RIHSC NO. 18-028CTP
OMB#
0910-0810
Exp.
11/30/2018
The Real Cost Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use
Youth Questionnaire
AGE CHECK
“Please answer each question as honestly as possible. Click on the button at the bottom of
the page to continue with the survey.”
1.A. How old are you?
Under 13 years old
13 years old
14 years old
15 years old
16 years old
17 years old
18 years old or older
[IF PARTICIPANT SELECTS B-F, CONTINUE TO PART A. IF PARTICIPANT SELECTS A or G, CONTINUE TO END PAGE.]
END PAGE
Thanks for coming back to complete the full survey! Unfortunately, you are not eligible to continue on with the survey.
WELCOME PAGE
[TEXT FOR PARTICIPANTS]: “Please answer the questions on the following pages as honestly as possible. Remember to read the instructions carefully.”
[Each item on the Copy Testing Questionnaire will be presented in a separate page, separated by a “NEXT” button. There will also be a “BACK” button presented on each page in case youth accidentally skip a question.]
[Not all questions will be asked to all participants, participants will get questions based on how they screen into the study. All surveys will take no longer than 20 minutes to complete]
PART I
[Questions to be presented prior to showing rough-cut advertisements to ALL PARTICIPANTS – (Part 1 questions are only asked once]
A1. Does anyone who lives with you now… (Select all that apply)
Smoke cigarettes?
Use vapes, electronic cigarettes, e-cigs, vape pens, mods or a hookah pen?
Use smokeless tobacco (such as dip, spit, chewing tobacco, snus pouches, or moist snuff)?
Use any other form of tobacco?
No one who lives with me now uses any form of tobacco
[A1 = E is an exclusive response and cannot be selected in conjunction with option A, B, C, or D]
A2. How many of your four closest friends [Fill smoke cigarettes/vape]?
0
1
2
3
4
A3. How many of your four closest friends use smokeless tobacco (such as such as dip, spit, chewing tobacco, snus pouches, or moist snuff))?
0
1
2
3
4
A4. During the past 30 days, have you personally… (Select all that apply)
Smoked cigarettes?
Smoked vapes, electronic cigarettes, e-cigs, vape pens, mods or a hookah pen such as JUUL, Phix, Cync, Breazy, Vaporfi, SMOK, Juno, Joyetech, NJOY, Blu, or Vuse?
Used smokeless tobacco (e.g. dip, spit, chewing tobacco, snus pouches, or moist snuff))?
Used any other form of tobacco?
I have not used any form of tobacco in the past 30 days
[A4 = E is an exclusive response and cannot be selected in conjunction with options A - D]
A5. Think back to the cigarette advertisements you have recently seen. What is the name of the cigarette brand of your favorite cigarette advertisement?”
A6. If you were given a tee shirt or a bag that had a tobacco industry cigarette brand image on it, would you use it?
Definitely Yes
Probably Yes
Probably No
Definitely No
A7. [RANDOMIZE ORDER. ALL ITEMS WILL BE PRESENTED ON THE SAME PAGE.]
A7_1. I would like to explore strange places.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A7_2. I like to do frightening things.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A7_3. I like new and exciting experiences, even if I have to break the rules.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A7_4. I prefer friends who are exciting and unpredictable.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A8_1. My family and community is very important to me
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
A8_2. My school life is an important aspect of my life
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
PART II
[(Questions to be provided after rough-cut advertisement) – AD VIEW PARTICIPANTS ONLY]
[TEXT FOR PARTICIPANTS]: “Please watch the video below. Please make sure you device volume is on so you can hear audio.
To start watching the video, click on the video or press the play button. When the video ends, click on the button at the bottom of the page to continue with the survey.”
The ad will play twice before questions begin.
[Perceived Ad Effectiveness]
B1. What do you think [or would you say] is the main message of this advertisement?
[FREE RESPONSE BOX]
B2. What do you like about this advertisement? Please be as specific as possible.
[FREE RESPONSE BOX]
B3. What do you dislike about this advertisement? Please be as specific as possible.
[FREE RESPONSE BOX]
B4. 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
Disgusted
Worried
Inspired
Happy
Uneasy
Surprised
Informed
B5. 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
I trust the information in this ad
This ad told me things I never knew before about tobacco
This ad is relevant to 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
B6. 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
B7. On a scale of 1 to 5, indicate whether the ad made smoking look like something you would or would not want to do.
Makes me want to use tobacco Makes me not want to use tobacco
1 2 3 4 5
B8. Is there anything confusing, unclear, or hard to understand in this ad?
Yes
No
[If B8 = Yes, Ask B9. If B8 = No, Ask B10]
B9. What is confusing about this ad?
[FREE RESPONSE BOX]
B10. If you saw this advertisement, on a scale from 1 to 5, where 1 is not at all likely and 5 is very likely, how likely would you be to do each of the following:
Not at all Very
1 2 3 4 5
Tell a friend
Look for more information online
Visit The Real Cost website or Facebook page
Share The Real Cost YouTube channel with a friend
Mention or like it on social media such as Facebook, Twitter, or Instagram
Do nothing
PART III
[Both ad exposure and control groups will see these questions]
[TEXT FOR PARTICIPANTS]: “Please answer each question as honestly as possible. Click on the button at the bottom of the page to continue with the survey.”
[Attitudes, Beliefs and Risk Perceptions]
How much do you agree or disagree with following statement:
C1. If I [FILL smoke/vape] I will…
C1_1. Have bad breath
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_2. Damage my body
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_3. Damage my lungs
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_4. Get stunted lungs
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_5. Inhale nicotine that can get to my brain in just 10 seconds and start making changes
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_6. Be controlled by tobacco / cigarettes / vaping
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_7. Become addicted by tobacco / cigarettes / vaping
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_8. Be unable to stop
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_9. Inhale harmful chemicals
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_10. Inhale microscopic metal particles such as nickel, tin, and lead
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_11. Develop cancer
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_12. Develop serious health problems
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_13. Miss out on activities I enjoy
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_14. Damage my skin, hair or nails
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_15. Shorten my life
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C1_16. Damage my teeth and gums
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
C2. [Fill Smoking cigarettes/vaping] is . . .
Very Bad
Bad
Neither Good or Bad
Good
Very Good
C3. [Fill Smoking cigarettes/vaping] is . . .
Very Unenjoyable
Unenjoyable
Neither enjoyable or unenjoyable
Enjoyable
Very Enjoyable
C4. Out of every 10 people your age, how many do you think [Fill smoke cigarettes/vape]? (Select one)
0 1 2 3 4 5 6 7 8 9 10
people people
D1. If I use smokeless tobacco (such as snus pouches, moist snuff, dip, spit, or chewing tobacco), I will…
D1_1. Damage my body
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_2. Develop serious health problems like gum disease
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_3. Be controlled by smokeless tobacco
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_4. Become addicted to smokeless tobacco
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_5. Consume harmful chemicals
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_6. Develop cancer
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_7. Lose my teeth
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_8. Miss out on activities or things that I enjoy
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_9. Gross out people I want to date
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D1_10. Have bad breath
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D2. Using smokeless tobacco is…
A. Very Bad
B. Bad
C. Neither Good or Bad
D. Good
E. Very Good
D3. Using smokeless tobacco is…
A. Very Unenjoyable
B. Unenjoyable
C. Neither enjoyable or unenjoyable
D. Enjoyable
E. Very Enjoyable
D4. How much do you agree with the following statement “Using smokeless tobacco is manly”…
A. Strongly Disagree
B. Disagree
C. Neither Agree or Disagree
D. Agree
E. Strongly Agree
D5. Out of every 10 people your age, how many do you think use smokeless tobacco? (Circle One)
0 1 2 3 4 5 6 7 8 9 10
people people
D6. Do you think that you will use smokeless tobacco soon?
Definitely yes
Probably yes
Don’t know
Probably not
Definitely not
[Attention-check items will be inserted randomly]
[TEXT FOR PARTICIPANTS]: “Please answer each question as honestly as possible.”
E1. Please select Tuesday and Friday from the list below. [RANDOMIZE ORDER]
Sunday
Tuesday
Thursday
Friday
E2. Jack’s favorite color is red. What is Jack’s favorite color?
Blue
Red
Green
Yellow
END PAGE
[TEXT FOR PARTICIPANTS]: “Thanks for completing the survey!
Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 20 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 | Dana Wagner |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |