Cohort 2--Youth 1st, 2nd, 3rd Follow-Up Questionnaire
Evaluation of the Food and Drug Administration's General Market Youth Tobacco Prevention Campaign
Attachment 2_E2b. Youth Follow-up 1 Instrument ExPECTT Cohort 2 Clean
Cohort 2--Youth 1st, 2nd, 3rd Follow-Up Questionnaire
OMB: 0910-0753
Attachment 2_E2B : Youth Follow-up 1 Instrument (EXPECTT II)
Form Approved
OMB No. 0910-0753
Exp. Date 09/30/2019
RIHSC No. 18-009CTP
Evaluation of the Public Education Campaign on Teen Tobacco (ExPECTT II) - First Follow-up
Subjects for Questionnaire:
Section A: Demographic Items
Section B: Tobacco Use Behavior
Section C: Tobacco Use Intentions and Self-Efficacy
Section D: Cessation (Intention, Behavior, Motivation)
Section E: Attitudes, Beliefs & Risk Perceptions, Social Norm
Section F: Media Use and Awareness
Section G: Environment
Introduction
This survey is all about you.
Your thoughts, your opinions, your experiences.
We want to know about some of your beliefs, attitudes and behaviors. We will ask about media use and about your use of substances that may be illegal for you to buy or use in your state, such as tobacco and marijuana. We will also ask about your experiences in school and in your home. Even if you don’t use tobacco or marijuana, we want to know what you think.
It will take about 45 minutes for you to complete this survey. Please take your time and answer as honestly and thoughtfully as you can.
This study is sponsored by the U.S. Food and Drug Administration (FDA). Your answers may be shared with the FDA but not your personal information. We will not share any information you give us with your parents or anyone outside the FDA and RTI research teams. All of your answers will be kept private. It is not completely safe to send data through the Internet but we are doing everything we can to protect your data. We will code your survey data and send it over a secure connection for added protection.
Your responses will be combined with those of others who are taking this survey before the data are reported.
Section A: Demographic Items
First, we want to ask you some questions about yourself.
A1_2. [DOB THIS QUESTION SHOULD BE COMPLETED BY[YOUTHFNAME]
What is your date of birth?
Month: __________________ Day: ______________ Year: ___________
Confirm your date of birth.
Month: __________________ Day: ______________ Year: ___________
PROGRAMMER:
PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007. SPELL OUT MONTHS IN FULL.
Please make sure that no invalid dates appear. That is Feb 30, Nov 31, etc. cannot be valid. Do not allow future dates. If the date is not valid, please display a hard error, “Please enter a valid date.” THIS ITEM SHOULD BE A REQUIRED ITEM. Use double entry verification. Both dates must match. If dates do not match, display a hard error, “Entries do not match. Please try again.”
DO NOT ALLOW MISSING DATA FOR THIS ITEM.
CALCULATE FILLAGE= (DATE TODAY)- DOB
ASK: All respondents.
A1_3. That would make you XX years old, is that correct?
1 Yes GO TO A2
2 No
ASK: All respondents.
DISPLAY: XX is the age of the respondent calculated from question A1_2.
A1_4. [IF A1_3 = NO]
To be sure we have the right information, please enter your birthdate once more.
What is your date of birth?
Month: __________________ Day: ______________ Year: ___________
Confirm your date of birth.
Month: __________________ Day: ______________ Year: ___________
PROGRAMMER:
PROGRAM DROP DOWN LISTS WITH MONTH, DAY AND YEAR. YEAR SHOULD RANGE FROM 1995 – 2007. SPELL OUT MONTHS IN FULL.
Please make sure that no invalid dates appear. That is Feb 30, Nov 31, etc. cannot be valid. Do not allow future dates. If the date is not valid, please display a hard error, “Please enter a valid date.” THIS ITEM SHOULD BE A REQUIRED ITEM. Use double entry verification. Both dates must match. If dates do not match, display a hard error, “Entries do not match. Please try again.”
DO NOT ALLOW MISSING DATA FOR THIS ITEM.
CALCULATE FILLAGE= (DATE TODAY)- DOB
ASK: All respondents who respond A1_3 = NO
A1_5. That would make you XX years old, is that correct?
1 Yes GO TO A2
2 No
ASK: All respondents for whom birthdate (A1_2) and age (A1_3) do not correspond.
DISPLAY: XX is the age of the respondent calculated from question A1_4.
A2. Are you male or female?
1 Female
2 Male
9 Prefer not to answer
ASK: All respondents.
A3. Are you Hispanic, Latino/a, or of Spanish origin?
1 No, not of Hispanic, Latino/a, or Spanish origin
2 Yes, Mexican American, Chicano/a
3 Yes, Puerto Rican
4 Yes, Cuban
5 Yes, another Hispanic, Latino/a, or Spanish origin
9 Prefer not to answer
ASK: All respondents.
A4. What race or races do you consider yourself to be? Please select 1 or more of these categories.
-
1
Yes
A4_1. White
1
A4_2. Black or African American
1
A4_3. American Indian or Alaska Native
1
A4_4. Asian Indian
1
A4_5. Chinese
1
A4_6. Filipino
1
A4_7. Japanese
1
A4_8. Korean
1
A4_9. Vietnamese
1
A4_10. Native Hawaiian
1
A4_11. Guamanian or Chamorro
1
A4_12. Samoan
1
A4_13. Other Asian
1
A4_14. Other Pacific Islander
1
ASK: All respondents.
A8. During the past 30 days, about how much money did you have each week to spend any way you wanted to?
1 None
2 $5 or less
3 $6 to $10
4 $11 to $20
5 $21 to $35
6 $36 to $50
7 $51 to $75
8 $76 to $125
9 $126 or more
99 Prefer not to answer
ASK: All respondents.
Section B: Tobacco Use Behavior
Thanks for your responses so far!
Now we want to know about your experiences with tobacco products.
Cigarette Use
B1. Have you ever tried cigarette smoking, even one or two puffs?
1 Yes
2 No GO TO B9
9 Prefer not to answer
ASK: All respondents.
GO TO: If respondent ever tried cigarette smoking, even one or two puffs or prefers not to answer whether they ever tried cigarette smoking, even one or two puffs, go to next question B3. If respondent never tried cigarette smoking, even one or two puffs, go to question B9.
B2. [IF B1=1 OR 9]
How old were you when you first tried cigarette smoking, even one or two puffs?
1 8 years old or younger
2 9 years old
3 10 years old
4 11 years old
5 12 years old
6 13 years old
7 14 years old
8 15 years old
9 16 years old
99 Prefer not to answer
ASK: Respondents who ever tried cigarette smoking, even one or two puffs, or preferred not to answer whether they ever tried cigarette smoking, even one or two puffs.
M1. Think back to when you first started smoking cigarettes. Was the first cigarette that you smoked menthol?
1 Yes
2 No
9 Don’t remember/Prefer not to answer
ASK: Respondents who ever tried cigarette smoking, even one or two puffs, or preferred not to answer whether they ever tried cigarette smoking, even one or two puffs.
B3. During the past 30 days, on how many days did you smoke cigarettes?
1 0 days GO TO B6
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever tried cigarette smoking, even one or two puffs, or preferred not to answer whether they ever tried cigarette smoking, even one or two puffs.
GO TO: If respondent smoked cigarettes on 0 days during the past 30 days, go to question B6. If respondent smoked cigarettes on at least 1 day in the past 30 days or prefers not to report the number of days he or she smoked cigarettes in the past 30 days, go to next question B4.
B4. [IF B3=2-9]
During the past 30 days, what type of cigarettes did you usually smoke?
1 Regular
2 Menthol
3 Both Regular and Menthol, equally
9 Prefer not to answer
ASK: Respondents who smoked cigarettes on at least 1 day in the past 30 days or prefers not to report the number of days they smoked cigarettes in the past 30 days.
B5. [IF B3=2-9]
During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?
1 Less than 1 cigarette per day
2 1 cigarette per day
3 2 to 5 cigarettes per day
4 6 to 10 cigarettes per day
5 11 to 20 cigarettes per day
6 More than 20 cigarettes per day
9 Prefer not to answer
ASK: Respondents who smoked cigarettes on at least 1 day in the past 30 days or prefers not to report the number of days they smoked cigarettes in the past 30 days.
B6. [IF B1=1 OR 9]
About how many cigarettes have you smoked in your entire life? Your best guess is fine.
1 0 cigarettes
2 1 or more puffs but never a whole cigarette
3 1 cigarette
4 2 to 5 cigarettes
5 6 to 15 cigarettes (about 1/2 a pack total)
6 16 to 25 cigarettes (about 1 pack total)
7 26 to 99 cigarettes (more than 1 pack, but less than 5 packs)
8 100 or more cigarettes (5 or more packs)
9 Prefer not to answer
ASK: Respondents who ever tried cigarette smoking, even one or two puffs, or preferred not to answer whether they ever tried cigarette smoking, even one or two puffs.
Other Substance Use
B9.
The next questions are about smokeless tobacco, such as dip, chewing tobacco, snuff, or snus. Common brands include [EDIT IF NECESSARY Copenhagen, Grizzly, Skoal, Camel Snus, Kodiak, and Longhorn].
Have you ever used smokeless tobacco even just a small amount?
1 Yes
2 No GO TO B11
9 Prefer not to answer GO TO B11
ASK: All respondents.
GO TO: If respondent ever used smokeless tobacco even just a small amount, go to next question B10. If respondent never used smokeless tobacco even just a small amount or prefers not to answer whether they ever used smokeless tobacco even just a small amount, go to question B11.
B10. [IF B9=1]
During the past 30 days, on how many days did you use smokeless tobacco?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever used smokeless tobacco even just a small amount.
C1_22. [IF B9 = 2]
Have you ever been curious about using smokeless tobacco?
Very curious
Somewhat curious
A little curious
Not at all curious
999 Prefer not to answer
ASK: B9 responses that indicated the respondent never used smokeless tobacco, or ‘preferred not to answer’ whether they had ever used smokeless
The next questions are about cigars, cigarillos, or little cigars such as Black & Mild, Swisher Sweets, Dutch Masters, Phillies Blunts, Prime Time, and Winchester.
B11. Have you ever smoked cigars, cigarillos, or little cigars even one time?
1 Yes
2 No GO TO B13
9 Prefer not to answer GO TO B13
ASK: All respondents
GO TO: If respondent ever smoked cigars, cigarillos, or little cigars even one time, go to next question B12. If respondent never smoked cigars, cigarillos, or little cigars even one time or prefers not to answer whether they ever smoked cigars, cigarillos, or little cigars even one time, go to question B13.
B12. [IF B11=1]
During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever smoked cigars, cigarillos, or little cigars even one time.
C1_19. [IF B11 = 2]
Have you ever been curious about smoking a cigar, cigarillo, or little cigar?
Very curious
Somewhat curious
A little curious
Not at all curious
999 Prefer not to answer
ASK: B11 responses that indicated the respondent never smoked a cigar, cigarillo, or little cigar, or ‘preferred not to answer’ whether they had ever tried a cigar, cigarillo, or little cigar.
B13. Have you ever tried smoking tobacco out of a water pipe (also called “hookah”), even one time?
1 Yes
2 No GO TO B15
9 Prefer not to answer GO TO B15
ASK: All respondents.
GO TO: If respondent ever smoked tobacco out of a water pipe even one time, go to next question B14. If respondent never smoked tobacco out of a water pipe even one time or prefers not to answer whether they ever smoked tobacco out of a water pipe even one time, go to question B15.
B14. [IF B13=1]
During the past 30 days, on how many days did you smoke tobacco out of a water pipe (also called “hookah”)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever smoked tobacco out of a water pipe even one time.
C1_21. [IF B13 = 2]
Have you ever been curious about smoking a hookah?
Very curious
Somewhat curious
A little curious
Not at all curious
999 Prefer not to answer
ASK: B13 responses that indicated the respondent never smoked a hookah, or ‘preferred not to answer’ whether they had ever smoked a hookah
The next questions are about vaping products or vapes. You may also know them as JUUL, e-cigarettes, vape pens, Suorin or mods. Some look like cigarettes, and others look like small boxes, pens, or pipes.
B15. Have you ever tried any vaping product, even one time?
1 Yes
2 No GO TO B17
9 Prefer not to answer GO TO B17
ASK: All respondents.
GO TO: If respondent ever tried an electronic vaping product even one time, go to next question B16. If respondent never tried an electronic vaping product even one time or prefers not to answer whether they ever tried an electronic vaping product even one time, go to question B17.
B16. [IF B15=1]
During the past 30 days, on how many days did you vape?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever tried an electronic vaping product even one time.
C1_20. [B15 = 2 ]
Have you ever been curious about vaping?
Very curious
Somewhat curious
A little curious
Not at all curious
999 Prefer not to answer
ASK: B15 responses that indicated the respondent never vaped or ‘preferred not to answer’ whether they had ever vaped.
M6. What was the first tobacco product you used?
1 Cigarette
2 Cigar
3 Hookah/Waterpipe
4 Smokeless
5 Vaping product
9 Don’t remember/Prefer not to answer
ASK: Respondents who report having used more than one tobacco product.
B17. Have you ever tried marijuana, even one time?
1 Yes
2 No GO TO C1
9 Prefer not to answer GO TO C1
ASK: All respondents.
GO TO: If respondent ever tried marijuana even one time, go to next question B18. If respondent never tried marijuana even one time or prefers not to answer whether they ever tried marijuana even one time, go to question C1.
B18. [IF B17=1]
During the past 30 days, on how many days did you use marijuana?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever tried marijuana even one time.
B19. [IF B17=1]
During the past 30 days, on how many days did you add marijuana to a tobacco product, such as a cigar, cigarillo or little cigar (sometimes known as a “blunt”)?
1 0 days
2 1 or 2 days
3 3 to 5 days
4 6 to 9 days
5 10 to 19 days
6 20 to 29 days or
7 All 30 days
9 Prefer not to answer
ASK: Respondents who ever tried marijuana even one time.
Section C: Tobacco Use Intentions and Self-Efficacy
Doing great! Now we want you to think about what you might do in the future.
C1. Thinking about the future…
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
9 Prefer Not to Answer |
C1_1. |
Do you think that you will smoke a cigarette soon? |
1 |
2 |
3 |
4 |
9 |
C1_2. |
Do you think you will smoke a cigarette at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_5. |
If one of your best friends were to offer you a cigarette, would you smoke it? |
1 |
2 |
3 |
4 |
9 |
C1_6. |
Do you think that you will use smokeless tobacco such as dip, chewing tobacco, snuff, or snus soon? |
1 |
2 |
3 |
4 |
9 |
C1_7. |
Do you think you will use smokeless tobacco at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_8. |
If one of your best friends were to offer you smokeless tobacco, would you use it? |
1 |
2 |
3 |
4 |
9 |
C1_9. |
Do you think you will smoke cigars, cigarillos, or little cigars soon? |
1 |
2 |
3 |
4 |
9 |
C1_10. |
Do you think you will smoke cigars, cigarillos, or little cigars at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_11. |
If one of your best friends were to offer you a cigar, cigarillo, or little cigar, would you smoke it? |
1 |
2 |
3 |
4 |
9 |
C1_12. |
Do you think that you will vape soon? |
1 |
2 |
3 |
4 |
9 |
C1_13. |
Do you think you will vape at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_14. |
If one of your best friends were to offer you a vaping product/vape would you use it? |
1 |
2 |
3 |
4 |
9 |
C1_15. |
Do you think that you will smoke a hookah soon? |
1 |
2 |
3 |
4 |
9 |
C1_16. |
Do you think you will smoke a hookah at any time in the next year? |
1 |
2 |
3 |
4 |
9 |
C1_17. |
If one of your best friends were to offer you a hookah would you smoke it? |
1 |
2 |
3 |
4 |
9 |
ASK: All respondents.
ATTNCHK1.
Please select Tuesday as the answer to this question.
1 Monday
2 Tuesday
3 Wednesday
4 Thursday
5 Friday
6 Saturday
7 Sunday
9 Prefer not to answer
ASK: All respondents.
C2. How sure are you that, if you really wanted to, you could say no to a cigarette offer if…
RANDOMIZE OPTIONS
|
1 Not at all sure |
2 Slightly sure |
3 Somewhat sure |
4 Mostly sure |
5 Completely sure |
9 Prefer Not to Answer |
|
C2_1. |
You are at a party where most people are smoking? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_2. |
A very close friend offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
C2_3. |
Someone you know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
C4. How sure are you that, if you really wanted to, you could say no to vaping if…,
[RANDOMIZE OPTIONS]
|
1 Not at all sure |
2 Slightly sure |
3 Somewhat sure |
4 Mostly sure |
5 Completely sure |
9 Prefer Not to Answer |
|
C4_1. |
You are at a party where most people are vaping? |
1 |
2 |
3 |
4 |
5 |
9 |
C4_2. |
A very close friend offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
C4_3. |
Someone you know offers it? |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
Section D: Cessation (Intention, Behavior, Motivation)
CHECKPOINT: ASK D1, D2 AND D3 OF RESPONDENTS WHO HAVE SMOKED ON 1 OR MORE DAYS IN THE PAST 30 DAYS OR PREFERRED NOT TO REPORT THE NUMBER OF DAYS THEY SMOKED IN THE PAST 30 DAYS.
D2. [IF B3=2-9]
During the past 3 months, did you stop smoking cigarettes for one day or longer because you were trying to quit smoking cigarettes for good?
1 Yes
2 No
9 Prefer not to answer
ASK: Respondents who smoked cigarettes on at least 1 day in the past 30 days or prefer not to report the number of days they smoked cigarettes in the past 30 days.
Section E: Attitudes, Beliefs & Risk Perceptions, Social Norm
What do you think? We want your opinions on cigarette use and other tobacco products.
Attitude
E1. Smoking cigarettes is… (pick one)
RANDOMIZE OPTIONS
E1_1. |
Bad |
|
|
|
|
|
|
|
Good |
E1_2. |
Unenjoyable |
|
|
|
|
|
|
|
Enjoyable |
E1_3. |
Harmful |
|
|
|
|
|
|
|
Not Harmful |
E1_4. |
Dangerous |
|
|
|
|
|
|
|
Not Dangerous |
ASK: All respondents.
E14. Vaping is… (pick one)
[RANDOMIZE Options]
E14_1. |
Bad |
|
|
|
|
|
|
|
Good |
E14_2. |
Unenjoyable |
|
|
|
|
|
|
|
Enjoyable |
E14_3. |
Harmful |
|
|
|
|
|
|
|
Not Harmful |
E14_4. |
Dangerous |
|
|
|
|
|
|
|
Not Dangerous |
ASK: All respondents.
Attitudinal Beliefs and Risk Perceptions
E3. How much do you agree or disagree with the following statements? If I smoke cigarettes I will…
RANDOMIZE OPTIONS
|
If I smoke I will… |
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E3_1. |
Become addicted [Contract, No Escape] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_2. |
Be controlled by smoking [Contract, No Escape] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_3. |
Be unable to stop when I want to [Contract, No Escape] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_4 |
Give up part of my freedom [Contract, No Escape] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_5. |
Stunt the growth of my lungs [Straw City, Little lungs] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_6. |
Have small lungs [Straw City, Little Lungs] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_7. |
Have trouble breathing [Straw City] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_8. |
Have yellow, stained teeth [Gift] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_9. |
Develop gum disease [Gift] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_10. |
Have grayish skin [16 Going on 70] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_11. |
Get wrinkles [16 Going on 70] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_12. |
Develop skin problems [16 Going on 70] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_13. |
Be less attractive [16 Going on 70] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_14. |
Lose my teeth [Tooth] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_15. |
Have bad breath [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_16. |
Get sick more often [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_17. |
Decrease my sports performance [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_18. |
End up wasting money on cigarettes [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_19. |
Harm others with second-hand smoke [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_20. |
Be a bad influence on others [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E3_21. |
[ADD KEY BELIEF FROM REAL COST ADVERTISING] |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
Notes:
Text in brackets signifies the RC ad to which the belief corresponds. Text in brackets is for planning only and will not be programmed/viewed by respondents.
Unrelated=belief is not related to campaign advertising.
We have added beliefs for Skin and Tooth in the even that these ads air again.
What do you think?
E13. How much do you agree or disagree with the following statements? If I vape I will…
RANDOMIZE OPTIONS
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E13_1. |
Become addicted [Candy House, Flavor of Addiction, other new vape ads] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_2. |
Be controlled by nicotine [Obey Nicotine, other new vape ads] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_3. |
Be unable to stop when I want to [All new vape ads] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_4. |
Deliver nicotine to my brain [Hacked ENDS, Nicky Tine, Brain Screw] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_7. |
Expose my brain to nicotine [Nicky Tine] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_8. |
Have bad breath [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_9. |
Get sick more often [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_10. |
Decrease my sports performance [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_11. |
End up wasting money on electronic cigarettes [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_12. |
Harm others with second-hand smoke [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_13. |
Be a bad influence on others [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_14. |
Be more likely to smoke cigarettes [Twice as likely] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_16. |
Inhale metal particles [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E13_17. |
Damage my body |
1 |
2 |
3 |
4 |
5 |
9 |
E13_18. |
Damage my lungs |
1 |
2 |
3 |
4 |
5 |
9 |
E18_19. |
Be exposed to harmful chemicals |
1 |
2 |
3 |
4 |
5 |
9 |
E13_20. |
[ADD KEY BELIEF FROM REAL COST ADVERTISING] |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
Notes:
Text in brackets signifies the RC ad to which the belief corresponds. Text in brackets is for planning only and will not be programmed/viewed by respondents.
Unrelated=belief is not related to campaign advertising.
E5. How much do you agree or disagree with the following statements about smoking cigarettes?
RANDOMIZE OPTIONS
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E5_1. |
Smoking takes away your freedom [Contract] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_2. |
Tobacco controls people [Contract] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_3. |
The lungs of teenage smokers may not grow to normal size. [Straw City, Little Lungs] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_4. |
Smoking as a teen can permanently stunt your lungs. [Straw City, Little Lungs] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_5. |
If I smoke, the consequences will find me. [Gift] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_6. |
Smoking causes gum disease [Gift] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_7. |
Cigarettes can stain teeth [Gift] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_8 |
If I smoke, nicotine will reprogram my brain
|
1 |
2 |
3 |
4 |
5 |
9 |
E5_9 |
The nicotine in cigarettes may hack your brain |
1 |
2 |
3 |
4 |
5 |
9 |
E5_10. |
Smoking just a few cigarettes can make you crave more. [general] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_11. |
Cigarette ingredients are dangerous. [general] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_12. |
Smoking may cause nicotine addiction [general] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_13. |
Cigarette smoke contains nicotine, an addictive substance [general] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_14. |
Smoking cigarettes helps people relieve stress. [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E5_15 |
For teens who smoke, it is hard to escape nicotine addiction |
1 |
2 |
3 |
4 |
5 |
9 |
E5_16. |
[ADD KEY BELIEF FROM REAL COST ADVERTISING] |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
Notes:
Text in brackets signifies the RC ad to which the belief corresponds. Text in brackets is for planning only and will not be programmed/viewed by respondents.
Unrelated=belief is not related to campaign advertising.
What do you think?
E15. How much do you agree or disagree with the following statements about vaping?
RANDOMIZE OPTIONS
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
E15_1. |
The nicotine in vapes may hack your brain. [Hacked ENDS] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_2. |
The nicotine in vapes can reprogram your brain. [Hacked ENDS] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_3. |
Vaping just a little can make you crave more. [Hacked ENDS] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_4. |
Flavored vapes may contain nicotine [Candy House, Flavor of Addiction] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_6. |
Addiction is a disease you can get from vaping [Infected] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_9. |
Vapes are addictive, like cigarettes [Nicky Tine, Brain Screw] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_10. |
Vape ingredients are dangerous. [general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_13. |
Vaping helps people relieve stress. [unrelated] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_14. |
Teens who vape are more likely to start smoke cigarettes [Twice] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_15. |
Most vapes teens use contain nicotine [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_16. |
Most vapes teens use contain just water vapor [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_17. |
Vapes can take your freedom [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_20. |
Vapes contain toxic chemicals [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_21. |
Vaping can harm your lungs [ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_22. |
Vapes contain formaldehyde[ENDS general] |
1 |
2 |
3 |
4 |
5 |
9 |
E15_23 |
Vaping can cause irreversible lung damage |
1 |
2 |
3 |
4 |
5 |
9 |
E15_24 |
Vaping can release dangerous chemicals into your bloodstream |
1 |
2 |
3 |
4 |
5 |
9 |
E15_25 |
The nicotine in vapes changes your brain |
1 |
2 |
3 |
4 |
5 |
9 |
E15_16 |
Vaping can permanently damage your lungs |
1 |
2 |
3 |
4 |
5 |
9 |
E15_27 |
Vaping is an epidemic |
1 |
2 |
3 |
4 |
5 |
9 |
E15_20. |
[ADD KEY BELIEF FROM REAL COST ADVERTISING] |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
Notes:
Text in brackets signifies the RC ad to which the belief corresponds. Text in brackets is for planning only and will not be programmed/viewed by respondents.
Unrelated=belief is not related to campaign advertising.
E9. Does cigarette smoke contain….
|
|
1 Definitely Yes |
2 Probably Yes |
3 Probably Not |
4 Definitely Not |
Don’t Know |
9 Prefer Not to Answer |
E9_15. |
Over 7,000 chemicals? |
1 |
2 |
3 |
4 |
5 |
9 |
Social Norms
Thank you for telling us your opinions.
We have a couple of questions about your friends, and people your age.
E11. How many of your four closest friends…
|
|
0 None |
1 One |
2 Two |
3 Three |
4 Four |
9 Prefer Not to Answer |
E11_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
E11_5. |
Vape? |
0 |
1 |
2 |
3 |
4 |
9 |
ASK: All respondents.
E12. How many other people your age…
|
|
0 None |
1 A few |
2 Some |
3 Most |
4 All |
9 Prefer Not to Answer |
E12_1. |
Smoke cigarettes? |
0 |
1 |
2 |
3 |
4 |
9 |
|
|
|
|
|
|
|
|
E12_7. |
Vape? |
0 |
1 |
2 |
3 |
4 |
9 |
|
|
|
|
|
|
|
|
ASK: All respondents.
Section F: Media Use and Awareness
Next, we’d like to ask you about your use of TV and other media.
F1. How often do you…
PROGRAMMER: RANDOMIZE F1_1 – F1_8
|
|
Several times a day |
About once a day |
3-5 days a week |
1-2 days a week |
Every few weeks |
Less Often |
Never |
|
F1_1. |
Watch television? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_2. |
Watch videos on YouTube/Twitch? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_4. |
Listen to streaming radio (Pandora, Spotify, SoundCloud, Tidal)? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_5. |
Playing games on anyelectronic devices including cell phones/smartphones, computers, laptops, tablets, consoles (Xbox, Wii, PSP) and handheld devices (Nintendo Switch, Nintendo 3DS, PlayStation, Vita, iPod) |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_7. |
Watch Netflix, Hulu or Amazon Prime video? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_8. |
Use Instagram? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_9. |
Use Snapchat? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_10. |
Use Facebook? |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
F1_12. |
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
9 |
ASK: All respondents.
Thinking only about yesterday, about how much time did you spend…
|
|
None |
At least one minute, but less than 1 hour |
1 hour or more, but less than 2 hours |
2 hours or more, but less than 3 hours |
3 hours or more |
Prefer not to answer |
F1_11. |
Watching TV shows on a TV, a computer or laptop, tablet, or smartphone? |
1 |
2 |
3 |
4 |
5 |
9 |
F1_12. |
Listening to radio? |
1 |
2 |
3 |
4 |
5 |
9 |
F1_13. |
Using social media such as Instagram, Snapchat or Facebook? |
1 |
2 |
3 |
4 |
5 |
9 |
ASK: All respondents.
ATTNCHK2
Please select basketball as the answer to this question.
1 Soccer
2 Baseball
3 Swimming
4 Softball
5 Basketball
9 Prefer not to answer
ASK: All respondents.
F1_14. Thinking only about yesterday, about how much time did you spend…
Gaming?
1 At least one minute, but less than 1 hour
2 1 hour or more, but less than 2 hours
3 2 hours or more, but less than 3 hours
4 3 hours or more
999 Prefer not to answer
ASK: All respondents
IF F1_14=4 ask F1_14a.
F1_14_a. What games did you play most in the past week? [Types the names of the games below]
[open-ended response #1]
[open-ended response #2]
[open-ended response #3]
999 Prefer not to answer
ASK: Respondents who report gaming 3 or more hours the previous day
We want to ask you about some slogans or themes that might or might not have appeared in the media around here, as part of ads about tobacco.
F
3_3.
In the past [FILL MONTHS] months,
that is since [FILL DATE], have you seen or heard the
following slogan or theme?
Digital Youth Against Tobacco (DYAT)
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F3_4. In the past [FILL MONTHS] months, that is since [FILL DATE], have you seen or heard the following slogan or theme?
T
he
Real Cost
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F3_11. In the past [FILL MONTHS] months, that is since [FILL DATE], have you seen or heard the following slogan or theme?
T
ips
from Former Smokers (Tips)
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F3_12. In the past [FILL MONTHS] months, that is since [FILL DATE], have you seen or heard the following slogan or theme?
truth
[insert current truth campaign name]
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F3_13. In the past [FILL MONTHS] months, that is since [FILL DATE], have you seen or heard the following slogan or theme?
Fresh
Empire
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F5_14. In the past [FILL MONTHS] months, that is since [FILL DATE], have you seen or heard the following slogan or theme?
Drop Vape
1 Yes
2 No
9 Not sure
ASK: All respondents
DISPLAY: FILL MONTHS is the total number of months of the recall period of interest. FILL DATE is the first day of the recall period.
F5_3. [IF F3_4=1 OR 3]
Where have you seen or heard about The Real Cost? Check all that apply.
RANDOMIZE OPTIONS
-
Yes
No
1
2
F5_3a. On TV or the Internet/online/social media
1
2
F5_3b. In a game
1
2
F5_3c. On the radio
1
2
F5_3d. In magazines
1
2
F5_3e. Billboards or other outdoor or mall ads
1
2
F5_3f. At the movie theatre
F5_3h. At school
1
2
F5_3g. I have not seen or heard about The Real Cost
ASK: Respondents who have seen or heard of The Real Cost slogan or theme in the past 3 months or were not sure if they have seen or heard of The Real Cost slogan or theme in the past 3 months.
F6. [IF F3_4=1 OR 3]
The Real Cost campaign is online. Have you ever seen The Real Cost on…Check all that apply.
-
YES
NO
1
2
F6_1. YouTube?
1
2
F6_2. Hulu?
1
2
F6_3. Facebook?
1
2
F6_4. Twitter?
1
2
F6_5. Spotify, Soundcloud or Pandora?
1
2
F6_6. PlayStation?
1
2
F6_7. Xbox?
1
2
F6_8. Instagram?
1
2
F6_9. Snapchat?
1
2
F6_10. Tumblr?
1
2
F6_11. [ADD SOCIAL MEDIA PROPERTY]
Prefer not to answer
ASK: Respondents who have seen or heard of The Real Cost slogan or theme in the past 3 months or were not sure if they have seen or heard of The Real Cost slogan or theme in the past 3 months.
Thanks for your responses!
F7_x. Now we would like to show you some advertisements that have been shown in the U.S. Once you have viewed the video or screenshot, please click on the forward arrow below to continue with the survey.
PROGRAMMER: DISPLAY VIDEOS OR SCREENSHOTS IN RANDOM ORDER. USE VIDEO FOR REAL COST ADS, USE SCREENSHOTS FOR OTHER ADS.
F8_x. Apart from this survey, how frequently have you seen this ad [SCREENSHOT LANGUAGE: these ads] in the past [FILL MONTHS]?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Very Often
9 Prefer not to answer
ASK: All respondents.
DISPLAY: SCREENSHOT LANGUAGE is entered when respondents are view screenshots for the truth, Tips From Former Smokers, and Fresh Empire ads. FILL MONTHS is the recall period of interest.
PROGRAMMER: LOOP BACK TO ASK ABOUT NEXT AD HERE. SHOW SCREENGRAB OF AD
F19_x. What is the main message of this ad? Select only one response
[RANDOMIZE ORDER OF CHECKBOX LIST]
1 Cigarettes can control your life [Contract]
2 Cigarettes may leave you with stained teeth and gum disease. [Gift]
3 Smoking can permanently stunt your lungs. [Straw City/Little Lungs]
4 Vaping can deliver nicotine to your brain [Hacked, ENDs version]
7 [ADD KEY MESSAGE FROM REAL COST ADVERTISING]
99 I am not sure
ASK: All respondents.
F11. Please tell us if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements.
|
|
1 Strongly Disagree |
2 Disagree |
3 Neither Agree or Disagree (Neutral) |
4 Agree |
5 Strongly Agree |
9 Prefer Not to Answer |
F11_1. |
This ad is worth remembering |
1 |
2 |
3 |
4 |
5 |
9 |
F11_2. |
This ad grabbed my attention |
1 |
2 |
3 |
4 |
5 |
9 |
F11_3. |
This ad is powerful |
1 |
2 |
3 |
4 |
5 |
9 |
F11_4. |
This ad is informative |
1 |
2 |
3 |
4 |
5 |
9 |
F11_5. |
This ad is meaningful to me |
1 |
2 |
3 |
4 |
5 |
9 |
F11_6. |
This ad is convincing |
1 |
2 |
3 |
4 |
5 |
9 |
F11_7. |
This ad is irritating |
1 |
2 |
3 |
4 |
5 |
9 |
ASK Randomly assign respondents to receive these questions for 1/4 RC ads.
F14. Did you talk to anyone about any of these ads?
1 Yes
2 No
9 Prefer not to answer
ASK: All respondents.
F15. [IF F14=1]
When you talked about the ads, did you talk about any of the following topics?
RANDOMIZE OPTIONS
Yes |
No |
|
1 |
2 |
F15_2. These ads were NOT good |
1 |
2 |
F15_3. I should not smoke or vape |
1 |
2 |
F15_4. The person I was talking to or someone else I know should not smoke or vape |
ASK: Respondents who talked to someone about any of the ads they viewed.
F16. Do your parents have rules about how much time you can spend using media, such as TV, computer, video games, cell phones, and music?
1 Yes, my parents have lots of rules about it.
2 Yes, my parents have a few rules about it.
3 No, my parents don’t have any rules about it.
9 Prefer not to answer
ASK: All respondents.
F17. Do your parents have rules about what you are allowed to do on the computer, which video games you are allowed to play, or what music you’re allowed to listen to?
1 Yes, my parents have lots of rules about it.
2 Yes, my parents have a few rules about it.
3 No, my parents don’t have any rules about it.
9 Prefer not to answer
ASK: All respondents.
F18. In general, how often do your parents make sure you follow the rules they have about using media, such as TV, computers, video games, and music?
1 Most of the time
2 Some of the time
3 A little of the time
4 Never
5 My parents don’t have rules about using media
9 Prefer not to answer
ASK: All respondents.
Section G: Environment
You’re almost done!
Just a few more questions about yourself and the people you live with.
G1. Other than you, has anyone who lives with you used any of the following during the past 30 days…? (You can choose one answer or more than one answer)
1 cigarettes
2 smokeless tobacco, such as chewing tobacco, snuff, snus (rhymes with goose) or dip, such as [NAME TOP BRANDS]
3 cigars, cigarillos, or little cigars such as [NAME TOP BRANDS]
4 tobacco out of a water pipe (also called “hookah”)
5 electronic vaping products or electronic cigarettes, such as [NAME TOP BRANDS]
6 any other form of tobacco
7 No, no one who lives with me has used any form of tobacco during the past 30 days
9 Prefer not to answer
ASK: All Respondents
DISPLAY: The text NAME TOP BRANDS is a placeholder for the names of the top brands in this category.
G2. Which statement best describes the rules about vaping in your home? Would you say…
1 Vaping is not allowed anywhere inside your home
2 Vaping is allowed in some places or at some times
3 Vaping is allowed anywhere inside the home
4 There are no rules about vaping inside the home
9 Prefer not to answer
ASK: All respondents.
G3. Which statement best describes the rules about smoking in your home? Would you say…
1 Smoking is not allowed anywhere inside your home
2 Smoking is allowed in some places or at some times
3 Smoking is allowed anywhere inside the home
4 There are no rules about smoking inside the home
9 Prefer not to answer
ASK: All respondents.
G4. How well would you say you have done in school? Would you say…
1 Much better than average
2 Better than average
3 Average
4 Below average
5 Much worse than average
9 Prefer not to answer
ASK: All respondents.
G5. I feel close to people at my school. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G6. I am happy to be at my school. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G7. I feel like I am a part of my school. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G8. How far do you think you will go in school?
1 I don’t plan to go to school anymore
2 9th grade
3 10th grade
4 11th grade
5 12th grade or GED
6 Some college or technical school but no degree
7 Technical school degree
8 College degree
9 Graduate school, medical school, or law school
99 Prefer not to answer
ASK: All respondents.
G9. How many close friends do you have? (Close friends include people whom you feel at ease with, can talk to about private matters, and can call on for help.)
__________ MIN 0 MAX 7
9 Prefer not to answer
PROGRAMMER: NUMERIC RESPONSE. ALLOW A MINIMUM OF 0 AND MAXIMUM OF 7.
IF ANYTHING ELSE IS TYPED IN, ERROR MESSAGE SHOULD SAY, “YOU HAVE ENTERED A NUMBER OUTSIDE THE ALLOWED RANGE. PLEASE ENTER A NUMBER BETWEEN 0 AND 7.” IN LOWERCASE LETTERS
ASK: All respondents.
G10. How often do you attend church or religious services? Would you say…
1 Never
2 Less than once a month
3 About once a month
4 About 2 or 3 times a month
5 Once a week
6 More than once a week
9 Prefer not to answer
ASK: All respondents.
Please tell us if you strongly agree, agree, disagree, or strongly disagree with the following statements.
G11. I would like to explore strange places. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G12. I like to do frightening things. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G13. I like new and exciting experiences, even if I have to break the rules. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G14. I prefer friends who are exciting and unpredictable. Would you say you…
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G15. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
_____ Number of days
2 None
3 Don’t know
9 Prefer not to answer
PROGRAMMER: NUMERIC RESPONSE. ALLOW A MINIMUM OF 1 AND MAXIMUM OF 30.
IF ANYTHING ELSE IS TYPED IN, ERROR MESSAGE SHOULD SAY, “YOU HAVE ENTERED A NUMBER OUTSIDE THE ALLOWED RANGE FOR THE NUMBER OF DAYS. PLEASE ENTER A NUMBER BETWEEN 1 AND 30.” IN LOWERCASE LETTERS
RESPONDENTS CAN ONLY RESPOND WITH THE OPTION NONE, DON’T KNOW, OR TYPE IN A NUMERIC RESPONSE OF 1-30. IF RESPONDENTS TRY TO ENTER A NUMBER OF DAYS AND EITHER NONE OR DON’T KNOW, ERROR MESSAGE SHOULD SAY “YOU HAVE ENTERED A NUMBER AND SELECTED NONE OR DON’T KNOW. PLEASE ENTER A NUMBER OF DAYS, CHOOSE NONE, OR CHOOSE DON’T KNOW AS YOUR RESPONSE.”
ASK: All respondents.
These next questions ask about how you feel about your current relationship with your parents or guardians. Please tell us if you strongly agree, agree, disagree, or strongly disagree with the following statement.
G16. Thinking about the adult or adults you live with would you say you are satisfied with the way you communicate with each other.
1 Strongly Disagree
2 Disagree
3 Neither agree nor disagree (neutral)
4 Agree
5 Strongly Agree
9 Prefer not to answer
ASK: All respondents.
G17. How close do you feel to the adult or adults you live with?
1 Not at all close
2 Not very close
3 Somewhat close
4 Quite close
5 Very close
9 Prefer not to answer
ASK: All respondents.
G18. How often has a parent or other adult caregiver said things that really hurt your feelings or made you feel like you were not wanted or loved?
1 One time
2 Two times
3 Three to five times
4 Six to ten times
5 More than ten times
6 This has never happened
7 Don’t know
9 Prefer not to answer
ASK: All respondents.
G19. Has a parent or other adult caregiver ever talked to you about reasons for not smoking cigarettes or using other types of tobacco like cigars and chewing tobacco?
1 Yes
2 No
9 Prefer not to answer
ASK: All respondents.
G20. During the past 7 days, on how many days did you and one or both of your parents or other adult caregivers do something together just for fun?
__________ MIN 0 MAX 7
9 Prefer not to answer
PROGRAMMER: NUMERIC RESPONSE. ALLOW A MINIMUM OF 0 AND MAXIMUM OF 7.
IF ANYTHING ELSE IS TYPED IN, ERROR MESSAGE SHOULD SAY, “YOU HAVE ENTERED A NUMBER OUTSIDE THE ALLOWED RANGE. PLEASE ENTER A NUMBER BETWEEN 0 AND 7.” IN LOWERCASE LETTERS
ASK: All respondents.
Thank you for taking this survey!
Thank you for taking time to complete this survey.
OMB No: 0910-0753 Expiration Date: 09/30/2019
Paperwork Reduction Act Statement: The public reporting burden for this collection of information has been estimated to average 45 minutes per response. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | PR* |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |
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