Attach4 Summary of Changes to Instruments for Wave 4

Attach4 Summary of Changes to Instruments for Wave 4.pdf

Population Assessment of Tobacco and Health (PATH) Study - Fourth Wave of Data Collection (NIDA)

Attach4 Summary of Changes to Instruments for Wave 4

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Population Assessment of Tobacco and Health (PATH) Study (NIDA)

Attachment 4
Summary of
Changes to
Instruments for
Wave 4

Attachment 4 - Summary of Changes to Instruments for Wave 4
The purpose of this attachment is to provide a high-level overview of changes to the PATH Study
instruments from Wave 3 to Wave 4. 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 4 that corresponds to the fluctuations in item counts (tables ‘b’).
The following tables outline changes in the (a) item counts and (b) instrument 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).
Changes to the instruments are implemented if they better serve the PATH Study’s overarching goal and
research objectives of measuring and understanding within-person change and between-person differences
in tobacco product use and related health outcomes over time. The PATH Study’s assessment of what
changes are required to the instruments is informed by several factors. For example, changes in the
tobacco marketplace (e.g., the evolving e-cigarette marketplace or new tobacco product images and
terminology) often necessitate corresponding changes to questions in a given wave. Regulatory actions and
activities can also influence whether to change questions in the instruments. Further, findings from one or
more previous waves of the PATH Study can identify the need to make changes to the instruments. When
making decisions about instrument changes, the PATH Study weighs whether such changes impact the
established trend line from previous waves’ data or lead to a net increase on respondent burden relative to
prior waves. To ensure no net increase in burden, the PATH Study uses a deliberate, methodical approach
to delete or cycle out questions to offset the increase in order to maintain stability in burden from one
wave to the next.
See section A.2b in Supporting Statement A for more information on the different types of questionnaires.

Attachment 4 - Summary of Changes to Instruments for Wave 4
1

Table 1a. ADULT QUESTIONNAIRE - Change in Total Item Counts from Wave 3 to Wave 4
Total Number of Items per Section
Wave 3

Adult Questionnaire Section

Wave 4

Change in Total Item
Count from W3 to W4

Extended

Aged-Up

Extended

Aged-Up/
New

Extended

Aged-Up/
New

Introductory Demographics

-2

Tobacco Use

102

-33

-13

Cigarette

Electronic Nicotine Products

Cigar

+12

Pipe

Hookah

-1

Snus

Nicotine Dependence

146

148

Packaging and Health Warnings

+16

Risk Perceptions and Attitudes

Media Use

-2

Secondhand Smoke Exposure

-1

Social Norms-Peer and Family Influences

-18

Health

160

221

180

268

+20

+47

Marketing, Advertising and Promotion

-4

Additional Demographics

Product Barcode Scanning

Contact Information

-1

1030

1156

1053

1223

+23

+67

Smokeless Tobacco
New Product - Placeholder

Polyuse

Total (Entire Questionnaire)
1

This table reflects total item counts; it does not account for the conditions in which the items are asked and should not be considered an indicator of increased
burden. For example, the item counts for the ‘aged-up’ respondents are included in the item counts for the ‘new’ respondents in this table. However, due to skip
patterns and programmed routing, 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 the Wave 4 Extended instruments, and increases to 68 minutes for the Wave 4 Aged-Up/New 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.

Attachment 4 - Summary of Changes to Instruments for Wave 4
TABLE 1b. ADULT QUESTIONNAIRE – Description of Content Changes from Wave 3 to Wave 4
Affected
Wave 4
Wave 4 Section
Respondent
Description of Questions
Change
Category
On respondent’s sex, race, ethnicity, active
New Cohort
Added
duty military status, and residency in the U.S.
Adults
during 2014.
Introductory
Demographics

Deleted

Continuing
Adults

On military branch in which respondent
served.

Deleted

Continuing
Adults

On US citizenship.

Added

New Cohort
Adults

Added

All Adults Age
25+

Deleted

All Young
Adults Age
18-24

Deleted

All Adults Age
25+

Deleted

All Adults Age
25+

Tobacco Use

Deleted

All Adults

On whether respondent has heard of a given
product (not including cigarettes), and
whether respondent has ever used a given
product (including blunts).
On the likelihood of smoking a cigarette or
hookah, or using smokeless tobacco soon
among non-users.
On non-user’s susceptibility to becoming a
user of traditional cigars, cigarillos, filtered
cigars or pipe tobacco including curiosity
about using, likelihood of using in the next
year or using soon, and whether respondent
might use if offered by best friend.
On curiosity about using snus, likelihood of
using snus in the next year, and whether
respondent might use snus if it were offered
by best friend.
On non-user’s susceptibility to becoming an
ENDS user including curiosity about using,
likelihood of using in the next year or using
soon, and whether respondent might use if
offered by best friend.
On use of Skoal Bandits.

Description of/Rationale for Change
These questions collect baseline demographic
information from respondents who are new to the
PATH Study in Wave 4.
Assessed in previous waves. It is not necessary to ask
continuing respondents again; however, question will
be asked of youth who age-up to the adult cohort in
Wave 4.
Assessed in previous waves. It is not necessary to ask
known US citizens again; however, question will be
asked of all respondents who did not previously report
being a US citizen.
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
In Wave 3, these items were asked of young adult nonusers aged 18 to 24. In Wave 4, these items will be
asked of all non-user adults.
These questions were deleted for young adults aged 18
to 24 to make time for new questions that are of
higher priority.

These questions were deleted for adults aged 25 or
older to make time for new questions that are of
higher priority.
These questions were deleted for adults aged 25 or
older to make time for new questions that are of
higher priority; construct will still be assessed for young
adults aged 18 to 24.
Changed in Wave 4 to ask about use of all pouched
smokeless tobacco and snus use. It is no longer
necessary to ask about Skoal Bandits (a brand of
pouched smokeless tobacco) specifically.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Cigarette

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Description of/Rationale for Change

Added

New Cohort
Adults

On age first smoked a cigarette and on the
amount smoked 12 months ago.

These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.

On whether favorite cigarette to smoke is the
first one in the morning, if they smoke more
frequently in the first hours after waking, and
if they smoke when they are ill.
On frequency of coupon use when purchasing
cigarettes.

Added

All Adults

Deleted

All Adults

Added

New Cohort
Adults

On age first used ENDS and on the amount
used 12 months ago.

Added

All Adults

On frequency of flavored ENDS use in the past
30 days.

Electronic Nicotine
Products

Added

All Adults

On dual use of cigarettes and ENDS.

(formerly the “Primary
Electronic Nicotine
Products” section)

Added

All Adults

Added

All Adults

Deleted

All Adults

Deleted

All Adults

On changing the voltage on ENDS devices.

Deleted

All Adults

On frequency of coupon use when purchasing
ENDS or e-liquid.

Deleted

All Adults

On use behaviors of secondary electronic
nicotine products.

On frequency of using ENDS to smoke
marijuana or marijuana derivatives.
On number of times ENDS used on average
day and number of puffs taken each time.
On using ENDS as an alternative to quitting
tobacco.

N/A
(formerly the “Secondary
Electronic Nicotine
Products” section)

To further enhance assessment of nicotine
dependence. These questions are from the Fagerstrom
Test for Nicotine Dependence.
These questions were deleted to make time for new
questions that are of higher priority.
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
To assess how often respondents used ENDS flavored
like menthol, mint or other flavors in the past 30 days.
To assess whether dual users of cigarettes and ENDS
use one product more than the other on days when
both products are used.
To identify respondents who use their ENDS device
solely for smoking marijuana.
To assess ENDS dosage.
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were cycled off 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.
Previously, respondents who use more than one ENDS
product reported on their primary and secondary
products separately. In Wave 4, respondents will
report on their combined use of all ENDS products. As
such, this section is no longer relevant to the PATH
Study in Wave 4 and has been deleted.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Cigars

Pipe

Hookah

Snus

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Added

All Adults

On frequency of flavored cigar and blunt use
in the past 30 days.

Added

New Cohort
Adults

On age first smoked a cigar and on the
amount smoked 12 months ago.

Deleted

All Adults

Deleted

All Adults

Added

New Cohort
Adults

Deleted

All Adults

Deleted

All Adults

Added

New Cohort
Adults

Added

All Adults

Deleted

All Adults

Deleted

All Adults

On price paid for shisha.

Added

New Cohort
Adults

On age first used snus and on the amount
used 12 months ago.

Added

All Adults

On frequency of flavored snus use in the past
30 days.

Added

All Adults

On use of pouched or loose snus.

Deleted

All Adults

On using snus as an alternative to quitting
tobacco.

Deleted

All Adults

On using a coupon when purchasing snus.

On smoking cigars as an alternative to quitting
tobacco.
On frequency of coupon use when purchasing
traditional cigars, cigarillos, and filtered cigars.
On age first smoked a pipe and on the amount
smoked 12 months ago.
On smoking pipes as an alternative to quitting
tobacco.
On frequency of coupon use when purchasing
pipe tobacco.
On age first smoked hookah and on the
amount smoked 12 months ago.
On frequency of flavored shisha use in the
past 30 days.
On smoking hookah as an alternative to
quitting tobacco.

Description of/Rationale for Change
To assess how often respondents smoked flavored
cigars or used flavored cigars to smoke blunts in the
past 30 days.
These questions collect baseline assessments of
tobacco use history from respondents that are new to
the PATH Study in Wave 4.
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were deleted to make time for new
questions that are of higher priority.
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were deleted to make time for new
questions that are of higher priority.
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
To assess how often respondents smoked flavored
shisha or hookah tobacco in the past 30 days.
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were deleted to make time for new
questions that are of higher priority.
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
To assess how often respondents use flavored snus in
the past 30 days.
To assess how the product being used most often is
being consumed (in pouched or loose form).
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were deleted to make time for new
questions that are of higher priority.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Added

New Cohort
Adults

On age first used smokeless tobacco and on
the amount used 12 months ago.

Added

All Adults

Added

All Adults

Added

All Adults

Deleted

All Adults

Deleted

All Adults

Added

All Adults

On reasons for using NRT.

All Adults

On whether respondent noticed health
warnings on packages of ENDS, traditional
cigars, cigarillos, filtered cigars, pipe tobacco,
and hookah tobacco.

Questions were cycled out in a previous wave; they are
cycled back in for Wave 4 to assess respondent
exposure to health warnings on packaging.

Added

All Adults

On health warning labels on ENDS, traditional
cigars, cigarillos, filtered cigars and hookah
tobacco packages including how often a
respondent looked closely at them and how
they make a respondent feel about the health
risks associated with use.

Questions were asked about other products in Wave 3;
they are added for ENDS, traditional cigars, cigarillos,
filtered cigars, and hookah in Wave 4 to assess
respondent exposure to and impact of health warnings
on packaging.

Added

All Adults

On perceived harmfulness of the nicotine in
cigarettes, ENDS, and NRT.

To assess whether respondents’ perceptions of harm of
nicotine vary by product.

Added

All Adults

On perceived addictiveness of reduced
nicotine cigarettes.

To assess respondents’ understanding and perceptions
of modified risk products.

Added

All Adults

On perceived harm of using flavored ENDS
compared to tobacco-flavored or unflavored
ENDS.

To assess whether respondents’ perceptions of harm
vary by flavoring.

Added

All Adults

Deleted

All Adults

On perceived harm of using e-cigarettes/ENDS
compared to NRT.
On smartphone or tablet ownership and on
using online apps related to tobacco/ENDS.

To assess respondent’s perception of harm amongst
reduced harm or modified risk products.
These questions were deleted to make time for new
questions that are of higher priority.

Smokeless Tobacco

Nicotine Dependence

Added
Packaging and Health
Warnings

Risk Perceptions and
Attitudes
(formerly the “Product
Regulation – Modified
Risk Tobacco Products”
section)

Media Use

On frequency of flavored smokeless tobacco
use in the past 30 days.
On use of pouched or loose smokeless
tobacco.
On quantity contained in a package of
pouched smokeless and length of time taken
to consume it.
On using smokeless tobacco as an alternative
to quitting tobacco.
On using a coupon when purchasing
smokeless tobacco.

Description of/Rationale for Change
These questions collect baseline assessments of
tobacco use history from respondents who are new to
the PATH Study in Wave 4.
To assess how often respondents use flavored
smokeless tobacco in the past 30 days.
To assess how the product being used most often is
being consumed (in pouched or loose form).
To complement other measures related to packaging
and dosage.
This measure is assessed by other questions in the
PATH Study and was deleted to avoid redundancy.
These questions were deleted to make time for new
questions that are of higher priority.
To explore whether respondents are using NRT for
reasons other than to quit tobacco.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Health

Marketing,
Advertising, and
Promotion

Added

Affected
Respondent
Category
All Adults

Added

All Adults

Added

New Cohort
Adults

On pregnancy history.

Added

New Cohort
Adults

On substance use history of alcohol,
marijuana, prescription drugs of abuse, and
illicit/street drugs.

Deleted

All Adults

On treatment for gum disease.

Deleted

Continuing
Adults

On respondent’s in-utero exposure to tobacco
products.

Deleted

All Adults

Deleted

All Adults

Deleted

All Adults

On ulcer or gastrointestinal bleeding.

Deleted

All Adults

On cataract or glaucoma.

Deleted

All Adults

On cancer and precancerous oral lesions.

Deleted

All Adults

On osteoporosis, fragile bones.

Deleted

All Adults

On rapid vision loss.

Wave 4
Change

Deleted

All Adults

Deleted

All Adults

Added

All Adults

Deleted

All Adults

Description of Questions

Description of/Rationale for Change

On frequency of tooth brushing.
On diagnosis of schizophrenia, schizoaffective
disorder or psychosis, or psychotic illness or
episode and age of diagnosis/onset.

To inform analysis of oral/dental health.
To ascertain prevalence of these diagnoses among
respondents.
These questions collect baseline assessments of
pregnancy history and outcomes from respondents
who are new to the PATH Study in Wave 4.
These questions collect baseline assessments of
substance use history from respondents who are new
to the PATH Study in Wave 4.
These questions were deleted to make time for new
questions that are of higher priority.
Asked at Wave 3; not necessary to ask again in Wave 4;
however, will be asked of youth who age-in to the
adult cohort.

On COPD, chronic bronchitis, emphysema,
asthma, lung or respiratory conditions.
On gum disease, teeth cleaning, bone loss
around teeth.

On heart conditions such as high blood
pressure, high cholesterol, congestive heart
failure, stroke, heart attack or bypass surgery.
On whether a doctor advised respondent to
stop using ENDS.
On exposure to anti-tobacco messaging,
generally.
On exposure to specific FDA and other
national media campaigns.

Respondents who indicate they have not seen a
medical doctor and/or dentist in the past 12 months
will not be asked if a medical doctor and/or nurse told
them they had these conditions in the past 12 months;
past 12 month status for respondents who indicate
they have seen a medical doctor and/or dentist in the
past 12 months will be assessed for these conditions.

Questions on exposure to specific FDA and other
national media campaigns were replaced with a
general question about exposure to any anti-tobacco
messaging.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Deleted

All Adults Age
25+

On whether respondent has a favorite tobacco
advertisement.

Added

All Adults

On interest in completing a web-based PATH
survey.

Deleted

All Adults

On whether tobacco users paid more for
health insurance premiums compared to nontobacco users.

Additional
Demographics

Description of/Rationale for Change
Question was deleted for adults aged 25 or older to
make time for new questions that are of higher
priority; construct will still be assessed for young adults
aged 18 to 24.
To assess interest in completing the PATH survey
online if it became available as a web survey in future
waves. This is expected to be asked once, in Wave 4.
These were deleted to make time for new questions
that are of higher priority.

Attachment 4 - Summary of Changes to Instruments for Wave 4
1

Table 2a. YOUTH QUESTIONNAIRE - Change in Total Item Counts from Wave 3 to Wave 4
Total Number of Items per Section
Wave 3

Youth Questionnaire Section

Wave 4

Change in Total Item
Count from W3 to W4

Extended

Aged-Up

Extended

Aged-Up/
New

Extended

Aged-Up/
New

Introductory Demographics

-1

Cigarette

Electronic Nicotine Products

Cigar

+12

Pipe

Hookah

Snus

Smokeless Tobacco

+11

Dissolvable Tobacco

Bidis and Kreteks

First Tobacco Product

Nicotine Dependence and Cessation /Quitter

Packaging and Health Warnings

-2

Risk Perceptions and Attitudes

+13

Media Use

-4

Secondhand Smoke Exposure

-3

Health

Marketing, Advertising and Promotion

-6

Social Norms-Peer and Family Influences

-18

Accessibility

Psychosocial

Substance Use

-1

Additional Demographics

Contact Information (Emancipated Youth)

-3

-5

Total (Entire Questionnaire)

601

670

659

705

+58

+35

Other Tobacco
New Product - Placeholder

This table reflects total counts of items; it does not account for the conditions in which the items are asked and should not be considered an indicator of
increased burden. For example, due to skip patterns and programmed routing, every respondent is not asked all items reflected in these counts. The average time
to complete the Youth interview remains at 35 minutes for the Wave 4 Extended instrument, and 45 minutes for the Wave 4 Aged-Up/New 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.

Attachment 4 - Summary of Changes to Instruments for Wave 4
TABLE 2b. YOUTH QUESTIONNAIRE – Description of Content Changes from Wave 3 to Wave 4
Affected
Wave 4
Wave 4 Section
Respondent
Description of Questions
Change
Category
Introductory
Demographics

(formerly the
“Primary Electronic
Nicotine Products”
section)

Deleted

On US citizenship.

Added

All Youth

On cigarette smoking in the past 3 days and on
identifying last brand smoked.

Deleted

All Youth

On frequency of coupon use when purchasing
cigarettes.

These questions were deleted to make time for
new questions that are of higher priority.

Added

All Youth

On ENDS use in the past 3 days and on identifying
last brand used.

Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.

Added

All Youth

On frequency of using ENDS to smoke marijuana or
marijuana derivatives.

To identify respondents who use their ENDS
device solely for smoking marijuana.

Added

All Youth

On frequency of flavored ENDS use in the past 30
days.

To assess how often respondents used ENDS
flavored like menthol or mint or other flavors.

Added

All Youth

On number of times ENDS used on average day and
number of puffs taken each time.

To assess ENDS dosage.

Deleted

All Youth

On changing the voltage on ENDS devices and the
number of milliliters of e-liquid an ENDS tank system
holds.

These questions were cycled off to make time for
new questions that are of higher priority.

Deleted

All Youth

On frequency of coupon use when purchasing ENDS
or e-liquid.

These questions were deleted to make time for
new questions that are of higher priority.

On use behaviors of secondary electronic nicotine
products.

Previously, respondents who use more than one
ENDS product reported on their primary and
secondary products separately. In Wave 4,
respondents will report on their combined use of
all ENDS products. As such, this section is no
longer relevant to the PATH Study in Wave 4 and
has been deleted.

N/A
(formerly the
“Secondary Electronic
Nicotine Products”
section)

Assessed in previous waves. It is not necessary to
ask known US citizens again; however, question
will be asked of all respondents who did not
previously report being a US citizen.
Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.

Continuing
Youth

Cigarette

Electronic Nicotine
Products

Description of/Rationale for Change

Deleted

All Youth

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Wave 4
Change

Affected
Respondent
Category

Description of Questions

All Youth

On cigar and blunt smoking in the past 3 days and
on identifying last brand smoked.

Added

All Youth

On frequency of flavored cigar and blunt use in the
past 30 days.

Added

All Youth

On pipe smoking in the past 3 days.

Added

All Youth

On hookah smoking in the past 3 days and on
identifying last brand smoked.

Added

All Youth

On frequency of flavored shisha use in the past 30
days.

To assess how often respondents smoked flavored
shisha or hookah tobacco in the past 30 days.

Deleted

All Youth

On price paid for shisha.

These questions were deleted to make time for
new questions that are of higher priority.

Hookah

Snus

Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.
To assess how often respondents smoked flavored
cigars or used flavored cigars to smoke blunts in
the past 30 days.
Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.
Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.

Added
Cigar

Pipe

Description of/Rationale for Change

Added

All Youth

On snus use in the past 3 days and on identifying
last brand used.

Added

All Youth

On frequency of flavored snus use in the past 30
days.

Added

All Youth

On use of pouched or loose snus.

Deleted

All Youth

On use of Skoal Bandits.

Deleted

All Youth

On using a coupon when purchasing snus.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Smokeless
Tobacco

Nicotine
Dependence and
Cessation/Quitter

Packaging and
Health Warnings

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Description of/Rationale for Change

Added

All Youth

On smokeless tobacco use in the past 3 days and on
identifying last brand used.

Added

All Youth

On frequency of flavored smokeless tobacco use in
the past 30 days.

Added

All Youth

On use of pouched or loose smokeless tobacco.

Added

All Youth

On quantity contained in a package of pouched
smokeless and length of time taken to consume it.

Added

All Youth

On NRT and prescription stop smoking medication
use in the past 3 days.

Added

All Youth

On whether respondent noticed health warnings on
packages of ENDS, traditional cigars, cigarillos,
filtered cigars, pipe tobacco, and hookah tobacco.

Added

All Youth

On health warning labels on ENDS, traditional cigars,
cigarillos, filtered cigars and hookah tobacco
packages including how often a respondent looked
closely at them and how they make a respondent
feel about the health risks associated with use.

Urine biospecimens will be collected from youth
respondents in Wave 4; Nicotine Exposure
Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen
analysis.
To assess how often respondents used flavored
smokeless tobacco in the past 30 days.
To assess how the product being used most often
is being consumed (in pouched or loose form).
To complement other measures related to
packaging and dosage.
To assess usage of these medications and to
inform biospecimen analysis. Urine biospecimens
will be collected from youth respondents in Wave
4; Nicotine Exposure Questions (NEQs) will be
asked of youth respondents in Wave 4 to inform
this analysis.
Questions were cycled out in a previous wave;
they are cycled back in for Wave 4 to assess
respondent exposure to health warnings on
packaging.
Questions were asked about other products in
Wave 3; they are added for ENDS, traditional
cigars, cigarillos, filtered cigars, and hookah in
Wave 4 to assess respondent exposure to and
impact of health warnings on packaging.

Deleted

All Youth

On noticing health warning labels on packages of
bidis and kreteks.

The question was deleted to make time for new
questions that are of higher priority.

On health warnings on packages of snus and
smokeless tobacco including whether they stopped
respondent from using product, whether
respondent tried to avoid looking at them, how
believable they are, and degree to which they make
respondent never want to use the product again
(among ever users).
On whether health warnings on packages of snus
and smokeless tobacco made respondent less likely
to start using (among never users).

The questions were cycled off to make time for
new questions that are of higher priority.

Deleted

All Youth

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4
Change

Affected
Respondent
Category

Description of Questions

Deleted

All Youth

On how frequently the respondent saw a list of
chemicals contained in tobacco products.

Added

All Youth

On perceived harmfulness of the nicotine in
cigarettes, ENDS, and NRT.

To assess whether respondents’ perceptions of
harm of nicotine vary by product.

Added

All Youth

On perceived harm of using flavored ENDS
compared to tobacco-flavored or unflavored ENDS.

To assess respondents’ perceptions of use/harm
as influenced by flavoring.

Added

All Youth

On likelihood of becoming addicted to cigarillos or
filtered cigars.

Added

All Youth

Added

All Youth

Deleted

All Youth

Deleted

All Youth

On smartphone or tablet ownership.

Deleted
Deleted

All Youth
All Youth

Secondhand
Smoke Exposure

Deleted

All Youth

On using online apps related to tobacco/ENDS.
On exposure to movies that depict tobacco use.
On rules of using combusted and non-combusted
tobacco products and ENDS inside the home.

Health

Added

All Youth

On use of anti-inflammatory medications.

Marketing,
Advertising, and
Promotion

Added

All Youth

On exposure to anti-tobacco messaging, generally.

Deleted

All Youth

On exposure to specific FDA and other national
media campaigns.

Wave 4 Section

Risk Perceptions
and Attitudes
(formerly the
“Product Regulation
– Modified Risk
Tobacco Products”
section)

Media Use

On perceived harm of intermittent versus daily use
of cigarettes, cigarillos, filtered cigars, snus, and
smokeless tobacco.
On length of time product can be used before harm
occurs from smoking cigarettes, traditional cigars,
cigarillos, filtered cigars, shisha or hookah tobacco,
and using snus or smokeless tobacco.
On perceived ease of use between flavored and
unflavored products for: ENDS, traditional cigars,
cigarillos, filtered cigars, shisha or hookah tobacco,
snus, and smokeless tobacco.

Description of/Rationale for Change

Questions were cycled out in a previous wave;
they are cycled back in for Wave 4 to assess
respondent perceptions of addiction and harm.

The questions were cycled off 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.
The questions were cycled off to make time for
new questions that are of higher priority.
The questions were cycled off to make time for
new questions that are of higher priority.
To assist us in interpreting biomarker data. There
are biomarkers such as hsCRP that are impacted
by use of anti-inflammatory meds. Controlling for
the use of these medications informs the models
& allows for a more accurate comparison of
biomarker levels within & across participants.
Questions on exposure to specific FDA and other
national media campaigns were replaced with a
general question about exposure to any antitobacco messaging.

Attachment 4 - Summary of Changes to Instruments for Wave 4
Wave 4 Section

Social Norms, Peer
and Family
Influences

Additional
Demographics

Wave 4
Change

Affected
Respondent
Category

Description of Questions

Description of/Rationale for Change

Deleted

All Youth

On whether respondent bought a product because
of a promotion.

The question was cycled off to make time for new
questions that are of higher priority.

Deleted

All Youth

On how many of respondent’s best friends smoke
traditional cigars and filtered cigars.

These questions were deleted to make time for
new questions that are of higher priority.

Added

All Youth age
17

On serving active duty in the military and branch in
which respondent served.

To inform Wave 4 weighting.

On interest in completing a web-based PATH survey.

To assess interest in completing the PATH survey
online if it became available as a web survey in
future waves. This is expected to be asked once,
in Wave 4.

Added

All Youth

Attachment 4 - Summary of Changes to Instruments for Wave 4
1

Table 3a. PARENT QUESTIONNAIRE - Change in Total Item Counts from Wave 3 to Wave 4
Total Number of Items per Section
Wave 3

Parent Questionnaire Section

Change in Total Item
Count form W3 to W4

Wave 4

Extended

Aged-Up

Extended

Aged-Up/
New

Extended

Aged-Up/
New

Family Composition

School, Home, and Tobacco Use

Health

+10

Respondent Characteristics

Contact Information

Total (Entire Questionnaire)

116

105

129

+17

+13

Attachment 4 - Summary of Changes to Instruments for Wave 4
TABLE 3b. PARENT QUESTIONNAIRE – Description of Content Changes from Wave 3 to Wave 4
Affected
Wave 4
Wave 4 Section
Respondent Description of Questions
Status
Category
On the name, age and relationship youth
Family
Added
All Parents
respondent’s guardians who live in the
Composition
home.
On youth respondent’s diagnosis of
schizophrenia, schizoaffective disorder or
Health
Added
All Parents
psychosis, or psychotic illness or episode
and age of diagnosis/onset.
Contact
Information

Added

All Parents

On interest in completing a web-based
PATH survey.

Description of/Rationale for Change
To obtain information about any other parental figures or guardians
in the household in addition to youth’s parents.

To ascertain prevalence of these diagnoses among respondents.
To assess interest in completing the PATH survey online if it became
available as a web survey in future waves. This is expected to be
asked once, in Wave 4.

Attachment 4 - Summary of Changes to Instruments for Wave 4
1

Table 4a. NICOTINE EXPOSURE QUESTIONNAIRE - Change in Total Item Counts from Wave 3 to Wave 4
Total Number of Items
Change in Total Item Count from
NEQs
W3 to W4
Wave 3
Wave 4
Total (Entire Questionnaire)

This table reflects total counts of items; it does not account for the conditions in which the items are asked and should not be considered an indicator
of increased burden. For example, due to skip patterns and programmed routing, every respondent is not asked all items reflected in these
counts. The average time to complete the Nicotine Exposure Questionnaire remains 5 minutes in the Wave 4 interview. NEQs are asked of all
respondents that consent to bio-specimen collection; there is no distinction made between the extended, new and aged-up respondent categories.

Attachment 4 - Summary of Changes to Instruments for Wave 4
TABLE 4b. NICOTINE EXPOSURE QUESTIONNAIRE – Description of Content Changes from Wave 3 to Wave 4
Affected
Wave 4
Wave 4 Section
Respondent
Changes from Wave 3
Description of/Rationale for Change
Status
Category
Urine biospecimens will be collected from youth respondents in Wave
NEQs
Added
All Youth
On tobacco use in the past 3 days.
4; Nicotine Exposure Questions (NEQs) will be asked of youth
respondents in Wave 4 to inform biospecimen analysis.

File Type	application/pdf
File Modified	2016-10-07
File Created	2016-10-05