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Attachment 5
Summary of Proposed Changes to Instruments
Attachment 5 - Summary of Changes to PATH Study Instruments
The purpose of this attachment is to provide a high-level overview of changes to the PATH questionnaires
from Wave 2 to Wave 3. This overview includes the change in total item counts per section across Waves
(tables ‘a’), as well as a description summary of the content that was added or deleted in Wave 3 that
corresponds to the fluctuations in item counts (tables ‘b’).
The following tables outline changes in the (a) item counts and (b) questionnaire content across Waves for
the:
- Adult Questionnaire (see Tables 1a and 1b),
- Youth Questionnaire (see Tables 2a and 2b),
- Parent Questionnaire (see Tables 3a and 3b), and
- Nicotine Exposure Questionnaire (see Tables 4a and 4b).
1
Table 1a. ADULT QUESTIONNAIRE - Change in Total Item Counts from Wave 2 to Wave 3
Total Number of Items per Section
Wave 2
Adult Questionnaire Section
Change in Total
Item Count from
W2 to W3
Wave 3
Extended
Aged-Up
Extended
Aged-Up
Extended
Aged-Up
3
3
11
11
+8
+8
Tobacco Use
129
129
102
102
-27
-27
Cigarette
53
57
48
56
-5
-1
Primary Electronic Nicotine Products
65
--
68
76
+7
+11
Secondary Electronic Nicotine Products
61
--
5
5
+5
+5
Cigar
42
46
63
79
+19
+33
Pipe
38
42
39
47
+1
+5
Hookah
49
53
51
59
+2
+6
Snus (formerly in “Smokeless Tobacco”)
46
50
46
54
--
+4
Smokeless Tobacco
41
45
43
51
+2
+6
--
--
5
5
+5
+5
Dissolvable Tobacco
42
46
--
--
-42
-46
Polyuse
5
5
5
5
--
--
Nicotine Dependence
144
144
146
146
+2
+2
Packaging and Health Warnings
17
17
25
25
+8
+8
Product Regulation-Modified Risk Tobacco Products
34
34
57
58
+23
+24
Media Use
15
15
10
10
-5
-5
Secondhand Smoke Exposure
10
10
12
12
+2
+2
Social Norms-Peer and Family Influences
4
4
31
31
+27
+27
Health (includes substance use items)
112
154
160
221
+48
+67
Marketing, Advertising and Promotion
23
29
21
21
-2
-8
Additional Demographics
25
25
27
27
+2
+2
Product Barcode Scanning
10
10
26
26
+16
+16
Introductory Demographics
New Product - Placeholder
2
Contact Information
25
25
29
29
+4
+4
Total (Entire Questionnaire)
928
1008
1030
1156
+102
+148
1
Note: This table reflects total item counts; it does not account for the conditions in which the items are asked. For example, due to skip patterns,
every respondent is not asked all items reflected in these counts. Consequently, the average time to complete the Adult interview remains at 60
minutes for both the Wave 2 and Wave 3 Extended instruments, and increases to 68 minutes for the Wave 3 Aged-Up instrument.
2
The section enables the PATH Study to be responsive to the changing marketplace and can be rapidly deployed. The module collects basic usage
information about products that are not currently included in the PATH Study. The module will remain suppressed until such time that emerging
products dictate its deployment.
1
Attachment 5 - Summary of Changes to PATH Study Instruments
TABLE 1b. ADULT QUESTIONNAIRE – Description of Content Changes from Wave 2 to Wave 3
Wave 3 Section
Introductory
Demographics
Affected
Respondent
Category
Description of Questions
Rationale for Change
Added
Adults
On respondent's nativity status, years lived in
the US, English proficiency, and other
languages spoken in the home.
To assess changes in the demographic profile of the
United States due to immigration and acculturation in
order to identify disparities in English proficiency and
comprehension, particularly as they relate to tobacco
communication tools such as graphic health warnings.
Added
Adults
On identifying the primary and secondary
electronic nicotine product for respondents
that use more than one e-product.
To ensure that all electronic nicotine products are
being assessed, in addition to e-cigarettes.
Wave 3
Change
Added
Adults
On non-user’s susceptibility to becoming a
snus user.
Formerly, questions were asked about “smokeless
tobacco” as a collective class of products which
included snus; in Wave 3, questions are asked
explicitly about a respondent’s susceptibility to snus,
separately from other smokeless tobacco products.
Added
Adults
On respondent’s use of tobacco products that
are not discussed elsewhere in the PATH
Study.
To identify new and emerging tobacco products that
are not captured in existing PATH survey questions.
Deleted
Adults
On respondent’s detailed use of and
susceptibility to dissolvable tobacco products.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On respondent's cigarette type in past 30 days
(manufactured vs. roll-your-own).
Added
Adults
On assessing sensory experiences associated
with smoking.
Tobacco Use
Cigarette
2
Given the low prevalence of dissolvable tobacco use,
detailed use and susceptibility questions are removed
from Wave 3. Prevalence of ever and past 12 month
use is retained.
To assess usage patterns for any respondent who has
smoked in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
To assess manufactured and roll-your-own cigarette
use in the past 30 days and to inform biospecimen
analysis.
A question is added to differentiate the nicotine effects
from the airway sensory effects of smoking and to
enable monitoring/evaluation of the cigarette smoking
experience.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
Deleted
Adults
Deleted
Adults
Cigarette
(continued)
Primary Electronic
Nicotine Products
(formerly the
“E-cigarette” and
“ENDS” sections)
Secondary Electronic
Nicotine Products
Description of Questions
On use of flavored cigarettes (not including
menthol/mint) in the past 30 days and among
respondents who have recently initiated
cigarette use.
On reasons respondent chose their regular
brand of cigarettes, including packaging,
perceived decrease in health implications,
perceived satisfaction, and social norms.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On changing the voltage on electronic nicotine
product devices.
Added
Adults
On the use of marijuana concentrates, waxes,
THC and hash oils in e-products.
Added
Adults
Added
Adults
Added
Adults
On motives for using e-products.
Deleted
Adults
On modifying e-products.
Deleted
Adults
Added
Adults
On respondent's use of e-products that use a
tank system.
On respondent’s typical purchase quantity and
price paid for disposable e-products.
On reasons for using e-products, including
media influence and advertising.
On lifetime use, fairly regular use, initiation
flavor, length of time since last use, and use of
nicotine in secondary e-products.
3
Rationale for Change
Since flavored cigarettes are no longer commercially
available in the United States, questions about nonmenthol flavors have been deleted from Wave 3.
These questions were deleted to make time for new
questions that are of higher priority.
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
To assess whether respondents are changing the
voltage on their electronic nicotine product and,
therefore, impacting exposure to nicotine and other
potentially harmful constituents.
To assess whether respondents are using
marijuana/marijuana derivatives in e-products to
interpret biospecimens.
To assess how much e-liquid a given tank system will
hold and how frequently it is refilled.
To account for respondents who purchase disposable
e-products in boxes or packs.
To assess the psychosocial motives for using a tobacco
product.
Cycled out for Wave 3; may consider again in a future
wave.
These questions were deleted to make time for new
questions that are of higher priority.
To assess respondent use of secondary electronic
nicotine product(s), asked of polyusers.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Cigars
Pipe
Affected
Respondent
Category
Description of Questions
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On comparative harm of cigars and cigarettes.
Added
Adults
On motives for smoking cigars.
Deleted
Adults
On reasons for smoking cigars, including
media influence and advertising.
Added
Adults
On comparative harm from pipe smoking and
cigarettes.
Added
Adults
On motives for pipe smoking.
Deleted
Adults
On reasons for pipe smoking, including media
influence and advertising.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On use of shisha made from tobacco, herbal
and tobacco-free shisha.
Added
Adults
On motives for smoking hookah.
Added
Adults
On the type of liquid used in the bowl of the
hookah.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Deleted
Adults
On using a coupon when purchasing shisha.
Wave 3
Change
Hookah
4
Rationale for Change
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
Questions about comparative harm are expanded to
include combustible tobacco products in Wave 3,
including cigars.
To assess the psychosocial motives for using a tobacco
product.
These questions were deleted to make time for new
questions that are of higher priority.
Questions about comparative harm are expanded to
include combustible tobacco products in Wave 3,
including pipes.
To assess the psychosocial motives for using a tobacco
product.
These questions were deleted to make time for new
questions that are of higher priority.
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
To assess use of conventional and herbal or tobaccofree shisha.
To assess for the psychosocial motives for using a
tobacco product.
To assess for the use of liquids other than water to
smoke hookah.
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
These questions were deleted to make time for new
questions that are of higher priority.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Hookah
(continued)
Deleted
Adults
On reasons for smoking hookah, including
media influence and advertising.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On motives for using snus.
Deleted
Adults
On reasons for using snus including media
influence, advertising, and perceived pleasure
experienced compared to cigarettes.
Added
Adults
On product attributes, detailed use,
purchasing, brand, and dual use.
Added
Adults
On motives for using smokeless tobacco.
Deleted
Adults
On reasons for using smokeless tobacco
including media influence and advertising.
New Product Placeholder
Added
Adults
On basic use patterns.
Nicotine Dependence
Added
Adults
On whether using tobacco or e-products is
causing a health problem or exacerbating an
existing condition.
Snus (formerly
embedded in the
“Smokeless Tobacco”
section)
Smokeless Tobacco
5
Rationale for Change
These questions were deleted to make time for new
questions that are of higher priority.
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
To assess the psychosocial motives for using a tobacco
product.
These questions deleted to make time for new
questions that are of higher priority.
To assess usage patterns for any respondent who has
used in the past 30 days; previously, questions were
limited to those respondents who met the criteria for
current established use.
To assess the psychosocial motives for using a tobacco
product.
These questions were deleted to make time for new
questions that are of higher priority.
The module collects basic usage information about
products that are not currently included in the PATH
Study. The module will remain suppressed until such
time that emerging products dictate its deployment.
Questions were cycled out in a previous wave; they are
cycled back in for Wave 3.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
On health warning labels on cigarette packs,
smokeless tobacco packages, and packages of
snus including how often a respondent looks
closely at them; tries to avoid looking at or
thinking about them; how believable they are;
and how they make a respondent feel about
use or the health risks associated with use.
On noticing health warnings on packages of ecigarettes, traditional cigars, cigarillos, filtered
cigars, pipe tobacco, shisha or hookah tobacco
and dissolvable tobacco.
On perceived harm in using modified risk
tobacco products such as cigarettes with
reduced nicotine, and products labeled
“organic” or “additive-free”.
Rationale for Change
Questions were cycled out in a previous wave; they are
cycled back in for Wave 3 for cigarettes and smokeless
tobacco. In Wave 3, questions are asked explicitly
about snus separately from other smokeless tobacco,
to assess respondent exposure to packaging and health
warnings on snus packages.
Added
Adults
Deleted
Adults
Added
Adults
Added
Adults
On perceived harm of nicotine to health.
Added
Adults
On absolute and comparative perceived harm.
Added
Adults
On general perceived harm of using snus,
perceived harm compared to smoking
cigarettes and using other types of smokeless
tobacco, and compared to snus products from
five years ago.
To assess respondent’s perception of risk/harm as they
relate specifically to snus products (separate from
smokeless tobacco products, in general).
Deleted
Adults
On views about tobacco use, in general.
Cycled out for Wave 3; as opinions generally remain
stable over time, question is not asked in Wave 3.
Deleted
Adults
On perceived harm of using dissolvable
tobacco products compared to smoking
cigarettes.
These questions were deleted to make time for new
questions that are of higher priority.
On perceived harm/risk in smoking menthol
versus non-menthol cigarettes.
Because this was asked of adult respondents in a
previous wave, it is not necessary to ask in Wave 3.
Question will continue to be asked of respondents who
age into the adult cohort.
Packaging and Health
Warnings
Product Regulation –
Modified Risk
Tobacco Products
Description of Questions
Deleted
Adults
6
Cycled out for Wave 3; may consider again in a future
wave depending on changes to regulatory control for
these products.
To assess respondents’ understanding and perceptions
of harm/risk associated with use of modified risk
products.
To assess respondents’ understanding and perceptions
of harm of nicotine.
To assess respondents’ understanding and perceptions
of harm/risk associated with using various products
including e-products, traditional cigars, cigarillos,
filtered cigars.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Media Use
Secondhand Smoke
Exposure
Social Norms, Peer
and Family Influences
(formerly the “Peer
and Family Influences”
section)
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Rationale for Change
Added
Adults
On platforms used to watch videos.
To assess media use and exposure to tobacco
campaign advertising via video streaming websites and
other viewing platforms, in addition to television.
Deleted
Adults
Deleted
Adults
Added
Adults
Added
Adults
Added
Adults
Added
Adults
On exposure to and interaction with tobacco
brands on various social media.
On exposure to tobacco brands in online
games.
On rules pertaining to the use of electronic
nicotine products inside the home.
On exposure to secondhand vapor from an eproduct.
On peer/ family opinion of using cigarettes, eproducts, cigars, hookah, pipe tobacco, snus
or other smokeless tobacco.
On respondents' physical, mental, and overall
health, quality of life, and satisfaction with
social activities and relationships compared to
12 months ago.
On previously reported health conditions
including pre-cancerous oral lesions, high
blood pressure, high cholesterol, stroke, and
asthma.
Added
Adults
Added
Adults
On cancer remission or reoccurrence.
Added
Adults
On COPD Severity.
Health
7
Cycled out for Wave 3.
These questions were deleted to make time for new
questions that are of higher priority.
To assess use of electronic nicotine products inside
homes separately from combustible tobacco products.
To assess exposure to secondhand vapor from an eproduct.
To assess the role of social context in relation to the
use of tobacco products.
To assess self-reported health status since the previous
wave.
To assess ongoing medical treatment for health
conditions that were reported in previous waves,
resulting in disability, hospitalization, or use of
medication.
Will be asked for any respondent who previously
reported a cancer diagnosis to assess the relationship
between tobacco use and cancer
diagnosis/reoccurrence.
To assess the severity of diagnosed COPD in
respondents.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Health
(continued)
Marketing,
Advertising, and
Promotion
Additional
Demographics
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Rationale for Change
Added
Adults
On dental health.
Added
Adults
On diagnosis with Type 1 or Type 2 diabetes.
Added
Adults
On ulcers/ H. Pylori infection and medications
to treat these conditions.
Added
Older adults
(40+)
Questions were added about dental health, diagnosis
with diabetes, and ulcers, because these conditions can
be related to tobacco. Questions were also added
about macular degeneration, orofacial clefts, and
erectile dysfunction per the 2014 Surgeon General’s
On macular degeneration.
Report which showed a causal relationship
between smoking and these conditions. These
Added
Adult males
On erectile dysfunction.
Added
Adult females
On orofacial clefts.
Added
Adults
Family history of tobacco use, problematic
alcohol use, and problematic drug use.
Deleted
Younger
adults (1839)
On congestive heart failure, stroke, heart
attack or bypass surgery, osteoporosis, fragile
bones, and rapid vision loss.
additions will obtain more granular information on the
respondent’s health and the health effects associated
with use of tobacco products.
To assess family history of substance use problems
which are often associated with nicotine dependence.
The items can provide context on the moderating and
mediating factors that may influence the trajectory to
nicotine dependence among tobacco users.
Given the low prevalence of diagnosis for these health
conditions among respondents under the age of 40,
these questions are removed from the survey for
younger adults; the questions will be asked of all
respondents who are aging into the adult cohort.
Added
Continuing
Adults
On purchasing a brand of tobacco other than
the respondent’s usual brand.
Deleted
Adults
Deleted
Adults
Deleted
Adults
Added
Young adults
On participation in tobacco-sponsored
sweepstakes.
On the manner in which discount coupons or
promotions were received.
On receiving free samples of tobacco
products.
On high school enrollment status.
8
Previously, items were asked only for respondents
aging into the cohort; for Wave 3, all respondents will
be asked. Will assess reasons why respondents switch
brands and how frequently they do so.
These questions were deleted to make time for new
questions that are of higher priority.
To assess grade level for young adult respondents
currently enrolled in high school.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Rationale for Change
Contact Information
Added
Adults
On best method of contacting respondent.
To inform contacting and tracking efforts for future
waves.
9
Attachment 5 - Summary of Changes to PATH Study Instruments
1
Table 2a. YOUTH QUESTIONNAIRE - Change in Total Item Counts from Wave 2 to Wave 3
Total Number of Items per Section
Wave 2
Youth Questionnaire Section
Change in Total
Item Count from W2
to W3
Wave 3
Extended
Aged-Up
Extended
Aged-Up
Extended
Aged-Up
Introductory Demographics
0
3
8
11
+8
+8
Cigarette
47
49
33
41
-14
-8
Primary Electronic Nicotine Products
60
63
57
64
-3
+1
Secondary Electronic Nicotine Products
--
--
5
5
+5
+5
Cigar
66
70
72
79
+6
+9
Pipe
12
13
10
11
-2
-2
Hookah
56
59
46
53
-10
-6
Snus (formerly in “Smokeless Tobacco”)
46
51
38
44
-8
-7
Smokeless Tobacco
42
47
34
40
-8
-7
Dissolvable Tobacco
4
5
2
3
-2
-2
Bidis and Kreteks
4
5
2
4
-2
-1
--
--
1
1
+1
+1
--
--
5
5
+5
+5
First Tobacco Product
1
1
1
1
--
--
Nicotine Dependence
12
12
20
20
+8
+8
Cessation / Quitter
8
8
10
10
+2
+2
Packaging and Health Warnings
Product Regulation-Modified Risk Tobacco Products
(Includes “Harm Perception” questions)
16
26
26
33
+10
+7
3
3
43
43
+40
+40
Media Use
16
18
11
12
-5
-6
Secondhand Smoke Exposure
4
4
5
5
+1
+1
Health
46
57
40
40
-6
-17
Marketing, Advertising and Promotion
26
26
17
17
-9
-9
Social Norms-Peer and Family Influences
8
8
39
39
+31
+31
Accessibility
3
3
5
5
+2
+2
Psychosocial
12
12
12
15
--
+3
Substance Use
18
29
19
29
+1
--
Additional Demographics
17
17
11
11
-6
-6
Contact Information (Emancipated Youth)
25
25
29
29
+4
+4
Total (Entire Questionnaire)
552
614
601
670
+49
+56
Other Tobacco
New Product - Placeholder
2
1
Note: This table reflects total counts of items; it does not account for the conditions in which the items are asked. For example, due to skip
patterns, every respondent is not asked all items reflected in these counts. The average time to complete the Youth interview increases from 32 to
35 minutes for the Wave 3 Extended instrument, and increases to 45 minutes for the Wave 3 Aged-Up instrument.
2
The section enables the PATH Study to be responsive to the changing marketplace and can be rapidly deployed. The module collects basic usage
information about products that are not currently included in the PATH Study. The module will remain suppressed until such time that emerging
products dictate its deployment.
10
Attachment 5 - Summary of Changes to PATH Study Instruments
TABLE 2b. YOUTH QUESTIONNAIRE – Description of Content Changes from Wave 2 to Wave 3
Wave 3 Section
Introductory
Demographics
Wave 3
Change
Affected
Respondent
Category
Rationale for Change
To assess changes in the demographic profile of
the United States due to immigration and
acculturation in order to identify disparities in
English proficiency and comprehension,
particularly as they relate to tobacco
communication tools such as graphic health
warnings.
To assess manufactured and roll-your own
cigarette use in the past 30 days, and prevalence
of menthol-flavored roll your own cigarette
tobacco among youth.
Added
Youth
On respondent's nativity status, years lived in the
US, English proficiency, and other languages spoken
in the home.
Added
Youth
On respondent’s cigarette type in the past 30 days
(manufactured versus roll-your own).
Added
Youth
On whether the respondent was able to purchase
cigarettes in the past 30 days.
To assess product accessibility for tobacco
products.
Added
Youth
On the likelihood of becoming addicted to
cigarettes.
To assess respondent understanding and
perception of risk associated with cigarettes.
Cigarette
Primary Electronic
Nicotine Products
(formerly the
“Electronic Nicotine
Delivery Systems
(ENDS)” section)
Description of Questions
On whether respondent chose their particular brand
of cigarettes based on the design of the packaging,
media influence, the brand’s popularity, or ease of
purchase.
On determining the primary and secondary
electronic nicotine product for respondents who use
more than one device type.
Deleted
Youth
Added
Youth
Added
Youth
On e-product characteristics.
Added
Youth
On the use of marijuana concentrates, waxes, THC
and hash oils in e-products.
Added
Youth
On whether the respondent was able to purchase
electronic nicotine products in the past 30 days.
11
These questions were deleted to make time for
new questions that are of higher priority.
To ensure that all electronic nicotine products are
being assessed, in addition to e-cigarettes.
To assess whether respondent is using e-products
that contain nicotine and whether they can
change the voltage on their product.
To assess whether respondents are using eproducts to consume marijuana/marijuana
derivatives In order to understand e-product use
patterns.
To assess product accessibility for tobacco
products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Rationale for Change
Primary Electronic
Nicotine Products
(continued)
Added
Youth
On respondent’s typical purchase quantity and price
paid for disposable e-products.
To account for respondents who purchase
disposable e-products in boxes or packs.
Added
Youth
On motives for using e-products.
To assess the psychosocial motives for using a
tobacco product.
Deleted
Youth
On e-product ownership
Deleted
Youth
On modifying e-products
Deleted
Youth
On whether respondent purchased e-products
within their own state, in another state, or outside
the US.
These questions were deleted to make time for
new questions that are of higher priority.
Deleted
Youth
On using e-products as a result of media influence
and advertising.
These questions were deleted to make time for
new questions that are of higher priority.
Added
Youth
On lifetime use, fairly regular use, initiation flavor,
length of time since last use, and use of nicotine in
secondary e-products.
To assess respondent use of secondary electronic
nicotine product(s), asked of polyusers of
electronic nicotine products.
Added
Youth
On whether the respondent was able to purchase
cigars, including for blunts, in the past 30 days.
To assess product accessibility for tobacco
products.
Added
Youth
On motives for smoking cigars.
To assess the psychosocial motives for using a
tobacco product.
Deleted
Youth
On purchasing behaviors, including whether the
respondent used coupons and purchased cigars
within their own state, in another state or outside
the US.
Deleted
Youth
On smoking cigars as a result of media influence and
advertising.
Added
Youth
On whether the respondent was able to purchase
pipe tobacco in the past 30 days.
Primary Electronic
Nicotine Products
(formerly the
“Electronic Nicotine
Delivery Systems
(ENDS)” section)
(continued)
Secondary
Electronic Nicotine
Product
Cigar
Pipe
12
These questions were deleted to make time for
new questions that are of higher priority.
These questions were deleted to make time for
new questions that are of higher priority.
To assess product accessibility for tobacco
products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Pipe
(continued)
Affected
Respondent
Category
Description of Questions
Rationale for Change
Deleted
Youth
On purchasing behaviors, including whether the
respondent used coupons and purchased pipe
tobacco within their own state, in another state or
outside the US.
These questions were deleted to make time for
new questions that are of higher priority.
Added
Youth
On whether the respondent was able to purchase
shisha, or hookah tobacco, in the past 30 days.
To assess product accessibility for tobacco
products.
Added
Youth
Deleted
Youth
Deleted
Youth
Wave 3
Change
Hookah
Snus (formerly
embedded in
“Smokeless
Tobacco” section)
Smokeless
Tobacco
Added
Youth
Added
Youth
Added
Youth
Deleted
Youth
Added
Youth
On alternative hookah-smoking methods such as
using herbal or tobacco-free shisha and filling the
bowl with liquids other than water.
On purchasing behaviors, including whether the
respondent used coupons and purchased shisha
within their own state, in another state or outside
the US.
To assess prevalence of emerging products and
behaviors.
These questions were deleted to make time for
new questions that are of higher priority.
On smoking hookah as a result of media influence
and advertising.
On non-user’s susceptibility to becoming a snus
user.
On whether the respondent was able to purchase
snus in the past 30 days, and whether they used a
coupon.
On perceived harm of using snus, perceived harm
compared to smoking cigarettes, and likelihood of
becoming addicted.
On using snus as a result of media influence or
advertising or because the sensations were stronger
or more pleasurable than with cigarette smoking.
On whether the respondent was able to purchase
smokeless tobacco in the past 30 days.
13
Formerly, questions were asked about “smokeless
tobacco” as a collective class of products which
included snus; in Wave 3, questions are asked
explicitly about a respondent’s susceptibility to
snus, separately from other smokeless tobacco
products.
To assess product accessibility for tobacco
products.
To assess respondent’s perception of harm
specifically as it relates to snus products (separate
from smokeless tobacco products, in general).
These questions were deleted to make time for
new questions that are of higher priority.
To assess product accessibility for tobacco
products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Affected
Respondent
Category
Description of Questions
Rationale for Change
Deleted
Youth
On purchasing behaviors, including whether the
respondent used coupons and purchased smokeless
tobacco within their own state, in another state or
outside the US.
These questions were deleted to make time for
new questions that are of higher priority.
Deleted
Youth
On using smokeless tobacco as a result of media
influence and advertising.
These questions were deleted to make time for
new questions that are of higher priority.
Added
Youth
On past 30 day use.
Deleted
Youth
On use patterns.
Added
Youth
On past 30 day use.
Deleted
Youth
On use patterns.
Other Tobacco
Added
Youth
On respondent’s use of tobacco products that are
not discussed elsewhere in the PATH Study.
New Product Placeholder
Added
Youth
On basic use patterns.
Wave 3 Section
Smokeless
Tobacco
(continued)
Wave 3
Change
Dissolvable
Tobacco
Bidis and Kreteks
14
To assess for current use of dissolvable tobacco,
and cessation or initiation within persons, across
the cohort and over time.
Given the low number of dissolvable tobacco
users, only questions about prevalence of “ever”,
“past 12 month”, and “past 30 day” use are
retained for dissolvable tobacco. All other
questions are removed from Wave 3.
To assess for current use of bidis or kreteks, and
cessation or initiation within persons, across the
cohort and over time.
Given the low number of bidi/kretek users, only
questions about prevalence of “ever”, “past 12
month”, and “past 30 day” use are retained for
these products. All other questions are removed
from Wave 3.
To identify new and emerging tobacco products
that are not captured in existing PATH survey
questions.
The module collects basic usage information
about products that are not currently included in
the PATH study. The module will remain
suppressed until such time that emerging
products dictate its deployment.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Packaging and
Health Warnings
Product Regulation
– Modified Risk
Tobacco Products
Affected
Respondent
Category
Description of Questions
Rationale for Change
Added
Youth
On health warning labels on cigarette packs and
smokeless tobacco and snus containers, including
how often a respondent looks closely at them; tries
to avoid looking at or thinking about them; how
believable they are; how they make a respondent
feel about use or the health risks associated with
use; and if they affect the likelihood a respondent
will start using the product.
Because health warning labels on tobacco
products did not change, these items were cycled
out in a previous wave to make room for other
questions; they will be asked again in Wave 3.
Deleted
Youth
On health warnings on packages of dissolvable
tobacco.
Cycled out for Wave 3.
Added
Youth
On perceived harm to health from cigarette
smoking.
Measures of absolute harm were added for Wave
3 to complement measures of comparative harm.
Added
Youth
On the respondent’s perceived likelihood of
becoming addicted to cigarettes.
Added
Youth
On perceived harm in using modified risk tobacco
products such as cigarettes with reduced nicotine,
and products labeled “organic” or “additive-free”.
Added
Youth
On perceived harm, addictiveness of nicotine.
Added
Youth
On perceived harm associated with snus use.
Added
Youth
On perceived harm of secondhand shisha/hookah
tobacco.
Added
Youth
On whether the respondent has considered
switching from a currently used product to an eproduct.
Deleted
Youth
On the perceived benefits gained from smoking.
Youth
On the length of time bidis/kreteks or dissolvable
tobacco can be used before experiencing health
consequences.
Wave 3
Change
Deleted
15
To assess respondents’ understanding and
perceptions of harm/risk associated with tobacco.
Question was modified to ask explicitly about snus
use, separate from other smokeless tobacco, in
Wave 3.
To assess respondent’s perceived harm to others
from exposure to secondhand smoke from a
hookah.
To assess the relationship between cessation and
uptake of various products.
These questions were deleted to make time for
new questions that are of higher priority.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Product Regulation
– Modified Risk
Tobacco Products
(continued)
Media Use
Secondhand
Smoke Exposure
Health
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Deleted
Youth
On the likelihood that the respondent will try a
modified risk tobacco product.
Deleted
Youth
On perceived harm of intermittent and daily use of
cigarettes, smokeless tobacco and snus, and the
length of time these products can be used before
health consequences occur.
Deleted
Youth
On the likelihood of becoming addicted to cigars.
Deleted
Youth
On existence of modified risk tobacco products.
Rationale for Change
These questions were deleted to make time for
new questions that are of higher priority.
To assess media use and exposure to tobacco
campaign advertising via video streaming
websites and other viewing platforms, in addition
to television.
Added
Youth
On platforms used to watch videos.
Deleted
Youth
On exposure to and interaction with
tobacco/tobacco brands on various social media.
Deleted
Youth
On exposure to tobacco brands in online games.
Deleted
Youth
On whether scanning a QR code took respondent to
a tobacco website.
Added
Youth
On rules pertaining to the use of electronic nicotine
products inside the home.
Added
Youth
On respondents' physical, mental, and overall
health, compared to 12 months ago.
To assess self-reported health status since the
previous wave.
Added
Youth
On emergency room visits due to an asthma attack.
To distinguish whether respondents are seeking
primary medical treatment for asthma at the
hospital or seeking care for acute asthma attacks.
Added
Youth
On overall dental health.
Changes in dental health can be related to
tobacco.
16
These questions were deleted to make time for
new questions that are of higher priority.
Previously, item was only asked of those
respondents aging into the cohort. Is not asked
of any respondent in Wave 3.
To assess use of electronic nicotine products
inside homes separately from combustible
tobacco products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Health
(continued)
Marketing,
Advertising, and
Promotion
Social Norms, Peer
and Family
Influences
(formerly the “Peer
and Family
Influences” section)
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Rationale for Change
Deleted
Youth
On shortness of breath and self-assessed difficulty
with exercise compared to peers.
Questions were deleted to give prominence to
asthma measures.
Questions asked solely of emancipated youth
respondents are removed from the survey;
removing the questions significantly decreased
the complexity of the youth survey and alleviated
disproportionate burden on resources. Given the
extremely low number of emancipated youths
sampled for PATH, the impact on the data is very
small, and is offset by the benefits of eliminating
the emancipated youth module. The questions in
the emancipated youth module will be asked of all
respondents when they age into the adult cohort.
Deleted
Emancipated
Youth
On various health-related conditions (including
emergency room visits, physical/mental
impairments, high blood pressure, cholesterol,
chronic bronchitis, ADHD/ADD, dental health,
diabetes).
Deleted
Youth
On seeing ads for or participating in tobacco
sweepstakes.
Cycled out for Wave 3.
Deleted
Youth
On specific manner in which respondents received
coupons for tobacco products.
These questions were deleted to make time for
new questions that are of higher priority.
Deleted
Youth
On receiving information, other than coupons or
promotions, from tobacco companies.
These questions were deleted to make time for
new questions that are of higher priority.
Added
Youth
On peer/ family opinion of using cigarettes, eproducts, cigars, pipe tobacco, hookah, snus or
other smokeless tobacco.
Added
Youth
On whether peer disapproval influences cessation.
Added
Youth
On whether the respondent’s best friends use snus.
Added
Youth
On parental boundary setting in regards to
electronic nicotine products.
17
To assess the role of social context in relation to
the use of tobacco products.
Formerly, question was asked about “smokeless
tobacco” as a collective class of products which
included snus; in Wave 3, question is asked
explicitly about snus, separately from other
smokeless tobacco products.
Previously, question was asked about “tobacco in
general”; in Wave 3, question is expanded to also
ask about e-cigarettes and other electronic
nicotine products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Change
Affected
Respondent
Category
Description of Questions
Added
Youth
On accessibility of e-cigarettes and other electronic
nicotine products in stores.
Added
Youth
On the likelihood that the respondent will purchase
e-cigarettes or other electronic nicotine products in
the next 30 days.
Added
Youth
On sensation-seeking behaviors.
Accessibility
Substance Use
Additional
Demographics
Deleted
Emancipated
Youth
On school attendance and performance, household
income, and home ownership.
Contact
Information
Added
Emancipated
Youth
On best method of contacting respondent.
18
Rationale for Change
To help inform the process and experience of
purchasing e-products among youth.
Questions were cycled out in a previous wave and
are asked again in Wave 3.
Questions asked solely of emancipated youth
respondents are removed from the survey;
questions in the emancipated youth module will
be asked of all respondents when they age into
the adult cohort.
To inform tracking efforts for future waves.
(Contact information for non-emancipated youth
is collected in the Parent interview.)
Attachment 5 - Summary of Changes to PATH Study Instruments
Table 3a. PARENT QUESTIONNAIRE - Change in Total Item Counts from Wave 2 to Wave 3
Total Number of Items per Section
Parent Questionnaire Section
Wave 2
Change in Total Item
Count from W2 to W3
Wave 3
Extended
Aged-Up
Extended
Aged-Up
Extended
Aged-Up
Family Composition
12
19
13
20
+1
+1
School, Home, and Tobacco Use
9
9
9
9
--
--
Health
21
38
21
42
--
+4
Respondent Characteristics
9
9
14
14
+5
+5
Contact Information
27
27
31
31
+4
+4
Total (Entire Questionnaire)
78
102
88
116
+10
+14
*Note: This table reflects total counts of items; it does not account for the conditions in which the items are asked. For
example, due to skip patterns, every respondent is not asked all items reflected in these counts. The average time to
complete the Parent interview increases from 14 to 16 minutes for the Wave 3 Extended instrument, and increases to
19 minutes for the Wave 3 Aged-Up instrument.
19
Attachment 5 - Summary of Changes to PATH Study Instruments
TABLE 3b. PARENT QUESTIONNAIRE – Description of Content Changes from Wave 2 to Wave 3
Wave 3 Section
Wave 3
Status
Affected
Respondent
Category
Description of Questions
Rationale for Change
Family
Composition
Added
Parent
On youth respondent’s date of birth.
Will be asked in any parent interview where sampled youth’s age is
missing (previously, an age range was collected for those youth
respondents who did not provide a date of birth).
Added
Parent
On rules pertaining to the use of electronic
nicotine products inside the home.
To assess use of electronic nicotine products inside homes separately
from combustible tobacco products.
Deleted
Parent
On number of days youth missed school.
The question was deleted to make time for new questions that are
of higher priority.
Added
Parent
Family history of tobacco use, problematic
alcohol use, or problematic drug use.
Added
Parent
On child’s diagnosis with Type 1 or Type 2
diabetes.
Deleted
Parent
On number of visits child made to the
emergency room.
These questions were deleted to make time for new questions that
are of higher priority.
Added
Parent
On housing type.
To characterize respondent’s housing type as an indicator of socioeconomic status which can be a factor in tobacco use initiation and
in patterns of tobacco use.
Added
Parent
On respondent's nativity status, years lived
in the US, and English proficiency.
To assess changes in the demographic profile of the United States
due to immigration and acculturation in order to identify disparities
in English proficiency and comprehension, particularly as they relate
to tobacco communication tools such as graphic health warnings.
Added
Parent
On perceived comparative harm of specific
tobacco product types.
To assess differences in harm perception among combusted and
non-combusted tobacco products and e-cigarettes/electronic
nicotine products.
Deleted
Parent
On perception of absolute harm caused by
tobacco use.
To assess respondents’ understanding and perceptions of harm/risk
associated with tobacco use in general.
School, Home and
Tobacco Use
Health
Respondent
Characteristics
20
To assess family history of substance use problems which are often
associated with nicotine dependence. The items can provide context
on the moderating and mediating factors that may influence the
trajectory to nicotine dependence among tobacco users.
To capture information on diabetes, to obtain more granular
information on the respondent’s health and the health effects
associated with use of tobacco products.
Attachment 5 - Summary of Changes to PATH Study Instruments
Wave 3 Section
Wave 3
Status
Affected
Respondent
Category
Description of Questions
Rationale for Change
Contact
Information
Added
Parent
On best method of contacting respondent.
To inform contact and tracking efforts for future waves.
21
Attachment 5 - Summary of Proposed Changes to PATH Study Instruments
Table 4a. NICOTINE EXPOSURE QUESTIONNAIRE - Change in Total Item Counts from Wave 2 to Wave 3
NEQs
Wave 2
Wave 3
Change since Wave 2
Total (Entire Questionnaire)
28
41
+13
*Note: This table reflects total counts of items; it does not account for the conditions in which the items are
asked. For example, due to skip patterns, every respondent is not asked all items reflected in these counts. The
average time to complete the Nicotine Exposure Questionnaire increases from 4 to 5 minutes in the Wave 3
interview. NEQs are asked of all respondents that consent to bio-specimen collection; there is no distinction
made between the extended and aged-up respondent categories.
22
Attachment 5 - Summary of Proposed Changes to PATH Study Instruments
TABLE 4b. NICOTINE EXPOSURE QUESTIONNAIRE – Description of Content Changes from Wave 2 to Wave 3
Wave 3 Section
Wave 3
Status
Added
Affected
Respondent
Category
Changes from Wave 2
Rationale for Change
Adults
Language was added to existing NEQs for
electronic nicotine products to clarify that
only those electronic nicotine products
that contain nicotine should be reported.
To assess whether the respondent has used an electronic nicotine
product containing nicotine before collecting the respondent's biospecimens.
Adults
Language was added to existing NEQs for
cigars to clarify that any cigar use,
including those cigars smoked with
marijuana (i.e., “blunts”), should be
reported.
To assess whether the respondent has smoked any cigar including
those smoked with marijuana, before collecting the respondent's biospecimens.
NEQs
Added
23
| File Type | application/pdf |
| File Modified | 2015-06-19 |
| File Created | 2015-06-09 |