Appendix E. Online Survey Instrument
U.S. Food and Drug Administration (FDA) Center for Tobacco Products (CTP)
FDA CTP Public Education Materials Study
SURVEY INSTRUMENT
Note: The survey respondent will NOT see any of the blue text.
[Landing Page/Introduction]
Please select your conference from the list below: [Drop-down menu of 13 conferences in 2018—the complete list of these conferences is available in the study protocol]
What year were you born?
[Drop-down menu with years]
[TERMINATE SURVEY AND GO TO TERMINATION TEXT 2 IF RESPONDENT WAS BORN IN 1999 OR LATER; THIS WILL BE ALTERED SO ONLY THOSE 18 YEARS OR OLDER MAY PARTICIPATE]
[TERMINATION TEXT 2:] Based on your answer, you do not qualify for this survey. Thank you very much for your time and consideration.
[INSERT INFORMED CONSENT INFORMATION HERE]
[Beginning of survey]
1. Were you aware of the existence of the FDA’s Center for Tobacco Products (CTP) before today?
Please select the response option that best applies to you:
Yes
No
I don’t know
I prefer not to answer
2. Which of the following best describes you?
General public
Please check the role that best describes you: [These options will only appear if the respondent checks “General public.”]
A tobacco product consumer
Concerned citizen
Family or friend of product consumer
Health information seeker
Other (please specify): ___________ [Open-ended text box]
I prefer not to answer
Health care professional
Please check the role that best describes you: [These options will appear only if the respondent checks “Health care professional.”]
Administrator
Nurse in a clinical setting
Nurse in a school setting
Physician
Physician Assistant
Other (please specify): ___________ [Open-ended text box]
I prefer not to answer
Media professional
Please check the role that best describes you: [These options will appear only if the respondent checks “Media professional.”]
Member of the press/reporter
Other communications professional
I prefer not to answer
Public health professional
Please check the role that best describes you: [These options will only appear if the respondent checks “Public health professional.”]
Advocate
Communicator
Educator/trainer
Practitioner
Researcher/scientist
Other (please specify): ___________ [Open-ended text box]
I prefer not to answer
Tobacco industry representative
Please check the role that best describes you: [These options will only appear if the respondent checks “Tobacco industry representative.”]
Importer
Grower
Manufacturer
Retailer
Trade association representative
Wholesaler or distributor
Other (please specify): ___________ [Open-ended text box]
I prefer not to answer
Other (please specify): ___________ [Open-ended text box]
I prefer not to answer
3. Which of these populations do you primarily serve? [CHECK ALL THAT APPLY]
Asians/Asian Americans
Blacks/African Americans
General public
Hawaiians/Pacific Islanders
Health care professionals (for example, physicians and clinicians)
Hispanics/Latinos
Please check the population that best describes the one that you serve: [These options will only appear if the respondent checks “Hispanics/Latinos.”]
English-dominant Hispanics/Latinos
Spanish-dominant Hispanics/Latinos
Bilingual Hispanics/Latinos
A mixture of all the above
I prefer not to answer
LGBTQI (lesbian, gay, bisexual, transgender, queer or questioning, and intersex people)
Media professionals
Native Americans/American Indians
Public health professionals (for example, public health educators and public health students)
Teachers
Tobacco industry representatives (for example, retailers and manufacturers)
Whites/Caucasians
Young adults
Youth/teens
Other (please specify): ____________ [open-ended text box]
I don’t know
None
I prefer not to answer
[Each survey respondent will view four tobacco education materials—materials will be rotated randomly among respondents. The random rotation will be programmed in the survey software.]
Next, you will be shown 4 materials. You will receive questions about the materials. The questions may seem repetitive but are necessary to evaluate the materials.
FIRST MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)
The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.
[First randomly selected material appears as a screen shot here.]
4. Have you seen this material before?
Please select the response option that best applies to you:
Yes
No
I don’t know
I prefer not to answer
5. To what extent does this material provide NEW information to you?
Please select the response option that best applies to you:
100% (all) new information
Approximately 75% new information
Approximately 50% new information
Approximately 25% new information
0% (no) new information
I don’t know
I prefer not to answer
6. To what extent is this material USEFUL to you?
Please select the response option that best applies to you:
100% (all) useful information
Approximately 75% useful information
Approximately 50% useful information
Approximately 25% useful information
0% (no) useful information
I don’t know
I prefer not to answer
7. How EASY TO UNDERSTAND is this material to you?
Please select the response option that best applies to you:
100% (all) easy to understand information
Approximately 75% easy to understand information
Approximately 50% easy to understand information
Approximately 25% easy to understand information
0% (no) easy to understand information
I don’t know
I prefer not to answer
SECOND MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)
The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.
[Second randomly selected material appears as a screen shot here.]
8. Have you seen this material before?
Please select the response option that best applies to you:
Yes
No
I don’t know
I prefer not to answer
9. To what extent does this material provide NEW information to you?
Please select the response option that best applies to you:
100% (all) new information
Approximately 75% new information
Approximately 50% new information
Approximately 25% new information
0% (no) new information
I don’t know
I prefer not to answer
10. To what extent is this material USEFUL to you?
Please select the response option that best applies to you:]
100% (all) useful information
Approximately 75% useful information
Approximately 50% useful information
Approximately 25% useful information
0% (no) useful information
I don’t know
I prefer not to answer
11. How EASY TO UNDERSTAND is this material to you?
Please select the response option that best applies to you:
100% (all) easy to understand information
Approximately 75% easy to understand information
Approximately 50% easy to understand information
Approximately 25% easy to understand information
0% (no) easy to understand information
I don’t know
I prefer not to answer
THIRD MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)
The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.
[Third randomly selected material appears as a screen shot here.]
12. Have you seen this material before?
Please select the response option that best applies to you:
Yes
No
I don’t know
I prefer not to answer
13. To what extent does this material provide NEW INFORMATION to the POPULATIONS you serve?
100% (all) new information
Approximately 75% new information
Approximately 50% new information
Approximately 25% new information
0% (no) new information
I don’t know
I prefer not to answer
14. To what extent is this material HELPFUL to the POPULATIONS you serve?
100% (all) helpful information
Approximately 75% helpful information
Approximately 50% helpful information
Approximately 25% helpful information
0% (no) helpful information
I don’t know
I prefer not to answer
15. To what extent is this material MOTIVATIONAL to the POPULATIONS you serve?
100% (all) motivational information
Approximately 75% motivational information
Approximately 50% motivational information
Approximately 25% motivational information
0% (no) motivational information
I don’t know
I prefer not to answer
FOURTH MATERIAL: This material will appear as a screenshot on the tablet for survey respondents to see. (The CTP staff person at the survey section of the exhibit also will show respondents the hard copy of the materials to which they are reacting.)
The next few questions ask you about your reactions to a tobacco education information material. Please ask the CTP booth staff person to show you this material in print.
[Fourth randomly selected material appears as a screen shot here.]
16. Have you seen this material before?
Please select the response option that best applies to you:
Yes
No
I don’t know
I prefer not to answer
17. To what extent does this material provide NEW INFORMATION to the POPULATIONS you serve?
100% (all) new information
Approximately 75% new information
Approximately 50% new information
Approximately 25% new information
0% (no) new information
I don’t know
I prefer not to answer
18. To what extent is this material HELPFUL to the POPULATIONS you serve?
100% (all) helpful information
Approximately 75% helpful information
Approximately 50% helpful information
Approximately 25% helpful information
0% (no) helpful information
I don’t know
I prefer not to answer
19. To what extent is this material MOTIVATIONAL to the POPULATIONS you serve?
100% (all) motivational information
Approximately 75% motivational information
Approximately 50% motivational information
Approximately 25% motivational information
0% (no) motivational information
I don’t know
I prefer not to answer
We would like to know more about your tobacco education information needs.
20. You already told us which populations you serve. For what specific populations do you need additional tobacco education materials?
[CHECK ALL THAT APPLY]
Asians/Asian Americans
Blacks/African Americans
General public
Hawaiians/Pacific Islanders
Health care professionals (for example, physicians and clinicians)
Hispanics/Latinos
Please check the population that best describes the one for which you need additional tobacco education materials: [These options will only appear if the respondent checks “Hispanics/Latinos.”]
English-dominant Hispanics/Latinos
Spanish-dominant Hispanics/Latinos
Bilingual Hispanics/Latinos
A mixture of all the above
LGBTQI (lesbian, gay, bisexual, transgender, queer or questioning, and intersex people)
Media professionals
Native Americans/American Indians
Public health professionals (for example, public health educators and public health students)
Teachers
Tobacco industry representatives (for example, retailers and manufacturers)
Whites/Caucasians
Young adults
Youth/teens
Other (please specify): ____________ [open-ended text box]
I don’t know
None
I prefer not to answer
21. For which of the following topics would you like to see more tobacco education materials developed? [CHECK ALL THAT APPLY]
Novel or alternative tobacco products
Please check the novel or alternative tobacco products for which you need more information: [These options will appear only if the respondent checks “Novel or alternative tobacco products.”] [CHECK ALL THAT APPLY]
Chewing tobacco (“spit,” “chew”)
Cigarillos or little cigars
Cigars
Dissolvables or dissolvable tobacco (can take the form of orbs, strips, or sticks and resemble candy or mints)
E-cigarettes and other electronic nicotine delivery systems (ENDS) such as hookah pens, e-pipes, vapes, and vaporizers
Gels
Kreteks (clove cigarettes that contain 60 percent to 90 percent tobacco)
Menthol cigarettes
Pipe tobacco
Snuff (“pinch,” “dip”)
Snus (spitless tobacco in teabag-like pouches)
Waterpipe or hookah tobacco
Other (please specify): ____________________ [open-ended text box]
None of the above
Prevention of tobacco use
Please check the tobacco products for which you need more information: [These options will appear only if the respondent checks “Prevention of tobacco use.”] [CHECK ALL THAT APPLY]
Chewing tobacco (“spit,” “chew”)
Cigarillos or little cigars
Cigars
Dissolvables or dissolvable tobacco (can take the form of orbs, strips, or sticks and resemble candy or mints)
E-cigarettes and other electronic nicotine delivery systems (ENDS) such as hookah pens, e-pipes, vapes, and vaporizers
Gels
Kreteks (clove cigarettes that contain 60 percent to 90 percent tobacco)
Menthol cigarettes
Pipe tobacco
Snuff (“pinch,” “dip”)
Snus (spitless tobacco in teabag-like pouches)
Waterpipe or hookah tobacco
Other (please specify): ____________________ [open-ended text box]
None of the above
Treatment of tobacco-associated health conditions
The latest science in tobacco research
Other (please specify): ____________ [open-ended text box]
None
I don’t know
I prefer not to answer
22. For tobacco education, which of the following formats would you like used? [CHECK ALL THAT APPLY]
Brochures
Digital assets
Infographics
Fact sheets
Postcards
Posters
Videos
Other (please specify): ____________ [open-ended text box]
None
I don’t know
I prefer not to answer
23. Of the following ways to deliver materials to you, how would you prefer to receive materials? [PLEASE SELECT THE RESPONSE OPTION THAT BEST APPLIES TO YOU]
A real-time, interactive webinar
Electronic download (for example, a printable PDF)
In person at a meeting or conference
Regular mail
Other (please specify): ____________ [open-ended text box]
None
I don’t know
I prefer not to answer
24. Which of the following engagement opportunities offered by the FDA Center for Tobacco Products interest you most? [CHECK ALL THAT APPLY]
In-person meetings (e.g., conferences, town hall meetings)
Teleconferences
Videos
Webinars
Other (please specify): ____________ [open-ended text box]
None
I don’t know
I prefer not to answer
25. In what country do you live? [Drop-down menu of countries]
I prefer not to answer
25a. [For those who responded “United States”] In what state do you work? [Drop-down menu of states]
I prefer not to answer
Thank you very much for taking the time to complete this survey!
The FDA Center for Tobacco Products (CTP) Team
Please go to the next page to submit your survey.
The Food and Drug Administration (FDA) is sponsoring this study. The mission of the FDA is to promote and protect public health. In conducting this study, FDA does not intend to sell tobacco, nor promote, condone, normalize, or encourage its use.
[End of survey]
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average no more than 6 minutes per response to complete this survey (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.”
Form Approved
OMB No. 0910-0810
Exp. Date11/2018
RIHSC #18-001
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Everly Macario |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |