Multicultural Campaign: Wave 3 focus group study of reactions to creative advertising concepts designed to prevent multicultural youth tobacco use

OMB# 0910-0796
Exp. 6/30/2018

Unique ID: __________________

Creative Concept Survey

Instructions: For each statement, fill in the one bubble that best represents your level of agreement or disagreement. Fill in your
selected responses like this:

Concept: ________
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

Concept: ________

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.
1

Concept: ________
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

Concept: ________

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

2

Concept: ________
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

Concept: ________

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

3

Concept: ________
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

Concept: ________

This ad GRABBED MY ATTENTION.
This ad RELATES TO MY FRIENDS AND ME.
This ad IS MEANINGFUL TO ME.
This ad would convince people my age to LIVE TOBACCO FREE.

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 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.

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