Académique Documents
Professionnel Documents
Culture Documents
2009-2010
2009-2010
CONTENTS
INTRODUCTION..........................................................................................................................4
TABLE 4. PATHS FOR CIGARETTE SMOKING QUESTIONS: RESPONDENTS WHO HAVE SMOKED
FEWER THAN 100 CIGARETTES IN THEIR ENTIRE LIFE AND HAVE NEVER SMOKED OR LAST
TABLE 5. PATHS FOR CIGARETTE SMOKING QUESTIONS: RESPONDENTS WHO HAVE SMOKED
100 OR MORE CIGARETTES IN THEIR ENTIRE LIFE AND LAST PUFFED ON A CIGARETTE MORE
CIGARETTE IN THE LAST 30 DAYS AND WHO HAVE SMOKED FEWER THAN 100 CIGARETTES IN
TABLE 7. PATHS FOR CIGARETTE SMOKING QUESTIONS: RESPONDENTS WHO NOW SMOKE
GENERAL HEALTH..................................................................................................................13
TOBACCO USE...........................................................................................................................14
CIGARETTE SMOKING..................................................................................................................14
.................................................................................................................32
CESSATION ................................................................................................................................41
.............................................................41
AT HOME ....................................................................................................................................57
Page 2 of 114
IN VEHICLES ...............................................................................................................................66
ADDICTION.................................................................................................................................85
SMOKER ASSISTANCE..................................................................................................................89
CLOSING .....................................................................................................................................92
Page 3 of 114
INTRODUCTION
This document contains the questions on the 2009-2010 National Adult Tobacco Survey (NATS)
sponsored by CDCs Office on Smoking and Health (OSH). The purpose of this introduction is
to provide the reader with information that will help in understanding and navigating the
questionnaire.
The NATS is a stratified, random-digit dialed, telephone survey of non-institutionalized adults
18 years of age and older. It is designed to yield data that are representative and comparable at
both national and state levels. The primary purpose of the NATS is to collect data on key
outcome indicators (KOI's) established by OSH1 in order to evaluate CDCs National Tobacco
Control Program. Data from the 2009-2010 NATS will be used as a baseline for measuring
progress in tobacco control across the current Funding Opportunity Agreement (2009-2014).
The key outcome indicator report designates each indicator by a three-level numeric descriptor
for example, 1.14.2. The first level identifies one of three OSH goal areas:
1.
2.
3.
The second level refers to an outcome in a logic model.2 For example, "1.14" refers to Outcome
14 of Goal 1: Reduced tobacco-use prevalence among young people. Finally, the third level
refers to a specific measure, or indicator, of an outcome. For example, KOI 1.14.2 is the
Proportion of established young smokers. For easy reference, this document identifies the KOI's
relevant to each question. A single question may be related to multiple KOI's and a single KOI
may be related to multiple questions.
Table 1 shows the major topics of the questionnaire in the first column, and the total number of
questions, the length of the maximum path3, the number of Key Outcome Indicator and Non-Key
Outcome Indicator tobacco questions, and the number of non-tobacco questions in each topic.
Starr G, Rogers T, Schooley M, Porter S, Wiesen E, Jamison N. Key Outcome Indicators for Evaluating
Comprehensive tobacco Control Programs. Atlanta, GA: Centers for Disease Control and Prevention; 2005. An
electronic copy and the ability to order paper copies are available at
http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/index.htm
2
As defined in the KOI document, a logic model is a visual representation of "presumed causal pathways that
connect program inputs, activities, and outputs with short-term, intermediate, and long-term outcomes."
3
The "maximum path" of a topic is the largest number of questions on that topic that could be asked of a single
respondent.
Page 4 of 114
Maximum
Path
KOI Tobacco
Questions
Non-KOI
Tobacco
Questions
Non-Tobacco
Questions
1
29
13
30
24
1
18
13
29
24
0
12
10
28
24
0
17
3
2
0
1
0
0
0
0
13
7
13
7
0
0
0
0
13
7
11
2
130
10
2
117
8
0
82
1
0
23
2
2
25
* Does not include the language used for the interview because the interviewer specifies the language without asking the
respondent a question.
The following list identifies frequently used question naming conventions to help you understand
the question names.
Beginning of name
hcw=Health care worker
cl=Cell phone screener
l=Landline screener
shs=Second hand smoke
slt=Smokeless tobacco
smok=Smoke
Middle of name
ge=Greater than or equal to
gt=Greater than
le=Less than or equal to
lt=Less than
End of name
opn=Opinion question
clc=Calculated variable
Any part of name
no, nos=Number
qt=Quit attempt
Tables 2 and 3 below are included to help you navigate the questionnaire. They correlate
question names with question numbers. Table 2 contains the question names in alphabetical
order, followed by the question number. Table 3 contains the question numbers in the order
asked in the questionnaire, followed by the question name.
Tables 4 to 7 below are included to help you understand the possible paths through the cigarette
smoking questions. These paths are especially complex because the questionnaire attempts to
identify respondents who smoke cigarettes but who are not smokers by the standard adult
definition (have smoked at least 100 cigarettes in their lifetime and now smoke some days or not
at all). The specific questions asked of respondents also depend on a variety of additional factors,
which are listed in the tables.
In each table, the first column lists the question numbers and the second column lists the
question names. The top rows in each subsequent column contain the responses a respondent
must give to be asked the questions in that column. Within a column, rows with a question name
indicate that the corresponding question could be asked of a respondent who gives the responses
listed in the column. (There can be minor skips within a column.) A blank row indicates that the
Page 5 of 114
Page 6 of 114
Qst No
103
101
115
23
22
24
29
25
30
112
105
116
36
38
37
21
118
119
27
26
109
110
113
102
77
18
104
1
70
72
71
60
69
59
68
64
67
63
61
62
66
65
111
127
Question Name
helpsmoker
hispanic
hispgroup
homecmpl
homerules2
homerulesopn
hypertension
income2
language
marital2
mentholcigs2
nojobs
parenting
pipeothdays
pipeothever
pipewtrdays
pipewtrever
qt12mos
qtads
qtasstawr
qtatt2
qtclasspgm
qtcounsl
qtexads
qtframe
qtfutasst
qtfutmed
qtline
qtlineawrnt
qtlineawrt
qtmed2
qtwant
qtwhen
racemulti
respdisease
rskaddictopn2
schoolopn2
sexualorient
shsasknot
shscomppub
shsexppub
shsexpwork
shsharmopn
shsindropn1
Qst No
128
98
99
75
74
76
117
129
131
97
20
78
125
42
41
40
39
49
46
45
48
51
52
47
55
57
58
50
43
44
53
54
56
100
114
121
123
130
94
90
89
80
95
91
Page 7 of 114
Question Name
shsindropn2
shsoutdropn
shspubopn
shsvehexp
shsvehpol
sltbrand
sltever2
sltnodays
slttaxopn
smok100
smok30dage
smok30dever
smok30dlast
smokdays30
smokever
smokhome7d2
smoklast
smoknow
smokorquit
smokpastyr
smokperday
smoksomeday
smokwake
smokwholage
smokwholcig
smokyrago
smokyrnum
snusever
snusnodays
specoffers
stateres
teensellopn
telnosgt1
telnosres
tobcompwork
tobusediscuss
weartobco
workindopn2
workoutdopn2
workplace
worksmokind
worksmokless
worksmokout
Qst No
92
93
96
87
88
33
31
32
120
2
15
14
16
8
5
73
6
3
7
10
4
9
19
13
12
17
11
34
35
28
108
122
106
107
84
126
124
85
86
79
81
83
82
Question Name
genhealth
smok100
smoknow
smokperday
smokever
smoklast
smokorquit
smokdays30
smoksomeday
smokpastyr
smokyrnum
smokwholcig
smokwholage
smok30dever
smok30dage
smok30dlast
smokyrago
futursmok2
smokwake
mentholcigs2
cigflavor
brand2
bghtpast30d
brandpast30d
buyquant2
costpack2
costcarton2
specoffers
buynet2
buyres2
sltever2
sltnodays
sltbrand
snusever
snusnodays
cigarever
cigarnodays
cigarflavr
pipewtrever
pipewtrdays
pipeothever
pipeothdays
qtlineawrnt
qtlineawrt
Qst No
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
Question Name
qtasstawr
qtads
qtexads
qtatt2
qt12mos
qtline
qtclasspgm
qtcounsl
qtmed2
qtwant
qtframe
qtwhen
qtfutasst
qtfutmed
hcwcare2
hcwadvise2
hcwqtask
hcwqtresp
hcwmoradvice
hcwmaterials2
hcwsugasst2
hcwsetdate2
hcwmed2
hcwfollowup
hcwask
hccoverage
hccpayqs
hccpayqo
smokhome7d2
homerules2
homecmpl
homerulesopn
employ2
nojobs
workplace
shsexpwork
worksmokind
worksmokout
worksmokless
tobcompwork
workindopn2
workoutdopn2
shsvehexp
shsvehpol
Page 8 of 114
Qst No
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
Question Name
shsexppub
shscomppub
shsindropn1
shsindropn2
shsoutdropn
shsasknot
shsharmopn
shspubopn
marital2
hispanic
hispgroup
racemulti
asian01
educa2
age
gender
childle17
telnosgt1
telnosres
stateres
countyfips
dcward
heartdisease
cancer
diabetes
respdisease
asthma
cholesterol
hypertension
cigtaxopn2
cigtaxopn3
slttaxopn
rskaddictopn2
teensellopn
schoolopn2
weartobco
parenting
tobusediscuss
helpnonsmok
helpsmoker
income2
sexualorient
language
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Question Name
SMOK100
SMOKNOW
SMOKPERDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
Smoked <100
Never smoked
Smoked <100
Puffed
Puffed > 1 year
ago
Never smoked
whole cigarette
Smoked <100
Puffed
Puffed > 1 year
ago
Smoked whole
cigarette
Never smoked 30
days in a row
Smoked <100
Puffed
Puffed > 1 year
ago
Smoked whole
cigarette
Smoked 30 days
in a row
Smoked <100
Puffed
Puffed 31 days to
1 year ago
Smoked whole
cigarette
Smoked 30 days
in a row
SMOK100
SMOK100
SMOK100
SMOK100
SMOK100
SMOK100
SMOK100
SMOKEVER
SMOKEVER
SMOKLAST
SMOKEVER
SMOKLAST
SMOKEVER
SMOKLAST
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOKYRAGO
FUTURSMOK2
SMOKYRAGO
FUTURSMOK2
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
FUTURSMOK2
SMOKWHOLCIG
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
FUTURSMOK2
FUTURSMOK2
FUTURSMOK2
Page 9 of 114
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Question Name
SMOK100
SMOKNOW
SMOKPERDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
Smoked >=100
Don't smoke now
Puffed > 1 year ago
Never smoked 30 days in a row
Smoked >=100
Don't smoke now
Puffed 31 days to 1 year ago
Smoked 30 days in a row
SMOK100
SMOKNOW
SMOK100
SMOKNOW
SMOK100
SMOKNOW
SMOK100
SMOKNOW
SMOKLAST
SMOKLAST
SMOKLAST
SMOKORQUIT
SMOKLAST
SMOKORQUIT
SMOKPASTYR
SMOKYRNUM
SMOKPASTYR
SMOKYRNUM
SMOKWHOLAGE
SMOK30DEVER
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
SMOKWHOLAGE
SMOK30DEVER
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
FUTURSMOK2
FUTURSMOK2
SMOKYRAGO
FUTURSMOK2
Page 10 of 114
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Question Name
Smoked <100
Puffed
Puffed <= 30 days ago
Never smoked whole
cigarette
SMOK100
SMOKNOW
SMOKPERDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
SMOK100
SMOK100
SMOK100
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKWHOLCIG
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOKYRAGO
FUTURSMOK2
SMOKYRAGO
FUTURSMOK2
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
Page 11 of 114
Smoked >=100
Don't smoke now
Puffed <= 30 days ago
SMOK100
SMOKNOW
SMOK100
SMOKNOW
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKWHOLAGE
SMOK30DEVER
SMOKYRAGO
FUTURSMOK2
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Question Name
SMOK100
SMOKNOW
SMOKPERDAY
SMOKEVER
SMOKLAST
SMOKORQUIT
SMOKDAYS30
SMOKSOMEDAY
SMOKPASTYR
SMOKYRNUM
SMOKWHOLCIG
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOK30DLAST
SMOKYRAGO
FUTURSMOK2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
BGHTPAST30D
BRANDPAST30D
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
SMOK100
SMOKNOW
SMOK100
SMOKNOW
SMOKDAYS30
SMOKSOMEDAY
SMOKDAYS30
SMOKSOMEDAY
SMOKWHOLAGE
SMOK30DEVER
SMOKWHOLAGE
SMOK30DEVER
SMOK30DAGE
SMOKWHOLAGE
SMOKYRAGO
SMOKYRAGO
SMOKYRAGO
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
SMOKWAKE
MENTHOLCIGS2
CIGFLAVOR
BRAND2
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
BUYQUANT2
COSTPACK2
COSTCARTON2
SPECOFFERS
BUYNET2
BUYRES2
Page 12 of 114
SMOK100
SMOKNOW
SMOKPERDAY
SMOK30DAGE
GENERAL HEALTH
GENHEALTH
Rationale: Provides an easy opening to the survey and can prove a useful covariate in analysis. Is
a Healthy People 2010 overarching quality of life measure.
/ASK ALL/
1.Would you say that in general your health is?
1.
2.
3.
4.
5.
Excellent
Very good
Good
Fair
Poor
7.
9.
Page 13 of 114
TOBACCO USE
CIGARETTE SMOKING
SMOK100
Rationale: Key Outcome Indicators 2.08.3, 3.14.1, 1.14.2
/ASK ALL/
HELP: 100 CIGARETTES = 5 PACKS
2.
YES
NO GO TO Q5 SMOKEVER
7.
9.
SMOKNOW
Rationale: Key Outcome Indicators 2.08.3, 3.14.1
/ASK IF Q2SMOK100=1/
3.
Do you now smoke cigarettes every day, some days, or not at all?
1.
2.
3.
EVERY DAY
SOME DAYS GO TO Q8 SMOKDAYS30
NOT AT ALL GO TO Q6 SMOKLAST
7.
9.
Page 14 of 114
/RANGE: 1-180/
On the average, about how many cigarettes a day do you now smoke?
HELP: 1 PACK = 20 CIGARETTES.
_ _ _. NUMBER OF CIGARETTES GO TO Q13 SMOKWHOLAGE
666.
888.
777.
999.
SMOKEVER
Rationale: Identification of occasional? smokers and screener for Key Outcome Indicators
1.10.5, 1.13.2
/ASK IF Q2 SMOK100=(2 OR 7) AND NOT REFUSED FROM Q2 TO THIS POINT/
5.
Have you ever tried cigarette smoking, even one or two puffs?
1.
2.
YES
NO GO TO Q18 FUTURSMOK2
7.
9.
Page 15 of 114
Was the last time you smoked a cigarette, even one or two puffs?
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
77.
DONT KNOW/NOT SURE GO TO Q18 FUTURSMOK2
PRE31
Page 16 of 114
year.
7.
You last smoked more than [Last two words of (Q6 SMOKLAST response category 1)]
ago. Is that because you are trying to quit smoking for good?
1. YES, RESPONDENT IS TRYING TO QUIT SMOKING FOR GOOD GO to
Q12 SMOKWHOLCIG
2. NO, RESPONDENT IS NOT TRYING TO QUIT SMOKING FOR GOOD.
7.
9.
Page 17 of 114
During the past 30 days, that is, since [DATE FILL], on how many days did you smoke
cigarettes?
_ _.
NUMBER OF DAYS
88.
77.
99.
Page 18 of 114
On the average, on days when you smoked during the past 30 days, that is, since [DATE
FILL], about how many cigarettes did you smoke a day?
HELP: 1 PACK=20 CIGARETTES.
_ _ _. NUMBER OF CIGARETTES
666.
888.
777.
999.
Page 19 of 114
/RANGE 1-365/
In the past year, that is, since [DATE FILL], on about how many days did you smoke
cigarettes, even just one puff?
_ _ _. NUMBER OF DAYS
888.
777.
999.
Page 20 of 114
On the average, on days when you smoked during the past year, that is, since [DATE
FILL], about how many cigarettes did you smoke a day?
HELP: 1 PACK=20 CIGARETTES.
_ _ _. NUMBER OF CIGARETTES IF Q2 SMOK100 EQ 1 GO TO
Q13 SMOKWHOLAGE
666.
888.
777.
999.
Q13 SMOKWHOLAGE
REFUSED GO TO PRE31
Page 21 of 114
YES
NO IF Q6 SMOKLAST <= 6 GO TO Q17 SMOKYRAGO,
ELSE IF Q6 SMOKLAST = (7-10) GO TO Q18 FUTURSMOK2
7.
9.
SMOKWHOLAGE
Rationale: Key Outcome Indicator 1.13.1
/ASK IF (Q2 SMOK100 EQ 1 OR Q12 SMOKWHOLCIG EQ 1) AND NOT REFUSED FROM
Q2 TO THIS POINT/
/RANGE: 1-130/
13.
How old were you when you smoked a whole cigarette for the first time?
_ _ _. AGE IN YEARS
888.
777.
999.
Page 22 of 114
Have you ever smoked at least one cigarette every day for 30 days in a row?
1.
2.
YES
NO IF Q6 SMOKLAST = (7-10), GO TO Q18 FUTURSMOK2;
ELSE IF Q6 SMOKLAST <= 6 GO TO Q17 SMOKYRAGO
7.
9.
SMOK30DAGE
Rationale: To obtain information on smoking history
Asked of respondents who (have ever smoked every day for 30 days in a row) or who (now
smoke every day and have smoked a whole cigarette).
/ASK IF [Q14 SMOK30DEVER EQ 1 OR (Q3 SMOKNOW EQ 1 AND Q13
SMOKWHOLAGE EQ (001-130))] AND NOT REFUSED FROM Q2 TO THIS POINT/
/RANGE: 1-130/
15.
How old were you when you first smoked at least one cigarette every day for 30 days in
a row?
_ _ _. AGE IN YEARS
777.
999.
Page 23 of 114
Think about the last time you smoked at least one cigarette every day for 30 days in a
row. How long ago was the last day of those 30 days? Was it?
01.
02.
03.
04.
05.
06.
07.
08.
Today or yesterday
In the past 7 days
In the past 30 days
In the past 1 year
In the past 5 years GO TO Q18 FUTURSMOK20
In the past 10 years GO TO Q18 FUTURSMOK2
In the past 15 years GO TO Q18 FUTURSMOK2
More than 15 years ago GO TO Q18 FUTURSMOK2
77.
99.
SMOKYRAGO
Rationale: To obtain information on smoking history
Asked of respondents (who have at least puffed on a cigarette in the past year) or (who now
smoke every day or some days).
/ASK IF (Q6 SMOKLAST EQ (1-6) OR Q3 SMOKNOW EQ (1 OR 2)) AND Q16
SMOKD30DLAST LE 4 AND NOT REFUSED FROM Q2 TO THIS POINT/
17.
Around this time last year, were you smoking cigarettes every day, some days, or not at
all?
1.
2.
3.
EVERY DAY
SOME DAYS
NOT AT ALL
7.
9.
Page 24 of 114
Very likely
Somewhat likely
Not at all likely
7.
9.
How soon after you wake up do you usually have your first cigarette?
1.
2.
3.
4.
Within 5 minutes
From 6 to 30 minutes
From more than 30 minutes to 1 hour
After more than 1 hour
7.
9.
Page 25 of 114
During the past 30 days, that is, since [DATE FILL], were the cigarettes that you usually
smoked menthol?
1.
2.
YES
NO
7.
9.
CIGFLAVOR
Rationale: To determine prevalence of flavored cigarette use.
/ASK IF Q20 MENTHOLCIGS2 EQ (1, 2, OR 7) AND NOT REFUSED FROM Q2 TO THIS
POINT/
21.
Were any of the cigarettes that you smoked in the past 30 days flavored to taste like
candy, fruit, chocolate, or other sweets?
1.
2.
YES
NO
7.
9.
Page 26 of 114
During the past 30 days, that is, since [DATE FILL], what brand of cigarettes did you
smoke most often?
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
96.
66.
77.
99.
GO TO Q25 BUYQUANT2
Page 27 of 114
Have you bought any cigarettes for yourself in the past 30 days, that is, since [DATE
FILL]?
1.
2.
YES
NO
7.
9.
Page 28 of 114
During the past 30 days, that is, since [DATE FILL], what brand of cigarettes did you
buy most often?
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
96.
66.
77.
99.
DID NOT BUY ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
DONT KNOW/NOT SURE
REFUSED GO TO PRE31
Page 29 of 114
The last time you bought cigarettes for yourself, did you buy them by the pack or by the
carton?
1.
2.
3.
BY THE PACK
BY THE CARTON GO TO Q27 COSTCARTON2
OTHER (SPECIFY) GO TO PRE31
7.
9.
COSTPACK2
Rationale: To obtain information on the cost of cigarettes.
/ASK IF Q25 BUYQUANT2 EQ 1 AND NOT REFUSED FROM Q2 TO THIS POINT/
/RANGE: $.01-$20.00/
INTERVIEWER: IF RESPONDENT ASKS ABOUT DISCOUNTS OR COUPONS,
READ:
Please report the cost after discounts or coupons.
26.
What price did you pay for the last pack of cigarettes you bought?
_ _. _ _.
77.77.
99.99.
Page 30 of 114
What price did you pay for the last carton of cigarettes you bought?
_ _ _. _ _. AMOUNT PAID FOR LAST CARTON OF CIGARETTES IF Q6
SMOKLAST EQ (1,2,3) GO TO PRE31
DONT KNOW/NOT SURE IF Q6 SMOKLAST EQ (1,2,3) GO TO
PRE31
REFUSED GO TO PRE31
777.77.
999.99.
SPECOFFERS
The last time you bought cigarettes, did you take advantage of coupons, rebates, buy 1
get 1 free, 2 for 1, or any other special promotions for cigarettes?
1.
2.
YES
NO
7.
9.
Page 31 of 114
In the past 12 months, that is, since [DATE FILL], have you bought cigarettes over the
Internet?
1.
2.
YES
NO
7.
9.
BUYRES2
Rationale: To obtain information about cigarette purchasing patterns
/ASK IF Q29 BUYNET2 EQ (1, 2, OR 7) AND NOT REFUSED FROM Q2 TO THIS POINT/
30. In the past 12 months, that is, since [DATE FILL], have you bought cigarettes on an Indian
reservation?
1.
2.
YES
NO
7.
9.
Page 32 of 114
Have you ever tried chewing tobacco, snuff, or dip, such as Skoal, Copenhagen, Grizzly,
Levi Garrett, Red Man, or Days Work, even just one time in your entire life?
1.
2.
YES
NO GO TO Q34 SNUSEVER
7.
9.
SLTNODAYS
Rationale: Key Outcome Indicator 1.14.2, 3.14.1
/RANGE: 1-30/
32.
During the past 30 days, that is, since [DATE FILL], on how many days did you use
chewing tobacco, snuff, or dip?
__
NUMBER OF DAYS
88.
NONE
77.
99.
Page 33 of 114
During the past 30 days, that is, since [DATE FILL], what brand of smokeless tobacco
did you use most often?
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
96.
BEECH-NUT REGULAR
COPENHAGEN
GRIZZLY
KODIAK
LEVI GARRETT
LONGHORN
MORGAN'S
RED MAN
RED MAN GOLDEN BLEND
RED SEAL
SKOAL
SOUTHERN PRIDE
STOKER CHEW
TAYLOR'S PRIDE
TIMBER WOLF
OTHER (SPECIFY)
66.
77.
99.
DID NOT USE ONE BRAND MOST OFTEN DURING THE PAST 30 DAYS
DONT KNOW/NOT SURE
REFUSED
Page 34 of 114
YES
NO GO TO Q36 CIGAREVER
7.
9.
SNUSNODAYS
Rationale: Key Outcome Indicator 1.14.2, 3.14.1
/ASK IF Q34 SNUSEVER EQ 1/
/RANGE: 1-30/
35.
During the past 30 days, that is, since [DATE FILL], on how many days did you use
snus?
__
NUMBER OF DAYS
88.
77.
99.
Page 35 of 114
Have you ever tried smoking cigars, cigarillos, or very small cigars that look like
cigarettes in your entire life, even one or two puffs?
1.
2.
YES
NO GO TO Q39 PIPEWTREVER
7.
9.
Page 36 of 114
During the past 30 days, that is, since [DATE FILL], on how many days did you smoke
cigars, cigarillos, or very small cigars that look like cigarettes?
__
NUMBER OF DAYS
88.
77.
99.
Page 37 of 114
Were any of the cigars, cigarillos, or very small cigars that look like cigarettes that you
smoked in the past 30 days flavored to taste like candy, fruit, chocolate, or other sweets?
1.
2.
YES
NO
7.
9.
PIPEWTREVER
Rationale: Key Outcome Indicator 1.13.2, Skip for 1.14.2, 3.14.1
/ASK ALL/
39.
The next question asks you about smoking tobacco in a water pipe. A water pipe is also
called a hookah. Have you ever tried smoking tobacco in a water pipe in your entire life,
even one or two puffs?
1.
2.
YES
NO GO TO Q41 PIPEOTHEVER
7.
9.
Page 38 of 114
During the past 30 days, that is, since [DATE FILL], on how many days did you smoke
tobacco in a water pipe?
__
NUMBER OF DAYS
88.
NONE
77.
99.
PIPEOTHEVER
Rationale: Key Outcome Indicator 1.13.2 , Skip for 1.14.2, 3.14.1
/ASK ALL/
41.
Have you ever smoked tobacco in a pipe other than a water pipe in your entire life, even
one or two puffs?
1.
2.
YES
NO IF [Q2 SMOK100 = (2 OR 7 OR 9) OR Q3 SMOKNOW = 3] AND [Q5
SMOKEVER = 2 OR Q6 SMOKLAST >=4], GO TO Q43 QTLINEAWRNT;
ELSE GO TO Q44 QTLINEAWRT
7.
9.
Page 39 of 114
/RANGE: 1-30/
42.
During the past 30 days, that is, since [DATE FILL], on how many days did you smoke
tobacco in a pipe other than a water pipe?
__
NUMBER OF DAYS
88.
NONE
77.
99.
Page 40 of 114
CESSATION
AWARENESS OF QUITLINES AND COUNTER-MARKETING
QTLINEAWRNT
Rationale: Key Outcome Indicator 3.08.6
Asked of respondents (who have smoked fewer than 100 cigarettes in their life or who now
smoke not at all) and (who have not used tobacco in the last 30 days).
/ASK IF NOT (Q3 SMOKNOW EQ (1 OR 2) OR Q6 SMOKLAST EQ (01-03) OR Q31
SLTNODAYS EQ (1-30) OR Q35 SNUSNODAYS EQ (1-30) OR Q37 CIGARNODAYS EQ
(1-30) OR Q40 PIPEWTRDAYS EQ (1-30) OR Q42 PIPEOTHDAYS EQ (1-30)) /
43.
A telephone quitline is a free telephone-based service that connects people who smoke
cigarettes or use other tobacco products with someone who can help them quit. Are you
aware of any telephone quitline services that are available to help people quit using
tobacco?
1.
2.
YES
NO
7.
9.
Page 41 of 114
A telephone quitline is a free telephone-based service that connects people who smoke
cigarettes or use other tobacco products with someone who can help them quit. Are you
aware of any telephone quitline services that are available to help you quit using tobacco?
1.
2.
YES
NO
7.
9.
QTASSTAWR
Rationale: Key Outcome Indicator 3.08.6
/ASK IF Q3 SMOKNOW EQ (1 OR 2) OR Q6 SMOKLAST EQ (01-03)/
45.
Are you aware of any individual or group counseling services, other than quitlines, that
are available to help you quit smoking cigarettes?
1.
2.
YES
NO
7.
9.
Page 42 of 114
In the past 30 days, have you seen, read, or heard any ads about quitting cigarettes?
1.
2.
YES
NO
7.
9.
QTEXADS
Rationale: Key Outcome Indicator 3.08.1
/ASK IF Q3 SMOKNOW EQ (1 OR 2) OR Q6 SMOKLAST EQ (01-03)/
47.
Have you ever seen or heard the slogan Become an EX in an ad? "EX" is spelled E-X.
1.
2.
YES
NO
7.
9.
Page 43 of 114
In your whole life, how many times have you stopped smoking for one day or longer
because you were trying to quit smoking cigarettes for good?
_ _.
NUMBER OF TIMES
88.
NONE
77.
99.
Page 44 of 114
During the past 12 months, that is, since [DATE FILL], how many times have you
stopped smoking for one day or longer because you were trying to quit smoking
cigarettes for good?
_ _.
NUMBER OF TIMES
88.
NONE
77.
99.
Page 45 of 114
YES
NO
7.
9.
QTCLASSPGM
Rationale: Key Outcome Indicators 3.11.3, 3.07.4
/ASK IF Q49 QT12MOS EQ (01-76)/
51.
YES
NO
7.
9.
Page 46 of 114
YES
NO
7.
9.
QTMED2
Rationale: Key Outcome Indicator 3.11.3
/ASK IF Q49 QT12MOS EQ (01-76)/
53.
YES
NO
7.
9.
Page 47 of 114
YES
NO GO TO Q59 HCWCARE2
7.
9.
QTFRAME
Rationale: Key Outcome Indicator 3.08.3
/ASK IF Q54 QTWANT EQ 1/
55.
YES
NO GO TO Q59 HCWCARE2
7.
9.
Page 48 of 114
7.
9.
QTFUTASST
Rationale: Key Outcome Indicator 3.08.4
/ASK IF Q56 QTWHEN = 1-5/
57.
When you try to quit smoking, do you plan to use a telephone quitline, a class or program
or one-on-one counseling from a healthcare provider to help you quit?
1.
2.
YES
NO
7.
9.
Page 49 of 114
When you try to quit smoking, do you plan to use a nicotine patch, nicotine gum,
lozenges, nasal spray, an inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix,
or varenicline to help you quit?
1.
2.
YES
NO
7.
9.
In the past 12 months, that is, since [DATE FILL], have you seen a doctor, dentist, nurse,
or other health professional?
1.
2.
YES
NO GO TO Q70 HCCOVERAGE
7.
9.
Page 50 of 114
In the past 12 months, that is, since [DATE FILL], did any doctor, dentist, nurse, or other
health professional advise you to quit smoking cigarettes or using any other tobacco
products?
1.
2.
YES
NO GO TO Q69 HCWASK
7.
9.
HCWQTASK
Rationale: Key Outcome Indicator 3.09.4
/ASK IF Q60 HCWADVISE2 EQ 1/
61.
The last time a health professional advised you to quit using tobacco, did they also ask if
you wanted to try to quit?
1.
2.
YES
NO GO TO Q63 HCWMORADVICE
7.
9.
Page 51 of 114
When the health professional asked if you wanted to try to quit, did you say?
1.
2.
7.
9.
HCWMORADVICE
Rationale: Key Outcome Indicator 3.09.5
/ASK IF Q60 HCWADVISE2 EQ 1/
63.
The last time a health professional advised you to quit using tobacco, did they also offer
any assistance, information, or additional advice to help you quit?
1.
2.
YES
NO GO TO Q70 HCCOVERAGE
7.
9.
HCWMATERIALS2
Rationale: Key Outcome Indicator 3.09.5
/ASK IF Q63 HCWMORADVICE EQ 1/
64.
The last time a health professional advised you to quit using tobacco, did they provide
you with booklets, videos, website addresses, or other information to help you quit?
1.
2.
YES
NO
7.
9.
Page 52 of 114
(The last time a health professional advised you to quit using tobacco,) Did they put you
in contact with, or tell you how to contact, a telephone quitline, a class or program, or
one-on-one counseling?
1.
2.
YES
NO
7.
9.
Did they help you set a specific date to quit using tobacco products?
1.
2.
YES
NO
7.
9.
Page 53 of 114
(Did they) Recommend or prescribe a nicotine patch, nicotine gum, lozenges, nasal spray,
an inhaler, or pills such as Wellbutrin, Zyban, buproprion, Chantix, or varenicline?
1.
2.
YES
NO
7.
9.
HCWFOLLOWUP
Rationale: Key Outcome Indicator 3.09.6
/ASK IF Q63 HCWMORADVICE EQ 1/
68.
(Did they) Schedule any follow-up contacts, either in person or by phone, or arrange for
someone else to call you to see how your quit attempt was going?
1.
2.
YES
NO
7.
9.
GO TO Q70 HCCOVERAGE
Page 54 of 114
In the past 12 months, that is, since [DATE FILL], did any doctor, dentist, nurse, or other
health professional ask if you smoke cigarettes or use any other tobacco products?
1.
2.
YES
NO
7.
9.
Now I am going to ask some questions about health insurance and quitting tobacco. Do
you have any kind of health insurance, including prepaid plans such as HMOs or
government plans such as Medicare or Medicaid?
2.
7.
9.
1.
Page 55 of 114
Does your health insurance help pay for counseling or medications to help people stop
smoking cigarettes?
1.
2.
YES
NO
7.
9.
IF (Q31 SLTEVER2 >= 2 OR Q32 SLTNODAYS >=77) AND (Q34 SNUSEVER >= 2 OR Q35
SNUSNODAYS>=77) AND (Q36 CIGAREVER >= 2 OR Q37 CIGARNODAYS >=77) AND
(Q39 PIPEWTREVER >= 2 OR Q40 PIPEWTRDAYS>=77) AND (Q41 PIPEOTHEVER >=2
OR Q42 PIPOTHDAYS>=77), GO TO PRE73
HCCPAYQO
Rationale: Key Outcome Indicator 3.08.7
Asked of respondents who have health care coverage and who, (in the past 30 days, have used
chewing tobacco, snuff, dip, or snus or have smoked a cigar, a cigarillo, a little cigar, or a pipe).
/ASK IF Q70HCCOVERAGE EQ 1 AND (Q32 SLTNODAYS EQ (1-30) OR Q35
SNUSNODAYS EQ (1-30) OR Q37 CIGARNODAYS EQ (1-30) OR Q40 PIPEWTRDAYS EQ
(1-30) OR Q42 PIPEOTHDAYS EQ (1-30))/
72.
Does your health insurance help pay for counseling or medications to help people stop
using tobacco products other than cigarettes?
1.
2.
YES
NO
7.
9.
Page 56 of 114
Not counting decks, porches, or garages, during the past 7 days, that is, since last
[TODAYS DAY OF WEEK[, on how many days did someone other than you smoke
tobacco inside your home while you were at home?
0_.
NUMBER OF DAYS
88.
NONE
77.
99.
Page 57 of 114
7.
9.
HOMECMPL
Rationale: Key Outcome Indicator: 2.06.4
Asked of respondents (who reported that no one else smoked tobacco in their home in the past 7
days and live in homes where smoking is never allowed) or (who reported that someone else
smoked tobacco in their home in at least one of the past 7 days and live in homes where smoking
is allowed at some times or in some places.
/ASK IF [Q73 SMOKHOME7D2 EQ 88 AND Q74 HOMERULES2 EQ 3] OR [Q73
SMOKHOME7D2 EQ (1-7) AND Q74 HOMERULES2 EQ 2]/
75.
Not counting decks, porches, or garages, to your knowledge, during the past 7 days, that
is, since last [TODAYS DAY OF WEEK], has anyone, including yourself, smoked
tobacco inside your home when he or she was not supposed to?
1.
2.
YES
NO
7.
9.
Page 58 of 114
Always be allowed
Be allowed only at some times or in some places
Never be allowed
7.
9.
Page 59 of 114
Are you currently working for pay or are you self-employed, either part-time or fulltime?
1.
2.
YES
NO GO TO PRE85
7.
9.
NOJOBS
Rationale: Screener for Key Outcome Indicators 2.04.3, 2.06.1, and 2.07.1
/ASK IF Q77 EMPLOY2 EQ 1/
78.
7.
9.
PREWORKPLACE
/ASK IF Q78 NOJOBS EQ 1/
Please answer the following questions for the job at which you spend the most time.
Page 60 of 114
Outdoors
In a vehicle
Indoors at home
Indoors in a place like an office building, retail store, restaurant, or factory
Somewhere else (Specify)
77.
99.
PRE80
/ASK IF Q79 WORKPLACE=2/
The next two questions refer to smoking in indoor areas. When answering the questions, please
count your vehicle as an indoor area.
Page 61 of 114
Now Im going to ask you about smoke you might have breathed at work because
someone else was smoking, either indoors or outdoors. During the past 7 days, that is,
since last [TODAYS DAY OF WEEK], on how many days did you breathe the smoke at
your workplace from someone other than you who was smoking tobacco?
0_.
NUMBER OF DAYS
88.
NONE
77.
99.
Page 62 of 114
Always allowed
Allowed only at some times or in some places
Never allowed
7.
9.
Page 63 of 114
Always allowed
Allowed only at some times or in some places
Never allowed
7.
9.
To your knowledge, during the past 30 days, that is, since [DATE FILL], has anyone,
including yourself, used tobacco of any kind at your work when he or she was not
supposed to?
1.
2.
YES
NO
7.
9.
Page 64 of 114
Always allowed
Allowed only at some times or in some places
Never allowed
7.
9.
WORKOUTDOPN2
Rationale: Key Outcome Indicator 2.03.7
/ASK ALL/
INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS
QUESTION IS BEING RANDOMLY REVERSED
86.
Always allowed
Allowed only at some times or in some places
Never allowed
7.
9.
Page 65 of 114
During the past 7 days, that is, since last [TODAYS DAY OF WEEK], on how many
days did you ride in a vehicle where someone other than you was smoking tobacco?
0_.
NUMBER OF DAYS
88.
NONE
77.
99.
Page 66 of 114
Not counting motorcycles, in the vehicles that you or family members who live with you
own or lease, is smoking
1.
2.
3.
IN PUBLIC PLACES
PRE89
/ASK ALL/
The next several questions ask about tobacco use in indoor and outdoor public places. Examples
of indoor public places are the indoor areas of stores, restaurants, bars, casinos, clubs, and sports
arenas. Examples of outdoor public places are stadiums and parks.
Page 67 of 114
[IF Q77 EMPLOY2 = 1: Not counting times while you were at work,] during the past 7
days, that is, since last [TODAYS DAY OF WEEK], on how many days did you breathe
the smoke from someone else who was smoking in an indoor or outdoor public place?
0_.
NUMBER OF DAYS
88.
NONE
77.
99.
SHSCOMPPUB
Rationale: Key Outcome Indicator 2.06.2
/ASK ALL/
90.
[IF Q77 EMPLOY2 = 1: Not counting times while you were at work,] to your
knowledge, during the past 7 days, that is, since last [TODAYS DAY OF WEEK], has
anyone, including yourself, used tobacco of any kind in an indoor or outdoor public place
when he or she was not supposed to?
1.
2.
YES
NO
7.
9.
PRE91
/ASK ALL/
Now we have three questions about your opinions on smoking in indoor and outdoor public
places.
Page 68 of 114
Always be allowed
Be allowed only at some times or in some places
Never be allowed
7.
9.
SHSINDROPN2
Rationale: Key Outcome Indicator 2.03.7.
/ASK ALL/
INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS
QUESTION IS BEING RANDOMLY REVERSED
92.
Always be allowed
Be allowed only at some times or in some places
Never be allowed
7.
9.
Page 69 of 114
Always be allowed
Be allowed only at some times or in some places
Never be allowed
7.
9.
How likely would you be to ask a stranger not to smoke around you if you couldnt move
away from their smoke?
1.
2.
3.
Very likely
Somewhat likely
Not at all likely
7.
9.
Page 70 of 114
Do you think that breathing smoke from other people's cigarettes or from other tobacco
products is?
1.
2.
3.
7.
9.
SHSPUBOPN
Rationale: Key Outcome Indicator 2.03.9
/ASK ALL/
96.
Should policies that dont allow tobacco use in indoor or outdoor public places be strictly
enforced?
1.
2.
YES
NO
7.
9.
DEMOGRAPHIC ITEMS
PRE97
/ASK ALL/
Now I would like to ask you some questions about yourself and your family. Please remember
that your answers will be private and that no one will be able to identify you from any published
reports.
Page 71 of 114
Married
Living with a partner
Divorced
Widowed
Separated
Single, that is, never married and not now living with a partner
OTHER (SPECIFY)
77.
99.
HISPANIC
Rationale: Key covariate
/ASK ALL/
98.
YES
NO GO TO Q100 RACEMULTI
7.
9.
Page 72 of 114
Which one or more of the following describe your Hispanic origin or ancestry?
01.
02.
03.
04.
05.
96.
Mexican
Puerto Rican
Cuban
Central or South American
Dominican
Some other Hispanic or Latino group (SPECIFY)
77.
99.
Page 73 of 114
Im going to read a list of racial categories. Which one or more of the following do you
consider yourself to be?
01.
02.
03.
04.
05.
96.
White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
OTHER (SPECIFY)
09.
77.
99.
Page 74 of 114
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other (SPECIFY)
77.
99.
Page 75 of 114
What is the highest level of school you have completed or the highest degree you have
received?
INTERVIEWER: READ ONLY IF NECESSARY.
17.
77.
99.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
Page 76 of 114
GENDER
Rationale: Key covariate
/ASK ALL/
INTERVIEWER: ASK ONLY IF NECESSARY.
104.
MALE
FEMALE
OTHER (SPECIFY)
7.
9.
Page 77 of 114
How many children aged 17 or younger live in your household 6 months or more of the
year?
__
NUMBER OF CHILDREN
88.
NONE
99.
REFUSED
TELNOSGT1
Rationale: Needed for weighting.
/ASK OF LANDLINE RESPONDENTS ONLY/
106.
Now Im going to ask you about how many different telephone numbers your household
has. Do not include numbers that are only used by a computer or fax machine. Also, do
not include cell phone telephone numbers. Do you have more than one landline telephone
number in your household?
1.
2.
YES
NO GO TO Q108 STATERES
7.
9.
Page 78 of 114
8.
NONE
7.
9.
STATERES
Rationale: To assign respondents to states.
/ASK ALL/
108.
Page 79 of 114
GO TO PRECHRONIC
DCWARD
/ASK IF Q108 STATERES = 11/
110.
Ward 1
Ward 2
Ward 3
Ward 4
Ward 5
Ward 6
Ward 7
Ward 8
996.
OTHER/SPECIFY
777.
999.
Page 80 of 114
Have you ever been told by a doctor or other health professional that you have heart
disease?
1.
2.
YES
NO
7.
9.
CANCER
Rationale: Key covariate
/ASK ALL/
112.
(Have you ever been told by a doctor or other health professional that you have) cancer,
other than skin cancer?
1.
2.
YES
NO
7.
9.
Page 81 of 114
(Have you ever been told by a doctor or other health professional that you have) diabetes,
or sugar diabetes?
INTERVIEWER: IF YES AND RESPONDENT IS FEMALE, ASK: Was this only
when you were pregnant?
1.
2.
3.
YES
YES, BUT FEMALE TOLD ONLY DURING PREGNANCY
NO
7.
9.
RESPDISEASE
Rationale: Key covariate
/ASK ALL/
114.
(Have you ever been told by a doctor or other health professional that you have) a chronic
lung disease, such as emphysema, chronic bronchitis, or chronic obstructive pulmonary
disease, also known as c-o-p-d?
1.
2.
YES
NO
7.
9.
Page 82 of 114
(Have you ever been told by a doctor or other health professional that you have) asthma?
1.
2.
YES
NO
7.
9.
CHOLESTEROL
Rationale: To identify smoking histories and adherence to AHRQ guidelines among respondents
with high cholesterol.
/ASK ALL/
116.
Key covariate
1.
2.
YES
NO
7.
9.
HYPERTENSION
Rationale: Key covariate
/ASK ALL/
117.
(Have you ever been told by a doctor or other health professional that you have) high
blood pressure, or hypertension?
1.
2.
YES
NO
7.
9.
Page 83 of 114
Would you be in favor of an increase in the tax on a pack of cigarettes if the money were
used to improve the publics health?
1.
2.
YES
NO GO TO Q120 SLTTAXOPN
7.
9.
CIGTAXOPN3
Rationale: Key Outcome Indicators 1.06.5, 3.08.5
/ASK IF Q118 CIGTAXOPN2 EQ 1/
119.
Current prices for a pack of cigarettes range from about four to eight dollars. Would you
be in favor of an additional tax on a pack of cigarettes of
1.
2.
3.
4.
5.
7.
9.
Page 84 of 114
Would you be in favor of an increase in the tax on chewing tobacco, snuff, dip, or snus if
the money were used to improve the publics health?
1.
2.
YES
NO
7.
9.
ADDICTION
RSKADDICTOPN2
Rationale: Programs try to communicate the addictive nature of tobacco.
/ASK ALL/
INTERVIEWER: THE ORDER OF THE RESPONSE CATEGORIES FOR THIS
QUESTION IS BEING RANDOMLY REVERSED
121.
7.
9.
Page 85 of 114
7.
9.
SCHOOLOPN2
Rationale: Key Outcome Indicator 1.06.7, 2.03.10
/ASK ALL/
123.
Should tobacco use be completely banned on school grounds, including fields and
parking lots, and at all school events, even for teachers and other adults?
1.
2.
YES
NO
7.
9.
Page 86 of 114
How likely is it that you would ever use or wear something--such as a lighter, t-shirt, hat
or sunglasses--that has a tobacco company name or picture on it
1.
2.
3.
4.
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
7.
9.
Now I want to ask you about the importance of discussing tobacco use with childen that
you have a parental relationship with. Are you currently parenting any children aged 17
or younger?
1.
2.
YES
NO IF (Q2 SMOK100 = 1 AND Q3 SMOKNOW = (1 OR 2)) OR Q6
SMOKLAST <= 3, GO TO Q128 HELPSMOKER, ELSE GO TO
Q127 HELPNONSMOK
7.
9.
Page 87 of 114
7.
9.
Page 88 of 114
In order to help someone you know to stop smoking or using tobacco, would you like the
1-800 quitline telephone number or the address for a website?
1.
2.
YES
NO
GO TO PREQ129
Page 89 of 114
A website that tells you about help you can get to stop smoking is www.smokefree.gov.
128.
In order to get help to stop using tobacco for good, would you like the 1-800 quitline
telephone number or the address for a website?
1.
2.
YES
NO
Page 90 of 114
08.
77.
99.
03.
02.
01.
05.
06.
07.
Page 91 of 114
Heterosexual, or straight
Gay or lesbian
Bisexual
Transgender
OTHER (SPECIFY)
06.
77.
99.
CLOSING
CLOSE
/ASK ALL/
Thats my last question. Everyones answers will be combined to give us information
about tobacco in the U.S. The information you have provided will be used to help
improve the health of people all across the US. Thank you very much for your time and
cooperation.
LANGUAGE
131.
ENGLISH
SPANISH
Page 92 of 114
Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease
Control and Prevention. The CDC is a federal agency charged with protecting and
improving the public's health. We're gathering information on health and tobacco from
selected people across the United States. Your phone number has been chosen randomly
from a list of all telephone numbers in the US.
YES
NO TERMINATE
LTELNOCORR
/ASK IF L1 LINTRO =1
INTERVIEWER: IF RESPONDENT EXPRESSES CONCERNS ABOUT THE
SURVEY, PLEASE READ ONE OR MORE OF THE FOLLOWING, AS
APPROPRIATE:
The survey takes about 15 to 25 minutes to complete, depending on your situation.
Your number was selected by chance from a list of all cell telephone numbers in the US.
The CDC uses the data collected by this study to develop more effective public health
programs to help people quit smoking and to help keep people from starting to smoke.
I can give you a 1-800 number to call to verify that this is a legitimate survey. Would you
like that 1-800 number? IF YES: 1-877-363-3246.
L2.
First, I need to verify that we have dialed the correct number. Is this [PHONE NUMBER
FILL]?
1.
2.
YES GO TO L3 LCELLPHONE
NO GO TO THNKWRG
7.
9.
Page 93 of 114
99
REFUSED TERMINATE
LCELLPHONE
/ASK IF L2 LTELNOCORR =1/
L3.
YES GO TO THNKCL
NO GO TO L4 LPRIVRES
7.
9.
Page 94 of 114
99
REFUSED TERMINATE
THNKCL
/IF L3 LCELLPHONE =1/
Thank you very much, but we are only interviewing people on landline telephones.
/TERMINATE/
LPRIVRES
/ASK IF L3 LCELLPHONE =2/
L4.
YES GO TO L5 LNOADULT
NO GO TO THNKPRV
7.
9.
Page 95 of 114
99
REFUSED TERMINATE
LNOADULT
/ASK IF L4 LPRIVRES =1/
L5.
I need to randomly select one adult who lives in your household to be interviewed. How
many members of your household, including yourself, are 18 years of age or older?
[RANGE: 1-76]
[USE 76 FOR 76 OR MORE PEOPLE]
_ _.
88.
77.
99.
Page 96 of 114
99
REFUSED TERMINATE
LAREYOUADULT
/ASK IF L5 NOADULT =1/
L6.
YES GO TO L7 LAREYOUMF
NO GO TO L8 ISADULTMW
7.
9.
MAYIE
/ASK IF L6 LAREYOUADULT =7/
May I speak with someone who can tell me whether or not they are the adult 18 years of
age or older who lives in your household?
01
02
03
99
REFUSED TERMINATE
Page 97 of 114
LISADULTMW
/ASK IF L6 LAREYOUADULT =2/
L8.
A MAN GO TO L9 LSPEAKADULT
A WOMAN GO TO L9 LSPEAKADULT
7.
9.
MAYIH
/ASK IF L8 LISADULTMW =7/
May I speak with someone who can tell me whether or not they are the adult 18 years of
age or older who lives in this household?
01
02
03
99
REFUSED TERMINATE
Page 98 of 114
MAYIF
/ASK IF L9 LSPEAKADULT =7/
May I speak with someone else who can tell me whether or not I can speak with the adult
who lives in this household?
01
02
03
99
REFUSED TERMINATE
LNOMEN
/ASK IF L5 LNOADULT >1/
/RANGE: 1-76/
L10.
99.
You said there are [FILL NUMBER OF ADULTS FROM LNOADULT (L5)] adults in
your household? How many are men?
__
88.
77.
DONT KNOW/NOT SURE GO TO MAYIG
REFUSED (INCLUDING HANG-UP) TERMINATE
Page 99 of 114
99
REFUSED TERMINATE
LNOWOMEN
/ASK IF L5 LNOADULT >1 /
/RANGE: 1-76/
L11. How many of the adults in your household are women?
__
88.
77.
99.
99
REFUSED TERMINATE
ADLTVERI
/ASK IF TOTAL OF L10 LNOMEN AND L11 LNOWOMEN <> NUMBER REPORTED IN
L5/
I am sorry. I just want to make sure I recorded this correctly. You said that there are \\:
[L10 + L11]: MEN AND WOMEN living in your household. Is that correct?
01 YES, CORRECT AS IS GO TO LSELRESP
02 NO GO BACK TO L5 LNOADULT
176.
OLDEST MAN
SECOND OLDEST MAN
THIRD OLDEST MAN
201.
202.
203.
276.
OLDEST WOMAN
SECOND OLDEST WOMAN
THIRD OLDEST WOMAN
LSELRESPPHONE
/ASK IF LSELRESP=101-276/
/PROGRAMMING: IF ONLY 1 MAN OR WOMAN IN HH, EXCLUDE AGE IDENTIFIER.
E.G ID LIKE TO SPEAK TO THE MAN OF THE HOUSEHOLD OR THE ID LIKE TO
SPEAK TO THE WOMAN OF THE HOUSEHOLD/
L12.
The person that Id like to speak to is the [AGE RANK AND GENDER (USE MAN
OR WOMAN, NOT MALE/FEMALE) OF SELECTED RESPONDENT FILL] in
your household. Are you the [AGE RANK AND GENDER OF SELECTED
RESPONDENT FILL] in your household?
1.
2.
YES GO TO YRTHE1
NO GO TO MAYIJ
7.
9.
MAYIJ
/ASK IF L12 LSELRESPPHONE =2/
May I speak with the [AGE RANK AND GENDER OF SELECTED RESPONDENT
FILL]?
01
02
03
99
REFUSED TERMINATE
MAYIK
/ASK IF L12 LSELRESPPHONE =7/
May I speak with someone else who lives in this household and might be able to tell me
whether or not I can speak with the [AGE RANK AND GENDER OF SELECTED
RESPONDENT FILL]?
01
02
03
99
REFUSED TERMINATE
YES
NO TERMINATE
LCONFIDENTIAL
/ASK IF L13 LSELRESPINTRO =1 OR L7 LAREYOUMF= (1, 2, OR 7)/
L14. I won't ask for your name, address, or other personal information that can identify you.
You dont have to answer any question you dont want to, and you can end the interview
at any time. The interview may take up to about 20 minutes and any information you give
me will be kept private, to the extent permitted by law. If you have any questions about
this survey, I will provide a telephone number for you to call to get more information.
This call may be monitored or recorded for quality assurance.
IS RESPONDENT CONTINUING WITH THE INTERVIEW?
1.
2.
YES
NO TERMINATE
Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease
Control and Prevention. The CDC is a federal agency charged with protecting and
improving the public's health. We're gathering information on health and tobacco from
selected cell phone users across the United States. Your phone number has been chosen
randomly from a list of all cell phone numbers in the US. If you are eligible for the study,
you will receive a $10 gift for responding to our questions.
YES CONTINUE
NO TERMINATE
First, I need to confirm that this is a cell phone. Is this a cell phone?
INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT
RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.
4.
YES GO TO C3 CLDRIVING
NO GO TO THNKC1
DOES NOT WANT TO BE CALLED AT THIS NUMBER GO TO
CLCALLBACK
NOT A SAFE TIMEDRIVING OR OTHER REASON GO TO THNKC2
7.
9.
1.
2.
3.
4.
YES GO TO MAYIA
NO GO TO THNKC1
DOES NOT WANT TO BE CALLED AT THIS NUMBER GO TO
C5 CLCALLBACK
NOT A SAFE TIMEDRIVING OR OTHER REASON GO TO THNKC2
7.
9.
1.
2.
3.
THNKC1
/ASK IF C2 CLTELNO=2 OR ELSEC2=2/
Thank you very much but we are only interviewing people who we reach on cell phones
at this time.
/TERMINATE/
THNKC2
/ASK IF C2 CLTELNO=4 OR ELSEC2=4/
Thank you very much. We will contact you at a later time.
/TERMINATE/
MAYIA
/ASK IF ELSEC2=1/
May I speak with them?
01
02
03
99
REFUSED TERMINATE
YES
NO TERMINATE
7.
9.
CLISTHIS
/ASK IF CLCALLBACK=1/
Is this other number a landline phone number in your home?
1.
2.
7.
9.
CLDRIVING
/ASK IF C2 CLTELNO=1/
C3.
Your safety is important to us. Are you driving a car or other vehicle right now?
1.
2.
YES GO TO THNKC3
NO
7.
9.
YES GO TO THNKC3
NO GO TO C4 CLLANDLINE
7.
9.
THNKC3
/ASK IF C3 CLDRIVING=2/
Thank you very much. We will contact you at a later time.
/TERMINATE/
CLLANDLINE
/ASK IF C3 CLDRIVING=2/
C4.
In your home, is a cell phone the only way you can be reached by telephone?
1.
2.
7.
9.
THNKDL
/ASK IF C4 CLLANDLINE = 2, 7 OR 9 OR CLISTHIS=1)/
Thank you very much, but we are only interviewing people who can be reached only by
cell phone.
/TERMINATE/
TELEPHONE NUMBER
REFUSED TERMINATE
CLBESTTIME
/ASK IF CLBETTERNO IS NOT BLANK OR MAYIA=3 /
What would be the best time to try to call back?
__:___m
999999.
REFUSED TERMINATE
CLNAME
/ASK IF CLBESTTIME IS NOT BLANK AND NOT MAYIA=3/
To make sure that we talk to you when we call back, please give us a name to ask for?
You can make up a name if you like. A first name only is fine.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ TERMINATE
999999.
REFUSED TERMINATE
CLNAMEOTH
/ASK IF CLBESTTIME IS NOT BLANK AND MAYIA=03/
Who should we ask for when we call? A first name or initial is fine.
___________ /ENTER NAME/
999999
REFUSED TERMINATE
Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease
Control and Prevention. The CDC is a federal agency charged with protecting and
improving the public's health. We're gathering information on health and tobacco from
selected cell phone users across the United States. May I speak with [FILL: CLNAME]?
[IF CLNAME DID NOT ANSWER PHONE Hello, my name is [NAME FILL]. Im
calling for the CDC, the Centers for Disease Control and Prevention.] We are calling
because you asked us to call you at this time on this number to answer questions on
health and tobacco.
YES
NO TERMINATE
[C4 CLLANDLINE=1] I need to verify that we have dialed the number correctly. Is this
[PHONE NUMBER FILL]?
[C5 CLINTRO2=1] I need to verify that we dialed the original number correctly. Was the
telephone number we originally called you at, [FILL ORIGINAL CELL PHONE
NUMBER]?
INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT
RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.
1.
2.
YES GO TO CLBUSONLY
NO GO TO THNKCWN
7.
9.
THNKCWN
/ASK IF C6 CLTELNOCORR=2 /
Thank you very much, but we seem to have dialed the wrong number. It's possible that
your number may be called at a later time.
/TERMINATE/
7.
9.
THNKCBS
/ASK IF C7 CLBUSONLY=1/
Thank you very much, but we are only interviewing people at cell phone numbers that are
used for personal calls.
/TERMINATE/
CLADULT
/ASK IF C7 CLBUSONLY =2 OR 3/
C8.
YES GO TO C9 CLPRIVRES
NO GO TO THNK18
7.
9.
THNK18
/ASK IF C8 CLADULT = 2/
Thank you very much, but we are only interviewing people 18 years of age or older.
/TERMINATE/
7.
9.
THNKPVT
/ASK IF C9 CLPRIVRES =2, 7 OR 9/
Thank you very much, but we are only interviewing people who live in private
residences.
/TERMINATE AUTOMATICALLY 420/
CLCONFIDENTIAL
/ASK IF C9 CLPRIVRES =1/
C10.
You are eligible to be interviewed. I won't ask for your name, address, or other personal
information that can identify you. You dont have to answer any question you dont want
to, and you can end the interview at any time. The interview may take up to about 15 to
25 minutes, depending on your situation, and any information you give me will be kept
private, to the extent permitted by law. If you have any questions about this survey, I will
provide a telephone number for you to call to get more information.
YES
NO TERMINATE