LGBT Young Adult Tobacco Use Prevention Campaign: Copy Testing

OMB# 0910-0674 Exp. 3/31/2016

LGBT Tobacco Prevention Campaign: Copy Testing

Appendix H: Copy Testing Questionnaire

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to
average 15 minutes per response to complete the questionnaire (the time estimated to read and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov

WELCOME PAGE

[TEXT FOR PARTICIPANTS]: “Thanks for taking the survey! Please answer the questions on the following pages as honestly as possible. As a thank you for your time, once you complete and submit the survey you will receive a $25 incentive! Participants who submit this survey in the presence of a survey staff member will receive a $25 cash incentive. Participants who submit this survey online will receive a $25 online gift card incentive. Click on the button at the bottom of the page to continue with the survey.”

Please remember to read the instructions carefully.

[Each item on the Copy Testing Questionnaire will be presented in a separate page, separated by a “NEXT” button.]

PART I

A1. Please verify your email address for your incentive. This should be the same email address you used when completing the original screener survey.

A1_1. Email address: ______________________

[A1 is only asked of participants who do not complete the Copy Testing Questionnaire as a follow-through experience. Email address here must match the email address used in the Screener Survey, if the email is not a match, participant will be redirected to the Screener Survey.]

[Questions to be presented prior to showing rough-cut advertisements to ALL PARTICIPANTS – (Part 1 questions are only asked once)]

A2. How many of your four closest friends smoke cigarettes?

0. 0

1. 1

2. 2

3. 3

4. 4

A3. During the past 30 days, have you personally… (Select all that apply)

1. Smoked cigarettes?

2. Smoked cigars, cigarillos, or little cigars (e.g. Swisher Sweets or Black &

3. Milds)?

4. Smoked electronic cigarettes, e-cigarettes, vape pens, or hookah pens such as Fin, NJOY, Blu, e-Go, or Vuse?

5. Smoked tobacco from a hookah or waterpipe?

6. I have not used any form of tobacco in the past 30 days

[A3 = 6 is an exclusive response and cannot be selected in conjunction with option A3=1, 2, 3, 4, or 5)

PART II

[(Questions to be provided after each rough-cut advertisement) – AD VIEWING PARTICIPANTS ONLY]

[TEXT FOR PARTICIPANTS]: “Please watch the video below. To start watching the video, click on the video or press the play button. When the video ends, click on the button at the bottom of the page to continue with the survey.

.”

[Perceived Ad Effectiveness]

B1. What do you think [or would you say] is the main message of this advertisement?

[FREE RESPONSE BOX]

B2. What do you like about this advertisement? Please be as specific as possible.

[FREE RESPONSE BOX]

B3. What do you dislike about this advertisement? Please be as specific as possible.

[FREE RESPONSE BOX]

B4. People sometimes have different emotional reactions when they see or hear advertisements. On a scale from 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this ad made you feel:

Not at all Very

1 2 3 4 5

[RANDOMIZE ORDER]

B4_1. Sad

B4_2. Afraid

B4_3. Irritated

B4_4. Ashamed

B4_5. Discouraged

B4_6. Hopeful

B4_7. Motivated

B4_8. Confident

B4_9. Determined

B4_10. Understood

B4_11. Angry

B4_12. Amused

B4_13. Disgusted

B4_14. Worried

B4_15. Inspired

B4_16. Happy

B4_17. Uneasy

B4_18. Surprised

B5. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:

[RANDOMIZE ORDER]

B5_1. This ad is worth remembering

B5_2. This ad grabbed my attention

B5_3. This ad is powerful

B5_4. This ad is informative

B5_5. This ad is meaningful to me

B5_6. This ad is convincing

B5_7. This ad is terrible

B5_8. This ad is silly

B5_9. This ad is annoying

B5_10. This ad was difficult to watch

B5_11. I trust the information in this ad

B5_12. This ad told me things I never knew before about tobacco

B5_13. The person/people in this ad are like me

B5_14. This ad gave me a reason not to use tobacco

B5_15. I can identify with what the ad says

B5_16. This ad is different from other anti-tobacco ads I’ve seen or heard

B6. On a scale of 1 to 5, how would you rate the claims or arguments in this ad:

Not believable Believable

1 2 3 4 5

B7. On a scale of 1 to 5, indicate whether the ad made smoking look like something you would or would not want to do.

Makes me want to smoke Makes me want to not smoke

1 2 3 4 5

B8. Is there anything confusing, unclear, or hard to understand in this ad?

1. Yes

0. No

[If B8=1, Ask B9. If B8=0, Ask B10]

B9. What is confusing about this ad?

[FREE RESPONSE BOX]

B10. If you saw this advertisement, on a scale from 1 to 5, where 1 is not at all likely and 5 is very likely, how likely would you be to do each of the following:

Not at all Very

1 2 3 4 5

B10_1. Tell a friend 

B10_2. Look for more information online

B10_3. Visit the [Campaign Brand Name] website, Facebook, or Tumblr

B10_4. Share the [Campaign Brand Name] YouTube channel with a friend

B10_5. Mention it on social media such as Facebook, Tumblr, Twitter, or Instagram

B10_6. Do nothing

[B10_6 is an exclusive response and cannot be selected in conjunction with option B10_1-B10_5)

[Show second rough-cut advertisement (AD VIEWING PARTICIPANTS ONLY) then re-ask Part II questions]

PART III

[Questions to be presented to ALL PARTICIPANTS – Part III questions are only asked once]

[Attitudes, Beliefs and Risk Perceptions]

How much do you agree or disagree with following statements:

C1. If I smoke I will…

C1_1. Damage my physical appearance

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_2. Be less attractive to others

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_3. Negatively affect my health

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_4. Cut my life short

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_5. Damage my body

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_6. Be controlled by tobacco

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_7. Consume harmful chemicals

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_8. Develop cancer

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C1_9. Miss out on activities I enjoy

1. Strongly Disagree

2. Disagree

3. Neither Agree or Disagree

4. Agree

5. Strongly Agree

C2. Smoking cigarettes is . . .

1. Very Bad

2. Bad

3. Neither Good or Bad

4. Good

5. Very Good

C3. Smoking cigarettes is . . .

1. Very Unenjoyable

2. Unenjoyable

3. Neither enjoyable or unenjoyable

4. Enjoyable

5. Very Enjoyable

PART IV

[Questions to be presented to ALL PARTICIPANTS – Part IV question only asked once]

D1. What is the highest grade or level of school that you have 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)

12. Don’t know

13. Prefer not to answer

D2. 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

11. Don’t know

12. Prefer not to answer

D3. What is your current age?

Age: ___ ___

END PAGE

[TEXT FOR ONSITE PARTICIPANTS ONLY]: “Thanks for completing the survey! Please let a researcher know that you are done so that you can receive your $25 cash incentive. Once you have received the incentive, please confirm below.”

YES, I have received my $25 cash incentive.

END PAGE

[TEXT FOR SOCIAL MEDIA PARTICIPANTS ONLY]: “Thanks for completing the survey! You will receive your $25 online gift card at the email address you provided within 48 hours.”

END PAGE

[TEXT FOR ONLINE PANEL PARTICIPANTS ONLY]: “Thanks for completing the survey! You will be redirected to [insert name of online research panel company] to receive your $25 online gift card.”

END PAGE