OMB Control # 0910-0810
Exp. 11-30-2018
You are going to see approximately 10 facts about tobacco. We will show you one fact at a time. After each fact is shown, we’d like to know what you think about each of them. Some of these facts may be used in advertisements to keep young people from smoking and using other tobacco products.
[RANDOMIZE ORDER, HIDE RESPONSE VALUES]
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-3 |
-2 |
-1 |
0 |
1 |
2 |
3 |
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Not telling me anything new |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Telling me something new |
Not attention grabbing |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Attention grabbing |
Not worth remembering |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Worth remembering |
Boring |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Interesting |
Stupid |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Not Stupid |
Not important |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Important |
Not informative |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Informative |
Not convincing |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Convincing |
Not believable |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Believable |
1 Very much
2 Somewhat
3 A little
4 Not at all
9 Prefer not to answer
1 Very likely
2 Somewhat likely
3 Somewhat unlikely
4 Very unlikely
9 Prefer not to answer
1 Very strong
2 Somewhat strong
3 Somewhat weak
4 Very weak
9 Prefer not to answer
[Repeat questions A1 – A4 for the remaining 9 or so facts]
Next we are going to ask you to review all the facts you have seen and tell us which facts are the best and which ones are the worst.
A5. Please review the facts you have seen and rank the 2 you think give the BEST reason not to smoke or use other tobacco products where 1=best; 2=second best
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Fact 1: Addiction keeps people smoking even when they want to quit. |
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Fact 2:… |
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… |
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… |
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______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
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Fact 1: Addiction keeps people smoking even when they want to quit. |
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Fact 2:… |
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… |
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… |
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… |
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… |
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… |
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… |
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… |
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… |
______________________________________________________________________________________________________________________
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Next, we are going to ask you some general questions about smoking.
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1 |
2 |
3 |
4 |
9 |
B1_1a. |
Be controlled by smoking (Addiction) |
1 |
2 |
3 |
4 |
9 |
B1_1b. |
Become addicted (Addiction) |
1 |
2 |
3 |
4 |
9 |
B1_1c. |
Develop a smoking-related disease (Health Effects) |
1 |
2 |
3 |
4 |
9 |
B1_1d. |
Damage my body (Health Effects) |
1 |
2 |
3 |
4 |
9 |
B1_1e. |
Inhale dangerous chemicals (HPHCs) |
1 |
2 |
3 |
4 |
9 |
B1_1f. |
Shorten my life (Mortality) |
1 |
2 |
3 |
4 |
9 |
B1_1g. |
Be less attractive to others (Social Norms) |
1 |
2 |
3 |
4 |
9 |
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1 |
2 |
3 |
4 |
9 |
B1_2a. |
Inhale dangerous chemicals |
1 |
2 |
3 |
4 |
9 |
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1 |
2 |
3 |
4 Disagree |
5 Strongly Disagree |
9 |
B2_1. |
Smoking can cause immediate damage to my body. (Health Effects) |
1 |
2 |
3 |
4 |
5 |
9 |
B2_2. |
E-cigarettes are less harmful than smoking regular cigarettes. (E-Cigarettes) |
1 |
2 |
3 |
4 |
5 |
9 |
B2_3. |
Using any kind of tobacco can pose some health risks. (Product Content/Design) |
1 |
2 |
3 |
4 |
5 |
9 |
__________ MIN 0 MAX 10
99 Prefer not to answer
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0 |
1 |
2 |
3 |
4 |
9 |
B4_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
B4_2. |
Use electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs” (For example, blu, NJOY, Mistic, 21st Century Smoke)? |
0 |
1 |
2 |
3 |
4 |
9 |
Please tell us if you strongly agree, agree, disagree, or strongly disagree with the following statements.
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|
1 |
2 |
3 |
4 |
5 |
9 |
B5_1 |
Like to explore strange places. |
1 |
2 |
3 |
4 |
5 |
9 |
B5_2 |
Like to do frightening things. |
1 |
2 |
3 |
4 |
5 |
9 |
B5_3 |
Like new and exciting experiences, even if I have to break the rules. |
1 |
2 |
3 |
4 |
5 |
9 |
B5_4 |
Prefer friends who are exciting and unpredictable. |
1 |
2 |
3 |
4 |
5 |
9 |
|
|
1 |
2 |
9 |
B6_1 |
Smokeless tobacco, such as chewing tobacco, snuff, snus or dip (For example, Copenhagen, Skoal, Grizzly, Kodiak, or Red Seal)? |
1 |
2 |
9 |
B6_2 |
Cigars, cigarillos, or little cigars,(For example, Swisher Sweets, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s)? |
1 |
2 |
9 |
B6_3 |
Tobacco out of a water pipe (also called “hookah”)? |
1 |
2 |
9 |
B6_4 |
Electronic cigarettes, also called “e- cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs”(For example, blu, NJOY, Mistic, 21st Century Smoke)? |
1 |
2 |
9 |
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1 |
2 |
3 |
4 |
9 |
B7_1 |
Do you think that you will try an e-cigarette soon? |
1 |
2 |
3 |
4 |
9 |
B7_2 |
Do you think you will try an e-cigarette at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
B7_3 |
If one of your best friends were to offer you an e-cigarette, would you use it? |
1 |
2 |
3 |
4 |
9 |
Next, we would like to ask you some general questions about your skills.
1 Strongly disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly agree
9 Prefer not to answer
1 Very confident
2 Somewhat confident
3 A little confident
4 Not at all confident
9 Prefer not to answer
1 Female
2 Male
9 Prefer not to answer
1 Yes
2 No
9 Prefer not to answer
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Native Hawaiian or Other Pacific Islander
5 White
5 Other
9 Prefer not to answer
C4. Other than you, has anyone who lives with you used any of the following during the past 30 days…? (You can CHOOSE ONE ANSWER or MORE THAN ONE ANSWER)
1 cigarettes
2 smokeless tobacco, such as chewing tobacco, snuff, snus or dip, such as Copenhagen, Skoal, Grizzly, Kodiak, and Red Seal
3 cigars, cigarillos, or little cigars, such as Swisher Sweets, Black & Mild, White Owl, Cheyenne, Dutch Masters, Garcia Y Vega or Middleton’s
4 tobacco out of a water pipe (also called “hookah”)
5 electronic cigarettes, also called “e-cigarettes”, “e-cigs”, “vapor pens”, or “e-hookahs” such as blu, NJOY, Mistic, 21st Century Smoke
6 any other form of tobacco (please specify)
7 No, no one who lives with me has used any form of tobacco during the past 30 days
9 Prefer not to answer
1 I don’t plan to go to school anymore
2 9th grade
3 10th grade
4 11th grade
5 12th grade or GED
6 Some college or technical school but no degree
7 Technical school degree
8 College degree
9 Graduate school, medical school, or law school
99 Prefer not to answer
__________ MIN 0 MAX 98
99 Prefer not to answer
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 20 minutes per response (the time to read and complete). You can send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Duke, Jennifer |
File Modified | 0000-00-00 |
File Created | 2021-01-26 |