“Hookah Purchase Journey: Online Hookah User Survey” - Appendix III

Appendix III: Online Survey

QUESTIONNAIRE

The following questions are about your hookah use and purchases as they relate to your in-home use only. There are additional questions related to hookah use outside the home, e.g., at a hookah bar, restaurant, or lounge, later in the survey, if they apply to you.

We are interested in the purchases you make each year. Disregarding the brands of hookah tobacco or herbal (non-tobacco) shisha, please provide the following information.

1. Which do you normally buy, hookah tobacco or herbal (non-tobacco) shisha? (SELECT ALL THAT APPLY)

   1. Tobacco

   2. Herbal (non-tobacco) shisha

2. For in-home use	a. How often do you purchase hookah shisha?	b. Each time you make a purchase, how many packs of shisha do you buy?	c. What is the typical pack size you buy? (SELECT ONE)	d. How much do you spend per pack, on average? (This should be the cost per pack, not the total expenditure)
[ASK IF CODE Q.1=1] Tobacco shisha	_____times per year	______ packs of tobacco each time	50g 100g 200g 250g 1,000g	$________.00
[ASK IF Q.1=2] Herbal (non-tobacco) shisha	_____times per year	______ packs of herbal (non-tobacco) shisha each time	50g 100g 200g 250g 1,000g	$________.00

[ASK IF Q.1=1]

3. Based on the information you just provided, your total annual expenditure per year for hookah tobacco is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on hookah tobacco purchases for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

Purchase Outlets	Allocate Percentage of Dollars Spent on Hookah Tobacco
Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
Independent Convenience Stores (such as small neighborhood shops)
Specialty Tobacco Stores
Online
From a restaurant, hookah bar, or lounge (for in-home use)
Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
Drug Stores (such as Walgreens, Rite-Aid, etc.)
Grocery Stores
Other (PLEASE SPECIFY)
Total (CALCULATED)	100%

[ASK IF Q.1=2]

3. Based on the information you just provided, your total annual expenditure per year for hookah herbal (non-tobacco) shisha is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on herbal (non-tobacco) shisha purchases for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

Purchase Outlets	Allocate Percentage of Dollars Spent on Hookah Herbal (non-tobacco) Shisha
Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
Independent Convenience Stores (such as small neighborhood shops)
Specialty Tobacco Stores
Online
From a restaurant, hookah bar, or lounge (for in-home use)
Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
Drug Stores (such as Walgreens, Rite-Aid, etc.)
Grocery Stores
Other (PLEASE SPECIFY)
Total (CALCULATED)	100%

5. Do you also purchase charcoal for your hookah? (SELECT ONE)

1. Yes [CONTINUE]

2. No [SKIP TO Q.9]

6. Do you normally buy quick-light charcoal, regular/natural charcoal, or both? (SELECT ONE)

1. Quick-light

2. Regular/natural

3. Both [IF SELECTED, ASK A-H IN Q.7]

6. Thinking about your in-home use only, please tell us about your hookah charcoal purchases. Disregarding the brands, please provide the following information:

For in-home use	a. How often do you purchase hookah quick-light charcoal?	b. Each time you purchase hookah charcoal, how many packs of quick-light charcoal do you buy?	c. How many pieces are normally in a pack of quick-light charcoal that you buy? (SELECT ONE)	d. How much do you spend per pack of quick-light charcoal, on average? (This should be the cost per pack, not the total expenditure)
[ASK IF Q.6=1/QUICK-LIGHT] Hookah quick-light charcoal	_____times per year	______ packs of quick-light charcoal each time	10 18 24 48 60 64 72 96 100 or more Other (specify number per pack)	$________.00
	e. How often do you purchase hookah regular charcoal?	f. Each time you purchase hookah charcoal, how many packs of regular charcoal do you buy?	g. How many pieces are normally in a pack of regular charcoal that you buy? (SELECT ONE)	h. How much do you spend per pack of regular charcoal, on average? (This should be the cost per pack, not the total expenditure)
[ASK IF Q6=2/REGULAR] Hookah regular charcoal	_____times per year	______ packs of regular charcoal each time	10 18 24 48 60 64 72 96 100 or more Other (specify number per pack)	$________.00

8. Based on the information you just provided, your total annual expenditure per year for charcoal is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on hookah charcoal purchases for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

   Purchase Outlets	Allocate Percentage of Dollars Spent on Charcoal
   Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
   Independent Convenience Stores (such as small neighborhood shops)
   Specialty Tobacco Stores
   Online
   From a restaurant, hookah bar, or lounge (for in-home use)
   Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
   Drug Stores (such as Walgreens, Rite-Aid, etc.)
   Grocery Stores
   Other (PLEASE SPECIFY)
   Total (CALCULATED)	100%

9. Do you ever buy hookah additives, like nicotine or flavor enhancers?

1. Yes [CONTINUE]

2. No [SKIP TO Q.12]

8. Thinking just about the hookah additives like nicotine or flavor enhancers you buy for in-home use:

For in-home use	a. How often do you purchase hookah additives?	b. Each time you purchase hookah additives, how many bottles do you buy?	c. How much do you spend per bottle, on average? (This should be the cost per bottle, not the total expenditure)
Hookah additives (like nicotine or flavor enhancers)	_____times per year	______ bottles of hookah additives each time	$________.00

8. Based on the information you just provided, your total annual expenditure per year for hookah additives is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on hookah additives for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

   Purchase Outlets	Allocate Percentage of Dollars Spent on Hookah Additives
   Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
   Independent Convenience Stores (such as small neighborhood shops)
   Specialty Tobacco Stores
   Online
   From a restaurant, hookah bar, or lounge (for in-home use)
   Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
   Drug Stores (such as Walgreens, Rite-Aid, etc.)
   Grocery Stores
   Other (PLEASE SPECIFY)
   Total (CALCULATED)	100%

9. Do you ever buy hookah pipes (entire unit)?

1. Yes [CONTINUE]

2. No [SKIP TO Q.15]

8. Thinking just about the hookah pipes (entire unit) you buy for in-home use:

For in-home use	a. How often do you purchase hookah pipes (entire unit)?	b. Each time you purchase a hookah pipe (entire unit), how many do you normally buy?	c. How much do you spend per pipe (entire unit), on average? (This should be the cost per pipe (entire unit))
Hookah pipes (entire unit)	_____times per year	______ hookah pipes each time	$________.00

8. Based on the information you just provided, your total annual expenditure per year on hookah pipes (entire unit) is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on hookah pipe (entire unit) purchases for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

   Purchase Outlets	Allocate Percentage of Dollars Spent on Hookah Pipes (entire unit)
   Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
   Independent Convenience Stores (such as small neighborhood shops)
   Specialty Tobacco Stores
   Online
   From a restaurant, hookah bar, or lounge (for in-home use)
   Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
   Drug Stores (such as Walgreens, Rite-Aid, etc.)
   Grocery Stores
   Other (PLEASE SPECIFY)
   Total (CALCULATED)	100%

9. Do you ever buy hookah replacements parts, like hoses and/or mouth pieces?

1. Yes [CONTINUE]

2. No [SKIP TO Q.18]

16. Thinking just about the hookah replacement parts you buy for in-home use:

For in-home use	a. How often do you purchase hookah hoses?	b. Each time you purchase hookah hoses, how many do you buy at one time?		c. How much do you spend per hose, on average? (This should be the cost per item, not the total expenditure)
Hookah hoses	_____times per year	______ hoses		$________.00
	d. How often do you purchase hookah mouth pieces or tips?	e. Each time you purchase mouth pieces or tips, how many packs do you buy?	f. How many mouth pieces or tips are in each pack?	g. How much do you spend per pack, on average? (This should be the cost per item, not the total expenditure)
Hookah mouth pieces and/or tips	_____times per year	____ packs	_____mouth pieces or tips per pack	$______.00

1. PLEASE SELECT #3 ON THE SCALE BELOW. (SELECT ONE) [RANDOMIZE ORDER]

1. #5

2. #3

3. #8

4. #10

17. Based on the information you just provided, your total annual expenditure per year for replacement parts is $ (INSERT CALCULATED AMOUNT). Please think about where you spend this money on hookah replacement parts for in-home use, and provide the approximate percentages below, based on your normal purchasing behavior. NOTE: The percentages must equal 100%.

Purchase Outlets	Allocate Percentage of Dollars Spent on Replacement Parts
Chain Convenience Stores (such as 7-11, Circle K, Wawa, etc.)
Independent Convenience Stores (such as small neighborhood shops)
Specialty Tobacco Stores
Online
From a restaurant, hookah bar, or lounge (for in-home use)
Mass merchandisers (such as Wal-Mart, K-Mart, Sam’s Club, etc.)
Drug Stores (such as Walgreens, Rite-Aid, etc.)
Grocery Stores
Other (PLEASE SPECIFY)
Total (CALCULATED)	100%

The following questions are about your hookah use and purchases when you are smoking hookah in hookah lounges, bars, or restaurants – excluding your in-home use. For this series of questions, we want you to think about MONTHLY expenditures, not yearly.

17. First, how many times PER MONTH do you typically visit a hookah lounge to smoke hookah?

(RECORD NUMBER) ______________

17. How much money do you typically spend, in total, PER MONTH in hookah lounges to smoke hookah?

(RECORD AMOUNT) $____________

17. Approximately what percentage of all your hookah visits involve you smoking a hookah pipe by yourself (i.e. not sharing a pipe with other people) vs. sharing a pipe with others as part of a group? (RECORD PERCENTAGES)

Type of Visit	% of Visits
a. Smoking hookah by self
b. Sharing a hookah pipe as part of a group
Must Equal 100%

[If Q.20A>0, THEN ASK Q.21. IF Q.20B>, THEN ASK Q.22]

17. When smoking a pipe by yourself (i.e., not sharing a pipe with other people), how many loads do you normally buy during a visit to a hookah lounge? (RECORD NUMBER) ________

17. When smoking as part of a group (i.e., sharing a pipe with other people), how many loads do you normally buy during a visit? (RECORD NUMBER) ________

[IF Q.20B>0, THEN ASK Q.23]

17. On average, how many people are in your group when smoking hookah as a group on one pipe?

(RECORD NUMBER) _________

17. What do you normally pay for your first load in a hookah lounge (including pipe, shisha, and charcoal)? (RECORD AMOUNT) $________

[IF 2+ IN Q.21, THEN ASK Q.25]

17. What do you normally pay for a refill or second load in a hookah lounge? (RECORD AMOUNT) $_________

17. Thinking about all visits to a hookah lounge in an average month, what percentage of the visits do you smoke hookah tobacco vs. herbal (non-tobacco) shisha? (RECORD PERCENTAGES BELOW)

Type of Shisha Smoked	% OF VISITS
Hookah tobacco
Herbal (non-tobacco) shisha
MUST EQUAL 100%

17. Again, thinking about all visits to a hookah lounge in an average month, what percentage of your visits do you use quick-light vs. regular charcoal? (RECORD PERCENTAGES BELOW OR SELECT DON’T KNOW/DON’T CHOOSE)

TYPE OF CHARCOAL	% OF VISITS
Quick-light
Regular Charcoal
MUST EQUAL 100%

Don’t know/Don’t Choose (X)

DEMOGRAPHIC QUESTIONS [DO NOT SHOW TEXT]

Now we have a few more questions so we may combine your answers with those of others participating in this study.

17. What is the last grade in school you had the opportunity to complete? (SELECT ONE)

1. Some elementary school

2. Elementary school

3. Some high school

4. High school degree (or equivalent)

5. Some technical school

6. Technical school certificate

7. Some college

8. College degree

9. Some post-graduate work

10. Graduate degree

17. What is your current employment status? (SELECT ALL THAT APPLY)

1. Employed full-time for wages

2. Employed part-time for wages

3. Self-employed

4. Out of work and looking for work

5. Out of work but not currently looking for work

6. A homemaker

7. A student

8. Military

9. Retired

10. Unable to work

17. Are you of Hispanic or Latino descent? (SELECT ONE)

1. Yes

2. No

17. Which of these categories describes you? (SELECT ALL THAT APPLY)

1. White/Caucasian

2. Black/African-American

3. Asian

4. Native American/Alaskan Native

5. Other (Specify)

17. Which of the following categories includes your total, annual household income in 2018, before taxes? (SELECT ONE)

1. Under $15,000

2. $15,000 to under $30,000

3. $30,000 to under $50,000

4. $50,000 to under $75,000

5. $75,000 to under $100,000

6. $100,000 to under $200,000

7. $200,000 or more

8. Prefer not to say

33. Please select choice B on the scale below. (SELECT ONE) [RANDOMIZE ORDER]

1. B

2. F

3. D

4. A

Thank you. That is all the questions we have for you today.

[FLAG ANYONE WHO GETS EITHER Q.33 OR Q.16.1 INCORRECT. MONITOR LENGTH OF INTERVIEW AND FLAG SPEEDERS.]

Version 11.1 PI: Carolina Ramôa, PhD

Date: April 18, 2019 Protocol 18-065CTP