The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use

OMB# 0910-0796

Exp. 06/30/2018

The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use,

Interview Activity – Page 2

Internal note: FMG will send worksheet through graphic design team once content is final.

ID#______________

List some of your favorite things or things in your life that mean something to you personally. It can be anything—some ideas below. Share at least 5 things and write a quick sentence about why you chose each.

Your favorite…

• Poster/ picture/ drawing/ painting/ meme

• Food

• Place in my town

• Website or app

• Item of clothing, shoes, bag or piece of gear

• Vehicle, bike, etc.

• Brand

• Trophy, badge, award

• Hobby or activity

• Spot in your house

• TV show, movie or video game

• Device of some kind (e.g., phone, tablet, gaming console, etc.)

• Etc.

Item and description	Why this means something to me personally
1.
2.
3.
4.
5.
6.
7.
8.

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 minutes per response to complete the Activity (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.