LGBT Campaign: Focus Group Study of Brand and Creative Concepts Designed to Prevent LGBT Young Adult Tobacco Use

Creative Concept Survey						Unique ID:
Version ____________
Ad #1__________
Instructions: For each statement in the left column, circle the * that best represents your level of agreement or disagreement with that statement.
					Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
(a) This ad gave me a reason to not use tobacco.					*	*	*	*	*
(b) I can identify with what the ad says.					*	*	*	*	*
(c) The person/people in this ad are like me.					*	*	*	*	*
Ad #2__________
Instructions: For each statement in the left column, circle the * that best represents your level of agreement or disagreement with that statement.
					Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
(a) This ad gave me a reason to not use tobacco.					*	*	*	*	*
(b) I can identify with what the ad says.					*	*	*	*	*
(c) The person/people in this ad are like me.					*	*	*	*	*
Ad #3__________
Instructions: For each statement in the left column, circle the * that best represents your level of agreement or disagreement with that statement.
					Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
(a) This ad gave me a reason to not use tobacco.					*	*	*	*	*
(b) I can identify with what the ad says.					*	*	*	*	*
(c) The person/people in this ad are like me.					*	*	*	*	*
Ad #4__________
Instructions: For each statement in the left column, circle the * that best represents your level of agreement or disagreement with that statement.
					Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
(a) This ad gave me a reason to not use tobacco.					*	*	*	*	*
(b) I can identify with what the ad says.					*	*	*	*	*
(c) The person/people in this ad are like me.					*	*	*	*	*
Ad #5__________
Instructions: For each statement in the left column, circle the * that best represents your level of agreement or disagreement with that statement.
					Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
(a) This ad gave me a reason to not use tobacco.					*	*	*	*	*
(b) I can identify with what the ad says.					*	*	*	*	*
(c) The person/people in this ad are like me.					*	*	*	*	*
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 50 minutes per response to complete the Creative Concept Survey (the time estimated to read, review, and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov