Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (SGM Population) (CTP

OMB# 0910-0796

Exp. 07/31/2021

Unique ID: _________

SCREENER

TITLE OF INFORMATION COLLECTION: Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (SGM Population)

Note to the interviewer: Text to read will be shown in plain text. Instructions will be shown in red italics and should not be read.

Hi, my name is _______ from [FACILITY NAME], a local market research firm! We are working on a research study about tobacco use, health, and ideas for future ads, and would like to include your opinions. I want to assure you that we are not from a tobacco company or a company that sells quit-smoking aids. We just want to learn about your experiences and find out what you think about tobacco products. If you qualify and participate in the discussion group, you will get [$50 for virtual focus groups, $75 for in-person focus groups].

To see if you qualify, we will need to ask personal questions about your demographics, including race/ethnicity, your income, your sexual orientation and gender identity. There are no right or wrong answers, and only the researchers will know how you answer these questions, so please be honest. We will try our best to keep your information private. Still, your information could be shared by accident. Your participation is voluntary, and you can stop at any time. There is no direct benefit to you for participating in the screening survey.

We will let you know in the next few days if you were selected, and if so, if you were selected for an in-person group or for a virtual group. Whether you are selected for an in-person group or virtual group, your participation in the group will take no more than 95 minutes of your time.

If you have any questions about the discussion group, you may contact the project staff through Shiloh Beckerley of Rescue Agency at 858-366-8189 or sbeckerley@rescueagency.com.

1. Do you consent to participate in this short screening survey? [Do NOT read answer choices. Select one response.]

   1. Yes

   2. No → [Read and end call; Does NOT Qualify] That’s okay. Thank you for your time!

[ASK ALL]

Great! I have a few questions to make sure you are eligible to participate.

2. What is the 5-digit zip code where you currently live? _______________ [Open-ended. Write response. Do NOT disqualify based on response, continue through survey.]

3. Which of the following best describes the area you live in? [Read answer choices. Select one response.]

   1. Urban

   2. Suburban

   3. Rural

4. How old are you? _____________ [Open-ended. Write response. If 18 years or younger, 55 years or older, or refuses to answer → Skip to disqualify script ]

5. Are you Hispanic, Latino/a, or Spanish origin? [Do not read answer choices. Select one response.]

   1. Not Hispanic, Latino/a, or Spanish origin

   2. Yes, Hispanic, Latino/a, or Spanish origin

   3. Prefer not to say / Refuse to answer → Skip to disqualify script [Does NOT Qualify]

For the next few questions, do not tell me your answer, just tell me the letter that corresponds to each answer I read or say stop when I say your answer.

Recruiter will read letter of answer option and answers. Recruiter will remind respondent to give the letter of the answer if he or she says the answer out loud by saying “remember, you should just give me the letter of the answer”.

6. What is your race? Choose all that apply. [Read answer choices. Can select multiple responses among answer choices a-e.]

   1. American Indian and Alaska Native

   2. Asian

   3. Black / African American

   4. Native Hawaiian and Other Pacific Islander

   5. White

   6. Prefer not to say / Refuse to answer → Skip to disqualify script [Does NOT Qualify]

7. What sex were you assigned at birth, on your original birth certificate? [Please respond with just the letter for the option that applies to you].

   1. Male

   2. Female

   3. Refused

   4. Don't know

8. Do you currently describe yourself as male, female or transgender? [Please respond with just the letter for the option that applies to you].

a. Male

b. Female

c. Transgender

d. None of these

9. Just to confirm, you were assigned {FILL} at birth and now you describe yourself as {FILL}. Is that correct?

a. Yes

b. No → Return to question 7 to clarify, if 9=B on second pass skip to disqualify script [Does NOT Qualify]

c. Refused → Skip to disqualify script [Does NOT Qualify]

d. Don’t know → Skip to disqualify script [Does NOT Qualify]

10. Which of the following best represents how you think of yourself? [Please respond with just the letter for the option that applies to you].

a. Lesbian or gay

b. Straight, that is not lesbian or gay

c. Bisexual

d. Something else*___________ (please specify)

e. I don’t know the answer → Skip to disqualify script [Does NOT Qualify]

[IF QUESTION 7 = a AND QUESTION 8 = a AND QUESTION 10 = b; OR

IF QUESTION 7 = b AND QUESTION 8 = b AND QUESTION 10 = b; → Skip to disqualify script [Does NOT Qualify]]

[IF QUESTION 7 = b AND QUESTION 8 = b AND QUESTION 10 = a → QUALIFY FOR CIS-GENDER LESBIAN/GAY FEMALE]

[IF QUESTION 7 = b AND QUESTION 8 = b AND QUESTION 10 = c → QUALIFY FOR CIS-GENDER BISEXUAL FEMALE]

[IF QUESTION 7 = a AND QUESTION 8 = a AND QUESTION 10 = a or c → QUALIFY FOR CIS-GENDER GAY/BISEXUAL MALE]

[IF QUESTION 7=a AND QUESTION 8 = b AND QUESTION 10 = any; OR

IF QUESTION 7=b AND QUESTION 8 = a AND QUESTION 10 = any; OR

IF QUESTION 7 = any AND QUESTION 8 = c or d AND QUESTION 10 = any → QUALIFY FOR TRANSGENDER/OTHER GENDER NON-CONFORMING]

11. Have you smoked at least 100 cigarettes in your ENTIRE LIFE? [Do NOT read answer choices. Record response.]

    1. Yes

    2. No → Skip to disqualify script [Does NOT Qualify]

    3. Prefer not to say/ Refuse to answer → Skip to disqualify script [Does NOT Qualify]

11. On how many of the past 30 days did you smoke cigarettes?

    1. 0 days → Skip to disqualify script [Does NOT Qualify]

    2. 1 – 30 days

    3. Prefer not to say/ Refuse to answer → Skip to disqualify script [Does NOT Qualify]

11. In the past 12 months, have you stopped smoking for one day or longer because you were trying to stop smoking cigarettes for good?

    1. Yes

    2. No → Skip to disqualify script [Does NOT Qualify]

    3. Prefer not to say/ Refuse to answer → Skip to disqualify script [Does NOT Qualify]

Some people that smoke cigarettes also use other tobacco products. I’m curious about your past and current use of other types of tobacco products.

11. Have you EVER [Do NOT read answer choices. Record responses as a. Yes, b. No, c. Prefer not to say/Refuse to answer] :

14a. Used an e-cigarette such as Fin, JUUL, Suroin, NJOY, blu, eGo, Logic, or Vuse even one time?

14b. Smoked a cigar, even one or two puffs?

14c. Smoked a cigarillo or little cigar, even one or two puffs? This includes Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts This does not include using the paper to smoke marijuana.

14d. Used or tried any smokeless tobacco products such as chewing tobacco, snuff, or snus?

14e. Tried ever tried smoking tobacco from a hookah or a waterpipe, even just one time? a. Yes, b. No, c. Prefer not to say/Refuse

[IF Q14 IS “YES”, CLASSIFIED AS DUAL USER]

Ask question 15 a-e for each “yes” in question 13.

11. On how many of the PAST 30 DAYS did you [Open-ended. Write response from 0 to 30]:

15a. Use an e-cigarette such as Fin, JUUL, Suroin, NJOY, blu, eGo, Logic, or Vuse?

15b. Smoke a cigar?

15c. Smoke a cigarillo or little cigar? This includes Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts.

15d. Use any smokeless tobacco products such as chewing tobacco, snuff, or snus?

15e. Smoke tobacco from a hookah or a waterpipe?

Thanks for answering those questions. Now, I’m going to ask some general questions about you.

[Additional Demographics]

11. Including yourself, how many people currently live in your household? [Do not read answer choices. Select one response.]

    1. 1

    2. 2

    3. 3

    4. 4

    5. 5

    6. 6

    7. 7

    8. 8 or more

    9. Prefer not to say / Refuse to answer

11. What is the total yearly income for your entire household before taxes? This should include the total income of everyone that lives in your home, including income from work, but also including benefits received such as social security, TANF, LEAP, unemployment insurance, child support or any other source of income. If you do not know the exact amount, your best estimate is fine. __________ [Open ended. Do not read answer choices, categorize based on response entered into open-end field. Select one response.]

1. Respondent provides a dollar amount

2. Prefer not to say / Refuse to answer

[Low SES eligibility based on 200% FPL]

# of People in Household (From Question 17)	Income (From Question 18)
1	$24,980 or less
2	$33,820 or less
3	$42,660 or less
4	$51,500 or less
5	$60,340 or less
6	$69,180 or less
7	$78,020 or less
8 or more	$86,860 or less

11. [Interviewer does NOT read this question, but uses it to determine qualification] Based on number of people in household and income:

    1. Respondent’s household income is lower than or equal to 200% FPL

    2. Respondent’s household income is higher than 200% FPL

[IF Q18 IS “A”, CLASSIFIED AS LOWER SES]

11. Are you interested in taking part in the [online/in person] discussion group? It will be held on ___________ (INSERT TIME/DATE)

    1. Yes

    2. No → Skip to disqualify script [Does NOT Qualify]

11. Just so you know, we’d like to audio record the discussion group. Would you be willing to be audio recorded during the discussion group? This is just to help the discussion group leader have a record for their analysis.

    1. Yes

    2. No → Skip to disqualify script [Does NOT Qualify]

11. We’d like to live-steam the discussion group. This means that while the group is taking place, members of our research team who could not be there in person would be able to watch the groups remotely. Groups will not be video recorded. Would you be willing to be live streamed during the discussion group?

    1. Yes

    2. No → Skip to disqualify script [Does NOT Qualify]

[Qualify Script - Meets criteria] - Great, thank you for answering all of our questions. Congrats! You have qualified for one of the discussion groups. We will call you within 48 hours to let you know if you’re invited to participate in the discussion group and provide details. If you attend, you’ll receive [$50 for virtual groups, $75 for in-person groups] for your participation! → Proceed with documenting participant contact information on Screener Contact Sheet to determine potential focus group scheduling.

[Disqualify Script - Does not meet criteria] - Those are all the questions I have for you today. Unfortunately, you don’t qualify to participate in our discussion groups this time. Thanks for your time and have a great day!

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 minutes per response to complete the screening survey (the time estimated to listen or 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

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