Qualitative Study on Consumer perceptions of Cigarettes Health Warning Images

OMB No. 0910-0796

Exp. 6/30/18

RTI/FDA Tobacco Focus Groups - Adults
Screening Questionnaire

Tobacco Discussion

Hello, this is _____________ from [FACILITY NAME], a local market research firm. May I please speak to_____________?

(Hello, this is ____________ from [FACILITY NAME], a local market research firm.) We are working with RTI International, a nonprofit research organization, and the Food and Drug Administration (FDA) on a research study about tobacco products, and would like to include your opinions. I want to assure you that we are not from a tobacco company or a company that sells quit-smoking aids.

We are holding a focus group discussion* on [DATE] with approximately 9 other people like you. This research activity is voluntary. The discussion group starts at [TIME] and will last approximately 90 minutes, as part of the discussion group you will also be asked to fill out a worksheet. For study purposes, the group discussion will be audio recorded, and other staff will observe the discussion via video streaming.

* If the respondent doesn’t know what a “focus group” is or needs clarification, say “a focus group is just another name for a group discussion. It involves a group of individuals who talk about a particular topic such as tobacco use.”

In appreciation for your participation, you will be reimbursed for your time, effort, and travel expenses. Participation in the group is completely voluntary and your responses will be kept private to the extent allowable by law. Would it be OK if I ask you a few questions now in order to see if you are eligible to be in one of the groups?

Yes – Continue.

No – Thank and end call.

Q1. What is your current age? _______ [RECRUIT AN EVEN NUMBER OF YOUNGER AND OLDER ADULT GROUPS]

18–20 Recruit for Younger Adult group

21–25 Recruit for Younger Adult group

26–29 Recruit for Younger Adult group

30–34 Recruit for Older Adult group

35–39 Recruit for Older Adult group

40–45 Recruit for Older Adult group

46–49 Recruit for Older Adult group

50–59 Recruit for Older Adult group

60–65 Recruit for Older Adult group

Over 65 Recruit for Older Adult group

Q2. What is your first language? (recruit a mix aim for 2 per group).

English Continue.

Something Else

What is your first language?____________________ Continue.

Q3a. On a scale of 1-5, how comfortable are you talking in a group of people in English? 1 is very uncomfortable and 5 is very comfortable. _______________

[TERMINATE if 3 or lower]. Thank the respondent and terminate.

Q3b. During the focus group discussion, you may be asked to review written materials and offer your opinions. On a scale of 1-5, how comfortable are you reading and understanding materials written in English? 1 is very uncomfortable and 5 is very comfortable. ______________

[TERMINATE if 3 or lower] Thank the respondent and terminate.

Q4. Have you smoked at least 100 cigarettes in your entire life?

Yes Continue.

No Thank the respondent and terminate.

Q5. Which of the following describes how often you smoke cigarettes …? (Read list.)

Every day Continue.

Some days Continue

Not at all Thank the respondent and terminate.

Q6. In the past 5 years, have you or any member of your household worked for any of the following? (Read list. If yes to any, thank the respondent and terminate.)

A tobacco or cigarette company

A public health or community organization involved in communicating the dangers of smoking or the benefits of quitting

A marketing, advertising, or public relations agency or department

The Federal Government (Read list. If yes to any, thank the respondent and terminate.)

The U.S. Food and Drug Administration (FDA)

The National Institutes of Health (NIH)

The Centers for Disease Control and Prevention (CDC)

The Substance Abuse and Mental Health Services Administration (SAMHSA)

The Centers for Medicare & Medicaid Services (CMS)

Q7. Have you or any member of your household ever lobbied on behalf of the tobacco industry?

Yes Thank the respondent and terminate.

No Continue.

Q8. Have you or any member of your household personally represented or worked on behalf of a tobacco company in connection with a tobacco lawsuit?

Yes Thank the respondent and terminate.

No Continue.

Q9. Have you participated in any paid market research in the past 6 months?

Yes Thank the respondent and terminate.

No Continue.

Q10. For study purposes, if you participate, the focus group discussion will be audio recorded. Are you okay with us audio recording your focus group?

Yes Continue.

No Thank the respondent and terminate.

Q11. What is your gender? (Recruit equal numbers of males and females per group)

Male

Female

Other

Q12. What is the highest level of education that you have completed? (Read list. Recruit a mix to show per group. No more than two postgraduates per group.)

Less than high school diploma Continue.

High school graduate or GED Continue.

Some college or 2-year degree Continue.

College degree Continue.

Postgraduate degree Continue.

Q13. Are you Hispanic, Latino/a, or of Spanish origin?

• No, not of Hispanic, Latino/a, or Spanish origin Continue.

• Yes Continue.

Q14. What is your race or ethnicity? Choose all that apply.

(Read list. Recruit a mix to show per group. Recruit no more than 75% Non-Hispanic Whites per group.)

• White

• Black or African American

• American Indian or Alaska Native

• Asian Indian

• Chinese

• Filipino

• Japanese

• Korean

• Vietnamese

• Other Asian

• Native Hawaiian

• Guamanian or Chamorro

• Samoan

• Other Pacific Islander

Great! You qualify for our study. The focus group discussion will be held on [DATE] at [TIME] and will last approximately 90 minutes. For your time and opinions, you will receive $75 at the end of the session.

Q15. Would you like to participate in the focus group discussion at [TIME] on [DATE]?

Yes Continue. Assign to appropriate group (see Q1)

No Thank the respondent and terminate.

Great! May I please have your mailing and/or e-mail address to send you a confirmation letter with directions? [Verify address and phone number.] We are asking for your contact information only to send you a reminder letter and giving you a call to remind you of the focus group discussion. We will destroy all contact information at the conclusion of the groups.

We are only inviting a few people, so it is very important that you notify us as soon as possible if for some reason you are unable to attend. Please call [recruiter] at [telephone number] if this should happen. We look forward to seeing you on [date] at [time]. If you normally wear corrective lenses, contacts, or glasses to read please remember to have them with you during the focus group.

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