Microsoft word - questionnaire for hsc website-final-120413

New Zealand Smoking Monitor (NZSM) Questionnaire
2011/12

Screeners (S1-S5):

S1) Can I just check, in the last (#), have you taken part in a telephone survey
conducted by the Ministry of Health around smoking and quitting. The study is called
the New Zealand Smoking Monitor.
# = add scripting to automatically update the script on the 1st of each month
eg. 1 July = ‘month’, 1 August = ‘2 months’, 1 September = ‘3 months’ etc)

Another market research company, TNS/ UMR, are also conducting this survey for the Ministry of Health. So we do not cause you too much inconvenience, if TNS/ UMR do call you to complete the New Zealand Smoking Monitor, please tell them that you have already completed the TNS/ UMR survey. This survey contains questions about smoking. When we talk about smoking, we are talking about cigarettes and tobacco, not marijuana or cannabis. S2) Have you ever smoked cigarettes or tobacco at all, even just a few puffs? Please include pipes and cigars. Interviewer notes: This does not include marijuana or cannabis. (2) – Ineligible. Thanks and see instruction below. (99) – Ineligible. Thanks and see instruction below. (98) – Ineligible. Thanks and see instruction below.
Option 1 only:
If code 2, 99, or 98, then:
Is there another person in your household aged 18 years and over who I could speak
with?
If YES, REPEAT INTRODUCTION WITH THAT PERSON
If NO, THANK AND CLOSE
S3) How often do you smoke now? READ OUT S4) In the last 3 months, have you deliberately stopped smoking cigarettes or tobacco for 24 hours or more because you were trying to quit smoking? Interviewer note: If ‘yes’, probe ‘was it in the last week?’ • Yes - quit in the last week (1) – Recruited as CSA.Go to S6. • Yes - quit in the last 3 months but not the last week S5) Did you quit smoking in the last 3 months? Interviewer note: If ‘yes’, probe ‘was it in the last week?’ • Yes - quit in the last week (1) – Recruited as EXS. Go to S6. • Yes – quit in the last 3 months but not the last week S6) CS & EXS: In the last 12 months, how many times did you quit smoking for 24 hours or more? Please include any attempt that you are currently making. Main questionnaire

1a) CS: In the last week, which of
If the respondent has not smoked in the last week, ask ‘what would you usually smoke?’ • Don’t know [DON’T READ] (99) • Refused [DON’T READ] (98) 2) CS: In the last week, on average, how soon after you wake up do you have your first smoke? Was it within Interviewer note: If the respondent has not smoked in the last week, ask ‘How soon after you wake up do you usually have your first smoke?’ READ OUT. Interviewer notes: This includes both Interviewer notes: This includes both If the respondent smoked less than 1 If the respondent smoked less than 1 If the respondent has not smoked in If the respondent reply in packs, ask ‘what size pack do you smoke – 20 or cigarettes do you usually smoke a 25?’, and work out the number of If the respondent reply in packs, ask ‘what size of pack do you smoke – 20 or 25?’, and work out the number of 4) In the last week, how often did you want to smoke but you didn’t because of where you were? For example, you were inside at work or on a plane. READ OUT. 5) In the last week, how often did you have the urge to smoke but you didn’t because you decided not to? 7) CSA & CSNA (IF S6 = 1-11) & EXS And during your most recent quit attempt, what, if any, help, programmes, or products did you use to help you quit? Multiple response allowed. Probe to no. Record ‘first mentioned’, ‘second mentioned’ and ‘other responses’. • Other health professional or health workers • Nicotine replacement medications eg. patches, gum • Other quit smoking medications eg. Zyban, Champix • Nicotine free cigarettes eg. e-cigarettes and herbal cigarettes Q8: CSA & CSNA (IF S6 = 1-11) After your attempt to quit, what were the reasons you started to smoke again? Please answer ‘yes’ or ‘no’ to each of the following: • Yes (1) • No (2) • Don’t know (99) • Refused (98)

Now we are going to ask you some questions about the last 7 days.
9) CS: I’m going to read a list of statements. Can you please tell me if you have done
any of these in the last week have you
a. Tried to quit b. Cut down the number of cigarettes you smoke c. Changed to a cheaper type of tobacco (Interviewer note: for example changed from smoking tailor-made cigarettes to roll-your-own) d. Changed to a cheaper brand e. Rolled smaller cigarettes f. Smoked duty free cigarettes g. Or have you made some other change to the way you smoke?
If the respondents did not answer ‘yes’ to any of the above, go to Q.11
• Yes (1) • No (2) • Don’t know (99) • Refused (98) 10a) CS: So, what were your reasons for < Q9 dummy response 1> in the last week? Record ‘first mentioned’, ‘second mentioned’ and ‘other responses’. • Smoking is anti-social/ not socially acceptable • Make it easier to stop smoking completely later on 10b) CS: So, what were your reasons for < Q9 dummy response 2> in the last week? Record ‘first mentioned’, ‘second mentioned’ and ‘other responses’. • Smoking is anti-social/ not socially acceptable • Make it easier to stop smoking completely later on 10c) CS: So, what were your reasons for < Q9 dummy response 3> in the last week? Record ‘first mentioned’, ‘second mentioned’ and ‘other responses’. • Smoking is anti-social/ not socially acceptable • Make it easier to stop smoking completely later on 11) Would you recommend any of the following to help people quit smoking? Please answer ‘yes’ or ‘no’ to each of the following: c. Nicotine replacement products such as patches, gum and lozenges d. Quit smoking medications such as Zyban and Champix • Yes (1) • No (2) • Don’t know (99) • Refused (98) mention Nortriptyline, Bupropion, Varenicline, Norpress code ‘yes’. mention Nortriptyline, Bupropion, Varenicline, Norpress code ‘yes’. 14) In the last 3 months, have you seen your doctor or practice nurse about your own health? 15) Did they ask you about your smoking? 16) Did they provide you with any help to quit? Now we are going to ask you some questions about where you may have seen or heard about smoking in the last week. 17) Do you recall seeing or hearing any advertising anywhere in the last week about not smoking, quitting smoking or the harmful effects of smoking? • Don’t know (99) – Go to Q19. • Refused 18) And in your opinion, did this advertising make smoking seem less attractive? 19) Now I want to ask you about the media more generally. First, thinking about news stories relating to smoking or tobacco that might have been on TV, radio, on the internet or in the newspaper. In the last week, have you seen or heard any news stories about smoking?
20) In the last week, have you seen smoking in any TV programmes or movies that
made smoking seem attractive?

21) In the last week, have you become aware of any changes in government policy
about smoking or tobacco?

Randomise Q22-25.

I am going to read out some statements. For each one I read, please tell me if you
personally strongly agree, agree, neither agree or disagree, disagree or strongly
disagree with each statement. [Repeat scale as necessary]
23) Smoking is more of a habit than an addiction. • Neither agree nor disagree (3) • Disagree
Randomise Q26-27

26) Society disapproves of smoking.
• Neither agree nor disagree (3) • Disagree 27) People should be able to quit without the help of programmes or products. • Neither agree nor disagree (3) • Disagree
28) (Non-core question – this question changes throughout the 2010/11 year to
address topical issues)
29) (Non-core question – this question changes throughout the 2010/11 year to
address topical issues)
30) (Non-core question – this question changes throughout the 2010/11 year to
address topical issues)


31) CS: The following question is about your smoking intentions in the next 3
months. Please tell me how much you agree or disagree with this statement. I intend
to stop smoking in the next 3 months. Do you:
READ OUT.
• Neither agree nor disagree (3) • Disagree • Don’t know [DON’T READ] (99) • Refused [DON’T READ] 32) EXS: The following question is about your quit smoking experience. How easy or hard would you say it has been to stay quit? Would you say it has been. READ OUT.

33a) CS: If you decided to give up
33b) EXS: How likely is it that you will still be quit in 3 months from now, on a Interviewer note: If respondent doesn’t Interviewer note: If respondent doesn’t understand the scale, say ‘0 means understand the scale, say ‘0 means you have no chance of success and you have no chance of success and 100 means you have a definite chance 100 means you have a definite chance The next few questions are to help us classify the information that we have collected. Your answers are confidential will not be identified with you personally. D1: [Interviewer to record gender if certain; otherwise read out] Sorry I have to ask this of everybody, but so we get it right D2: Which of these age groups do you belong to? READ OUT D3: Including yourself, how many people aged 18 or older usually lives in your house? Interviewer note: If respondent unsure what ‘usually’ meant, say please include the person who lives in the house for four or more days per week. D4: Are there any children aged under 18-years-old usually lives in your house? D5: Please tell me the ages of the children who live in your house, from the youngest to the oldest. a. 0-4 years b. 5-7 years c. 8-12 years d. 13-14 years e. 15-16 years f. 17 years • Record actual number for each category • Don’t know • School Certificate or National Certificate Level 1 or NCEA Level 1 • Sixth Form Certificate or National Certificate Level 2 or NZ UE before 1986 or • Higher School Certificate or Higher Leaving Certificate or NZ University • Bursary/Scholarship or National Certificate Level 3 or NCEA Level 3 or NZ • Other secondary school qualification gained in NZ D7: And just reminding you that your responses are confidential. Broadly, what of the following groups that I will read out best describes your total household income from all sources, before tax or anything was taken out of it, in the last 12 months? Please say ‘stop’ when I read out the group that your household income falls into. • Don’t know [DON’T READ] (99) • Refused [DON’T READ] D8: Which ethnic group or groups do you belong to?
D9: Do you live in a rural area or district that has a population of less than 2,000
people?

Source: http://www.hpa.org.nz/sites/default/files/Questionnaire%20for%20HSC%20website-FINAL-120413.pdf