OMB Control # 0910-0810 Exp.
Date: 11/30/18
QUESTIONNAIRE
Part I
ALL PARTICIPANTS
(Questions to be presented prior to showing rough-cut advertisement)
A1. Does anyone who lives with you now…
Smoke cigarettes?
Smoke cigars, cigarillos, or little cigars?
Use e-cigarettes (e.g., e-cigs, vape pens, personal vaporizers, mods, e-cigars, e-pipes, e-hookahs and hookah pens)?
Use any other form of tobacco (e.g., chewing tobacco, snus, or hookah)?
No one who lives with me now uses any form of tobacco
A2. How many of your four closest friends smoke cigarettes?
0
1
2
3
4
A3. About how many cigarettes have you smoked in your entire life? Your best guess is fine.
None
1 or more puffs but never a whole cigarette
1 cigarette
2 to 5 cigarettes
6 to 15 cigarettes (about 1/2 a pack total)
16 to 25 cigarettes (about 1 pack total)
26 to 99 cigarettes (more than 1 pack, but less than 5 packs)
100 or more cigarettes (5 or more packs)
Part II
AD VIEW PARTICIPANTS ONLY
(Questions to be provided after rough-cut advertisement)
Perceived Ad Effectiveness
We would now like to show you an advertisement and then gather your reactions to that ad. Please make sure the volume on your computer is turned up, so that you can both see and hear the video. Please click the forward arrow to continue.
What do you think [or would you say] is the main message of this advertisement?
What do you like about this advertisement? Please be as specific as possible.
What do you dislike about this advertisement? Please be as specific as possible.
Is there anything confusing, unclear, or hard to understand in this ad?
Yes
No
[If B4 = Yes, Ask B5. If B4 = No, Ask B6]
What is confusing about this ad?
People sometimes have different emotional reactions when they see or hear advertisements. On a scale from 1 to 5, where 1 means “not at all” and 5 means “very”, please indicate how much this ad made you feel:
Not at all Very
1 2 3 4 5
[RANDOMIZE ORDER]
Sad
Afraid
Irritated
Ashamed
Discouraged
Hopeful
Motivated
Understood
Angry
Amused
Worried
Disgusted or grossed out
Happy
Uneasy
Surprised
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
[RANDOMIZE ORDER]
This ad is worth remembering
This ad grabbed my attention
This ad is powerful
This ad is informative
This ad is meaningful to me
This ad is convincing
This ad is terrible
This ad is silly
This ad is annoying
This ad is interesting
This ad was difficult to watch
I would watch this ad again
I really like this ad
I trust the information in this ad
This ad told me things I never knew before about tobacco
The characters in this ad are like me
This ad gave me a reason not to use tobacco
I can identify with what the ad says
This ad is different from other anti-tobacco ads I’ve seen or heard
On a scale of 1 to 5, how would you rate the claims or arguments in this ad:
Not believable Believable
1 2 3 4 5
On a scale of 1 to 5, indicate whether the ad made smoking look like something you would or wouldn’t want to do.
Makes me want to smoke Makes me not want to smoke
1 2 3 4 5
If you saw this advertisement, on a scale from 1 to 5, where 1 is not at all likely and 5 is extremely likely, how likely would you be to do each of the following:
Not at all Very
1 2 3 4 5
A. Look for more information online
B. Visit ‘The Real Cost’ website
C. Tell a friend
D. Mention it on social media (e.g., Twitter or Facebook)
E. Check it out on social media (e.g., Tumblr or Instagram)
F. Watch this ad again
G. Watch a different ad about the main character
H. Use/search the hashtag
Part III
ALL PARTICIPANTS
Attitudes, Beliefs and Risk Perceptions
How much do you agree or disagree with following statements:
C1. If I smoke I will…
C1_1. Damage my body
A. Strongly Disagree
B. Disagree
C. Neither Agree Nor Disagree
D. Agree
E. Strongly Agree
C1_2. Be controlled by smoking
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C1_3. Inhale chemicals
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C1_4. Develop cancer
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C1_5. Be unable to stop when I want
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C1_6. Shorten my life
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C1_7. Damage my lungs
Strongly Disagree
Disagree
Neither Agree Nor Disagree
Agree
Strongly Agree
C2. Smoking cigarettes is…
A. Very Bad
B. Bad
C. Neither Good Nor Bad
D. Good
E. Very Good
C3. Smoking cigarettes is…
A. Very Unenjoyable
B. Unenjoyable
C. Neither Enjoyable Nor Unenjoyable
D. Enjoyable
E. Very Enjoyable
C4. Out of every 10 people your age, how many do you think smoke cigarettes?
0 people 1 2 3 4 5 6 7 8 9 10 people
C5. Do you think that you will smoke a cigarette soon?
Definitely yes
Probably yes
Don’t know
Probably not
Definitely not
Additional Demographics
C6.What is your birthdate?
MM/DD/YYYY
C7. What is your zip code?
[___________]
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 10 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
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Alexander, Tesfa |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |