AD1024
GO TO AD1024
GO TO AD1024

AD1022

Screen ID:

On how many of the past 30 days did you use dissolvable tobacco?
|__|__|
Days
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users
1

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PROGRAM: Range check: 1-30 days
GO TO: If AD1022 = 0 and some day user, go to AD1024
Else if AD1022 = 0 and experimental current user, go to AD1025
Else go to AD1023
PATH ID:

AD1023

Screen ID:

On average, on those [FILL NUMBER OF DAYS FROM AD1022 days I days you used], how many pieces
of dissolvable tobacco did you usually use each day?
|__|__|
1
-8 DON’T KNOW
-7 REFUSED
ASK: Someday users and Experimental Current Users who have used dissolvable tobacco at least one day
in past 30 or did not provide the number of days used in the past 30 (AD1022>0 OR AD1022 IN (DK, R))
PROGRAM: If AD1022=1, DK or RF, display “days you used”; else display “# days” where # = number of
days reported in AD1022.
GO TO: EXPERIMENTAL CURRENT USER DISSOLVABLE GO TO AD1025
PATH ID:

AD1024

Screen ID:

(On the days that you use dissolvable tobacco,) {how/How} soon after you wake up do you typically have
your first piece of dissolvable tobacco of the day? Please enter the number of minutes or hours.
I___I___I___I
GO TO AD1025
Minutes after waking
I___I___I___I
GO TO AD1025
2
Hours after waking
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PROGRAM: For Every Day dissolvable tobacco users display “How”; For Some Day dissolvable tobacco
users display ‘On the days that you use dissolvable tobacco, how’
1

PATH ID:

AD1092

Screen ID:

(On the days that you use dissolvable tobacco, would | Would) you say you have your first piece of
dissolvable tobacco within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who don’t know or refuse to answer how soon after waking up (AD1024=-8,-7)
PROGRAM: For Every day dissolvable tobacco users, display “Would”. For Some day dissolvable tobacco
users, display “On the days that you use dissolvable tobacco, would”.

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PATH ID:

AD1025

Screen ID:

Around this time 12 months ago, were you using dissolvable tobacco every day, some days, or not at all?
1
Every day
2
Some days
3
Not at all
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
GO TO: If EXPERIMENTAL CURRENT USER, GO TO AD1060
If Former users 12 month, go to AD1030
Else go to AD1097
PATH ID:

AD1097

Screen ID:

The next questions ask about your experience buying dissolvable tobacco.
In the past 30 days, did you use a coupon when buying dissolvable tobacco?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users
PATH ID:

GO TO AD1030
GO TO AD1030
GO TO AD1030

AD1098

Screen ID:

How many times in the past 30 days have you used a coupon to buy dissolvable tobacco?
1

I__I__I
Number of times
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have used a coupon to buy dissolvable tobacco in the last 30 days (AD1097=1)
PATH ID:

AD1030

Screen ID:

How [do/did] you usually buy dissolvable tobacco for yourself? Is it…
1
In person
2
From the internet
3
By telephone
4
I [do I did] not buy my own dissolvable tobacco
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month

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GO TO AD1047
GO TO AD1047
GO TO AD1047
GO TO AD1047
GO TO AD1047

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PROGRAM: Display instruction for question and response option 4 fill: for current dissolvable tobacco users
display “do”; For 12 month former dissolvable tobacco users display “did”
PATH ID:

AD1032

Screen ID:

[Do/Did] you usually buy dissolvable tobacco...?
1 In your own state
2 In another state
3 Outside the US
-8 DON’T KNOW
-7 REFUSED
ASK: Current users or Former users 12 month who usually buy dissolvable tobacco in person (AD1030=1)
PROGRAM: For current dissolvable tobacco users display “Do”; For 12 month former dissolvable tobacco
users display “Did”
PATH ID:

AD1033

Screen ID:

Where [do/did ] you buy your dissolvable tobacco most of the time?
A convenience store or gas station
1
A supermarket, grocery store, or drug store
2
A warehouse club, such as Sam’s or Costco
3
A smoke shop, tobacco specialty store or tobacco outlet store
4
A duty free shop or military commissary
5
6
A bar, pub, restaurant or casino
7
A friend or relative
8
A swap meet or flea market
9
A liquor store
10 Or from somewhere else
SPECIFY: ____________________________
-8 DON’T KNOW
-7 REFUSED
ASK: Current users or Former users 12 month who usually buy dissolvable tobacco in person (AD1030=1)
PROGRAM: For current dissolvable tobacco users display “do”; For 12 month former dissolvable tobacco
users display “did”
If OS field selected and additional OS screen is shown, display question text and add the following text:
“Please type your answer using the computer keyboard.”
PATH ID:

AD1047

Screen ID:

[Do I Did] you have a regular brand of dissolvable tobacco that you usually [use I used]?
1
2
-8
-7

Yes
No
DON’T KNOW
REFUSED

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ASK: Current users and Former users 12 month
PROGRAM: For current users display “Do” and “use”; for 12 month former users display “Did” and “used”.
PATH ID:

AD1048

Screen ID:

What brand of dissolvable tobacco [do I did] you [usually I last] use? Please select it from the choices below
by touching the screen. [ If you do not see it below, touch the button marked “NEXT”. I If you do not see it
below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A RESPONDENT
SELECTS A BRAND, GO TO AD1070]
1
Something else
GO TO AD1049
-8 DON’T KNOW
GO TO AD1050
-7 REFUSED
GO TO AD1050
ASK: Current users and Former users 12 month
GO TO: If AD1050 NOT IN (1, DK, RF), go to AD0170
PROGRAM: For current users who have regular brand (AD1047=1), display “do” and “usually”; For current
users who do not have a regular brand (AD1047=2, DK, RF), display “did” and “last”. For 12 month former
users who had a regular brand (AD1047=1), display “did” and “usually”; For 12 month former users who did
not have a regular brand (AD1047=2, DK, RF), display “did” and “last”.
PATH ID:

AD1070

Screen ID:

You selected [BRANDFILL] as your brand. What kind of [BRANDFILL] [do I did] you [usually I last] use?
Please select it from the choices below by touching the screen. [ If you do not see it below, touch the button
marked “NEXT”. I If you do not see it below, touch the box marked “Something else”. ]
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “Something else”.
[SHOW PICTURES OR TEXT ON THE TOUCHSCREEN OF THE MAJOR PRODUCTS ASSOCIATED
WITH BRAND SELECTED IN AD1048]
1
-8
-7

Something else
GO TO AD1071
DON’T KNOW
GO TO AD1050
REFUSED
GO TO AD1050
ASK: Current users and Former users 12 month who selected a brand image in AD1048.
PROGRAM: For current users who have regular brand (AD1047=1), display “do” and “usually”; For current
users who do not have a regular brand (AD1047=2, DK, RF, DK, RF), display “did” and “last”. For 12 month

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former users who had a regular brand (AD1047=1), display “did” and “usually”; For 12 month former users
who did not have a regular brand (AD1047=2, DK, RF, DK, RF), display “did” and “last”.
PATH ID:

AD1049

Screen ID:

You said that your brand was not pictured. What is it?
1
__________________________
GO TO AD1050
-8 DON’T KNOW
GO TO AD1050
-7 REFUSED
GO TO AD1050
ASK: Current users and Former users 12 month who did not select an image of their regular brand
(AD1048=1)
PATH ID:

AD1071

Screen ID:

You said that the type of [BRANDFILL]s that you [use I used] is not pictured. What type is it?
1
-8
-7

__________________________
DON’T KNOW
REFUSED
ASK: Current users and Former users 12 month who did not select the type of product they use
(AD1070=”Something else”) but who DID select a brand (AD1048<>1, -8, -7). Do not ask of respondents
who wrote a brand into AD1049.
PROGRAM: For current users, display “use”; for 12 month former users, display “used”.
PATH ID:

AD1050

Screen ID:

[Is / was] [your regular brand I the last brand] you [use I used] flavored to taste like menthol, mint, clove,
spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month
GO TO: If current user or former user 12 month AND AD1047 = 1, go to AD1051
Else go to AD0104

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PATH ID:

AD1051

Screen ID:

About how long (did you use/have you been using) your regular brand of dissolvable tobacco? Please
choose whether (you used/you've been using) your regular brand for years, months, or days. Then enter
the number of years, months, or days using the number keypad.
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who have a regular brand (AD1047=1)
PROGRAM: For current users, display “have you been using” and “you’ve been using.” For former users 12
months, display “did you use” and “you used.”
1

PATH ID:

AD0104

Screen ID:

You said earlier that you last used dissolvable tobacco [TIME OF LAST USE]. Think about the
very last piece you used. Was the brand [NEQBRAND]?
1

Yes

2

No

-7

DON’T KNOW

-8

REFUSED

ASK: Respondents who have used dissolvable tobacco today, yesterday or the day before
yesterday (AD0100=1, 2 or 3 or 4) AND who selected a valid brand (AD1048<>1, -8, -7) AND
valid sub brand (AD1070<>1, -8, -7).
DISPLAY:
For ‘TIME OF LAST USE’,
If AD0100=1, display “in the past hour”
If AD0100=2, display “sometime today”
If AD0100=3, display “yesterday”
If AD0100=4, display “the day before yesterday”
For ‘NEQBRAND’, fill with selection stored in AD1070

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Box AD2
Display question AD1060, AD1061, AD1085, AD1062, AD1075, AD1063, AD1064, AD1065, AD1067,
AD1068, AD1076, AD1072 on one screen. Show the intro/transition text from AD1060 first, then show
each item with responses. As each item is answered, show the next one.
PROGRAM: Randomize order of AD1060 through AD1072.
PATH ID:

AD1060

Screen ID:

The next questions are about the reasons people use dissolvable tobacco. Please select which reasons
[apply to you I applied to you when you used to use dissolvable tobacco].
I [use I used] dissolvable tobacco because…
It [is I was] affordable.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “apply to you”, “use” and “is”; for former users, display “applied to
you when you used to use dissolvable tobacco”, “used” and “was”.
PATH ID:

AD1061

Screen ID:

People in the media or other public figures [use I used] dissolvable tobacco.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.
PATH ID:

AD1085

Screen ID:

I [can I could] use dissolvable tobacco at times when or in places where smoking cigarettes [isn’t I wasn’t]
allowed.
1
Yes
2
No
-8
DON”T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “can” and ”isn’t”; for former users, display “could” and “wasn’t”.

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PATH ID:

AD1062

Screen ID:

It might [be I have been] less harmful to me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AD1075

Screen ID:

It might [be I have been] less harmful to people around me than cigarettes.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AD9062

Screen ID:

Dissolvable tobacco might [be I have been] less harmful than smokeless tobacco, such as snus pouches,
loose snus, moist snuff, dip, spit, or chew.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “be”; for former users, display “have been”.
PATH ID:

AD1063

Screen ID:

Dissolvable tobacco [comes I came] in flavors I [like I liked].
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “come” and “like”; for former users, display “came” and “liked”.

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PATH ID:

AD1064

Screen ID:

Using dissolvable tobacco helps people to quit smoking cigarettes.
1
2
-8
-7

Yes
No
DON’T KNOW
REFUSED

ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AD1065

Screen ID:

Dissolvable tobacco doesn’t smell.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PATH ID:

AD1067

Screen ID:

Dissolvable tobacco [is I was] more acceptable to non-tobacco users.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “is”; for former users, display “was”.
PATH ID:

AD1068

Screen ID:

People who are important to me [use I used] dissolvable tobacco.
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “use”; for former users, display “used”.

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PATH ID:

AD1076

Screen ID:

No one can tell when I [am I was] using dissolvable tobacco.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “am”; for former users, display “was”.
PATH ID:

AD1072

Screen ID:

The advertising for dissolvable tobacco [appeals I appealed] to me.
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current users, display “appeals”; for former users, display “appealed”.
GO TO: If (Current user OR Experimental Current user) AND Current user cig, go to AD1086
Else If ((Current user OR Experimental Current user) AND Former user 12 month cig) OR (former user 12
months AND (current user cig or former user 12 months cig)), go to AD1080
Else go to next section
PATH ID:

AD1086

Screen ID:

In the past 30 days, have you used dissolvable tobacco at times when or in places where you could not
smoke regular cigarettes?
1
Yes
2
No
GO TO AD1080
-8 DON’T KNOW
GO TO AD1080
-7 REFUSED
GO TO AD1080
ASK: Current users and Experimental Current users who are also Current users of cigarettes

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PATH ID:

AD1087

Screen ID:

How often do you use dissolvable tobacco at times when or in places where you could not smoke regular
cigarettes?
1
Every day
2
Some days
3
Rarely
-8 DON’T KNOW
-7 REFUSED
ASK: Experimental Current users and respondents who used dissolvable tobacco when could not smoke
regular cigarettes (AD1086=1)
PATH ID:

AD1080

Screen ID:

[Do | Did] you use dissolvable tobacco as a way of cutting down on your cigarette smoking?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month who are also Current users or
Former users 12 month of cigarettes
PROGRAM: For current or experimental current dissolvable tobacco users display “do”; For 12 month
former dissolvable tobacco users display “did”
PATH ID:

AD1081

Screen ID:

[Do | Did] you use dissolvable tobacco as an alternative to quitting tobacco altogether?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users, Experimental Current users, and Former users 12 month
PROGRAM: For current dissolvable tobacco users display “do”; For 12 month former dissolvable tobacco
users display “did”

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POLYUSE SECTION
BOX

AN1

Screen ID:

PROGRAM: Define the following variables:
CURRENT PRODUCT COUNT = 0 +1 FOR EVERY PRODUCT THE RESPONDENT USES EVERY DAY
OR SOME DAYS [CIGARETTES, E-CIGARETTES, CIGARS, CIGARILLOS, FILTERED CIGARS, PIPE,
HOOKAH, SMOKELESS, SNUS, DISSOLVABLE]. Range 0 to 10.
SOME DAY PRODUCT COUNT = 0 +1 FOR EVERY PRODUCT THE RESPONDENT USES SOME DAYS
[CIGARETTES, E-CIGARETTES, CIGARS, CIGARILLOS, FILTERED CIGARS, PIPE, HOOKAH,
SMOKELESS, SNUS, DISSOLVABLE]. Range 0 to 10.
TOBACCO PRODUCT LIST = [A LIST OF ALL TOBACCO PRODUCTS THE RESPONDENT USES]
CURRENT COMBUSTIBLE USER = YES IF (CURRENT SMOKER = YES OR CURRENT CIGAR
SMOKER = YES OR CURRENT CIGARILLO SMOKER = YES OR CURRENT FC SMOKER = YES OR
CURRENT PIPE SMOKER = YES OR CURRENT HOOKAH USER = YES)
CURRENT NONCOMBUSTIBLE USER = YES IF (CURRENT USER DISSBL= YES OR CURRENT USER
SMKLS= YES OR CURRENT USER SNUS=YES)
TOBACCO PRODUCT LIST = [A LIST OF ALL TOBACCO PRODUCTS THE RESPONDENT USES]
Format the list with commas between each product name, with “, and” before the last item in the list.
If CURRENT USER CIG=1 (Yes) or EXPERIMENTAL CURRENT USER CIG= 1 (Yes) then include
“cigarettes” in the TOBACCO PRODUCT LIST
If CURRENT USER ECIG=1 (Yes) or EXPERIMENTAL CURRENT USER ECIG= 1 (Yes) then include “ecigarettes” in the TOBACCO PRODUCT LIST
If CURRENT USER GTRAD=1 (Yes) or EXPERIMENTAL CURRENT USER GTRAD=1 (Yes) then include
“cigars” in the TOBACCO PRODUCT LIST
If CURRENT USER GRILLO=1 (Yes) or EXPERIMENTAL CURRENT USER GRILLO=1 (Yes) then
include “cigarillos” in the TOBACCO PRODUCT LIST
If CURRENT USER GFILTER=1 (Yes) or EXPERIMENTAL CURRENT USER GFILTER=1 (Yes) then
include “filtered cigars” in the TOBACCO PRODUCT LIST
If CURRENT USER PIPE=1 (Yes) or EXPERIMENTAL CURRENT USER PIPE=1 (Yes) then include
“pipe” in the TOBACCO PRODUCT LIST
If CURRENT USER HOOK=1 (Yes) or EXPERIMENTAL CURRENT USER HOOK=1 (Yes) then include
“hookah” in the TOBACCO PRODUCT LIST
If CURRENT USER SNUS=1 (Yes) or EXPERIMENTAL CURRENT USER SNUS=1 (Yes) then include
“snus” in the TOBACCO PRODUCT LIST
If CURRENT USER SMKLS=1 (Yes) OR EXPERIMENTAL CURRENT USER SMKLS=1 (Yes) then
include “smokeless tobacco” in the TOBACCO PRODUCT LIST
If CURRENT USER DISSBL=1 (Yes) OR EXPERIMENTAL CURRENT USER DISSBL=1 (Yes) then
include “dissolvable tobacco” in the TOBACCO PRODUCT LIST
Define the following variables (see Appendix B):
Ever user Tobacco
Current user Tobacco
Experimental current user Tobacco
Experimental former user Tobacco
Former user Tobacco

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Former user 12 Month Tobacco
GO TO:
If Former User 12 month Tobacco, go to next section
Else If NOT Current User Tobacco, go to next section
If Some Day Product Count>1 and NOT Every Day User Tobacco, go to AY0005
Else go to BOX AN2
PATH ID:

AY0005

Screen ID:

You mentioned that you use [TOBACCO PRODUCT LIST] on some days.
Thinking about [both/all] of these products, do you now use at least one of them every day or are there
some days you do not use [either/any] of these products?
1

I use at least one of these products every day

2

There are some days I don’t use [either/any] of these products

-8

DON’T KNOW

-7

REFUSED

ASK: Respondents who are Some Day Users of more than one tobacco product (Some Day Product
Count>1) and are not Everyday Users of any products (EVERY DAY CIGARETTE=NO AND EVERY DAY
CIGAR=NO AND EVERY DAY FC=NO AND EVERY DAY PIPE=NO AND EVERY DAY HOOKAH=NO AND
EVERY DAY DISSOLVABLE=NO AND EVERY DAY E-CIG=NO AND EVERY DAY SMOKELESS=NO)
PROGRAM: If Current Product Count = 2, display “both” and “either”
If Current Product Count > 2, display “all” and “any”
BOX

AN2

Screen ID:

PROGRAM: Define the following variables (see Appendix B):
EVERYDAY USER TOB
AFTER CREATING NEW VARIABLES, DO THE FOLLOWING:
GO TO: If EVERYDAY USER TOB AND Product Count>1, go to AY0010
Else go to BOX AN3
PATH ID:

AY0010

Screen ID:

You mentioned that you use [TOBACCO PRODUCT LIST]. How soon after waking do you usually first use
any one of these products?
1
Minutes
_________________ GO TO BOX AN3
2
Hours
_________________ GO TO BOX AN3
-8
DON’T KNOW
-7
REFUSED
ASK: Daily Tobacco users who use more than one tobacco product (Product Count>1)

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PATH ID:

AY0015

Screen ID:

Would you say you have your first tobacco product within the first 30 minutes after you wake up?
1
Yes
2
No
3
It varies
-8
DON’T KNOW
-7
REFUSED
ASK: Daily Tobacco users who don’t know or refuse to answer how soon after waking up (AY0010=-8,-7)
BOX

AN3

Screen ID

DEFINE:
CREATE AN ARRAY USEPROD WITH 9 ELEMENTS - ONE FOR EACH TOBACCO TYPE (EXCLUDING
CIGARETTES) - THAT IDENTIFIES WHETHER THE RESPONDENT IS A CURRENT OR SOME DAY
USER OF THE SPECIFIC TOBACCO TYPE.
USEPROD(1-9): Current users of: (1) e-cigarettes; (2) Traditional cigars; (3) Cigarillos; (4) Filtered cigars;
(5) Pipes; (6) Hookahs; (7) Snus pouches; (8) Dissolvable tobacco; (9) Smokeless tobacco; (10) Cigarettes
CREATE AN ARRAY HNUPROD WITH 9 ELEMENTS – ONE FOR EACH TOBACCO TYPE (EXCLUDING
CIGARETTES) – THAT IDENTIFIES WHETHER THE RESPONDENT HAS HEARD OF BUT NEVER
USED THE SPECIFIC TOBACCO TYPE.
HNUPROD(1-9): Heard of but have never used: (1) e-cigarettes; (2) Traditional cigars; (3) Cigarillos; (4)
Filtered cigars; (5) Pipes; (6) Hookahs; (7) Snus pouches; (8) Dissolvable tobacco; (9) Smokeless tobacco.
PATH ID:

AX0307

Screen ID:

Have you considered switching from [USEPROD(1-9)] to any of the following products? Choose all that
apply.
1
I have not considered switching to another product
2
[FILL RESPONSE OPTIONS WITH HNUPROD(1-9)
-8
DON’T KNOW
-7
REFUSED
ASK: Current users of [USEPROD(1-9)]. Ask the question one time for each product in USEPROD(1-9).
Each time the question is asked, fill response options with HNUPROD(1-9).
NOTE: This question will ask about switching from each product the respondent uses to all products they
have heard of but never used.

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PATH ID:

AX0306

Screen ID:

Have you considered using any of the following products in addition to [USEPROD(1-9)]? Choose all that
apply.
1
I have not considered using additional products
2
[FILL RESPONSE OPTIONS WITH HNUPROD(1-9)
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Some day users of [USEPROD(1-9)]. Ask the question one time for all products in
USEPROD(1-9). The question is asked onced, fill response options with HNUPROD(1-9).
NOTE: This question will ask about using products they’ve heard of in addition to products they use.

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NICOTINE DEPENDENCE SECTION
BOX AN5
DEFINE THE FOLLOWING VARIABLES (see Appendix B)
EXPERIMENTAL_PRODUCT_COUNT
FORMER_12M_PRODUCT_COUNT
NDSKIP
IF ( [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT >= 2) AND
(CURRENT_USER_ECIG = 0 AND FORMER_USER_12MONTH_ECIG = 0)] THEN NDSKIP = 1; ELSE
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT >= 3) AND
(CURRENT_USER_ECIG = 1 OR FORMER_USER_12MONTH_ECIG = 1)] THEN NDSKIP = 2; ELSE
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT = 2) AND
(CURRENT_USER_ECIG = 1 OR FORMER_USER_12MONTH_ECIG = 1)] THEN NDSKIP = 3; ELSE
NDSKIP = 0.
ROUTE INSTRUCTIONS:
For current users and former users that have quit using tobacco in the past 12 months (note these
are established tobacco users, determined by the variable CURRENT_USER_TOB = 1 and
FORMER_USER_12_MONTH_TOB = 1 in Appendix B). Respondents will be asked the questions in the
NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP LOOP #4 sections up to two
times, according to the following conditions:
Condition a) Respondents who currently use or formerly used in the past 12 months only one product.
Condition a will be asked the questions in the loop one time, with fills tailored to their specific product.
Condition b) Respondents who currently use or formerly used in the past 12 months more than one
product, where one of those products is/was an e-cigarette. Condition b will respond to the questions in
the loop twice. The first time they will respond to questions with fills tailored to their e-cigarettes. The
second time they will respond to questions with fills tailored to either:
(b1) their other specific product, if they use two products total (e-cigarettes + one other product),
or
(b2) their tobacco use overall, if they use more than two products total (e-cigarettes + tobacco).
There are a few questions for Condition b that are asked only 1 time, and not repeated in each loop.
Condition c) Respondents who currently use or formerly used in the past 12 months more than one
product, where none of those products is an e-cigarette. Condition c will respond to the questions in the
loop one time, with fills tailored to their tobacco use overall.
For experimental users who are experimenting with more than 1 product (note these are not
established tobacco users, determined b the variable CURRENT_USER_TOB = 0 in Appendix B).
Experimental tobacco users who are not current tobacco users and who are experimenting with just one
product will be asked the NRT/Rx NEQ questions but will skip the withdrawal/dependence and quitting
questions. Experimental tobacco users who are not current tobacco users and who are experimenting
with more than one product will be asked the NRT/Rx NEQ questions and the withdrawal/dependence
questions but will skip the quitting questions. Experimental users will furthermore be routed according to
condition b, b1, b2 and c as described for current users.
All other respondents will go to the NRT/Rx NEQ questions and will skip the withdrawal/dependence
and quitting questions.

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# Of Products Used
(Currently or in past
12 months)

E-Cigarette
User

Number of
Times
Through
Section

Loop Order

NDSKIP
value

a

1

n/a

1

n/a

0

b / b1

2

Yes

2

E-Cig /
Product

3

c

2 or more

No

1

Overall
tobacco

1

b / b2

3 or more

Yes

2

E-Cig /
Overall
tobacco

2

Condition

IF CURRENT_USER_TOB=1 OR FORMER_USER_12_MONTH_TOB = 1 ROUTE AS FOLLOWS:
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT = 1)] GO TO
AN0010 and loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and
NDSKIP LOOP #4 sections ONCE using appropriate product specific fill as defined by the groups
and fill specs below (condition a).
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT = 2) AND
(CURRENT_USER_ECIG = 1 OR FORMER_USER_12MONTH_ECIG = 1)] GO TO AN0010 and
loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP LOOP
#4 sections TWICE using appropriate product specific fills for each iteration (condition b / b1). If
CURRENT_USER_CIG=1 OR FORMER USER12MONTH_CIG = 1, then ask about cigarettes on
the first loop and e-cigarettes on the second loop. For all others, ask about e-cigarettes on the
first loop and the other product they use on the second loop.
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT >= 2) AND
(CURRENT_USER_ECIG = 0 AND FORMER_USER_12MONTH_ECIG = 0)] GO TO AN0010
and loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP
LOOP #4 sections ONCE using the tobacco use fill (condition c).
IF [(CURRENT_PRODUCT_COUNT + FORMER_12M_PRODUCT_COUNT >= 3) AND
(CURRENT_USER_ECIG = 1 OR FORMER_USER_12MONTH_ECIG = 1)] GO TO AN0010 and
loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP LOOP
#4 sections TWICE using the e-cigarette fill for one iteration and the tobacco use fill for the other
iteration (condition b / b2). Ask about e-cigarettes on the first loop and tobacco in general on the
second loop.
ELSE, IF (CURRENT_USER_TOB = 0 (NO) AND FORMER_USER_12_MONTH_TOB = 0 AND
EXPERIMENTAL_CURRENT_USER_TOB = 1) ROUTE AS FOLLOWS:
IF EXPERIMENTAL_PRODUCT_COUNT = 1 GO TO AN0010 and loop through the NDSKIP
LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP LOOP #4 sections ONCE using
appropriate product specific fills as defined by the groups and fill specs below (condition a).

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IF (EXPERIMENTAL_PRODUCT_COUNT = 2 AND EXPERIMENTAL_CURRENT_ECIG = 1)
GO TO GO TO AN0010 and loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP
LOOP #3 and NDSKIP LOOP #4 sections TWICE, using appropriate product-specific fills as
defined by the groups and fill specs below for each iteration (conditionb / b1). If
EXPERIMENTAL_CURRENT_CIG=1 then ask about cigarettes on the first loop and e-cigarettes
on the second loop. For all others, ask about e-cigarettes on the first loop and the other product
they use on the second loop.
IF (EXPERIMENTAL_PRODUCT_COUNT >= 2 AND EXPERIMENTAL_CURRENT_ECIG = 0)
GO TO AN0010 and loop through the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3
and NDSKIP LOOP #4 sections ONCE using the tobacco use fill (condition c).
IF (EXPERIMENTAL_PRODUCT_COUNT >= 3 AND EXPERIMENTAL_CURRENT_ECIG = 1)
GO TO AN0010 and ask all questions in the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP
LOOP #3 and NDSKIP LOOP #4 sections TWICE, using the e-cigarette fill for one iteration and
the tobacco use fill for the other iteration (condition b / b2). Ask about e-cigarettes on the first
loop and tobacco in general on the second loop.
After completing the NDSKIP LOOP #1, NDSKIP LOOP #2, NDSKIP LOOP #3 and NDSKIP LOOP #4
sections the specified number of times, continue with the remainder of the nicotine dependence
section, following appropriate skips.
ELSE, GO TO AN0330 and follow appropriate skip patterns for all respondents.

DEFINE THE FOLLOWING RESPONSE GROUPS. IF NDSKIP = 0 OR 3 THESE RESPONSE GROUPS
ARE USED TO DEFINE THE FILLS IN THE NICOTINE DEPENDENCE SEQUENCE OF QUESTIONS.
IF NDSKIP = 0, any one of the values in the table can be assigned to the GROUP variable. IF NDSKIP =
3 any value except NE can be assigned to the GROUP variable.
Group
NC

NE

NG

NL

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Definition
Cigarette smoker
[CURRENT USER CIG = YES OR FORMER USER 12 MONTH CIG = YES AND
(CURRENT USER, GTRAD, GRILLO, GFILTR, PIPE, HOOK, SNUS, SMKLS
DISSBL = NO AND FORMER USER 12 MONTH ECIG, GTRAD, GRILLO, GFILTR,
PIPE, HOOK, SNUS, SMKLS, DISSBL = NO)]
E-cigarette user
NDSKIP = 0 AND CURRENT USER ECIG = YES OR FORMER USER 12 MONTH
ECIG = YES AND (CURRENT USER CIG, GTRAD, GRILLO, GFILTR, PIPE, HOOK,
SNUS, SMKLS DISSBL = NO AND FORMER USER 12 MONTH CIG, GTRAD,
GRILLO, GFILTR, PIPE, HOOK, SNUS, SMKLS, DISSBL = NO)]
Traditional cigar smoker
CURRENT USER GTRAD= YES OR FORMER USER 12 MONTH GTRAD = YES
AND (CURRENT USER CIG, GRILLO, GFILTR, PIPE, HOOK, SNUS, SMKLS
DISSBL = NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR,
PIPE, HOOK, SNUS, SMKLS, DISSBL = NO)]
Cigarillo smoker
CURRENT USER GRILLO= YES OR FORMER USER 12 MONTH GRILLO = YES
AND (CURRENT USER CIG, GTRAD, GFILTR, PIPE, HOOK, SNUS, SMKLS
DISSBL = NO AND FORMER USER 12 MONTH CIG, ECIG, GTRAD, GFILTR,

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PIPE, HOOK, SNUS, SMKLS, DISSBL = NO)]
NF

NP

NH

NU

NS

ND

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Filtered cigar smoker
CURRENT USER GFILTR= YES OR FORMER USER 12 MONTH GFILTR = YES
AND (CURRENT USER CIG, GTRAD, GRILLO, PIPE, HOOK, SNUS, SMKLS
DISSBL = NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR,
PIPE, HOOK, SNUS, SMKLS, DISSBL = NO)]
Pipe smoker
CURRENT USER PIPE= YES OR FORMER USER 12 MONTH PIPE = YES AND
(CURRENT USER CIG, GTRAD, GRILLO, GFILTR, HOOK, SNUS, SMKLS DISSBL
= NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR, GFILTR,
HOOK, SNUS, SMKLS, DISSBL = NO)]
Hookah smoker
CURRENT USER HOOK= YES OR FORMER USER 12 MONTH HOOK = YES AND
(CURRENT USER CIG, GTRAD, GRILLO, GFILTR, PIPE, SNUS, SMKLS DISSBL =
NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR, GFILTR, PIPE,
SNUS, SMKLS, DISSBL = NO)]
Snus user
CURRENT USER SNUS= YES OR FORMER USER 12 MONTH SNUS = YES AND
(CURRENT USER CIG, GTRAD, GRILLO, GFILTR, PIPE, HOOK, SMKLS DISSBL =
NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR, GFILTR, PIPE,
HOOK, SMKLS, DISSBL = NO)]
Smokeless user
CURRENT USER SMKLS= YES OR FORMER USER 12 MONTH SMKLS = YES
AND (CURRENT USER CIG, GTRAD, GRILLO, GFILTR, PIPE, HOOK, SNUS
DISSBL = NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR,
GFILTR, PIPE, HOOK, SNUS, DISSBL = NO)]
Dissolvable user
CURRENT USER DISSBL= YES OR FORMER USER 12 MONTH DISSBL = YES
AND (CURRENT USER CIG, GTRAD, GRILLO, GFILTR, PIPE, HOOK, SNUS
SMKLS = NO AND FORMER USER 12 MONTH CIG, ECIG, GRILLO, GFILTR,
GFILTR, PIPE, HOOK, SNUS, SMKLS = NO)]

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USE THE FOLLOWING FILLS WHEN CALLED:
ND FILL1:
IF NDSKIP = 0 OR 3:
IF NC=YES, FILL WITH “smoke cigarettes”
IF NDSKIP = 0 AND NE=YES, FILL WITH “use e-cigarettes”
IF NG=YES, FILL WITH “smoke cigars”
IF NL=YES, FILL WITH “smoke cigarillos”
IF NF=YES, FILL WITH “smoke filtered cigars”
IF NP=YES, FILL WITH “smoke a pipe”
IF NH=YES, FILL WITH “smoke hookah”
IF NU=YES, FILL WITH “use snus pouches”
IF NS=YES, FILL WITH “use smokeless tobacco”
IF ND=YES, FILL WITH “use dissolvable tobacco”
IF NDSKIP = 1 FILL WITH “use tobacco”
IF NDSKIP = 2 FILL WITH “use e-cigarettes” the first time through the
loop, and with “use tobacco” the second time through the loop.
IF NDSKIP = 3 AND NC = YES, FILL WITH “smoke cigarettes” the first
time through the loop and “use e-cigarettes” the second time through the
loop.
IF NDSKIP = 3 AND (one-of NG, NL, NF, NP, NH, NU, NS, ND) = YES,
FILL WITH “use e-cigarettes” the first time through the loop and
appropriate fill as described above for each product the second time
through the loop.
ND FILL2:
IF NDSKIP = 0 OR 3:
IF NC=YES FILL WITH “cigarettes”
IF NDSKIP = 0 AND NE=YES FILL WITH “e-cigarettes”
IF NG=YES FILL WITH “cigars”
IF NL=YES FILL WITH “cigarillos”
IF NF=YES FILL WITH “filtered cigars”
IF NP=YES FILL WITH “pipe smoking”
IF NH=YES FILL WITH “hookah”
IF NU=YES FILL WITH “snus pouches”
IF NS=YES FILL WITH “smokeless tobacco”
IF ND=YES FILL WITH “dissolvable tobacco”
IF NDSKIP = 1 FILL WITH “tobacco”
IF NDSKIP = 2 FILL WITH “e-cigarettes” the first time through the loop,
and with “tobacco” the second time through the loop.
IF NDSKIP = 3 AND NC = YES, FILL WITH “cigarettes” the first time
through the loop and “e-cigarettes” the second time through the loop.
IF NDSKIP = 3 AND (one-of NG, NL, NF, NP, NH, NU, NS, ND) = YES,
FILL WITH “e-cigarettes” the first time through the loop and appropriate
fill as described above for each product the second time through the loop.

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ND FILL3:
IF NDSKIP = 0 OR 3:
IF NC=YES FILL WITH “smoking cigarettes”
IF NDSKIP = 0 AND NE=YES FILL WITH “using e-cigarettes”
IF NG=YES FILL WITH “smoking cigars”
IF NL=YES FILL WITH “smoking cigarillos”
IF NF=YES FILL WITH “smoking filtered cigars”
IF NP=YES FILL WITH “smoking a pipe”
IF NH=YES FILL WITH “smoking hookah”
IF NU=YES FILL WITH “using snus pouches”
IF NS=YES FILL WITH “using smokeless tobacco”
IF ND=YES FILL WITH “using dissolvable tobacco”
IF NDSKIP = 1 FILL WITH “using tobacco”
IF NDSKIP = 2 FILL WITH “using e-cigarettes” the first time through the
loop, and with “using tobacco” the second time through the loop.
IF NDSKIP = 3 AND NC = YES, FILL WITH “smoking cigarettes” the first
time through the loop and “using e-cigarettes” the second time through
the loop.
IF NDSKIP = 3 AND (one-of NG, NL, NF, NP, NH, NU, NS, ND) = YES,
FILL WITH “using e-cigarettes” the first time through the loop and
appropriate fill as described above for each product the second time
through the loop.
ND FILL4:
IF NDSKIP = 0 OR 3:
IF NC=YES FILL WITH “cigarette smoking”
IF NDSKIP = 0 AND NE=YES FILL WITH “e-cigarette use”
IF NG=YES FILL WITH “cigar smoking”
IF NL=YES FILL WITH “cigarillo smoking ”
IF NF=YES FILL WITH “filtered cigar smoking”
IF NP=YES FILL WITH “pipe smoking”
IF NH=YES FILL WITH “hookah smoking”
IF NU=YES FILL WITH “snus pouch use”
IF NS=YES FILL WITH “smokeless tobacco use”
IF ND=YES FILL WITH “dissolvable tobacco use”
IF NDSKIP = 1 FILL WITH “tobacco use”
IF NDSKIP = 2 FILL WITH “e-cigarette use” the first time through the
loop, and with “tobacco use” the second time through the loop.
IF NDSKIP = 3 AND NC = YES, FILL WITH “cigarette smoking” the first
time through the loop and “e-cigarette use” the second time through the
loop.
IF NDSKIP = 3 AND (one-of NG, NL, NF, NP, NH, NU, NS, ND) = YES,
FILL WITH “e-cigarette use” the first time through the loop and
appropriate fill as described above for each product the second time
through the loop.

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PROGRAM:
START ND SKIP LOOP #1
ND SKIP LOOP #1 includes AN0005 through AN0225. Question AN0255 is only asked once – include in
first loop; do not include AN0255 in second loop.
PATH ID:

AN0005

Screen ID:

IF NDSKIP = 0, DISPLAY THE FOLLOWING TEXT:
The next questions ask about your experience with [NDFILL 2].
IF NDSKIP = 3, DISPLAY THE FOLLOWING TEXT:
FIRST LOOP THROUGH SERIES DISPLAY: The next questions ask about your experience with [NDFILL2].
SECOND LOOP THROUGH SERIES DISPLAY: The next questions ask about your experience with ecigarettes.
IF NDSKIP = 1, DISPLAY THE FOLLOWING TEXT:
The next questions ask about your experience with tobacco products. You said that you use the following
tobacco products: [LIST ALL PRODUCTS RESPONDENT CURRENTLY USES, UP TO 9 TOTAL, USING
NDFILL2 TEXT. IF PRODUCT COUNT=2, SEPARATE WITH ‘and’. IF PRODUCT COUNT >2, SEPARATE
WITH COMMAS WITH “, and” PRECEEDING LAST PRODUCT]
Please think about [both I all] of these products together as you answer the next series of questions. [If
Product Count=2, display “both”; if Product Count>2, display “all”]
IF NDSKIP= 2, DISPLAY THE FOLLOWING TEXT:
FIRST LOOP THROUGH SERIES DISPLAY: The next questions ask about your experience with tobacco
products and e-cigarettes. You said that you use the following tobacco products, in addition to e-cigarettes:
[LIST ALL PRODUCTS RESPONDENT CURRENTLY USES, UP TO 9 TOTAL, USING NDFILL2 TEXT. IF
PRODUCT COUNT=2, SEPARATE WITH ‘and’. IF PRODUCT COUNT >2, SEPARATE WITH COMMAS
WITH “, and” PRECEEDING LAST PRODUCT
We will first ask you questions about [LIST ALL PRODUCTS RESPONDENT CURRENTLY USES, UP TO 9
TOTAL, USING NDFILL2 TEXT. IF PRODUCT COUNT=2, SEPARATE WITH ‘and’. IF PRODUCT COUNT
>2, SEPARATE WITH COMMAS WITH “, and” PRECEEDING LAST PRODUCT]
Please think about [both I all] of these products together as you answer the next series of questions. We will
ask you questions about e-cigarettes later. [If Product Count=2, display “both”; if Product Count>2, display
“all”]
SECOND LOOP THROUGH SERIES DISPLAY: Now we would like to ask about your experience with ecigarettes. Please think only about e-cigarettes as you answer the next series of questions.

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PATH ID:

AN0010

Screen ID:

Do you consider yourself addicted to [ND FILL2]?
1
No, not at all
2
Yes, somewhat addicted
3
Yes, very addicted
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB =1/YES).
PATH ID:

AN0015

Screen ID:

Do you ever have strong cravings to [ND FILL1]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PATH ID:

AN0020

Screen ID:

Have you ever felt like you really needed to [ND FILL1]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).

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PATH ID:

AN0055

Screen ID:

Please rate your level of agreement for each statement using the following scale: 1= not true of me at all to
5=extremely true of me.
I find myself reaching for [ND FILL2] without thinking about it.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
BOX
PROGRAM: Randomize order of items AN0025-AN0100.
PATH ID:

AN0025

Screen ID:

I frequently crave [ND FILL2].
1
Not true of me at all
2
3
4
5
Extremely true of me
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).

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PATH ID:

AN0030

Screen ID:

[My urges keep getting stronger if I don’t I I still have urges to] [ND FILL1].
1
Not true of me at all
2
3
4
5
Extremely true of me
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display “My urges keep getting stronger if I don’t”; if
former user 12 month, display “I still have urges to”.
PATH ID:

AN0035

Screen ID:

[FILL AS SHOWN BELOW] me.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM:
IF NDSKIP = 0, 3:
IF NC=YES FILL WITH “Cigarettes control”
IF NE=YES FILL WITH “E-cigarettes control”
IF NG=YES FILL WITH “Cigars control”
IF NL=YES FILL WITH “Cigarillos control”
IF NF=YES FILL WITH “Filtered cigars control”

IF NP=YES FILL WITH “Pipe smoking controls”
IF NH=YES FILL WITH “Hookah smoking controls”
IF NU=YES FILL WITH “Snus pouches control”
IF NS=YES FILL WITH “Smokeless tobacco controls”
IF ND=YES FILL WITH “Dissolvable tobacco controls”

IF NDSKIP = 1, fill with “Tobacco controls”
IF NDSKIP = 2, fill with “E-cigarettes control” the first time through, then “Tobacco controls” the second time
through.

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PATH ID:

AN0045

Screen ID:

[[My [ND FILL4] is out of control. I My urge to [ND FILL1] is out of control.]]
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display “My [ND FILL4] is out of control.”; if former user
12 month, display “My urge to [ND FILL1] is out of control.”
PATH ID:

AN0060

Screen ID:

I usually want to [ND FILL1] right after I wake up.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PATH ID:

AN0065

Screen ID:

I can only go a couple of hours without [[ND FILL3] I wanting to [ND FILL1]].
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display “[ND FILL3].”; if former user 12 month, display

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“wanting to [ND FILL1].”
PATH ID:

AN0050

Screen ID:

[I frequently [ND FILL1] I I find myself almost [ND FILL3]] without thinking about it.
1
2
3
4
5
-8
-7

Not true of me at all

Extremely true of me
DON’T KNOW
REFUSED

ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display “I frequently [ND FILL1]”; if former user 12
month, display “I find myself almost [ND FILL3]”.
PATH ID:

AN0070

Screen ID:

[ND FILL3] [really helps I would really help] me feel better if I’ve been feeling down.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: Make ND FILL3 titlecase. If current or current experimental user, display “really helps”; if
former user 12 month, display “would really help”.

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PATH ID:

AN0075

Screen ID:

[ND FILL3] helps me think better.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PATH ID:

AN0255

Screen ID:

Most of the people I spend time with are tobacco users.
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
NOTE: If NDSKIP=2 OR 3, only ask this question once; do not repeat in second loop.
PATH ID:

AN0080

Screen ID:

I [would ]feel alone without my [ND FILL2].
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display “would”; if former user 12 month, no display.

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PATH ID:

AN0085

Screen ID:

[I would find it really hard to stop [ND FILL3]. I I find it really hard to not [ND FILL 1].
1
2
3
4
5
-8
-7

Not true of me at all

Extremely true of me
DON’T KNOW
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display ‘I would find it really hard to stop [ND FILL3].’; if
former user 12 month, display “I find it really hard to not [ND FILL 1].”.
PATH ID:

AN0090

Screen ID:

[[I would find it hard to stop [ND FILL3] for a week. I I would find it hard to not [ND FILL1] for another week.]]
1
Not true of me at all
2
3
4
5
Extremely true of me
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display ‘I would find it hard to stop [ND FILL3] for a
week.’; if former user 12 month, display “I would find it hard to not [ND FILL1] for another week.”.

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PATH ID:

AN0095

Screen ID:

[After not [ND FILL3] for a while, I need I I would like] to [ND FILL1] in order to feel less restless and irritable.
Not true of me at all
1
2
3
4
Extremely true of me
5
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display ‘After not [ND FILL3] for a while, I need’; if
former user 12 month, display “I would like”.
PATH ID:

AN0100

Screen ID:

[[After not [ND FILL3] for a while, I need I I feel like I need] to [ND FILL1] in order to keep myself from
experiencing any discomfort.
Not true of me at all
1
2
3
4
Extremely true of me
5
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PROGRAM: If current or current experimental user, display ‘After not [ND FILL3] for a while, I need; if former
user 12 month, display “I feel like I need”.
PATH ID:

AN0110

Screen ID:

Do you believe that [ND FILL3] is causing a health problem or making it worse?
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).

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PATH ID:

AN0812

Screen ID:

In the past 12 months, did you give up or cut down on activities that were enjoyable or important to you
because [ND FILL4] was not permitted at the activity?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
PATH ID:

AN0813

Screen ID:

In the past 12 months, did you find it difficult to keep from [ND FILL3] in places where it was prohibited?
1
2
-8

Yes
No
DON’T KNOW

-7
REFUSED
ASK: All current tobacco users (CURRENT_USER_TOB = 1/YES), Past year quitters
(FORMER_12MONTH_USER=1/YES), Current experimental users (EXPERIMENTAL_CURRENT_USER_
TOB=1/YES).
GO TO:
Current tobacco users (CURRENT_USER_CIGS = 1/YES) GO TO AN0105
Past year quitters (FORMER_12MONTH_USER=1/YES) GO TO BOX4
Current experimental users (EXPERIMENTAL_CURRENT_USER_CIGS=1/YES) GO TO AN0330
PATH ID:

AN0105

Screen ID:

In the past 12 months, have you tried to quit [ND FILL3]? Choose all that apply.
1
Yes, I have tried to quit completely
2
Yes, I have tried to quit by reducing or cutting back
3
No, I have reduced or cut back instead of trying to quit
4
No, I have not tried to quit at all
-8
DON’T KNOW
-7
REFUSED
ASK: Current tobacco users (CURRENT_USER_TOB = 1/YES)
PROGRAM: Options 1 or 2 cannot be selected if options 3 or 4 are selected.

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BOX4

Screen ID:

PROGRAM: Create new variables
Past year quitters and attempters. 12MoQuitAttempt=1/YES, [IF AN0105 in [1,2] OR Past 12 month former
user=1/YES]. ELSE, 12MoQuitAttempt=2/NO.
Past year reducers. 12MoQuitCutdown=1/YES, if AN0105=3. ELSE, 12MoQuitCutdown=2/NO.
GO TO:
Current users who have tried to quit completely (12MoQuitAttempt = YES) go to AN0115
Former 12 month users, go to AN0115
Past year reducers (12MoQuitCutdown=1/Yes) GO TO AN0330
Else, go to AN0330
PATH ID:

AN0115

Screen ID:

In total, how many times in the past 12 months have you tried to quit [ND FILL2] completely?
I___I___I___I
Number of times
2
NONE
GO TO AN0330
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES)
GO TO:
Former users 12 month who provided a valid response in A*1009, go to AN0257
Former users 12 month who did not provide a valid response in A*1009, go to AN0145
Else GO TO AN0120
1

PATH ID:

AN0120

Screen ID:

In the past 12 months, have you stopped [ND FILL3] for one day or longer because you were trying to quit?
1
Yes
2
No
GO TO AN0130
-8
DON’T KNOW
GO TO AN0130
-7
REFUSED
GO TO AN0130
ASK: Current users who have tried to quit completely in the past 12 months (AN0105=1 OR 2 AND AN0115
NE 2)

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PATH ID:

AN0125

Screen ID:

In the past 12 months, how many times have you stopped [ND FILL3] for one day or longer because you
were trying to quit?
1
1 time
GO TO AN0130
2
2-3 times
GO TO AN0130
3
4 or more times
GO TO AN0130
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who have tried to stop for one day or longer (AN0120=1)
PATH ID:

AN0256

Screen ID:

Would you say that in the past 12 months it was more than 3 times that you have stopped [NDFILL3] for one
day or longer because you were trying to quit?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: : Current users who did not provide number of quit attempt times (AN0125 IN (DK, RF))
PATH ID:

AN0130

Screen ID:

The last time you stopped [ND FILL3] in the past 12 months because you were trying to quit, how long did
you stop for?

1

I___I___I___I
Number

1
2
3
4
5
UNIT

Minutes
Hours
Days
Weeks
Months

GO TO AN0135
GO TO AN0135
GO TO AN0135
GO TO AN0135
GO TO AN0135

-8
DON’T KNOW
GO TO AN0300
-7
REFUSED
GO TO AN0300
ASK: Current users who have tried to quit completely in the past 12 months (AN0105=1 OR 2 AND AN0115
NE 2)

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PATH ID:

AN0300

Screen ID:

Was it more than a week, a week, or less than a week?
1
More than one week
2
One week
3
Less than one week
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who did not provide a duration for the last quit attempt (AN0130 IN (DK, RF))
PATH ID:

AN0135

Screen ID:

When was the approximate end date of this last quit attempt that lasted [enter duration from AN0130 OR
enter “more than a week” “less than a week” or “a week” from AN0300]?
I___I___I I___I___I I___I___I___I___I
MONTH
DAY
YEAR
-8
DON’T KNOW
-7
REFUSED
ASK: Current users who provided a duration for the last quit attempt (AN0130 NOT IN (DK,RF))
1

PATH ID:

AN0140

Screen ID:

In the past 12 months, was [DURATION OF LAST QUIT ATTEMPT] the longest you went without [ND
FILL3] because you were trying to quit?
1
Yes
GO TO AN0330
2
No
GO TO AN0145
-8
DON’T KNOW
GO TO AN0330
-7
REFUSED
GO TO AN0330
ASK: Current users who provided a duration for the last quit attempt (AN0130 NOT IN (DK,R))
PROGRAM: Fill “DURATION OF LAST QUIT ATTEMPT” with the duration from AN0130 (ex. “45 days”)
GO TO:
If Current user and AN0140=1, -8 or -7, GO TO AN0330.
If Current user and AN0140=2, GO TO AN0145.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0257

Screen ID:

You previously mentioned that you stopped [ND FILL3] [ENTER LENGTH OF TIME SINCE LAST USE IN
A*1009] ago. Is this the longest you have gone without [ND FILL3] in the past 12 months?
1
Yes
GO TO AN0330
2
No
GO TO AN0145
-8
DON’T KNOW
GO TO AN0330
-7
REFUSED
GO TO AN0330
ASK: Former users 12 month who provided a valid response in A*1009
PROGRAM: Fill [ENTER LENGTH OF TIME SINCE A*1009] with time entered (ex. “45 days”) in
corresponding A*1009 item by product:
IF NDSKIP=0, 3:
NC=AC1009 NP=AP1009
NE=AE1009 NH=AH1009
NG=AG1009 NU=AS1009
NL=AG1009 NS=AS1009
NF=AG1009 ND=AD1009
IF NDSKIP = 1:
Use longest time period among AC1009, AG1009, AP1009, AH1009, AS1009, NS1009, AD1009
IF NDSKIP = 2:
Use AE1009 for e-cigarette loop, and longest time period among AC1009, AG1009, AP1009, AH1009,
AS1009, AD1009 for tobacco use loop.
PATH ID:

AN0145

Screen ID:

In the past 12 months, what was the longest time you stopped [ND FILL3] because you were trying to quit?

1

I___I___I___I
Number

1
2
3
4
5
UNIT

Minutes
Hours
Days
Weeks
Months

GO TO AN0330
GO TO AN0330
GO TO AN0330
GO TO AN0330
GO TO AN0330

-8
DON’T KNOW
GO TO AN0305
-7
REFUSED
GO TO AN0305
ASK: Current users and Former users 12 month who said their last quit attempt was not their longest in the
past 12 months (AN0140=2 or AN0257=2) or Former users 12 month who did not provide a valid response
in A*1009.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0305

Screen ID:

Was it more than a week, a week, or less than a week?
1
More than one week
2
One week
3
Less than one week
-8
DON’T KNOW
-7
REFUSED
ASK: Current users and Former users 12 month who did not give a duration for their longest quit in the past
12 months (AN0145=-8 or -7)
GO TO: If 12MoQuitAttempt=YES, GO TO AN0210.
Else GO TO AN0330.
PATH ID:

AN0210

Screen ID:

[Now we have some questions about different ways that can help people to stop using tobacco. I Now we
have some questions about how you went about completely quitting using tobacco.]
Thinking back to [the time you tried to quit I the last time you tried to quit I when you quit] [ND FILL3] in the
past 12 months, did you rely on the support of friends and family to help you?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.
DISPLAY: If NDSKIP=2 or 3, only display introduction text in the first loop; do not repeat in the second loop.
If current user of tobacco, display ‘Now we have some questions about different ways that can help people
to stop using tobacco.’ If former 12 month user of tobacco, display ‘Now we have some questions about how
you went about completely quitting using tobacco.’ Else, no display text shown.

PATH – Wave 1
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154

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0215

Screen ID:

Thinking back to [the time you tried to quit I the last time you tried to quit I when you quit] [ND FILL3] in the
past 12 months, did you use any of the following to help you: counseling, a telephone help line or quit line,
books, pamphlets, videos, a quit tobacco clinic, class, or support group, or an internet or web-based
program?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.
PATH ID:

AN0225

Screen ID:

Thinking back to [the time you tried to quit I the last time you tried to quit I when you quit] [ND FILL3] in the
past 12 months, did you use any different tobacco product to help you quit? Choose all that apply.
1
I did not use any different tobacco products to help me quit
2
Cigarettes
3
E-cigarettes
4
Traditional cigars
5
Cigarillos
6
Filtered cigars
7
Pipe tobacco
8
Hookah
9
Snus pouches
10
Smokeless tobacco, like dip, chew, or snuff
11
Dissolvable tobacco
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES)
PROGRAM: For respondents where PRODUCT COUNT = 1, omit the single product they currently use from
the list of response options.
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.

PROGRAM:
END NDSKIP LOOP#1

PATH – Wave 1
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155

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0330

Screen ID:

Have you ever used a nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
1
Yes
2
No
GO TO AN0331
-8
DON’T KNOW
GO TO AN0331
-7
REFUSED
GO TO AN0331
ASK: All respondents
GO TO:
If 12MoQuitAttempt=YES AND AN0330=1, GO TO AN0150.
If 12MoQuitCutdown=YES and AN0330=1, GO TO AN0811
If Experimental_Current_User_TOB=YES and AN0330=1, GO TO AN0811
Else if AN0330=1, GO TO AN0307.
Else GO TO AN0331.
PROGRAM:
START NDSKIP LOOP#2
ND SKIP LOOP #2 includes questions AN0150 through AN0165.
IF NDSKIP = 0 OR 1, ASK THESE QUESTIONS 1 TIME FOLLOWING THE GENERAL ROUTING AND
FILL INSTRUCTIONS PROVIDED AT THE START OF THIS SECTION.
IF NDSKIP = 2 OR 3 ASK THESE QUESTIONS 2 TIMES FOLLOWING THE GENERAL ROUTING AND
FILL INSTRUCTIONS PROVIDED AT THE START OF THIS SECTION.
PATH ID:

AN0150

Screen ID:

Thinking back to [the time you tried to quit I the last time you tried to quit I when you quit] [ND FILL3] in the
past 12 months, did you use a nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
1
Yes
2
No
GO TO AN0331
-8
DON’T KNOW
GO TO AN0331
-7
REFUSED
GO TO AN0331
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who have ever used NRT (AN0330=1)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’. Else display ‘the last time you tried to quit’.

PATH – Wave 1
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156

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0155

Screen ID:

Did you use the nicotine patch, gum, inhaler, nasal spray, lozenge or pill to quit [ND FILL3] completely?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT to help them (AN0150=1)
PATH ID:

AN0811

Screen ID:

Did you use the nicotine patch, gum, inhaler, nasal spray, lozenge or pill to quit to relieve or avoid any bad
after-effects after you stopped or cut down on your [ND FILL3]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT to help them quit
(AN0150=1) and Current users who have tried to cut down (12MoQuitCutdown=YES) and Experimental
users who have ever used NRT (AN0330=1/YES)
BOX
IF NDSKIP=0 OR 1, EXPERIMENTAL_CURRENT_USER_TOB GO TO AN0307
IF NDSKIP=2 OR 3, AND THIS IS THE FIRST TIME THROUGH LOOP #2,
EXPERIMENTAL_CURRENT_USER_TOB GO BACK TO START OF LOOP #2. IF SECOND TIME
THROUGH LOOP #2, EXPERIMENTAL_CURRENT_USER_TOB GO TO AN0307.
PATH ID:

AN0160

Screen ID:

Which medication did you use [the time you tried to quit [ND FILL3] I the last time you tried to quit [ND
FILL3] I when you quit [ND FILL3]]? Choose all that apply.
1
Nicotine patch
2
Nicotine gum
3
Nicotine inhaler
4
Nicotine nasal spray
5
Nicotine lozenge or pill
6
None of the above
GO TO AN0170
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT to help them (AN0150=1)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.

PATH – Wave 1
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157

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0165

Screen ID:

In total, [during the time you tried to quit I during the last time you tried to quit I during your last quit attempt
when you stopped] [ND FILL3] [completely], how long did you use a nicotine patch, gum, inhaler, nasal
spray, lozenge or pill?
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
REFUSED
-7
DON’T KNOW
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT to help them (AN0150=1
and AN0160 NE 6)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘during the time you tried to
quit’; if current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘during the
last time you tried to quit’; if former user 12 month, display ‘during your last quit attempt when you stopped’
and ‘completely’.
1

PROGRAM
END NDSKIP LOOP#2
PATH ID:

AN0170

Screen ID:

Are you currently using a nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
1
Yes
2
No
GO TO AN0307
-8
REFUSED
GO TO AN0307
-7
DON’T KNOW
GO TO AN0307
ASK: Past year quitters and attempters who used NRT to help them (12MoQuitAttempt=YES AND
AN0330=1)
PATH ID:

AN0251

Screen ID:

About how long have you been using the nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who are currently using NRT (AN0170=1)
1

PATH – Wave 1
Adult Extended Questionnaire

158

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0307

Screen ID:

When did you last use a nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
1
In the past hour
2
Sometime today
3
Yesterday
4
Day before yesterday
5
Three or more days ago
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used NRT (AN0330=1)
PATH ID:

AN0308

GO TO AN0309
GO TO AN0308
GO TO AN0308
GO TO AN0308
GO TO AN0175
GO TO AN0331
GO TO AN0331

Screen ID:

When you last used a nicotine patch, gum, inhaler, nasal spray, lozenge or pill [FILL BASED ON AN0307],
was it in the…
1
Morning
2
Afternoon
3
Evening
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used NRT today, yesterday or the day before yesterday (AN0307=2 or 3 or 4)
PROGRAM: [FILL BASED ON AN0307]
If AN0307=4, display “the day before yesterday”
Else, display text as shown in options selected in AN0307, making first letter lowercase.
PATH ID:

AN0309

Screen ID:

When you used a nicotine patch, gum, inhaler, nasal spray, lozenge or pill [FILL BASED ON AN0307], how
many did you use?
I__I__I
Number
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have used NRT in past hour, today, yesterday or the day before yesterday
(AN0307=1 or 2 or 3 or 4)
PROGRAM: [FILL BASED ON AN0307]
If AN0307=1 OR 2, display “today”
If AN0307=4, display “the day before yesterday”
Else, display text as shown in options selected in AN0307, making first letter lowercase.
GO TO:
Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT three or more days ago (AN0307
> 4), GO TO AN0175
Else, GO TO AN0331
1

PATH – Wave 1
Adult Extended Questionnaire

159

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0175

Screen ID:

How long ago did you stop using the nicotine patch, gum, inhaler, nasal spray, lozenge or pill?
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used NRT three or more days ago
(AN0307 > 4)
1

PATH ID:

AN0331

Screen ID:

Have you ever used any of the following prescription drugs: Chantix, varenicline, Wellbutrin, Zyban, or
buproprion?
1
Yes
2
No
GO TO BOX AN4
-8
DON’T KNOW
GO TO BOX AN4
-7
REFUSED
GO TO BOX AN4
ASK: All respondents
GO TO:
If 12MoQuitAttempt=YES AND AN0331=1, GO TO AN0180
If 12MoQuitAttempt=YES AND AN0331=2, -8 or -7, GO TO BOX AN4
If FORMER_12PLUS_TOB, GO TO NEXT SECTION
If CURRENT_USER_TOB GO TO AN0230.
Else if AN0331=1, GO TO AN0327
Else, GO TO TO NEXT SECTION
PROGRAM:
START NDSKIP LOOP#3
ND SKIP LOOP #3 includes questions AN0180 through AN0205.
IF NDSKIP = 0 OR 1, ASK THESE QUESTIONS 1 TIME FOLLOWING THE GENERAL ROUTING AND
FILL INSTRUCTIONS PROVIDED AT THE START OF THIS SECTION.
IF NDSKIP = 2 OR 3 ASK THESE QUESTIONS 2 TIMES FOLLOWING THE GENERAL ROUTING AND
FILL INSTRUCTIONS PROVIDED AT THE START OF THIS SECTION.

PATH – Wave 1
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160

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0180

Screen ID:

Thinking back to [the time you tried to quit I the last time you tried to quit I when you quit] [ND FILL3] in the
past 12 months, did you use Chantix, varenicline, Wellbutrin, Zyban, or bupropion?
1
Yes
2
No
GO TO BOX AN4
-8 DON’T KNOW
GO TO BOX AN4
-7 REFUSED
GO TO BOX AN4
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who have ever used a prescription drug to
stop smoking (AN0331=1)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’. Else display ‘the last time you tried to quit’.
PATH ID:

AN0185

Screen ID:

Did you use Chantix, varenicline, Wellbutrin, Zyban, or bupropion to quit [ND FILL3] completely?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used a prescription drug to help them
(AN0180=1)
PATH ID:

AN0190

Screen ID:

Which prescription drug did you use [the time you tried to quit [ND FILL 3] I the last time you tried to quit [ND
FILL 3] I when you quit [ND FILL 3]]? Choose all that apply.
1
Chantix or varenicline
2
Wellbutrin, Zyban, or bupropion
3
None of the above
GO TO AN0200
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used a prescription drug to help them
(AN0180=1)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.
Option 3 cannot be selected if options 1 or 2 are selected.

PATH – Wave 1
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161

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0195

Screen ID:

In total, [during the time you tried to quit I during the last time you tried to quit I during your last quit attempt
when you stopped] [ND FILL3] [completely], how long did you use Chantix, varenicline, Wellbutrin, Zyban, or
bupropion]?
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8 DON’T KNOW
-7 REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used a prescription drug to help them
(AN0180=1 and AN0190 NE 3)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘during the time you tried to
quit’; if current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘during the
last time you tried to quit’; if former user 12 month, display ‘during your last quit attempt when you stopped’
and ‘completely’.
1

PROGRAM:
NDSKIP LOOP#3 ENDS HERE
PATH ID:

AN0200

Screen ID:

Are you currently using Chantix, varenicline, Wellbutrin, Zyban, or bupropion?
1
Yes
2
No
GO TO AN0327
-8 REFUSED
GO TO AN0327
-7 DON’T KNOW
GO TO AN0327
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used a prescription drug to help them
(AN0180=1)

PATH – Wave 1
Adult Extended Questionnaire

162

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0252

Screen ID:

About how long have you been using Chantix, varenicline, Wellbutrin, Zyban, or bupropion?
I___I___I
DAYS
I___I___I
2
MONTHS
I___I___I
3
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Past year quitters and attempters (12MoQuitAttempt=YES) who used a prescription drug to help them
(AN0180=1) and are currently using a prescription drug (AN0200=1)
1

PATH ID:

AN0327

Screen ID:

When did you last use Chantix, varenicline, Wellbutrin, Zyban, or bupropion?
1
In the past hour
GO TO AN0329
2
Sometime today
GO TO AN0328
3
Yesterday
GO TO AN0328
4
Day before yesterday
GO TO AN0328
5
Three or more days ago
GO TO AN0205
-8
DON’T KNOW
GO TO Box AN4
-7
REFUSED
GO TO Box AN4
ASK: Respondents who have ever used a stop smoking prescription drug (AN0331=1)
PATH ID:

AN0328

Screen ID:

When you last used Chantix, varenicline, Wellbutrin, Zyban, or bupropion [FILL BASED ON AN0327], was it
in the…
1
Morning
2
Afternoon
3
Evening
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have taken a prescription drug to stop smoking today, yesterday or the day before
yesterday (AN0327=2 or 3 or 4)
PROGRAM: [FILL BASED ON AN0327]
If AN0327=4, display “the day before yesterday”
Else, display text as shown in options selected in AN0327, making first letter lowercase.

PATH – Wave 1
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163

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0329

Screen ID:

When you used Chantix, varenicline, Wellbutrin, Zyban, or bupropion [FILL BASED ON AN0327], how many
did you take?
I__I__I
Number
-8
DON’T KNOW
-7
REFUSED
ASK Respondents who have used a prescription drug to stop smoking in past hour, today, yesterday or the
day before yesterday (AN0327=1 or 2 or 3 or 4)
PROGRAM: [FILL BASED ON AN0327]
If AN0327=1 OR 2, display “today”
If AN0327=4, display “the day before yesterday”
Else, display text as shown in options selected in AN0327, making first letter lowercase.
GO TO:
IF EXPERIMENTAL CURRENT_TOB=1/YES GO TO AX0006
IF Past Year Quitters and Attempters (12MoQuitAttempt=YES) who used a prescription drug three or more
days ago (AN0327=5), GO TO AN0205
IF Past Year Quitters and Attempters (12MoQuitAttempt=YES) who did not use a prescription drug to help
them (AN0180=2), GO TO Box AN4
ELSE GO TO NEXT SECTION
1

PATH ID:

AN0205

Screen ID:

How long ago did you stop using Chantix, varenicline, Wellbutrin, Zyban, or bupropion?
I___I___I
DAYS
I___I___I
2
MONTHS
3
I___I___I
YEARS
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) who used a prescription drug three or
more days ago (AN0327=5)
1

Box AN4
ND SKIP LOOP 4 STARTS HERE. Questions include AN0804 through AN0245.
Display question AN0804, AN0805, AN0806, AN0807, AN0808, AN0809, AN0810, on one screen. Show
the transition text and question stem from AN0804 first, then show each item with the yes/no responses. As
each item is answered, show the next one.

PATH – Wave 1
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164

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0804

Screen ID:

The next questions ask about how you felt within days after [the time you tried to quit I the last time you tried
to quit I when you quit] [ND FILL3] in the past 12 months.
Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Feel depressed?
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)
PROGRAM: If current user that has tried to quit one time (AN0125=1), display ‘the time you tried to quit’; if
current user that has tried to quit more than one time (AN0125>1 OR AN0256=1), display ‘the last time you
tried to quit’; if former user 12 month, display ‘when you quit’.
BOX
PROGRAM: Randomize order of AN0805-AN0809.
PATH ID:

AN0805

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Have difficulty falling asleep or staying asleep?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)
PATH ID:

AN0806

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Have difficulty concentrating?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)

PATH – Wave 1
Adult Extended Questionnaire

165

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0807

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Eat more than usual or gain weight?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)
PATH ID:

AN0808

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Become easily irritated, angry, or frustrated?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)
PATH ID:

AN0809

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Feel anxious or nervous?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)
PATH ID:

AN0810

Screen ID:

Within days after stopping or cutting down on your [ND FILL4] in the past 12 months, did you….
Feel more restless than usual?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Past Year Quitters and Attempters (12MoQuitAttempt=YES) and Current users who have tried to cut
down (12MoQuitCutdown=YES)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0230

Screen ID:

Overall, on a scale from 1 to 10 where 1 is not at all interested and 10 is extremely interested, how
interested are you in quitting [ND FILL 4]? Please enter a number from 1 to 10.
1
Not at all interested
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10 Extremely Interested
-8 DON’T KNOW
-7 REFUSED
ASK: Current users
PATH ID:

AN0235

Screen ID:

Do you plan to ever quit [ND FILL3] for good?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Current users
PATH ID:

GO TO AX0006
GO TO AX0006
GO TO AX0006

AN0240

Screen ID:

When do you plan to quit [ND FILL3] for good?
1
In the next 7 days
2
In the next 30 days
3
In the next 6 months
4
In the next year
5
More than one year from now
-8 DON’T KNOW
-7 REFUSED
ASK: Current users who say they plan to quit for good (AN0235=1)

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GO TO AX0006
GO TO AX0006
GO TO AX0006
GO TO AX0006

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AN0245

Screen ID:

If you did try to quit [ND FILL4] altogether in the next 6 months, how likely do you think you would be to
succeed?
1
Not at all likely
2
A little likely
3
Somewhat likely
4
Very likely
-8 DON’T KNOW
-7 REFUSED
ASK: Current users who have some interest in quitting in the next 6 months (AN0240<=3)

PROGRAM:
NDSKIP LOOP#4 ENDS HERE.
PATH ID:

AX0006

Screen ID:

If you had to do it over again, would you have ever started using tobacco?
1
Definitely would not
2
Probably would not
3
Probably would
4
Definitely would
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Former users, Experimental users

PATH – Wave 1
Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5

PACKAGING AND HEALTH WARNINGS SECTION
PATH ID:

AR0141

Screen ID:

In the past 12 months, how often have you seen a list of the chemicals contained in tobacco products?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AR0142

Screen ID:

In the past 12 months, how often have you thought about the chemicals contained in tobacco products?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AR0005

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on cigarette packages?
1
Never
GO TO AR0060
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
GO TO AR0060
-7
REFUSED
GO TO AR0060
ASK: All respondents
GO TO: If Current or Experimental Current User CIGS and AR0005>=2, go to AR0202
Else if Former user CIGS OR Experimental Former user CIGS, go to AR0040
Else if AC1002=2, -8 or -7, go to AR0055
Else go to AR0060

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0202

Screen ID:

In the past 30 days, how often, if at all, have you read or looked closely at the health warnings on cigarette
packages?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have noticed the health warnings in the past
month (AR0005>=2).
PATH ID:

AR0010

Screen ID:

In the past 30 days, how often, if at all, have the health warnings stopped you from having a cigarette when
you were about to smoke one?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have seen health warnings in the past
month (AR0005>=2).
PATH ID:

AR0015

Screen ID:

In the past 30 days, have you tried to avoid looking at or thinking about the health warnings on cigarette
packs - such as covering them up, keeping them out of sight, using a cigarette case, avoiding certain
warnings, or any other means?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have seen health warnings in the past
month (AR0005>=2)

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0025

Screen ID:

How believable do you consider the health warnings on cigarette packs to be?
1
Not at all believable
2
A little believable
3
Somewhat believable
4
Very believable
5
Extremely believable
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have seen health warnings in the past
month (AR0005>=2)
PATH ID:

AR0030

Screen ID:

How do the health warnings on cigarette packs make you feel about smoking?
1
Very concerned
2
Somewhat concerned
3
Neither concerned nor unconcerned
4
Somewhat unconcerned
5
Very unconcerned
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have seen health warnings in the past
month (AR0005>=2)
PATH ID:

AR0035

Screen ID:

To what extent, if at all, do the health warnings on cigarette packs make you think about the health risks of
smoking?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes who have seen health warnings in the past
month (AR0005>=2)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0040

Screen ID:

To what extent, if at all, do the health warnings on cigarette packs make you more likely to [stay] quit [from]
smoking?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of cigarettes
who have seen health warnings in the past month (AR0005>=2)
PROGRAM: For former and experimental former users only, display “stay” and “from”
PATH ID:

AR0055

Screen ID:

To what extent, if at all, have the health warnings on cigarette packs made you less likely to start smoking?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have never used cigarettes (AC1002=2, -8 or -7) who have seen health warnings in
the past month (AR0005>=2)
PATH ID:

AR0060

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of smokeless
tobacco products like snus, moist snuff, dip, spit and chew?
1
Never
GO TO BOX AR1
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
GO TO BOX AR1
-7
REFUSED
GO TO BOX AR1
ASK: Respondents who have heard of smokeless tobacco (AS1001=1)
GO TO: If Current or Experimental Current User SMKLSS AND AR0060>=2, go to AR0205.
If Former or Experimental Former User SMKLSS AND AR0060>=2, go to AR0090.
Else go to BOX AR1

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0205

Screen ID:

In the past 30 days, how often, if at all, have you read or looked closely at the health warnings on smokeless
tobacco packages?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)
PATH ID:

AR0065

Screen ID:

In the past 30 days, how often, if at all, have the health warnings stopped you from having a smokeless
tobacco product when you were about to use one?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)
PATH ID:

AR0070

Screen ID:

In the past 30 days, have you tried to avoid looking at or thinking about the health warnings on packages of
smokeless tobacco products -- such as covering them up, keeping them out of sight, avoiding certain
warnings, or any other means?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0075

Screen ID:

How believable do you consider the health warnings on packages of smokeless tobacco products to be?
1
Not at all believable
2
A little believable
3
Somewhat believable
4
Very believable
5
Extremely believable
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)
PATH ID:

AR0080

Screen ID:

How do the health warnings on packages of smokeless tobacco products make you feel about using it?
1
Very concerned
2
Somewhat concerned
3
Neither concerned nor unconcerned
4
Somewhat unconcerned
5
Very unconcerned
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)
PATH ID:

AR0085

Screen ID:

To what extent, if at all, do the health warnings on packages of smokeless tobacco products make you think
about the health risks of using smokeless tobacco products?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current smokeless tobacco users who have noticed smokeless health
warnings on packages (AR0060>=2)

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Adult Extended Questionnaire

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PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0090

Screen ID:

To what extent, if at all, do the health warnings on packages of smokeless tobacco products make you more
likely to [stay] quit [from] using smokeless tobacco products?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of
smokeless tobacco who have noticed smokeless health warnings on packages (AR0060>=2)
PROGRAM: For former and experimental former users only, display “stay” and “from”
BOX AR1
If Current user OR Experimental Current user OR Former user OR Experimental Former user CIGS and
AC9007 = 2, go to AR0095
Else go to BOX AR2
PATH ID:

AR0095

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of roll-your-own
tobacco?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of roll-yourown cigarettes
BOX AR2
If Current user OR Experimental Current user OR Former user OR Experimental Former user ECIG, go to
AR0110
Else go to BOX AR3

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0110

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of e-cigarettes?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of ecigarettes
BOX AR3
If Current user OR Experimental Current user OR Former user OR Experimental Former user GTRAD, go
to AR0115
Else go to BOX AR4
PATH ID:

AR0115

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of traditional
cigars?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of cigars
BOX AR4
If Current user OR Experimental Current user OR Former user OR Experimental Former user GRILLO, go
to AR0120
Else go to BOX AR5

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0120

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of cigarillos?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of cigarillos
BOX AR5
If Current user OR Experimental Current user OR Former user OR Experimental Former user LFC, go to
AR0125
Else go to BOX AR6
PATH ID:

AR0125

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of filtered cigars?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of FCs
BOX AR6
If Current user OR Experimental Current user OR Former user OR Experimental Former user PIPE, go to
AR0130
Else go to BOX AR7

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0130

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of pipe tobacco?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of pipes.

BOX AR7
If Current user OR Experimental Current user OR Former user OR Experimental Former user HOOK, go to
AR0135
Else go to BOX AR8
PATH ID:

AR0135

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of shisha or
hookah tobacco?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of hookahs.
BOX AR8
If Current user OR Experimental Current user OR Former user OR Experimental Former user DISSBL, go
to AR0140.

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Adult Extended Questionnaire

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PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0140

Screen ID:

In the past 30 days, how often, if at all, have you noticed the health warnings on packages of dissolvable
tobacco?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current users, Experimental Current users, Former users and Experimental Former users of
dissolvable tobacco

PATH – Wave 1
Adult Extended Questionnaire

179

PATH
Adult Extended Questionnaire
Version 7.5

PRODUCT REGULATION - MODIFIED RISK TOBACCO PRODUCTS
DISPLAY TRANSITION TEXT: The next questions ask about your opinions on tobacco use.
PATH ID:

AX0005

Screen ID:

How would you describe your overall opinion of using tobacco?
1
Very positive
2
Positive
3
Neither positive nor negative
4
Negative
5
Very negative
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AN0250

Screen ID:

To what extent, if at all, do you believe nicotine to be the main substance in tobacco that makes people want
to use tobacco products?
1
Not at all
2
A little
3
Somewhat
4
Very much
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AR0143

Screen ID:

If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely
would you be to use that product?
1
Very likely
2
Somewhat likely
3
Somewhat unlikely
4
Very unlikely
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
GO TO: If Current or Experimental Current user tobacco, go to AX0004
Else go to AC9050

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0004

Screen ID:

In the past 30 days, how often did you think about the harm your tobacco use might be doing to you?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of tobacco
GO TO: If current user CIGS go to AC9055
Else go to AC9050
PATH ID:

AC9055

Screen ID:

In the past 30 days, have you stubbed out a cigarette before you finished it because you thought about the
harm of smoking?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current users of cigarettes
PATH ID:

AC9050

Screen ID:

How harmful do you think cigarettes are to health?
1
Not at all harmful
2
Slightly harmful
3
Somewhat harmful
4
Very harmful
5
Extremely harmful
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
BOX AR9
If AE1001 = 1, go to AE1099
Else go to BOX AR10

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AE1099

Screen ID:

Is using e-cigarettes less harmful, about the same, or more harmful than smoking cigarettes? [SHOW
IMAGE OF E-CIGARETTES]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of e-cigarettes (AE1001=1)
BOX AR10
If AG9002(1) = 1, go to AG1099
Else go to BOX AR11
PATH ID:

AG1099

Screen ID:

Is smoking traditional cigars less harmful, about the same, or more harmful than smoking cigarettes?
[SHOW IMAGE OF TRADITIONAL CIGARS]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of traditional cigars ((AG9002(1)=1))
BOX AR11
If AG9002(2) = 1, go to AG1106
Else go to BOX AR12
PATH ID:

AG1106

Screen ID:

Is smoking cigarillos less harmful, about the same, or more harmful than smoking cigarettes? [SHOW
IMAGE OF CIGARILLOS]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of cigarillos or filtered cigars ((AG9002(2)=1))

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AG1107

Screen ID:

Is smoking filtered cigars less harmful, about the same, or more harmful than smoking cigarettes? [SHOW
IMAGE OF FILTERED CIGARS]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of cigarillos or filtered cigars ((AG9002(2)=1))
BOX AR12
If AP1001 = 1, go to AP1099
Else go to BOX AR13
PATH ID:

AP1099

Screen ID:

Is smoking pipes filled with tobacco less harmful, about the same, or more harmful than smoking cigarettes?
[SHOW IMAGE OF PIPES]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of pipe tobacco (AP1001=1)
BOX AR13
If AH1001 = 1, go to AH1099
Else go to BOX AR14
PATH ID:

AH1099

Screen ID:

Is smoking tobacco in a hookah less harmful, about the same, or more harmful than smoking cigarettes?
[SHOW IMAGE OF HOOKAH]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of a hookah (AH1001=1)
BOX AR14
If AS1001 = 1, go to AS1105
Else go to BOX AR15

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AS1105

Screen ID:

Is using smokeless tobacco less harmful, about the same, or more harmful than smoking cigarettes?
[SHOW IMAGE OF SMOKELESS/SNUS]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of smokeless tobacco (AS1001=1)
BOX AR15
If AD1001 = 1, go to AD1099
Else go to AC1110
PATH ID:

AD1099

Screen ID:

Is using dissolvable tobacco less harmful, about the same, or more harmful than smoking cigarettes?
[SHOW IMAGE OF DISSOLVABLE TOBACCO]
1
Less harmful
2
About the same
3
More harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of dissolvable tobacco (AD1001=1)
PATH ID:

AC1110

Screen ID:

How harmful do you think today’s cigarettes are compared to those of five years ago?
1
Much less harmful
2
Somewhat less harmful
3
About the same
4
Somewhat more harmful
5
Much more harmful
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AS1110

Screen ID:

How harmful do you think today’s smokeless tobacco products are compared to those of five years ago?
1
Much less harmful
2
Somewhat less harmful
3
About the same
4
Somewhat more harmful
5
Much more harmful
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have heard of smokeless tobacco (AS1001=1)
PATH ID:

AG1110

Screen ID:

How harmful do you think today’s cigars, cigarillos or filtered cigars are compared to those of five years ago?
1
Much less harmful
2
Somewhat less harmful
3
About the same
4
Somewhat more harmful
5
Much more harmful
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have heard of cigars (AG1001=1)
Box AC4
Display question AC9060, AC9065, AC9070, AC9075, AC9080, AC9085, AC9090, AC9100, AC9105,
AC9110, AC9115 on one screen. Show the intro/transition text from AC9060 first, then show each item with
a Y/N response. As each item is answered, show the next one.
PATH ID:

AC9060

Screen ID:

I am going to read you a list of diseases that may or may not be caused by smoking cigarettes. Based on
what you know or believe, does smoking cause…
Stroke in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
NOTE: The list of health effects should include the diseases that are featured on the new health warnings
if/when they come on cigarette packs, thus these current questions are subject to change based on this
future information.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AC9065

Screen ID:

Lung cancer in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9070

Screen ID:

Heart disease in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9075

Screen ID:

Blindness in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9080

Screen ID:

Poor circulation (also called peripheral vascular disease) in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AC9085

Screen ID:

Bladder cancer in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9090

Screen ID:

Mouth cancer in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9100

Screen ID:

Lung disease such as emphysema in smokers?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9105

Screen ID:

Lung disease in non-smokers from second-hand smoke?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

PATH – Wave 1
Adult Extended Questionnaire

187

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AC9110

Screen ID:

Heart attack in non-smokers from second-hand smoke?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9115

Screen ID:

Harm to fetuses (or unborn children) during pregnancy from second-hand smoke?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AC9120

Screen ID:

To what extent, if at all, do you believe the nicotine in cigarettes to be the chemical that causes most of the
cancer caused by smoking?
1
Not at all
2
A little
3
Somewhat
4
Very much
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5

MEDIA USE SECTION
PATH ID:

AX0494

Screen ID:

The next questions ask about your TV, radio, internet and cell phone use.
About how long do you spend watching TV on a typical day?
1
None
2
Less than 1 hour
3
1 to 2 hours
4
3 to 4 hours
5
More than 4 hours
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0060

Screen ID:

About how long do you listen to the radio on a typical day?
1
None
2
Less than 1 hour
3
1 to 2 hours
4
3 to 4 hours
5
More than 4 hours
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0486

Screen ID:

Overall, how often do you use the internet?
1 Several times a day
2 About once a day
3 3-5 days a week
4 1-2 days a week
5 Every few weeks
6 Less often
7 Don’t have regular internet access
-8 DON’T KNOW
-7 REFUSED
ASK: All respondents

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GO TO AX0055
GO TO AX0055
GO TO AX0055

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0062

Screen ID:

Do you have a Facebook, Google Plus, MySpace, Twitter, or other social networking account?
1
Yes
2
No
GO TO AX0487
-8
DON’T KNOW
GO TO AX0487
-7
REFUSED
GO TO AX0487
ASK: Respondents who have access to the internet (AX0486 NE 7, -8 OR -7)
PATH ID:

AX0063

Screen ID:

How often do you visit your Facebook, Google Plus, MySpace, Twitter, or other social networking account?
1
Several times a day
2
Daily
3
Weekly
4
Monthly or less
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have a Facebook or other social networking account (AX0062 = 1)
PATH ID:

AX0487

Screen ID:

In the past 6 months, have you ever signed up for email alerts about tobacco products, read articles online
about tobacco products, or watched a video online about tobacco products?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have access to the internet (AX0486 NE 7, -8 OR -7)
PATH ID:

AX0055

Screen ID:

Do you have a cell phone for personal use?
1
2
-8
-7

Yes
No
DON’T KNOW
REFUSED

GO TO NEXT SECTION
GO TO NEXT SECTION
GO TO NEXT SECTION

ASK: All respondents

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0495

Screen ID:

Is your cell phone a smart phone?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have a cell phone for personal use (AX0055=1)
PATH ID:

AX0056

Screen ID:

Do you send or receive text messages on your cell phone?
1
Yes
2
No
GO TO AX0058
-8
DON’T KNOW
GO TO AX0058
-7
REFUSED
GO TO AX0058
ASK: Respondents who have a cell phone for personal use (AX0055=1)
PATH ID:

AX0057

Screen ID:

On average, about how many text messages do you send and receive on a normal day?
1
-8
-7

I__I__I__I
DON’T KNOW
REFUSED

ASK: Respondents who send and receive text messages (AX0056=1)
GO TO: If AX0495 = 1, go to AX0058
Else go to NEXT SECTION
PATH ID:

AX0058

Screen ID:

Have you ever downloaded an app (or application) using your cell phone?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have a smart phone (AX0495=1)

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0496

Screen ID:

A Quick Response code is a white square with black dots in it, sometimes called a QR code.
[INSERT IMAGE OF QR CODE FOR PATH WEBSITE]
Have you ever used a smart phone to scan a QR code for a tobacco product or to enter a sweepstakes or
drawing from a tobacco company?
1
Yes
2
No
GO TO NEXT SECTION
-8 DON’T KNOW
GO TO NEXT SECTION
-7 REFUSED
GO TO NEXT SECTION
ASK: Respondents who have a smart phone (AX0495=1)
PATH ID:

AX0497

Screen ID:

Did this code take you to a tobacco company web site?
1
Yes
2
No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who have scanned a QR code (AX0496 = 1).

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Adult Extended Questionnaire
Version 7.5

SECONDHAND SMOKE EXPOSURE SECTION
DISPLAY TRANSITION TEXT: The next questions ask about tobacco use at your workplace and your
home.
PATH ID:

AM0014

Screen ID:

Which best describes your current job or paid employment status?
1
Work full-time at least 35 hours per week
2
Work part-time 15 to 34 hours per week
3
Work part-time less than 15 hours per week
4
I don't currently work for pay
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0064

GO TO AX0066
GO TO AX0066
GO TO AX0066

Screen ID:

Do you work indoors, outdoors, or in a vehicle? Choose all that apply.
1
Indoors
2
Outdoors
3
In a vehicle
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who work full time or part time (AM0014=1,2,3)
PATH ID:

AX0065

Screen ID:

How recently did someone smoke around you while you were at work?
1
Never
2
Today
3
In the past week
4
In the past two weeks
5
In the past month
6
Longer than a month ago but within the past year
7
More than a year ago
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who work full time or part time (AM0014=1,2,3)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR0144

Screen ID:

In your childhood, did you live with a regular smoker who smoked inside your home? Please think about
anyone who smoked cigarettes, cigars, a pipe or hookah.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0066

Screen ID:

Does anyone who lives with you now do any of the following? Choose all that apply.
1
Smoke cigarettes
2
Use smokeless tobacco, such as chewing tobacco, snuff, dip, or snus
3
Smoke cigars, cigarillos, or filtered cigars
4
Use any other form of tobacco
5
No one who lives with me now uses any form of tobacco
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents that do not live alone where other household members are reported (PL.HHSIZE > 1)
PROGRAM: Option 5 cannot be selected if options 1 through 4 are also selected.
PATH ID:

AR1045

Screen ID:

These next few questions ask about rules of using tobacco inside your home. Please think about everyone
who might be in your home including children, adults, visitors, guests, or workers.
For tobacco products that are burned, such as cigarettes, cigars, pipes or hookah, which statement best
describes the rules about smoking a tobacco product inside your home?
1
It is not allowed anywhere or at any time inside my home
2
It is allowed in some places or at some times inside my home
3
It is allowed anywhere and at any time inside my home
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AR1050

Screen ID:

Now think about other tobacco products that are not burned, like smokeless tobacco, dissolvable tobacco,
and electronic cigarettes. Which statement best describes the rules about using these products inside your
home?
1 It is not allowed anywhere or at any time inside my home
2 It is allowed in some places or at some times inside my home
3 It is allowed anywhere and at any time inside my home
-8 DON’T KNOW
-7 REFUSED
ASK: All respondents
PATH ID:

AX0068

Screen ID:

During the past seven days, about how many hours were you around others who were smoking[, whether or
not you were smoking yourself]? Include time in your home, in a car, at work, or outdoors.
I__I__I__I
Number of hours
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: If Current or Experimental Current user CIGS or CIGARFILL or PIPE or HOOK, display ‘,
whether or not you were smoking yourself’
1

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Adult Extended Questionnaire
Version 7.5

PEER AND FAMILY INFLUENCES
GO TO: If Current user TOB OR Experimental Current user TOB OR Former user 12 months TOB OR
Experimental Former user TOB, go to AX0070
Else go to AX0007
PATH ID:

AX0070

Screen ID:

In the past 12 months, to what extent, if at all, [has/did] the disapproval of close friends and family of your
smoking [led/lead] you to think about quitting?
1
Not at all
2
Somewhat
3
Very much
-8
DON’T KNOW
-7
REFUSED
ASK: Current, Experimental Current, Former user 12 month, and Experimental former tobacco users
PROGRAM: For Current and Experimental Current tobacco users display “has”, “led”; For Former user 12
month and Experimental Former tobacco users, display “did”, “lead”.
PATH ID:

AX0071

Screen ID:

Thinking about the people who are important to you, how would you describe their opinion on using
tobacco?
1
Very positive
2
Positive
3
Neither positve nor negative
4
Negative
5
Very negative
-8
DON’T KNOW
-7
REFUSED
ASK: Current, Experimental Current, Former user 12 month, and Experimental Former tobacco users
PATH ID:

AX0007

Screen ID:

How would you describe most people’s opinion of using tobacco?
1
Very positive
2
Positive
3
Neither positive nor negative
4
Negative
5
Very negative
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

196

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Adult Extended Questionnaire
Version 7.5

HEALTH EFFECTS OUTCOME SECTION
DISPLAY TRANSITION TEXT: The next questions ask about some basic medical information that is
important for the study.
PATH ID:

AX0090

Screen ID:

In general, how would you rate your physical health?
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0091

Screen ID:

In general, how would you rate your mental health, which includes stress, depression, and problems with
emotions?
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0088

Screen ID:

In general, would you say your overall health is…
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0185

Screen ID:

In general, would you say your quality of life is…
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0092

Screen ID:

In general, how satisfied are you with your social activities and relationships?
1
Extremely satisfied
2
Very satisfied
3
Moderately satisfied
4
A little satisfied
5
Not at all satisfied
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0310

Screen ID:

The next questions ask about your height and weight. Do you want to answer these questions in…
1
Feet and pounds, or
2
Meters and kilograms?
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

PATH – Wave 1
Adult Extended Questionnaire

GO TO AX0108
GO TO AX0311
GO TO AX0108
GO TO AX0108

198

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0108

Screen ID:

About how tall are you without shoes?
I__I
Feet
I__I__I
2
Inches
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who prefer to answer in feet (AX0310=1, -8 or -7)
PROGRAM: Range check: Feet (3 to 8); Inches (0 to 11).
1

PATH ID:

AX0311

Screen ID:

About how tall are you without shoes?
I__I__I.I__I__I
Meters
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who prefer to answer in meters (AX0310=2)
PROGRAM: Range check: Meters (0.9 to 2.7).
1

PATH ID:

AX0109

Screen ID:

About how much do you weigh without clothes or shoes?
I__I__I__I
Pounds
-8
DON’T KNOW
-7
REFUSED
ASKRespondents who prefer to answer in pounds (AX0310=1, -8 or -7)
PROGRAM: Range check: Pounds (75 to 450).
1

PATH ID:

AX0312

Screen ID:

About how much do you weigh without clothes or shoes?
I__I__I__I
Kilograms
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who prefer to answer in kilograms (AX0310=2)
PROGRAM: Range check: Kilograms (34 to 205).
1

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0001

Screen ID:

In the past 12 months, have you seen a medical doctor?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0002

Screen ID:

In the past 12 months, have you seen a dentist?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0302

Screen ID:

In the past 12 months, have you visited an emergency room or urgent care center for a health problem of
your own?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0186
GO TO AX0186
GO TO AX0186

AX0155

Screen ID:

In the past 12 months, how many times have you visited an emergency room or urgent care center for a
health problem of your own?
1
I__I__I
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
GO TO: If Current, Experimental Current, Former 12 month tobacco user or Experimental Former user, go to
AX0003
Else go to AX0186

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0003

Screen ID:

In the past 12 months, did any medical doctor, dentist or other health professional advise you to stop using
tobacco[ or e-cigarettes]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Experimental Former users that have quit in the past 12 months (AC1009 OR AE1009 OR AG1009
OR AP1009 OR AH1009 OR AS1009 OR AD1009 <= 12 months), Current users, Experimental Current
users, and Former 12 month tobacco users, who have seen a medical doctor (AX0001=1) or dentist
(AX0002=1)
PROGRAM: For respondents who use e-cigarettes (CURRENT USER ECIG OR EXPERIMENTAL
CURRENT USER ECIG OR FORMER USER 12 MONTH ECIG), display “ or e-cigarettes”.
PATH ID:

AX0104

Screen ID:

To what extent, if at all, has [using / your past use of] tobacco products damaged your health?
1
Not at all
2
A little
3
Somewhat
4
A lot
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who used any tobacco in their lifetime (EVER_USE_TOB = 1)
PROGRAM: For Current and Experimental Current tobacco users display “using”; For Former and
Experimental Former tobacco users display “your past use of”.
PATH ID:

AX0105

Screen ID:

To what extent, if at all, are you worried that [using / your past use of] tobacco products will damage your
health in the future?
1
Not at all worried
2
A little worried
3
Moderately worried
4
Very worried
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who used any tobacco in their lifetime (EVER_USE_TOB = 1)
PROGRAM: For Current and Experimental Current tobacco users display “using”; For Former and
Experimental Former tobacco users display “your past use of”.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0186

Screen ID:

The next set of questions is about limitations caused by any long-term physical, mental or emotional
problem or illness. Please do not include temporary conditions, such as a cold, [or ]broken limbs[, or
pregnancy].
Do you have serious difficulty walking or climbing stairs?
1
Yes
2
No
GO TO AX0094
-8
DON’T KNOW
GO TO AX0094
-7
REFUSED
GO TO AX0094
ASK: All respondents
PROGRAM: If female or gender unknown (AM0004=2, -8 or -7), display “, or pregancy”. If male
(AM0004=1), display “or “ (and do not display “, or pregancy).
PATH ID:

AX0093

Screen ID:

To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs,
carrying groceries, or moving a chair?
1
Completely
2
Mostly
3
Moderately
4
A little
5
Not at all
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have serious difficulty walking (AX0186=1)
PATH ID:

AX0094

Screen ID:

To what extent are you able to carry out your everyday activities such as using a telephone, paying bills,
taking medications, preparing light meals, doing laundry, or going shopping?
1
Completely
2
Mostly
3
Moderately
4
A little
5
Not at all
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0188

Screen ID:

Do you have difficulty dressing or bathing?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0097
GO TO AX0097
GO TO AX0097

AX0095

Screen ID:

To what extent are you able to carry out your everyday activities such as bathing, dressing, or getting
around the house?
1
Completely
2
Mostly
3
Moderately
4
A little
5
Not at all
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have difficulty dressing/bathing (AX0188=1)
PATH ID:

AX0097

Screen ID:

Does your health limit you in any of the following activities? Choose all that apply.
1
Lifting 10 pounds
2
Walking up 10 steps
3
Walking 3 blocks
4
Walking 1 mile
5
Standing 20 minutes
6
Bending or stooping
7
Reaching overhead
8
Using fingers to grasp
9
None of the above
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: Option 9 cannot be selected if any options 1 through 8 are selected.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0187

Screen ID:

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as
visiting a doctor's office or shopping?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0189

Screen ID:

Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating,
remembering, or making decisions?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0190

Screen ID:

Are you deaf or do you have serious difficulty hearing?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0100

Screen ID:

In the past 7 days, how would you rate your pain on average on a scale from 0 to 10 where 0 is no pain and
10 is the worst pain imaginable?
0
1
2
3
4
5
6
7
8
9
10

No pain

Worst pain imaginable

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Adult Extended Questionnaire
Version 7.5
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0101

Screen ID:

In the past 7 days, how would you rate your fatigue on average? By fatigue, we mean feeling unrested or
overly tired during the day, no matter how many hours of sleep you’ve had.
1
None
2
Mild
3
Moderate
4
Severe
5
Very severe
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

PATH ID:

AX0102

Screen ID:

In general, please rate how well you carry out your usual social activities and roles. This includes activities at
home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.
1
Excellent
2
Very Good
3
Good
4
Fair
5
Poor
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0103

Screen ID:

In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious,
depressed, or irritable?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0111

Screen ID:

Has a doctor or other health professional ever told you that you had any of the following heart conditions?
Choose all that apply.
1
2
3
4

High blood pressure
High cholesterol
Congestive heart failure
A stroke
A heart attack (also called myocardial infarction) or needed bypass
5
surgery
6
Some other heart condition
7
None of the above
-8 DON’T KNOW
-7 REFUSED
ASK: All respondents
PROGRAM: Option 7 cannot be selected if any option 1 through 6 is selected.
PATH ID:

AX0114

GO TO AX0114
GO TO AX0115
GO TO AX0116
GO TO AX0117
GO TO AX0112
GO TO AX0219
GO TO AX0119
GO TO AX0119
GO TO AX0119

Screen ID:

How old were you when you were first told you had high blood pressure?
1
|___|___|___| years old
GO TO AX0115
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had high blood pressure (AX0111 IN high blood pressure)
PATH ID:

AX0253

Screen ID:

When you were first told you had high blood pressure, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0114 (AX0114 = -8, -7).

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0115

Screen ID:

How old were you when you were first told you had high cholesterol?
1
|___|___|___| years old
GO TO AX0160
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had high cholesterol (AX0111 IN high cholesterol)
PATH ID:

AX0254

Screen ID:

When you were first told you had high cholesterol, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0115 (AX0115 = -8, -7).
PATH ID:

AX0160

Screen ID:

Have you ever taken any medications to reduce cholesterol, for example: pravastatin (Pravachol),
atorvastatin (Lipitor), simvastatin (Zocor)?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had high cholesterol (AX0111 IN high cholesterol)
PATH ID:

AX0116

Screen ID:

How old were you when you were first told you had congestive heart failure?
1
|___|___|___| years old
GO TO AX0117
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had congestive heart failure (AX0111 IN congestive heart failure)

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207

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0255

Screen ID:

When you were first told you had congestive heart failure, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0116 (AX0116 = -8, -7).
PATH ID:

AX0117

Screen ID:

How old were you when you were first told you had a stroke?
1
|___|___|___| years old
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had a stroke (AX0111 IN stroke)
PATH ID:

AX0256

GO TO AX0112

Screen ID:

When you were first told you had a stroke, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0117 (AX0117 = -8, -7).
PATH ID:

AX0112

Screen ID:

How old were you when you were first told you had a heart attack (also called myocardial infarction) or
needed bypass surgery?
1
|___|___|___| years old
GO TO AX0219
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had a heart attack (AX0111 IN heart attack)

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PATH ID:

AX0252

Screen ID:

When you were first told you had a heart attack (also called myocardial infarction) or needed bypass
surgery, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0112 (AX0112 = -8, -7).
PATH ID:

AX0219

Screen ID:

In the past 12 months, did you take any heart or blood pressure medications regularly? (Taken regularly
means according to a health care provider’s instructions.)
1
Yes
2
No
GO TO AX0119
-8
DON’T KNOW
GO TO AX0119
-7
REFUSED
GO TO AX0119
ASK: Respondents who have been told they had a heart condition (AX0111 IN 1, 2, 3, 4, 5, OR 6)
BOX – DISPLAY INSTRUCTIONS
For AX0159, display a “Yes” and “No” column with options for each response category.
PATH ID:

AX0159

Screen ID:

What type of heart or blood pressure medications do you regularly take?
1
2
3
4
5

Calcium Channel Blocker – for example: nifedipine (Procardia, Adalat), diltiazem
(Cardizem), amlodipine (Norvasc), verapamil (Calan), nisoldipine (Sular)
Beta Blocker – for example: metoprolol (Lopressor), atenolol (Tenormin), propranolol
(Inderal)
Angiotensin Receptor Blocker – for example: losartan (Cozaar), irbesartan (Avapro),
valsartan (Diovan), candesartan (Atacand), telmisartan (Micardis), olmesartan (Benicar)
Ace Inhibitor – for example: enalapril (Vasotec), lisinopril (Zestril, Prinivil), captopril
(Capoten), benazepril (Lotensin), quinapril (Accupril), fosinopril (Monopril)
Diuretic – for example: furosemide (Lasix), indapamide (Lozol), triamterene (Dyrenium),
thiazides (HCTZ), triamterene/HCTZ (Dyazide)

6

Digoxin (Lanoxin)

7

Methyldopa (Aldomet) or Hydralazine (Apresoline)

8

Other antiarrhythmics

9

Some other heart or blood pressure medication

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-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who took heart or blood pressure medications in the past 12 months (AX0219=1)
PATH ID:

AX0119

Screen ID:

Has a doctor or other health professional ever told you that you had any of the following lung or respiratory
conditions? Choose all that apply.
1
COPD
2
Chronic bronchitis
3
Emphysema
4
Asthma
5
Some other lung or respiratory condition
6
None of the above
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: Option 6 cannot be selected if any option 1 through 5 is selected.
PATH ID:

AX0120

GO TO AX0120
GO TO AX0121
GO TO AX0123
GO TO AX0124
GO TO AX0283
GO TO AX0129
GO TO AX0129
GO TO AX0129

Screen ID:

How old were you when you were first told you had COPD?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0121

ASK: Respondents who have had COPD (AX0119 IN COPD)
PATH ID:

AX0257

Screen ID:

When you were first told you had COPD, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0120 (AX0120 = -8, -7).

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PATH ID:

AX0121

Screen ID:

How old were you when you were first told you had chronic bronchitis?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0123

ASK: Respondents who have had chronic bronchitis (AX0119 IN chronic bronchitis)
PATH ID:

AX0258

Screen ID:

When you were first told you had chronic bronchitis, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0121 (AX0121 = -8, -7).
PATH ID:

AX0123

Screen ID:

How old were you when you were first told you had emphysema?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0124

ASK: Respondents who have had emphysema (AX0119 IN emphysema)
PATH ID:

AX0259

Screen ID:

When you were first told you had emphysema, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0123 (AX0123 = -8, -7).

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PATH ID:

AX0124

Screen ID:

How old were you when you were first told you had asthma?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0283

ASK: Respondents who have had asthma (AX0119 IN asthma)
PATH ID:

AX0260

Screen ID:

When you were first told you had asthma, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0124 (AX0124 = -8, -7).
PATH ID:

AX0283

Screen ID:

In the past 12 months, did you take medication regularly for COPD or asthma? (Taken regularly means
according to a health care provider’s instructions.)
1
Yes
2
No
GO TO AX0125
-8
DON’T KNOW
GO TO AX0125
-7
REFUSED
GO TO AX0125
ASK: Respondents who have been told they had COPD or asthma (AX0119 IN COPD OR ASTHMA)

DISPLAY INSTRUCTION: For AX0128, display as a stem and leaf question. For each leaf, display a
yes/no response.

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PATH ID:

AX0128

Screen ID:

In the past 12 months, which of the following medications did you regularly take for COPD or asthma?
Quick-relief inhaler - for example: albuterol (ProAir, Ventolin, Xopenex), ipratropium
(Atrovent), or a combination inhaler (Combivent)
Controller or long-acting inhaler including steroid inhaler – for example: beclomethasone
(Qvar), fluticasone (Flovent), salmeterol (Serevent), tiotropium (Spiriva), or a
combination inhaler (Advair)
Other controlling medication – for example: montelukast (Singulair), zafirlukast
(Accolate), theophylline, roflumilast (Daliresp)
Oral or injected steroid medication – for example: prednisone, prednisolone (Orapred),
dexamethasone (Decadron)

1
2
3
4
5

Oxygen therapy

6
Some other lung or respiratory medication
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who took medication regularly for COPD or asthma in the past 12 months (AX0283=1)
PATH ID:

AX0125

Screen ID:

In the past 12 months, have you had an asthma attack that required use of an oral or injected steroid
medication at the time of the attack? Examples of oral or injected steroid medications include prednisone,
prednisolone (Orapred), and dexamethasone (Decadron).
1
Yes
2
No
GO TO AX0127
-8
DON’T KNOW
GO TO AX0127
-7
REFUSED
GO TO AX0127
ASK: Respondents who have had asthma (AX0119 IN asthma)
PATH ID:

AX0126

Screen ID:

In the past 12 months, how many asthma attacks have you had that required use of an oral or injected
steroid medication at the time of the attack?
1

|___|___|___| episodes

-8

DON’T KNOW

-7

REFUSED

ASK: Respondents who have had an asthma attack in the past 12 months (AX0125=1)

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PATH ID:

AX0127

Screen ID:

In the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?
1
Yes
2
No
GO TO AX0129
-8
DON’T KNOW
GO TO AX0129
-7
REFUSED
GO TO AX0129
ASK: Respondents who have had asthma (AX0119 IN asthma)
PATH ID:

AX0282

Screen ID:

In the past 12 months, how many times have you had to visit an emergency room or urgent care center
because of asthma?
1

|___|___|___| times

-8

DON’T KNOW

-7

REFUSED

ASK: Respondents who have gone to emergency room for asthma (AX0127=1)
PATH ID:

AX0129

Screen ID:

Have you ever been told by a dentist, hygienist, or other health professional that you have gum disease?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0130
GO TO AX0130
GO TO AX0130

AX0131

Screen ID:

How old were you when you were first told you had gum disease?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0130

ASK: Respondents who have had gum disease (AX0129=1)

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PATH ID:

AX0261

Screen ID:

When you were first told you had gum disease, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0131 (AX0131 = -8, -7).
PATH ID:

AX0130

Screen ID:

Have you ever had treatment for [gum disease I your gums] such as scaling and root planing, sometimes
called deep cleaning?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: If respondent has had gum disease (AX0129=1), display ‘gum disease’. If not (AX0129=2, -8 or
-7), display ‘your gums’.
PATH ID:

AX0132

Screen ID:

Have you ever been told by a doctor, dentist, or other health professional that you have pre-cancerous oral
lesions?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0281
GO TO AX0281
GO TO AX0281

AX0133

Screen ID:

How old were you when you were first told you had pre-cancerous oral lesions?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0281

ASK: Respondents who have had pre-cancerous oral lesions ( AX0132=1)

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PATH ID:

AX0262

Screen ID:

When you were first told you had pre-cancerous oral lesions, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0133 (AX0133 = -8, -7).
PATH ID:

AX0281

Screen ID:

Have you ever been told by a doctor or other health professional that you have diabetes, sugar diabetes,
high blood sugar, or borderline diabetes?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0141
GO TO AX0141
GO TO AX0141

AX0280

Screen ID:

How old were you when you were first told you had diabetes, sugar diabetes, high blood sugar, or borderline
diabetes?
1

|___|___|___| years old

-8

DON’T KNOW

-7

REFUSED

GO TO AX0141

ASK: Respondents who have diabetes or raised glucose levels ( AX0281=1)

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PATH ID:

AX0263

Screen ID:

When you were first told you had diabetes, sugar diabetes, high blood sugar, or borderline diabetes, were
you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0280 (AX0280 = -8, -7).
PATH ID:

AX0141

Screen ID:

Have you ever been told by a doctor or other health professional that you had an ulcer? Include stomach,
duodenal or peptic ulcers.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0147
GO TO AX0147
GO TO AX0147

AX0143

Screen ID:

How old were you when you were first told you had an ulcer?
1
|___|___|___| years old
GO TO AX0147
-8
DON’T KNOW
-7
REFUSED
ASK: Respondent who were told they had an ulcer (AX0141=1)
PATH ID:

AX0264

Screen ID:

When you were first told you had an ulcer, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0143 (AX0143 = -8, -7).

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PATH ID:

AX0147

Screen ID:

Have you ever been told by a doctor or other health professional that you had stomach or other gastrointestinal bleeding?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0149
GO TO AX0149
GO TO AX0149

AX0148

Screen ID:

How old were you when you were first told you had stomach or other gastro-intestinal bleeding?
1
|___|___|___| years old
GO TO AX0149
-8
DON’T KNOW
-7
REFUSED
ASK: Respondent who were told they had stomach or other GI bleeding (AX0147=1)
PATH ID:

AX0266

Screen ID:

When you were first told you had stomach or other gastro-intestinal bleeding, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0148 (AX0148 = -8, -7).
PATH ID:

AX0149

Screen ID:

Have you ever been told by a doctor or other health professional that you have osteoporosis, sometimes
called thin or brittle bones?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

PATH – Wave 1
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GO TO AX0196
GO TO AX0196
GO TO AX0196

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PATH ID:

AX0150

Screen ID:

How old were you when you were first told you had osteoporosis, sometimes called thin or brittle bones?
1
|___|___|___| years old
GO TO AX0196
-8
DON’T KNOW
-7
REFUSED
ASK: Respondent who were told they had osteoporosis or had a history of unexplained bone fractures
(AX0149=1)
PATH ID:

AX0267

Screen ID:

When you were first told you had osteoporosis, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0150 (AX0150 = -8, -7).
PATH ID:

AX0196

Screen ID:

Have you ever been told by a doctor or health professional that you had a bone fracture because you have
fragile bones?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0191
GO TO AX0191
GO TO AX0191

AX0198

Screen ID:

How old were you when you were first told you had a bone fracture because you have fragile bones?
1
|___|___|___| years old
GO TO AX0191
-8
DON’T KNOW
-7
REFUSED
ASK: Respondent who were told they had a bone fracture (AX0196=1)

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PATH ID:

AX0268

Screen ID:

When you were first told you had a bone fracture because of fragile bones, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0198 (AX0198 = -8, -7).
PATH ID:

AX0191

Screen ID:

Are you blind or do you have serious difficulty seeing, even when wearing glasses?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0151

Screen ID:

Have you ever been told by a doctor or other health professional that you have a cataract or glaucoma?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0144
GO TO AX0144
GO TO AX0144

AX0152

Screen ID:

How old were you when you were first told you had a cataract or glaucoma?
1
|___|___|___| years old
GO TO AX0144
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who were told they had a cataract or glaucoma (AX0151=1)

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PATH ID:

AX0269

Screen ID:

When you were first told you had a cataract or glaucoma, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0152 (AX0152 = -8, -7).
PATH ID:

AX0144

Screen ID:

Have you ever been told by a doctor or other health professional that you had cancer?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0158
GO TO AX0158
GO TO AX0158

AX0145

Screen ID:

What kind of cancer? Choose all that apply. [ If you do not see the kind below, touch the button marked
“NEXT”. I If you do not see the kind below, touch the box marked “OTHER”. ]
PROGRAM:
[If screens 1-3] Display: If you do not see the kind below, touch the button marked “NEXT”.
[If last screen] Display: If you do not see the kind below, touch the box marked “OTHER”.
1
2
3
4
5
6
7
8
9
10
11
12
13

BLADDER
BLOOD
BONE
BRAIN
BREAST
CERVIX (CERVICAL)
COLON
ESOPHAGUS (ESOPHAGEAL)
GALLBLADDER
KIDNEY
LARYNX/WINDPIPE
LEUKEMIA
LIVER

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14
LUNG
15
LYMPHOMA/HODGKINS' DISEASE
16
MELANOMA
17
MOUTH/TONGUE/LIP
18
NERVOUS SYSTEM
19
OVARY (OVARIAN)
20
PANCREAS (PANCREATIC)
21
PROSTATE
22
RECTUM (RECTAL)
23
SKIN (NON-MELANOMA)
24
SKIN (DON'T KNOW WHAT KIND)
25
SOFT TISSUE (MUSCLE OR FAT)
26
STOMACH
27
TESTIS (TESTICULAR)
28
THROAT
29
THYROID
30
UTERUS (UTERINE)
31
OTHER
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have had cancer (AX0144=YES)
PATH ID:

AX0146

Screen ID:

At what age were you first diagnosed with [TYPE OF CANCER/cancer]?
1 |___|___|___| years old
GO TO AX0158
-8 DON’T KNOW
-7 REFUSED
ASK: Respondent who reported having cancer (AX0144=1)
PROGRAM: Fill TYPE OF CANCER with AX0145. Repeat for each type.
For English: If AX0145=31, -8 or -7, display ‘cancer’. If AX0145=12 or 15, only display text in response
option and do not display ‘cancer’. If AX0145=6, 8, 19, 20, 22, 27, or 30, only display the text that is shown
in parentheses in the response option and ‘cancer’ (ex. “cervical cancer” instead of “cervix (cervical)
cancer”). Else, display text as shown in option and ‘cancer’.

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PATH ID:

AX0265

Screen ID:

When you were first diagnosed with [TYPE OF CANCER/cancer], were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0146 (AX0146 = -8, -7).
PROGRAM: Fill TYPE OF CANCER with AX0145.
If AX0145=31, -8 or -7, display ‘cancer’. If AX0145=12 or 15, only display text in response option and do not
display ‘cancer’. If AX0145=6, 8, 19, 20, 22, 27, or 30, only display the text that is shown in parentheses in
the response option and ‘cancer’ (ex. “cervical cancer” instead of “cervix (cervical) cancer”). Else, display
text as shown in option and ‘cancer’.
BOX – DISPLAY INSTRUCTIONS
For AX0158, display a ‘Yes’ and ‘No’ column with options for each response category.
PATH ID:

AX0158

Screen ID:

Do you take any of the following medications? Choose all that apply.
1
2
3

Aspirin
Tylenol (acetaminophen)
Cox-2 inhibitors, for example: Celebrex
Other anti-inflammatory medications, for example:
4
ibuprofen, Motrin, Advil, Naprosyn, or Aleve
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0156

GO TO AX0154
GO TO AX0154
GO TO AX0154
GO TO AX0154
GO TO AX0154

Screen ID:

On average, in the past 12 months, how frequently do you take aspirin? Please do not count other pain
relievers such as Ibuprofen and Tylenol.
1
2
3
4
5
6
7

Never
Less than once a month
1-3 days per month
1-2 days per week
3-4 days per week
5-6 days per week
Daily

PATH – Wave 1
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-8
DON’T KNOW
GO TO AX0154
-7
REFUSED
GO TO AX0154
ASK: Respondents who report taking aspirin (AX0158(1)=1)
PATH ID:

AX0157

Screen ID:

What type of aspirin do you usually take?
1
Baby aspirin (162 mg or less)
2
Regular or extra strength aspirin
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have taken aspirin in the past 12 months (AX0156>1)
PATH ID:

AX0154

Screen ID:

The next questions ask about your close biological or blood relatives, including your father, mother, sisters
or brothers, both living and deceased.
Were any of your close biological or blood relatives ever told by a health professional that they had asthma?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0153

Screen ID:

Were any of your close biological or blood relatives ever told by a health professional that they had a heart
attack or needed bypass surgery?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0488
GO TO AX0488
GO TO AX0488

AX0195

Screen ID:

Were they told they had a heart attack or needed bypass surgery before the age of 50?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents whose close relative had heart attack (AX0153=1)

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Adult Extended Questionnaire

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0488

Screen ID:

The following questions are about common psychological, behavioral, and personal problems. These
problems are considered significant when you have them for two or more weeks, when they keep coming
back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go
on.
After each of the following questions, please tell us the last time, if ever, you had the problem, by answering
whether it was in the past month, 2-12 months ago, over a year ago, or never.
ASK: All respondents.
PATH ID:

AX0161

Screen ID:

When was the last time that you had significant problems with…
Feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0162

Screen ID:

When was the last time that you had significant problems with…
Sleep trouble, such as bad dreams, sleeping restlessly, or falling asleep during the day?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0163

Screen ID:

When was the last time that you had significant problems with…
Feeling very anxious, nervous, tense, scared, panicked, or like something bad was going to happen?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0164

Screen ID:

When was the last time that you had significant problems with…
Becoming very distressed and upset when something reminded you of the past?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0165

Screen ID:

When was the last time that you did the following things two or more times...
Lied or conned to get things you wanted or to avoid having to do something?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0166

Screen ID:

When was the last time that you did the following things two or more times...
Had a hard time paying attention at school, work, or home?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0167

Screen ID:

When was the last time that you did the following things two or more times…
Had a hard time listening to instructions at school, work, or home?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0168

Screen ID:

When was the last time that you did the following things two or more times…
Were a bully or threatened other people?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0169

Screen ID:

When was the last time that you did the following things two or more times…
Started physical fights with other people?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AX0250

Screen ID:

When was the last time that you did the following things two or more times…
Felt restless or the need to run around or climb on things?
1
2
3
4
-8
-7
ASK: All respondents
PATH ID:

Past month
2 to 12 months ago
Over a year ago
Never
DON’T KNOW
REFUSED

AX0251

Screen ID:

When was the last time that you did the following things two or more times…
Gave answers before the other person finished asking the question?
1
2
3
4
-8
-7
ASK: All respondents

PATH – Wave 1
Adult Extended Questionnaire

Past month
2 to 12 months ago
Over a year ago
Never
DON’T KNOW
REFUSED

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0084

Screen ID:

The next questions ask about your use of alcohol and other drugs. Remember all the information you give
to the PATH Study will be kept private.
Have you ever used alcohol at all, including sips of someone’s drink or your own drink?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AX0085
GO TO AX0085
GO TO AX0085

AX0086

Screen ID:

About how old were you when you first drank alcohol at all, counting small tastes or sips?
1
|__|__| years old
GO TO AX0074
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used alcohol (AX0084=1)
PATH ID:

AX0087

Screen ID:

When you first drank alcohol at all, counting small tastes or sips, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0086 (AX0086 = -8, -7).
PATH ID:

AX0074

Screen ID:

About how old were you when you had your first alcoholic drink, other than small tastes or sips?
A drink is a can or bottle of beer; a wine cooler or a glass of wine, champagne, or sherry; a shot of liquor or
a mixed drink or cocktail.
1
I have never had a drink of alcohol other than a few sips
2
I___I___I years old
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used alcohol (AX0084=1)

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229

GO TO AX0073
GO TO AX0073

PATH
Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0270

Screen ID:

When you had your first alcoholic drink, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0074 (AX0074 = -8, -7).
GO TO: If Ever User Tobacco, go to AX0077
Else go to AX0073
PATH ID:

AX0077

Screen ID:

[At the age that you first started drinking | When you were AGE OF ALCOHOL USE years old], did you also [
smoke cigarettes | use tobacco products | smoke cigarettes or use other tobacco products ]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Ever tobacco users if onset of tobacco use precedes onset of alcohol use (age in AC1006 or AE1006
or AG1006 or AP1006 or AH1006 or AS1006 or AD1006 < age in AX0074).
PROGRAM: If AX0074=-8 or -7, display "At the age that you first started drinking". If AX0074 NE -8 or -7,
display "When you were AGE OF ALCOHOL USE years old" and fill with age reported in AX0074.
If cigarette-only user (EVER_USER_CIG=1 ONLY), display “smoke cigarettes”.
If non-cigarette tobacco user (EVER_USER_CIG=2 AND EVER USER ECIG=1 OR EVER USER GTRAD=1
OR EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display “use
tobacco products”.
If cigarette+tobacco user (EVER_USER_CIG=1 AND EVER USER ECIG=1 OR EVER USER GTRAD=1 OR
EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display
“smoke cigarettes or use other tobacco products”.

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Adult Extended Questionnaire
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PATH ID:

AX0073

Screen ID:

How long has it been since you last used alcohol?
1
Within the past 30 days
2
More than 30 days ago, but within the past year
GO TO AX0303
3
More than a year ago
GO TO AX0303
-8
DON’T KNOW
GO TO AX0303
-7
REFUSED
GO TO AX0303
ASK: Respondents who have ever used alcohol (AX0084=1)
GO TO: If AX0073 NE 1 AND female respondent has been pregnant (AX0134=1) AND has ever used
alcohol (AX0084=1), GO TO AX0303.
Else if AX0073 NE 1, GO TO AX0085.
PATH ID:

AX0075

Screen ID:

In the past 30 days, on how many days did you have one or more alcoholic drinks?
Count a drink as a can or bottle of beer; a wine cooler or a glass of wine, champagne, or sherry; a shot of
liquor or a mixed drink or cocktail.
|__|__|
[RANGE: 0 - 30]
Number of days
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used alcohol (AX0084=1) and have used alcohol in the past 30 days
(AX0073=1)
1

PATH ID:

AX0076

Screen ID:

On average, on those [days that you drank in the past 30 days I NUMBER OF DAYS FROM AX0075 days],
how many alcoholic drinks did you usually have each day?
Count a drink as a can or bottle of beer; a wine cooler or a glass of wine, champagne, or sherry; a shot of
liquor or a mixed drink or cocktail.
|__|__|
[RANGE: 1 - 90]
Number of drinks
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who drank alcohol one or more days (AX0075 NE 0)
PROGRAM: If AX0075=-8 or -7, FILL=[days that you drank in the past 30 days].
If AX0075 > 0, fill NUMBER OF DAYS FROM AX0075 with the number reported.
1

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0085

Screen ID:

Have you ever used marijuana, hash, THC, grass, pot or weed?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: If AG9105=1, do not ask this question.
PATH ID:

AX0079

GO TO AX0089
GO TO AX0089
GO TO AX0089

Screen ID:

How old were you when you first used marijuana, hash, THC, grass, pot, or weed?
1
I___I___I___I years old
GO TO AX0080
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used marijuana (AX0085=1 OR AG9105=1)
PATH ID:

AX0271

Screen ID:

When you first used marijuana, hash, THC, grass, pot, or weed, were you…
1
Less than 18 years old,
2
18 to 24 years old,
3
25 to 34 years old,
4
35 to 44 years old,
5
45 to 54 years old, or
6
55 years old or older?
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who refused to give or did not know age in AX0079 (AX0079 = -8, -7).
GO TO: If Ever user Tobacco, go to AX0080
Else go to AX0078

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0080

Screen ID:

[At the age that you first started using marijuana, hash, THC, grass, pot, or weed | When you were AGE OF
MARIJUANA USE years old], did you also [ smoke cigarettes | use tobacco products | smoke cigarettes or
use other tobacco products ]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Ever tobacco users if onset of tobacco use precedes onset of marijuana use (age in AC1006 or
AE1006 or AG1006 or AP1006 or AH1006 or AS1006 or AD1006 < age in AX0079).
PROGRAM: If AX0079=-8 or -7, display "At the age that you first started using marijuana, hash, THC, grass,
pot, or weed". If AX0079 NE -8 or -7, display "When you were AGE OF MARIJUANA USE years old" and fill
with age reported in AX0079.
If cigarette-only user (EVER_USER_CIG=1 ONLY), display “smoke cigarettes”.
If non-cigarette tobacco user (EVER_USER_CIG=2 AND EVER USER ECIG=1 OR EVER USER GTRAD=1
OR EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display “use
tobacco products”.
If cigarette+tobacco user (EVER_USER_CIG=1 AND EVER USER ECIG=1 OR EVER USER GTRAD=1 OR
EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display
“smoke cigarettes or use other tobacco products”.
PATH ID:

AX0078

Screen ID:

How long has it been since you last used marijuana, hash, THC, grass, pot, or weed? Was it …
1
Within the past 30 days
2
More than 30 days ago, but within the past year
3
More than a year ago
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used marijuana (AX0085=1 OR AG9105=1)

BOX – DISPLAY INSTRUCTIONS
For AX0089, display a “Yes” and “No” column with options for each response category.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0089

Screen ID:

Have you ever used any of the following prescription drugs that were not prescribed for you or that you took
only for the experience or feeling they caused?
1
Ritalin® or Adderall®
2
Painkillers, sedatives, or tranquilizers
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
BOX – DISPLAY INSTRUCTIONS
For AX0220, display a “Yes” and “No” column with options for each response category.
PATH ID:

AX0220

Screen ID:

Have you ever used any of the following substances?
1
Cocaine or crack
2
Stimulants like methamphetamine or speed
3
Any other drugs like heroin, inhalants, solvents, or hallucinogens
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
BOX – FILL INSTRUCTIONS
CREATE [SUBSTANCEFILL]
Display: If AX0089[1]=1, display ‘Ritalin® or Adderall®’
If AX0089[2]=1, display ‘painkillers, sedatives, or tranquilizers’
If AX0220[1]=1, display ‘cocaine or crack’
If AX0220[2]=1, display ‘stimulants like methamphetamine or speed’
If AX0220[3]=3, display ‘any other drugs like heroin, inhalants, solvents, or hallucinogens’
Repeat AX0081- AX0083 for each group of substances respondent reports ever using in AX0089 and
AX0220.
Else, GO TO BOX SA

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0082

Screen ID:

How old were you when you first used [SUBSTANCEFILL]?
1
I___I___I___I years old
GO TO AX0083
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who have ever used [SUBSTANCEFILL] (AX0089[1]=1 OR AX0089[2]=1 OR
AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
PATH ID:

AX0272

Screen ID:

When you first used [SUBSTANCEFILL], were you…
1 Less than 18 years old,
2 18 to 24 years old,
3 25 to 34 years old,
4 35 to 44 years old,
5 45 to 54 years old, or
6 55 years old or older?
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who refused to give or did not know age in AX0082 (AX0082 = -8, -7).
PATH ID:

AX0083

Screen ID:

[At the age that you first started using [SUBSTANCEFILL] | When you were AGE OF SUBSTANCE USE
years old], did you also [smoke cigarettes | use tobacco products | smoke cigarettes or use other tobacco
products]?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Ever tobacco users if onset of tobacco use precedes onset of substance use (age in AC1006 or
AE1006 or AG1006 or AP1006 or AH1006 or AS1006 or AD1006 < age in AX0084).
PROGRAM: If AX0082=-8 or -7, display "At the age that you first started using [SUBSTANCEFILL]". If
AX0082 NE -8 or -7, display "When you were AGE OF SUBSTANCE USE years old" and fill with age
reported in AX0082.
If cigarette-only user (EVER_USER_CIG=1 ONLY), display “smoke cigarettes”.
If non-cigarette tobacco user (EVER_USER_CIG=2 AND EVER USER ECIG=1 OR EVER USER GTRAD=1
OR EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display “use
tobacco products”.
If cigarette+tobacco user (EVER_USER_CIG=1 AND EVER USER ECIG=1 OR EVER USER GTRAD=1 OR
EVER USER GRILLO=1 OR EVER USER GFILTER=1 OR EVER USER PIPE=1 OR EVER USER
HOOK=1 OR EVER USER SNUS=1 OR EVER USER SMKLS=1 OR EVER USER DISSBL=1), display
“smoke cigarettes or use other tobacco products”.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0081

Screen ID:

How long has it been since you last used [SUBSTANCEFILL]? Was it …
1
Within the past 30 days
2
More than 30 days ago, but within the past year
3
More than a year ago
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents that have ever used [SUBSTANCEFILL] (AX0089[1]=1 OR AX0089[2]=1 OR
AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
BOX SA
PROGRAM:
If AX0084=1 OR AX0085=1 OR AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR
AX0220[2]=1 OR AX0220[3]=1, GO TO AX0170.
If no substances were selected in AX0084=2, -8 or -7 AND AX0085=2, -8 or -7 AND AG9105=2, -8 or -7
AND AX0089[1]=2, -8 or -7 AND AX0089[2]=2, -8 or -7 AND AX0220[1]=2, -8 or -7 AND AX0220[2]=2, -8 or
-7 AND AX0220[3]=2, -8 or -7, AND FEMALE RESPONDENT (AM0004=2), GO TO AX0134; IF MALE
RESPONDENT (AM0004=1, -8 or -7). GO TO AX0177.
PATH ID:

AX0170

Screen ID:

When was the last time that…
You used alcohol or other drugs weekly or more often?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1))
BOX SA2
If respondent reports ever using only one substance (ONE SELECTED IN AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1), go to
AX0171.
If respondent reports ever using two or more substances (TWO OR MORE SELECTED IN AX0084=1 OR
AX0085=1 OR AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR
AX0220[3]=1), go to AX0175.

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0175

Screen ID:

You mentioned that you used alcohol or drugs at least weekly sometime in the past. Which substances did
you use weekly or more often? Please do not include drugs that were prescribed for you. Choose all that
apply.
1
Alcohol
2
Marijuana, hash, THC, or grass, pot, or weed
3
Ritalin® or Adderall®
4
Painkillers, sedatives, or tranquilizers
5
Cocaine or crack
6
Stimulants like methamphetamine or speed
7
Any other drugs like heroin, inhalants, solvents, or hallucinogens
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who used alcohol or other drugs weekly or more often (AX0170 IN (1,2,3)) AND report
ever using two or more substances (TWO OR MORE IN AX0084=1 OR AX0085=1 OR AG9105=1 OR
AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
PROGRAM: List only those substances a respondent previously indicated he/she has ever used. Display
option 1 if AX0084=1; display option 2 if AX0085=1 OR AG9105=1; display option 3 if AX0089[1]=1; display
option 4 if AX0089[2]=1; display option 5 if AX0220[1]=1; display option 6 if AX0220[2]=1; display option 7 if
AX0220[3]=1.
GO TO: If AX0193 IN (1,2,3) OR AX0172 IN (1,2,3) OR AX0173 IN (1,2,3) OR AX0174 IN (1,2,3) OR
AX0194 IN (1,2,3), go to AX0176
Else if AM0004=2, go to AX0134
Else go to AX0177
PATH ID:

AX0171

Screen ID:

When was the last time that…
You spent a lot of time getting alcohol or other drugs?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0193

Screen ID:

When was the last time that…
You spent a lot of time using or recovering from alcohol or other drugs?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
PATH ID:

AX0172

Screen ID:

When was the last time that…
You kept using alcohol or other drugs even though it was causing social problems, leading to fights, or
getting you into trouble with other people?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
PATH ID:

AX0173

Screen ID:

When was the last time that…
Your use of alcohol or other drugs reduced your involvement with activities at work, school, home, or social
events?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)

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Adult Extended Questionnaire
Version 7.5
PATH ID:

AX0174

Screen ID:

When was the last time that…
You had withdrawal problems such as shaky hands, throwing up, having trouble sitting still or sleeping?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
PATH ID:

AX0194

Screen ID:

When was the last time that…
You used any alcohol or other drugs to stop being sick or avoid withdrawal problems?
1
Past month
2
2 to 12 months ago
3
Over a year ago
4
Never
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who report ever using alcohol or ever using drugs (AX0084=1 OR AX0085=1 OR
AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR AX0220[3]=1)
GO TO: If AX0193 IN (1,2,3) OR AX0172 IN (1,2,3) OR AX0173 IN (1,2,3) OR AX0174 IN (1,2,3) OR
AX0194 IN (1,2,3), AND ever used two or more substances (TWO OR MORE SELECTED IN AX0084=1 OR
AX0085=1 OR AG9105=1 OR AX0089[1]=1 OR AX0089[2]=1 OR AX0220[1]=1 OR AX0220[2]=1 OR
AX0220[3]=1), go to AX0176.
If AM0004=2, go to AX0134
Else go to AX0177.

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PATH ID:

AX0176

Screen ID:

You mentioned that alcohol or drugs caused some problems for you. Which substances caused these
problems? Please do not include drugs that were prescribed for you. Choose all that apply.
1 Alcohol
2 Marijuana, hash, THC, grass, pot, or weed
3 Ritalin® or Adderall®
4 Painkillers, sedatives, or tranquilizers
5 Cocaine or crack
6 Stimulants like methamphetamine or speed
7 Any other drugs like heroin, inhalants, solvents, or hallucinogens
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who indicated alcohol or drugs caused problems for them (AX0193 IN (1,2,3) OR
AX0172 IN (1,2,3) OR AX0173 IN (1,2,3) OR AX0174 IN (1,2,3) OR AX0194 IN (1,2,3).
PROGRAM: List only those substances a respondent previously indicated he/she has ever used. Display
option 1 if AX0084=1; display option 2 if AX0085=1 OR AG9105=1; display option 3 if AX0089[1]=1; display
option 4 if AX0089[2]=1; display option 5 if AX0220[1]=1; display option 6 if AX0220[2]=1; display option 7 if
AX0220[3]=1.
GO TO: GO TO: If AM0004 = 2, go to AX0134
Else go to AX0177
PATH ID:

AX0134

Screen ID:

The next questions are about your pregnancy history.
Have you ever been pregnant? Please include current pregnancy, live births, miscarriages, abortions,
ectopic or tubal pregnancies and stillbirths.
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents (AM0004=2)
PATH ID:

GO TO AX0084
GO TO AX0084
GO TO AX0084

AX0135

Screen ID:

Have any of your pregnancies ended in the following? Choose all that apply.
1
Miscarriage
2
Abortion
3
Ectopic or tubal pregnancy
4
Stillbirth
5
None of the above
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have been pregnant (AX0134=1)

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PATH ID:

AX0308

Screen ID:

How many of your pregnancies have resulted in a live birth?
1
|___|___|
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have been pregnant (AX0134=1)
GO TO: If AX0308 > 0, go to AX0300
Else if Age < 50, go to AX0136
Else go to AX0084
PATH ID:

AX0300

Screen ID:

For [that birth \ those FILL## births], did any of the following occur? Choose all that apply.
1
Preterm birth (birth of baby less than 37 weeks gestational age)
2
Baby with low birth weight (less than 5 pounds 8 ounces)
3
Baby with birth defects
4
Placenta Previa
5
Placenta Abruption
6
Pre-eclampsia
7
None of the above
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have had a live birth (AX0308 > 0)
PROGRAM: If AX0308=1, display “that birth”. If AX0308>1, display: ‘those ## births’, FILL## with number
of births in AX0308.
PATH ID:

AX0136

Screen ID:

Are you pregnant now?
1
Yes
2
No
GO TO AX0309
-8 DON’T KNOW
GO TO AX0309
-7 REFUSED
GO TO AX0309
ASK: Female respondents who are <50 years old AND have ever been pregnant (AX0134=1)

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PATH ID:

AX0137

Screen ID:

How many months or weeks pregnant are you? Please enter the number of months or weeks.
|___|___|
Months
|___|___|
2
Weeks
-8 DON’T KNOW
-7 REFUSED
ASK: Female respondents who are currently pregnant (AX0136=1)
1

PATH ID:

AX0309

Screen ID:

In thinking of your most recent pregnancy, in what year did you become pregnant?
|___|___|___|___|
Year
-8 DON’T KNOW
-7 REFUSED
ASK: Female respondents that report ever being pregnant (AX0134=1) but are not currently pregnant
(AX0136=2)
1

PATH ID:

AX0303

Screen ID:

During your [most recent / current] pregnancy, [did you consume / have you consumed] any alcoholic
drinks?
A drink is a can or bottle of beer; a wine cooler or a glass of wine, champagne, or sherry; a shot of liquor or
a mixed drink or cocktail.
1
Yes
2
No
GO TO AX0304
-8
DON’T KNOW
GO TO AX0304
-7
REFUSED
GO TO AX0304
ASK: Female respondents who have been pregnant (AX0134=1) and who have ever used alcohol
(AX0084=1)
PROGRAM: Display “current”, “have you consumed” if currently pregnant (AX0136=1). Else display “most
recent”, “did you consume”.

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PATH ID:

AX0138

Screen ID:

During your [most recent / current] pregnancy, how many alcoholic drinks [did/have] you [have/had] in an
average week?
A drink is a can or bottle of beer; a wine cooler or a glass of wine, champagne, or sherry; a shot of liquor or
a mixed drink or cocktail.
1
Less than 1 drink a week
2
1 to 3 drinks a week
3
4 to 6 drinks a week
4
7 to 13 drinks a week
5
14 drinks or more a week
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have ever been pregnant and consumed alcoholic drinks during their most
recent pregnancy (AX0303 = 1)
PROGRAM: If currently pregnant (AX0136=1), display “current”, “have” and “had”. Else display “most
recent”, “did” and “have”.
PATH ID:

AX0304

Screen ID:

During your [most recent / current] pregnancy, [did you smoke / have you smoked] any cigarettes?
1
Yes
2
No
GO TO AX0305
-8
DON’T KNOW
GO TO AX0305
-7
REFUSED
GO TO AX0305
ASK: Female respondents who have been pregnant (AX0134=1) and have ever smoked cigarettes
(EVER_USER_CIG = 1)
PROGRAM: Display “current”, “have you smoked” if currently pregnant (AX0136=1). Else display “most
recent”, “did you smoke”.

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PATH ID:

AX0139

Screen ID:

During your [most recent / current] pregnancy, how many cigarettes [did you smoke/have you smoked] on
an average day?
A pack usually has 20 cigarettes in it.
1
Less than 1 cigarette a day
2
1 to 5 cigarettes a day
3
6 to 10 cigarettes a day
4
11 to 20 cigarettes a day
5
21 to 40 cigarettes a day
6
41 cigarettes or more a day
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have ever been pregnant (AX0134=1) and smoked cigarettes during their
most recent pregnancy (AX0304=1)
PROGRAM: Display “current”, “have you smoked” if currently pregnant (AX0136=1). Else display “most
recent”, “did you smoke”.
PATH ID:

AX0305

Screen ID:

During your [most recent/ current] pregnancy, [did/have] you [TOBACCO PRODUCT LIST]??
1
Yes
2
No
GO TO AX0141
-8
DON’T KNOW
GO TO AX0141
-7
REFUSED
GO TO AX0141
ASK: Female respondents who have ever been pregnant (AX0134=1) and have ever used any tobacco in
lifetime (EVER USER ECIG=1 OR EVER USER GTRAD=1 OR EVER USER GRILLO=1 OR EVER USER
GFILTER=1 OR EVER USER PIPE=1 OR EVER USER HOOK=1 OR EVER USER SNUS=1 OR EVER
USER SMKLS=1 OR EVER USER DISSBL=1
PROGRAM: [TOBACCO PRODUCT LIST] = A list of all tobacco products the respondent has ever used,
excluding cigarettes.
If EVER USER ECIG=1 then include “use any e-cigarettes”. (If AX0136=1, include “used any e-cigarettes”).
If EVER USER GTRAD=1 then include “smoke any cigars”. (If AX0136=1, include “smoked any cigars”).
If EVER USER GRILLO=1 then include “smoke any cigarillos”. (If AX0136=1, include “smoked any
cigarillos”).
If EVER USER GFILTER=1 then include “smoke any filtered cigars”. (If AX0136=1, include “smoked any
filtered cigars”).
If EVER USER PIPE=1 then include “smoke a pipe any”. (If AX0136=1, include “smoked a pipe any”).
If EVER USER HOOK=1 then include “smoke hookah any”. (If AX0136=1, include “smoked hookah any”).
If EVER USER SNUS=1 then include “use any snus”. (If AX0136=1, include “used any snus”).
If EVER USER SMKLS=1 then include “use any smokeless tobacco”. (If AX0136=1, include “used any
smokeless tobacco”).
If EVER USER DISSBL=1 then include “use any dissolvable tobacco”. (If AX0136=1, include “used any
dissolvable tobacco”).

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DISPLAY:
If currently pregnant (AX0136=1), display “current” and “have”. Else, display “most recent” and “did”.
If EVER USER of one product, then display as shown.
If EVER USER of two products, use “and” to connect the two displays.
If EVER USER of three or more products, format the list with commas between each display, and with “, or”
before the last item in the list.
PATH ID:

AX0140

Screen ID:

During your [most recent/ current] pregnancy, how many times [did/have] you [TOBACCO PRODUCT LIST]
on an average day?
1
Less than 1 time a day
2
1 to 5 times a day
3
6 to 10 times a day
4
11 to 20 times a day
5
21 to 40 times a day
6
41 times or more a day
-8
DON’T KNOW
-7
REFUSED
ASK: Female respondents who have ever been pregnant (AX0134=1) and have used tobacco products
other than cigarettes during their most recent pregnancy (AX0305=1)
PROGRAM: If currently pregnant (AX0136=1), display “have”. Else, display “did”.

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INDUSTRY ADVERTISING AND PROMOTION SECTION
DISPLAY TRANSITION TEXT: The following questions ask about tobacco advertising that you may have
seen.
PATH ID:

AX0177

Screen ID:

Thinking about everything that happened around you in the past 6 months, since [6 month anchor], how
often have you noticed things that promote tobacco?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: display 6 month anchor as “Month Year” (ex. ”…in the past 6 months, since May 2013, how
often…”
PATH ID:

AX0178

Screen ID:

In the past 6 months, since [6 month anchor], have you noticed tobacco ads or promotions on store windows
or inside stores where tobacco is sold?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: display 6 month anchor as “Month Year”
PATH ID:

AX0179

Screen ID:

In the past 6 months, since [6 month anchor], have you received an e-mail message with promotions or
coupons for cigarettes or tobacco products?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: display 6 month anchor as “Month Year”

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PATH ID:

AX0180

Screen ID:

In the past 6 months, since [6 month anchor], have you received promotions or coupons for cigarettes or
tobacco products in the mail?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: display 6 month anchor as “Month Year”
PATH ID:

AX0205

Screen ID:

The next questions are about things you may have seen inside or outside shops or stores where people can
buy tobacco products.
In the past 30 days, have you seen cigarette or other tobacco packages being displayed, including on
shelves or on the counter?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
GO TO: If Current User Tobacco AND has a regular brand (AC1047 = 1 OR AE1047 = 1 OR AG1047 = 1
OR AP1047 = 1 OR AH1047 = 1 OR AS1047 = 1 OR AD1047 = 1), go to AX0206
If Current or Experimental Current User Tobacco AND does not have a regular brand, go to AX0209
If Former User Tobacco, go to AX0212
Else, if experimental current user or never user and age 18-24, go to AX0197
Else, go to BOX AX7
PATH ID:

AX0206

Screen ID:

In the past 30 days, when you were in a store that sells tobacco, did you buy a brand of tobacco product
other than your usual brand because you noticed a special price offer?
1
Yes
2
No
GO TO AX0208
-8
DON’T KNOW
GO TO AX0208
-7
REFUSED
GO TO AX0208
ASK: Current tobacco users who have a regular brand

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PATH ID:

AX0207

Screen ID:

In the past 30 days, has this happened just once or twice, a few times, or quite regularly?
1
Once or twice
2
A few times
3
Quite regularly
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who bought a brand other than their usual brand because it was on sale (AX0206=1)
PATH ID:

AX0208

Screen ID:

In the past 30 days, have you bought a brand of tobacco product other than your usual brand because of a
promotion?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current tobacco users who have a regular brand
PATH ID:

AX0209

Screen ID:

In the past 30 days, have you ever bought a brand of tobacco product because you noticed a promotion for
it?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current or Experimental Current tobacco users who do not have a regular brand (AC1047 = 2 OR
AE1047 = 2 OR AG1047 = 2 OR AP1047 = 2 OR AH1047 = 2 OR AS1047 = 2 OR AD1047 = 2)
GO TO: If Current or Experimental Current tobacco user and doesn’t have a regular brand and age 18 to 24,
go to AX0197
Else, go to BOX AX7
PATH ID:

AX0210

Screen ID:

In the past 30 days, have you bought a brand of tobacco product other than your usual brand because you
noticed it displayed in the store or on signs?
1
Yes
2
No
GO TO AM0016
-8
DON’T KNOW
GO TO AM0016
-7
REFUSED
GO TO AM0016
ASK: Current tobacco users who have a regular brand

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PATH ID:

AX0211

Screen ID:

In the past 30 days, has this happened just once or twice, a few times, or quite regularly?
1
Once or twice
2
A few times
3
Quite regularly
-8
DON’T KNOW
-7
REFUSED
ASK: Current tobacco users who bought a brand other than their usual brand because it was on display
(AX0210=1)
GO TO: IF AGE 18 TO 24, go to AX0197
ELSE go to BOX AX7.
PATH ID:

AX0212

Screen ID:

Since you quit using tobacco, has there been a time when seeing a tobacco product display or other signs
that tobacco is sold there, has given you an urge to buy tobacco?
1
Yes
2
No
GO TO AX0197
-8
DON’T KNOW
GO TO AX0197
-7
REFUSED
GO TO AX0197
ASK: Former tobacco users who are not experimental current users of tobacco
GO TO: If AX0212 = 1, go to AX0213
PATH ID:

AX0213

Screen ID:

In the past 30 days, since you quit using tobacco, has this happened just once or twice, a few times, or quite
regularly?
1
Once or twice
2
A few times
3
Quite regularly
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who had the urge to buy tobacco when seeing a display (AX0212=1)

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PATH ID:

AX0197

Screen ID:

What is the brand of your favorite tobacco advertisement?
PROGRAM:
[If multiple screens] Display: If you do not see it below, touch the button marked “NEXT”.
[If single screen OR last screen of multiple screens] Display: If you do not see it below, touch the box
marked “The brand is not listed”.
[SHOW PICTURES OR TEXT OF THE MAJOR BRANDS ON THE TOUCHSCREEN. WHEN A
RESPONDENT SELECTS A BRAND, GO TO AX0181]
The brand is not listed
SPECIFY: __________________
2 I do not have a favorite advertisement
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents aged 18 to 24.
PROGRAM: Option 2 should appear first in the list of brands.
1

PATH ID:

AX0181

Screen ID:

DISPLAY 20 RANDOMLY SELECTED TOBACCO ADS HERE, ONE AT A TIME. THE SELECTION OF
SPECIFIC ADS WILL BE MADE JUST PRIOR TO LAUNCH OF FIELD OPERATIONS BASED ON THE
MOST CURRENT INFORMATION.
EACH PICTURE SHOWS A TOBACCO ADVERTISEMENT
In the past 12 months, have you seen this advertisement before this study?
1 Yes
2 No
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents age 18 to 24
PATH ID:

GO TO NEXT AD; IF LAST AD, GO TO BOX AX7
GO TO NEXT AD; IF LAST AD, GO TO BOX AX7
GO TO NEXT AD; IF LAST AD, GO TO BOX AX7

AX0184

Screen ID:

How much do you like this advertisement? Do you…
1
Like this ad
2
Have no opinion about this ad
3
Dislike this ad
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents age 18 to 24

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ADDITIONAL DEMOGRAPHICS
BOX AX7
GO TO: If AM0014 IN (1,2,3), go to AM0016
Else if AM0014 = 4, go to AM0017
Else go to AM0018
DISPLAY TRANSITION TEXT: Finally, we have a few additional questions about you, your work, education
and health insurance.
PATH ID:

AM0016

Screen ID:

What is your main job title or occupation?
________________________________________________________________
ASK: Respondents who currently work for pay (AM0014=1,2,3)
GO TO: AM0018
PATH ID:

AM0017

Screen ID:

Are you currently:
1
Looking for paid work
2
A student not looking for paid work
3
A homemaker or caregiver not looking for paid work
4
Retired
5
Unable to work for physical or mental health reasons
6
Unable to work due to other reasons
7
None of the above
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who don’t currently work for pay (AM0014=4)

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PATH ID:

AM0018

Screen ID:

What is the highest grade or level of school you completed?
1
Less than high school
2
Some high school, no diploma
3
GED
4
High school graduate—diploma
5
Some college but no degree
6
Associate degree—occupational/vocational
7
Associate degree—academic program
8
Bachelor’s degree (ex: BA, AB, BS)
9
Master’s degree (ex: MA, MS, MEng, Med, MSW)
10
Professional school degree (ex: MD, DDS, DVM, JD)
11
Doctorate degree (ex: PhD, EdD)
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AM0019

Screen ID:

Are you currently enrolled in a degree program?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AM0015
GO TO AM0015
GO TO AM0015

AM0020

Screen ID:

Which type of degree program are you currently enrolled in?
1
Technical/vocational program
2
2-year degree program
3
4-year degree program
4
Graduate/professional program
5
Other type of degree program
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who are enrolled in a degree program (AM0019=1)

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PATH ID:

AM0015

Screen ID:

In the past 30 days, because of a shortage of money, were you unable to pay any important bills on time,
such as rent, electricity or telephone bills?
1
Yes
2
No
7
Not applicable
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

AM0030

Screen ID:

Which of the following categories best describes your total household income in the past 12 months?
This is the total income before taxes of all persons in your household combined. Please include money from
jobs, relatives, pensions, dividends, interest, social security payments or retirement benefits, net income
from business, farm or rent, and any other money received by household members.
1
Less than $10,000
2
$10,000 to $14,999
3
$15,000 to $24,999
4
$25,000 to $34,999
5
$35,000 to $49,999
6
$50,000 to $74,999
7
$75,000 to $99,999
8
$100,000 to $149,999
9
$150,000 to $199,999
10
$200,000 or more
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021
GO TO AM0021

AM0031

Screen ID:

Is your total household income during the past 12 months above or below $50,000?
1
Above $50,000
2
Below $50,000
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who did not know or refused to give their household income (AM0030=DK,R)

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PATH ID:

AM0021

Screen ID:

The next question asks about your level of sexual attraction to BOTH males and females. Please consider
the response choices carefully, as it is important that you understand them and are as honest as you can be
in your answer.
To whom have you felt sexually attracted, even if you did not take any action based on feeling attracted?
1
Only to females, never to males
2
Mostly to females, and at least once to a male
3
About equally often to females and to males
4
Mostly to males, and at least once to a female
5
Only to males, never to females
6
I have never felt sexually attracted to anyone at all
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PROGRAM: Order shown is for male respondents. Reverse the order of categories 1 to 5 for female
respondents.
PATH ID:

AM0022

Screen ID:

Do you think of yourself as:
1
[Gay | Lesbian or gay]
GO TO AM0026
2
[Straight, that is not gay | Straight, that is, not Lesbian or gay]
GO TO AM0026
3
Bisexual
GO TO AM0026
4
Something else
ASK: All respondents
PROGRAM: Do not display the standard DK/R probe if this item is left blank. Instead, when this item is left
blank, go to AM0024.
For male respondents, display the first option for response categories 1 and 2. For female respondents,
display the second option.

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PATH ID:

AM0023

Screen ID:

By something else, do you mean that…
You are not straight, but identify with another label such as queer,
trisexual, omnisexual or pan-sexual
2 You are transgender, transsexual, or gender variant
You have not figured out your sexuality or are in the process of
3
figuring it out
4 You do not think of yourself as having a sexuality
5 You do not use labels to identify yourself
6 You made a mistake and did not mean to pick this answer
7 You mean something else
-8 DON’T KNOW
-7 REFUSED
ASK: Respondents who selected “something else” in (AM0022 =4)
1

PATH ID:

AM0028

GO TO AM0026
GO TO AM0026
GO TO AM0026
GO TO AM0026
GO TO AM0026
GO TO AM0028
GO TO AM0025
GO TO AM0024
GO TO AM0026

Screen ID:

Do you think of yourself as:
1
[Gay | Lesbian or gay]
GO TO AM0026
2
[Straight, that is not gay | Straight, that is, not Lesbian or gay]
GO TO AM0026
3
Bisexual
GO TO AM0026
4
Something else
GO TO AM0026
-8
DON’T KNOW
GO TO AM0024
-7
REFUSED
GO TO AM0026
ASK: Respondents that selected ‘You made a mistake and did not mean to pick this answer’ (AM0023=6)
PROGRAM: For male respondents, display the first option for response categories 1 and 2. For female
respondents, display the second option.
PATH ID:

AM0024

Screen ID:

You did not enter an answer for the question. Is that because:
You don’t understand the words
GO TO AM0026
You understand the words, but you have not figured out your
GO TO AM0026
2
sexuality or are in the process of figuring it out
7 You mean something else
-7 You don’t want to answer the question
GO TO AM0026
ASK: Respondents who selected “don’t know” in (AM0022=-8 or AM0023=-8)
PROGRAM: If a respondent leaves this question unanswered, do not display the standard DK/R probe.
Instead, go to AM0026.
1

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PATH ID:

AM0025

Screen ID:

What do you mean by something else? Please type in your answer:
1
[OPEN TEXT FIELD]
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who selected “something else” in (AM0023=7 or AM0024=7)
BOX – DISPLAY INSTRUCTIONS
For AM0026, display a “Yes” and “No” column with options for each response category.
PATH ID:

AM0026

Screen ID:

Are you currently covered by any of the following types of health insurance or health coverage plans?
1
2
3

Insurance through a current or former employer or union (of yourself or a family member)
Insurance purchased directly from an insurance company (by yourself or a family member)
Medicare, for people 65 and older, or people with certain disabilities
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low
4
incomes or a disability
5 TRICARE or other military health care
6 VA (including those who have ever enrolled for or used VA health care)
7 Indian Health Service
8 Any other type of health insurance or health coverage plan
-8 DON’T KNOW
-7 REFUSED
ASK: All respondents
GO TO: If Current tobacco user (CURRENT_USER_TOB=1/YES) OR Experimental Current tobacco
user (EXPERIMENTAL_CURRENT_USER_TOB=1/YES), go to AM0029
Else go to AL3000
PATH ID:

AM0029

Screen ID:

To your knowledge, compared to people who don’t use tobacco, do you pay more for your health insurance
coverage because of your tobacco use?
1
Yes
2
No
-8
DON’T KNOW
-7
REFUSED
ASK: Current and Experimental Current tobacco users

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PATH ID:

AX0214

Screen ID:

We would like to scan the bar code on any tobacco products you have right now for your own use[, including
your ECIGFILLs]. Our interviewer will do the scanning for you. Other people in your home might see the
products as you hand them to the interviewer.
Is it OK to scan your tobacco products now?
1
Yes
2
No
GO TO AL3000
-7
REFUSED
GO TO AL3000
ASK: Current and Experimental Current tobacco users
PROGRAM: Fill with “, including your ECIGFILLs” if CURRENT_USER_ECIG = 1/YES or
EXPERIMENTAL_CURRENT_USER_ECIG= 1/YES
PATH ID:

AX0215

Screen ID:

Thank you. Please hand the computer to the interviewer. Then get any tobacco products you have right
now for your own use [including your ECIGFILLs] and give them to the interviewer. The interviewer will give
them right back to you.
-7
REFUSED
ASK: Current and Experimental Current tobacco users who agreed to scanning (AX0214=1)
PATH ID:

AL3004

Screen ID:

Monitor Password: _____
The interviewer must now enter the Monitor Password into the computer.
ASK: Current and Experimental Current tobacco users who agreed to scanning (AX0214=1)
PROGRAM: THE MONITOR PASSWORD IS 8954. AFTER THE INTERVIEWER ENTERS THE
PASSWORD, SWITCH TO CAPI MODE.
PATH ID:

AX0218

Screen ID:

HOW MANY PRODUCTS DID THE RESPONDENT GIVE YOU TO SCAN?
ENTER A NUMBER BETWEEN ZERO AND 10.
1

I__I__I

ASK: Current and Experimental Current tobacco users who agreed to scanning (AX0214=1)
GO TO:
IF AX0218 = 0 GO TO AL3009
ELSE GO TO AX0217_1

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PATH ID:

AL3009

Screen ID:

THE RESPONDENT GAVE YOU ZERO PRODUCTS TO SCAN.
IF THIS IS CORRECT, PRESS 1 TO CONTINUE. IF THIS IS INCORRECT, GO BACK AND MAKE A
CORRECTION.
PROGRAM: IF 1 IS PRESSED, GO TO AL3006
PATH ID:

AX0217_1

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #1. YOU CAN SCAN UP TO 10 PRODUCTS TOTAL.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Current and Experimental Current tobacco users who agreed to scanning (AX0214=1)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_2

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #2.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.

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WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_3

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #3.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_4

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #4.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.

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IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_5

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #5.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_6

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #6.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.

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IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_7

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #7.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_8

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #8.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.

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SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_9

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #9.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE
ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO:
IF BLANK, GO TO AL3006
ELSE GO TO NEXT BAR CODE
PATH ID:

AX0217_10

Screen ID:

THIS IS PRODUCT BAR CODE SCAN #10.
SCAN THE BAR CODE FOR ALL PRODUCTS PROVIDED BY THE RESPONDENT. IF THE
RESPONDENT GIVES YOU MORE THAN ONE OF THE EXACT SAME ITEM, JUST SCAN ONE OF THE

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ITEMS.
SCAN EACH BARCODE TWICE.
IF YOU CANNOT FIND A BAR CODE ON THE PRODUCT, ENTER “X” IN BOTH FIELDS.
IF YOU CANNOT GET A SUCCESSFUL SCAN AFTER MAKING THREE ATTEMPTS, ENTER “Y” IN
BOTH FIELDS.
WHEN YOU ARE FINISHED WITH SCANNING ALL PRODUCTS, LEAVE THE FIELDS BLANK AND
PRESS ENTER TO CONTINUE. RETURN ALL PRODUCTS TO THE RESPONDENT.
ASK: Respondents who use a tobacco product and did not refuse to get products for scanning (AX0215 <> 7)
GO TO: AL3006.
PATH ID:

AL3000

Screen ID:

You have finished this part of the questionnaire. Please hand the computer to the interviewer.
ASK: Current and Experimental Current tobacco users who DID NOT agree to scanning (AX0214=2,
refused, or don’t know) AND respondents who are not Current or Experimental Current tobacco users
(CURRENT_USER_TOB=2/NO or EXPERIMENTAL_CURRENT_USER_TOB=2/NO)
PATH ID:

AL3003

Screen ID:

Monitor Password: _____
The interviewer must now enter the Monitor Password into the computer.
ASK: Current and Experimental Current tobacco users who DID NOT agree to scanning (AX0214=2,
refused, or don’t know) AND respondents who are not Current or Experimental Current tobacco users
(CURRENT_USER_TOB=2/NO or EXPERIMENTAL_CURRENT_USER_TOB=2/NO)
PROGRAM: THE MONITOR PASSWORD IS 8954. AFTER THE INTERVIEWER ENTERS THE
PASSWORD, SWITCH TO CAPI MODE.

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PATH ID:

AL3007

Screen ID:

DO NOT SCAN BAR CODES FOR THIS RESPONDENT.
[COLLECT CONTACT INFORMATION FOR THIS RESPONDENT | THIS RESPONDENT HAS ALREADY
PROVIDED CONTACT INFORMATION]
PRESS 1 TO CONTINUE
ASK: Current and Experimental Current tobacco users who DID NOT agree to scanning (AX0214=2,
refused, or don’t know) AND respondents who are not Current or Experimental Current tobacco users
(CURRENT_USER_TOB=2/NO or EXPERIMENTAL_CURRENT_USER_TOB=2/NO)
PROGRAM: If this respondent has completed a parent interview, display “THIS RESPONDENT HAS
ALREADY PROVIDED CONTACT INFORMATION” and DO NOT go to the contact information section, and
return to IMS. If this respondent has NOT completed a parent interview, display “COLLECT CONTACT
INFORMATION FOR THIS RESPONDENT” and GO TO the contact information section.
PATH ID:

AL3006

Screen ID:

[COLLECT CONTACT INFORMATION FOR THIS RESPONDENT | THIS RESPONDENT HAS ALREADY
PROVIDED CONTACT INFORMATION]
PRESS 1 TO CONTINUE
ASK: Current and Experimental Current tobacco users who DID agree to scanning (AX0214=1) and for
whom scanning is complete
PROGRAM: If this respondent has completed a parent interview, display “THIS RESPONDENT HAS
ALREADY PROVIDED CONTACT INFORMATION” and DO NOT go to the contact information section, and
return to IMS. If this respondent has NOT completed a parent interview, display “COLLECT CONTACT
INFORMATION FOR THIS RESPONDENT” and GO TO the contact information section.

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CONTACT INFORMATION SECTION
BOX AL1
ASK CONTACT INFORMATION 1 TIME FOR ADULT RESPONDENT.
IF ADULT RESPONDENT IS SAME RESPONDENT ON PARENT INTERVIEW AND CONTACT
INFORMATION WAS NOT OBTAINED ON PARENT INTERVIEW, PROCEED WITH CONTACT
INFORMATION SECTION.
IF ADULT RESPONDENT IS NOT THE SAME RESPONDENT FROM PARENT INTERVIEW, PROCEED
WITH CONTACT INFORMATION SECTION.
ELSE SKIP CONTACT INFORMATION SECTION AND GO TO AL3005 TO END INTERVIEW.
PATH ID:

AL0001

Screen ID:

I’d like to take a brief moment to confirm your contact information for my records. I’ll use this information to
contact you about your participation in the study.
Can you tell me your full name?
VERIFY ALL SPELLING. IF PERSON HAS NO MIDDLE NAME, LEAVE MIDDLE INITIAL BLANK. IF
NEEDED: FULL NAME INCLUDES FIRST NAME, MIDDLE INITIAL, AND LAST NAME.
NAME: ______________________________________________________________
FIRST
MI
LAST
I need to confirm your street address. Is this address correct?
[PROGRAM: DISPLAY ADDRESS FROM THE SAMPLE FILE IN AN EASY TO READ FORMAT.]
READ ADDRESS. VERIFY ALL SPELLING. PROBE FOR APT NUMBER IF NEEDED. DO NOT ENTER
A PO BOX HERE.
___________________________________________________________________
STREET
APT #
___________________________________________________________________
CITY
STATE
ZIP
PROGRAM: PRE-POPULATE NAME FIELDS (FIRST, MI, LAST) BASED ON INFO OBTAINED IN THE
SCREENER. If the first name is don’t know or refused, continue on to ask MI and LAST. If Street is don’t
know or refused, continue on to ask the rest of the address fields.

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PATH ID:

AL0002

Screen ID:

Do you receive mail at the address you just gave me?
1
2
-8
-7
ASK: All respondents
PATH ID:

YES
NO
DON’T KNOW
REFUSED

GO TO AL0004

AL0003

Screen ID:

Can I please have your mailing address? VERIFY ALL SPELLING.
_________________________________________________________________
MAILING ADDRESS
__________________________________________________________________
CITY
STATE
ZIP
PROGRAM: If Mailing Address is don’t know or refused, continue on to ask the rest of the address fields.
PATH ID:

AL0004

Screen ID:

What is the best telephone number to reach you?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
______________________________ _________
AREA CODE
PHONE NUMBER
EXT
ASK: All respondents
PROGRAM:
If the area code is don’t know or refused, do not ask the rest of the phone number or the
extension.
PATH ID:

AL0005

Screen ID:

Is this a home or cell phone number?
1
2
3
-8
-7
ASK: All respondents

PATH – Wave 1
Adult Extended Questionnaire

HOME
CELL
OTHER
DON’T KNOW
REFUSED

GO TO AL0006
GO TO AL0032
GO TO AL0006
GO TO AL0006
GO TO AL0006

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PATH ID:

AL0032

Screen ID:

May we contact you by text message at this number?
1
YES
2
NO
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who said their best number is a cell phone (AL0005=2).
PATH ID:

AL0006

Screen ID:

Is there a second telephone number where you can be reached?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
______________________________ _________
AREA CODE
PHONE NUMBER
EXT
ASK: All respondents
PROGRAM: If the area code is don’t know or refused, do not ask the rest of the phone number or the
extension.
PATH ID:

AL0007

Screen ID:

Is this a home or cell phone number?
1
2
3
-8
-7
ASK: All respondents
PATH ID:

HOME
CELL
OTHER
DON’T KNOW
REFUSED

GO TO AL0012
GO TO AL0033
GO TO AL0012
GO TO AL0012
GO TO AL0012

AL0033

Screen ID:

May we contact you by text message at this number?
1
YES
2
NO
-8
DON’T KNOW
-7
REFUSED
ASK: Respondents who said their second number is a cell phone (AL0007=2).

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PATH ID:

AL0012

Screen ID:

Can you please give me your e-mail address?
VERIFY ALL SPELLING AND PUNCTUATION. RECORD TEXT BEFORE @ SYMBOL IN THE EMAIL
NAME FIELD. TEXT AFTER THE @ SYMBOL IS ENTERED IN THE EMAIL PROVIDER FIELD.
_____________________________@________________
E-MAIL ADDRESS
ASK: All respondents
PATH ID:

AL0017

Screen ID:

Of all the contact information you just provided, what is the best way to reach you
PROBE WITH RESPONSE OPTIONS IF NECESSARY.
IF RESPONDENT SAYS CELL PHONE, PROBE ON PHONE CALL OR TEXT MESSAGE.
1
2
3
4
5
-8
-7
ASK: All respondents
PATH ID:

HOME PHONE
CELL PHONE
TEXT MESSAGE
E-MAIL
OTHER
DON’T KNOW
REFUSED

AL0018

Screen ID:

Do you anticipate moving or relocating either permanently or temporarily in the next 6 to 12 months?
1
YES
2
NO
3
MAYBE
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents
PATH ID:

GO TO AL0020
GO TO AL0020
GO TO AL0020

AL0019

Screen ID:

Can you tell me more about your plans to move? [For example, your new street address or the city or state
to which you plan to move?] PROBE FOR AND RECORD ANY KNOWN INFORMATION.
__________________________________________________________________
ASK: Respondents who indicate they might be moving (AL0018=1)

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PATH ID:

AL0020

Screen ID:

In case we cannot reach you, can you please give me the contact information of two relatives, friends or
neighbors who will always know how to get in touch with you? We would prefer to have information for
people who do not live with you.
Who is the first person? VERIFY ALL SPELLING.
__________________________________________________________________
FIRST NAME
MI
LAST NAME
ASK: All respondents
PROGRAM: If the first name is don’t know or refused, continue on to ask MI and LAST.
PATH ID:

AL0021

Screen ID:

How is [FIRST NAME IN AL0020] related to you?
1
HUSBAND/WIFE
2
FATHER/MOTHER (INCLUDING IN-LAWS)
4
GRANDPARENT
5
SON/DAUGHTER (INCLUDING IN-LAWS)
7
GRANDCHILD
8
BROTHER/SISTER (INCLUDING IN-LAWS)
13
FRIEND/NEIGHBOR
91
OTHER RELATIVE (SPECIFY) ________________
92
OTHER NON-RELATIVE (SPECIFY) ____________
DON’T KNOW
-8
REFUSED
-7
ASK: All respondents who provided a name in AL0020 (AL0020 NE DK or RF)
PATH ID:

AL0022

Screen ID:

What is [FIRST NAME IN AL0020]’s address and telephone number? VERIFY ALL SPELLING.
_________________________________________________________________
MAILING ADDRESS
__________________________________________________________________
CITY
STATE
ZIP
_________
______________________________ _________
AREA CODE
PHONE NUMBER
EXT
ASK: All respondents who provided a name in AL0020 (AL0020 NE DK or RF)
PROGRAM: If Mailing Address is don’t know or refused, continue on to ask the rest of the address fields. If
the area code is don’t know or refused, do not ask the rest of the phone number or the extension.

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PATH ID:

AL0024

Screen ID:

Can you please tell me [FIRST NAME IN AL0020]’s e-mail address? VERIFY ALL SPELLING AND
PUNCTUATION.
_____________________________@________________
E-MAIL ADDRESS
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents who provided a name in AL0020 (AL0020 NE DK or RF)
PATH ID:

AL0025

Screen ID:

What is the name of the second friend or relative? Again, we would prefer someone who does not live with
you.
__________________________________________________________________
FIRST NAME
MI
LAST NAME
ASK: All respondents who provided a name in AL0020 (AL0020 NE DK or RF)
PROGRAM: If the first name is don’t know or refused, continue on to ask MI and LAST.
PATH ID:

AL0026

Screen ID:

How is [FIRST NAME IN AL0025] related to you?
1
HUSBAND/WIFE
2
FATHER/MOTHER (INCLUDING IN-LAWS)
4
GRANDPARENT
5
SON/DAUGHTER (INCLUDING IN-LAWS)
7
GRANDCHILD
8
BROTHER/SISTER (INCLUDING IN-LAWS)
13
FRIEND/NEIGHBOR
91
OTHER RELATIVE (SPECIFY) ________________
92
OTHER NON-RELATIVE (SPECIFY) ____________
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents who provided a name in AL0025 (AL0025 NE DK or RF)

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PATH ID:

AL0027

Screen ID:

What is [FIRST NAME IN AL0025]’s address and telephone number? VERIFY ALL SPELLING.
_________________________________________________________________
MAILING ADDRESS
__________________________________________________________________
CITY
STATE
ZIP
_________
______________________________ ____________
AREA CODE
PHONE NUMBER
EXT
ASK: All respondents who provided a name in AL0025 (AL0025 NE DK or RF)
PROGRAM: If Mailing Address is don’t know or refused, continue on to ask the rest of the address fields. If
the area code is don’t know or refused, do not ask the rest of the phone number or the extension.
PATH ID:

AL0029

Screen ID:

Can you please tell me [FIRST NAME IN AL0025]’s e-mail address? VERIFY ALL SPELLING AND
PUNCTUATION.
_____________________________@________________
E-MAIL ADDRESS
-8
DON’T KNOW
-7
REFUSED
ASK: All respondents who provided a name in AL0025 (AL0025 NE DK or RF)
PATH ID:

AL3005

Screen ID:

Thank you for taking the time to answer these questions.
ENTER 1 TO CONTINUE. THIS IS THE END OF THE ADULT QUESTIONNAIRE.
ASK: All respondents for whom contact information is collected.

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APPENDIX A: LOGIC CHECKS AND CONFIRMATIONS
Question
Called From

Type of
check

Logic

AC1006

Range/soft

If AC1006< =5

AC1007

Range/soft

If AC1007< =5

AC1020

AC1021

Range/soft

Range/soft

PATH – Wave 1
Adult Extended Questionnaire

If AC1020< =5

If AC1021 > 40

Message to display
The computer recorded that you first smoked
all or part of a cigarette at age [AC1006]. Is
that correct?
Yes
No, I need to change my answer
DK/R
The computer recorded that you started
smoking cigarettes fairly regularly at age
[AC1007]. Is that correct?
Yes
No, I need to change my answer
DK/R
The computer recorded that you started
smoking cigarettes every day at age
[AC1020]. Is that correct?
Yes
No, I need to change my answer
DK/R
The computer recorded that on average, you
now smoke [AC1021] cigarettes a day. Is that
correct?
Yes
No, I need to change my answer
DK/R

272

Response options and actions

Yes: Go to Box AC 1
No: Go back to AC1006
DK/R: Go to Box AC 1

Yes: Go to Box AC 1
No: Go back to AC1007
DK/R: Go to Box AC 1

Yes: Go to AC9020
No: Go back to AC1020
DK/R: Go to AC9020

Yes: Go to AC9004
No: Go back to AC1021
DK/R: Go to AC9004

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Adult Extended Questionnaire
Version 7.5
Question
Called From

AC1022

Type of
check

Consistency

Logic

If AC1022 = 0 OR
AC1022 = 30

Message to display

You said that you smoked cigarettes some
days. Is that correct?
Yes
No
DK/R

Response options and actions
Yes: If AC1022 = 0, some day smokers
go to AC1024, while current
experimental smokers go to AC1025.
If AC1022 = 30, some day smokers
and current experimental smokers go
to AC1023
No: Go to AC1003

AC1024

AC9003

AM0001

Range/soft

Range/soft

Confirmation

PATH – Wave 1
Adult Extended Questionnaire

If AC1024 > 40

The computer recorded that on average, you
smoked [AC1024] cigarettes a day 12 months
ago. Is that correct?
Yes
No, I need to change my answer
DK/R

Yes: Go to AC1025
No: Go back to AC1024
DK/R: Go to AC1025

If AC9003 > 40

The computer recorded that on average, you
smoked [AC9003] cigarettes a day while you
were smoking regularly. Is that correct?
Yes
No, I need to change my answer
DK/R

Yes: Go to BOX AC2
No: Go back to AC9003
DK/R: Go to BOX AC2

If response is nonmissing value:

The computer recorded your date of birth as
{AM0001 RESPONSE}. Is that correct?
Note: Continue confirmation routine each
time the respondent re-answers the
question.

Yes: Continue to AGE ELIGIBILITY
DETERMINATION
No: "Please answer this question
again" - loop back to AM0001
DK/R: Follow general DK/Ref probe
rules.

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Adult Extended Questionnaire
Version 7.5
Question
Called From

Type of
check

Logic

Message to display

If response is nonmissing value:

The computer recorded your age as {AM0002
RESPONSE}. Is that correct?
Note: Continue confirmation routine each
time the respondent re-answers the
question.

AM0002

Confirmation

AN0115

If response is nonConfirmation
missing value:

AN0125

AN0130

AY0010

Confirmation

If response is nonmissing value:

Range/soft

IF AN0130num >18
and AN0130unit = 2
IF AN0130num >12
and AN0130unit = 3
IF AN0130num >2
and AN0130unit = 4

Confirmation

PATH – Wave 1
Adult Extended Questionnaire

If response is nonmissing value:

The computer recorded that during the past
12 months you have tried to quit [ND FILL2]
completely {AN0115 #} times. Is that
correct?
The computer recorded that during the past
12 months you have stopped [ND FILL2]
forone day or longer because you were
trying to quit {AN0125 #} times. Is that
correct?
The computer recorded that the last time you
stopped [ND Fill3] in the past 12 months
because you were trying to quit, was for a
duration of [fill AN0130num AN0130unit(s)].
Is that correct?
Yes
No, I need to change my answer
DK/R
The computer recorded that you usually first
use a tobacco product {AY0010 # [AY0010
unit]} after waking. Is that correct?

274

Response options and actions
Yes: Go to AGE ELIGIBILITY
DETERMINATION
No: "Please answer this question
again" - loop back to AM0002
DK/R: Follow general DK/Ref probe
rules.
Yes: Continue to next question
No: "Please answer this question
again" - loop back to AN0115
DK/R: Follow general DK/Ref probe
rules.
Yes: Continue to next question
No: "Please answer this question
again" - loop back to AN0125
DK/R: Follow general DK/Ref probe
rules.

Yes: Go to AN0135
No: Go back to AN0130
DK/R: Go to AN0135

Yes: Continue to next question
No: "Please answer this question
again" - loop back to AY0010
DK/R: Follow general DK/Ref probe
rules.

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Adult Extended Questionnaire
Version 7.5

APPENDIX B: USER GROUP DEFINITIONS
User group
Ever user [PROD]

Cigarettes
Has ever smoked a cigarette, even one or two puffs.
IF AC1002=1 THEN EVER USER = 1 (YES).
IF AC1002=2 OR DK/R THEN EVER USER = 2 (NO).

Current user [PROD]

Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime), and now smokes everyday or some
days.
IF AC1002=1 AND AC1005=5 AND AC1003 = 1 OR 2, THEN CURRENT USER = 1 (YES).
IF AC1002=2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003 = 3,DK/R, THEN CURRENT USER =2 (NO).

Everyday user [PROD]

Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime), and now smokes everyday.
IF AC1002=1 AND AC1005=5 AND AC1003 = 1 THEN EVERYDAY USER = 1 (YES).
IF AC1002=2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Some day user [PROD]

30 day user [PROD]

Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime) and now smokes some days.
IF AC1002= 1 AND AC1005=5 AND AC1003 = 2 THEN SOME DAY USER = 1 (YES).
IF AC1002=2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003 = 1, 3, DK/R THEN SOME DAY USER =2 (NO).
Not used in any skip patterns, not defined.
Has ever smoked a cigarette, has NOT smoked 100 cigarettes (lifetime) and now smokes everyday or
some days.

Experimental current user [PROD]

PATH – Wave 1
Adult Extended Questionnaire

IF AC1002=1 AND AC1005=1, 2, 3, 4 AND AC1003 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1
(YES).
IF AC1002=2, DK/R OR AC1005=5, DK/R OR AC1003 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2
(NO).

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Version 7.5
User group

Experimental former user [PROD]

Former user [PROD]

Cigarettes
Has ever smoked a cigarette, has NOT smoked 100 cigarettes (lifetime) and now does not smoke at all.
Note: might currently use other products.
IF AC1002=1 AND AC1005=1, 2, 3, 4 AND AC1003 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).
IF AC1002=2, DK/R OR AC1005=5, DK/R OR AC1003 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER =
2 (NO).
Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime) and now does not smoke at all.
Note: might currently use other products.
IF AC1002=1 AND AC1005=5 AND AC1003=3 THEN FORMER USER = 1 (YES).
IF AC1002=2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003=1, 2, DK/R THEN FORMER USER = 2 (NO).

Former user 12 Month [PROD]

Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime), now does not smoke at all, and quit
smoking within the past 12 months. Note: might currently use other products.
IF AC1002=1 AND AC1005=5 AND AC1003=3 AND AC1009 <= 12 MONTHS AGO THEN FORMER USER 12
MONTH = 1 (YES).
IF AC1002=2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003=1, 2, DK/R OR AC1009 > 12 MONTHS AGO,
DK/R THEN FORMER USER 12 MONTHS = 2 (NO).
Has ever smoked a cigarette, has smoked 100 cigarettes (lifetime), now does not smoke at all, and quit
smoking within longer than 12 months ago. Note: might currently use other products.

Former user 12 Month Plus [PROD]

PATH – Wave 1
Adult Extended Questionnaire

IF AC1002=1 AND AC1005=5 AND AC1003=3 AND AC1009 > 12 MONTHS AGO THEN FORMER USER 12
MONTH PLUS = 1 (YES).
IF AC1002= 2, DK/R OR AC1005=1, 2, 3, 4, DK/R OR AC1003=1, 2, DK/R OR AC1009 <= 12 MONTHS AGO,
DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

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