OMB#
0910-0810
Exp.
11/30/2018
SURVEY QUESTIONNAIRE
RIHSC #_________
TITLE OF INFORMATION COLLECTION:
Point-of-Sale Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Encourage Adult Smokers to Quit Smoking
PART A
ALL PARTICIPANTS
(Questions to be presented prior to showing execution)
A1. Are you thinking about trying to quit smoking cigarettes?
Yes → go to A2
No → skip to A3
A2. How soon are you likely to try to quit smoking cigarettes? Would you say…
within the next 30 days
within the next 6 months
within the year
longer than a year
A3. How many cigarettes per day do you smoke?
10 or less
11 to 20
21 to 30
More than 31
A4. How soon after you wake up do you smoke your first cigarette?
Within 5 minutes
6 to 30 minutes
31 to 60 minutes
After 60 minutes
A5. On a scale of 1 to 7, how motivated are you to quit smoking cigarettes in the next 12 months?
Not at all Motivated |
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Highly Motivated |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
PART B
AD EXPOSURE PARTICIPANTS ONLY
(Questions to be presented after showing execution)
Instructions
We would now like to show you an advertisement and then gather your reactions to that ad. Please click the forward arrow to continue.
What do you think [or would you say] is the main message of this advertisement? Please be as specific as possible.
[OPEN END]
What do you like about this advertisement? Please be as specific as possible.
[OPEN END]
What do you dislike about this advertisement? Please be as specific as possible.
[OPEN END]
B4. Is there anything confusing, unclear, or hard to understand in this advertisement?
Yes → go to B5
No → skip to B6
B5. What about this advertisement is confusing, unclear, or hard to understand?
[OPEN END]
B6. After viewing this advertisement, would you say you feel more ready to try to quit smoking cigarettes again?
Definitely → go to B7
Probably → go to B7
Probably Not → skip to B8
Definitely Not → skip to B8
B7. What about the advertisement makes you ready to try to quit smoking cigarettes again? Please be as specific as possible.
[OPEN END]
B8. Why doesn’t the advertisement make you ready to try to quit smoking cigarettes again? Please be as specific as possible.
[OPEN END]
B9. People sometimes have different emotional reactions when they see advertisements. On a scale from 1–7, where 1 means “not at all” and 7 means “very”, please indicate how much this advertisement made you feel:
Not at all |
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Very |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
[RANDOMIZE ORDER]
Ashamed
Discouraged
Hopeful
Understood
Worried
Inspired
Determined
Empowered
Stressed
Guilty
Sad
Irritated
Motivated
Angry
Confident
Stressed
Regretful
Afraid
Surprised
B10. 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 offensive
This ad is terrible
This ad is silly
This ad is annoying
This ad is interesting
I trust the information in this ad
This ad told me things I didn't know about quitting smoking cigarettes
This ad is different from other anti-tobacco ads I’ve seen or heard
This ad makes me think about quitting smoking cigarettes in a new way
This ad seemed to be written with someone like me in mind
I can identify with what the ad says
This is an ad that would make me stop and think
This ad makes me feel more confident in my ability to quit smoking cigarettes
I would look at this ad again
I like the look and feel of this ad
B11. On a scale of 1–7 where 1 is “not at all believable” and 7 is “very believable”, how would you rate the main message in this advertisement:
Not at all Believable |
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Very Believable |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
INSTRUCTIONS
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statement:
B12. On a scale of 1 to 7, indicate whether the ad made you want to smoke or not smoke.
Makes me want to smoke |
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|
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Makes me not want to smoke |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
B13. On a scale from 1–7, where 1 is “not at all likely” and 7 is “very likely”, how likely would you be to do each of the following after seeing this advertisement:
[RANDOMIZE ORDER]
Not at all Likely |
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|
|
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Very Likely |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Look for resources to help me quit smoking cigarettes
Visit the website everytrycounts.gov for information on quitting cigarettes
Call 1-800-QUIT-NOW for assistance in quitting smoking cigarettes
Talk to my doctor about quitting smoking cigarettes
Tell a friend about my plans to quit smoking cigarettes
Make a plan for small steps I can take to try to quit smoking cigarettes
B14. On a scale of 1 to 7, where 1 is “not at all likely” and 7 is “very likely”, please indicate how much this ad made you want to try any of the following products because you think it will help you quit:
Not at all Likely |
|
|
|
|
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Very Likely |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
E-cigarette products (i.e., e-cigarette, vape, vape pen, e-hookah)
Smokeless tobacco (i.e., chewing tobacco, dip, spit, pouches, moist snuff, or snus)
Hookah
Cigars, little cigars or cigarillos
Nicotine gum/patch/lozenge
Other (please specify)
PART C
ALL PARTICIPANTS
INSTRUCTIONS
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
C1. If I quit smoking cigarettes my health will improve.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C2. If I quit smoking cigarettes my quality of life will improve.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C3. If I take small steps towards quitting, I will get closer to quitting for good.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C4. On a scale of 1–7, where 1 is “not at all important” and 7 is “very important”, how important is it for you to try to quit smoking cigarettes?
Not at all Important |
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Very Important |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
C5. On a scale of 1–7, where 1 is “not at all confident” and 7 is “very confident”, how confident are you that you could try to quit smoking cigarettes if you wanted to?
Not at all Confident |
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|
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Very Confident |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
C6. On a scale of 1–7, where 1 is “not at all believable” and 7 is “very believable”, how believable is the following statement:
Each time you try to quit smoking cigarettes you get closer to quitting for good.
Not at all Believable |
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|
|
|
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Very Believable |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
C7. On a scale of 1–7, where 1 is “not at all ready” and 7 is “very ready”, how ready are you to try to quit smoking cigarettes?
Not at all Ready |
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|
|
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Very Ready |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
C8. On a scale of 1 to 7, how motivated are you to quit smoking cigarettes in the next 12 months?
Not at all Motivated |
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Highly Motivated |
||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
INSTRUCTIONS
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
C9. When I think about quitting smoking I feel discouraged.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C10. When I think about quitting smoking I feel hopeful.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C11. I have been thinking a lot about quitting smoking recently.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C12. I am eager for a life without smoking.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
C13. I am not prepared to make changes in my life in order to quit smoking.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Part D
AD EXPOSURE PARTICIPANTS ONLY
(Questions to be presented after showing full campaign)
INSTRUCTIONS
Sometimes you see different ads running for the same company that are similar in look and feel to one another as part of a broader advertising campaign. We would now like to show you the ad you just saw along with three other ads in this same campaign and then gather your reactions to the campaign as a whole. Please click the forward arrow to continue.
D1. After seeing all of these ads together, does the main message change at all for you?
Yes No
[If yes go to D2.]
D2. How does the main message change when you see all the ads together? Please be as specific as possible.
[OPEN END]
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statement:
D3. Seeing multiple ads together makes the campaign message clearer to me.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
D4. On a scale of 1–7, where 1 is “not at all ready” and 7 is “very ready”, how ready are you to try to quit smoking after seeing all of these ads together?
Not at all Ready |
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Very Ready |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
D5. On a scale of 1–7, where 1 is “not at all believable” and 7 is “very believable”, how believable is the following statement after seeing all these ads together:
Each time you try to quit smoking cigarettes you get closer to quitting for good.
Not at all Believable |
|
|
|
|
|
Very Believable |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
D6. On a scale of 1–7, where 1 is “not at all confident” and 7 is “very confident”, how confident after seeing all of these ads together would you be in your ability to try to quit smoking if you wanted to?
Not at all Confident |
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Very Confident |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
INSTRUCTIONS
Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements:
D7. These ads give me a new way to think about quitting.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
D8. These ads seem to be written with someone like me in mind.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
D9. Are you thinking about trying to quit smoking cigarettes?
Yes → go to D8
No → skip to survey submit landing page
D10. How soon are you likely to quit smoking? Would you say…
within the next 30 days
within the next 6 months
within the year
longer than a year
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 20 minutes per response to complete the 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 | Cameron Wimpy |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |