**HINTS 2005**

**HEALTH INFORMATION NATIONAL TRENDS SURVEY 2005**

**FINAL MAIN STUDY INSTRUMENT**

**ENGLISH VERSION**

**September 2005**

**Revised December 2005**

**Annotated**

> **NATIONAL CANCER INSTITUTE (NCI)**
>
> The Privacy Act requires us to tell you that we are authorized to
> collect this information by Section 411.285a, 42 USC. You do not have
> to provide the information requested. However, the information you
> provide will help the National Cancer Institute's ongoing efforts to
> promote good health and prevent disease. There are no penalties should
> you choose [not]{.underline} to participate in this study.
>
> The information we collect in this study is in accordance with the
> clearance requirements of the paperwork Reduction Act of 1995. We may
> not conduct or sponsor, and you are not required to respond to, a
> collection of information unless it displays a valid control number
> from the Office of Management and Budget in the Federal Government. We
> estimate that it will take you between 25 and 30 minutes to answer our
> questions in this interview. This includes the time it takes to hear
> the instructions, gather the necessary facts, and complete the
> interview. Send comments regarding this burden estimate or any other
> aspect of this collection of information, including suggestions for
> reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge
> Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0538)
>
> OMB \# 0925-0538
>
> Expiration Date: 11/30/2007

**Table of Contents**

[**HOUSEHOLD ENUMERATION (he) 1**](#__RefHeading___Toc113854655)

[Group Assignment (GA) 5](#__RefHeading___Toc113854656)

[HEALTH Communication (HC) 9](#__RefHeading___Toc113854657)

[Cancer Communication (CA) 13](#__RefHeading___Toc113854661)

[PROSTATE CANCER (PC) 21](#__RefHeading___Toc113854668)

[CERVICAL CANCER (CV) 23](#__RefHeading___Toc113854669)

[BREAST CANCER (BC) 27](#__RefHeading___Toc113854670)

[COLON CANCER (CC) 29](#__RefHeading___Toc113854671)

[Mental Model of Cancer: COLON (MM) 31](#__RefHeading___Toc113854672)

[Skin PROTECTION (SP) 33](#__RefHeading___Toc113854673)

[Mental Model of Cancer: skin (MM) 35](#__RefHeading___Toc113854674)

[Tobacco Use (TU) 37](#__RefHeading___Toc113854675)

[Mental Model of Cancer: LUNG (MM) 43](#__RefHeading___Toc113854680)

[ENERGY BALANCE (EB) 47](#__RefHeading___Toc113854681)

[HEALTH STATUS (HS) 53](#__RefHeading___Toc113854687)

[social NETWORKS (SN) 55](#__RefHeading___Toc113854690)

[demographics (DM) 57](#__RefHeading___Toc113854691)

[DEBRIEFING QUESTIONS (DB) 61](#__RefHeading___Toc113854692)

[CONTACT INFORMATION (CI) 65](#__RefHeading___Toc113854693)

[APPENDIX A: ITEM TU-19 VARIABLE LIST 67](#__RefHeading___Toc113854694)

[APPENDIX B: VARIATION IN TELEPHONE VS.
WEB](#__RefHeading___Toc113854695)

[VERSIONS OF INSTRUMENT 69](#__RefHeading___Toc113854695)

This page left blank intentionally.

[]{#__RefHeading___Toc113854655 .anchor}HOUSEHOLD ENUMERATION (he)

HE-0. \[PHONE NUMBER\]

USE AUTODIALER 1

BYPASS AUTODIALER 2

\[SINTRO_1\] Hello, this is {INTERVIEWER NAME} and I'm calling about a
federally-sponsored research study for the National Cancer Institute.
\[This is a nationwide study about health issues related to cancer.\]
\[We are not asking for donations or selling anything.\]

OR

Hello, this is {INTERVIERWER NAME} and your household has been selected
for a nationwide research study on health issues related to cancer.
\[This study is sponsored by a part of the federal government called the
National Cancer Institute.\] \[We are not asking for donations or
selling anything.\]

HE-1. Are you a member of this household and at least 18 years old?

YES 1 (HE-3)

NO 2

BUSINESS ADDRESS 3 (END STATEMENT 1)

HE-2. May I speak with a household member who is at least 18 years old?

\[IF NEEDED: Household members include people who think of this
household as their primary place of residence. It includes persons who
usually stay in the household but are temporarily away on business,
vacation, in a hospital, or living at school in a dorm, fraternity or
sorority.\]

AVAILABLE 1 (SINTRO_1)

NOT AVAILABLE 2 (MAKE APPOINTMENT)

THERE ARE NONE 3 (END STATEMENT 2)

HE-3. Is this phone number used for\...

home use, 1

home and business use, or 2

business use only? 3 (END STATEMENT 1)

\[HE-4 INTRO\] I have some questions to see if someone in your household
is eligible to participate in this study. \[If so, this person will be
paid {\$5/\$15} for completing an interview over the telephone.\]

HE-4. Including yourself, how many people [aged 18 or older]{.underline}
currently live in this household?

\[IF NEEDED: Include people who [usually]{.underline} stay in this
household, but are temporarily away on business, vacation, or in the
hospital. Do [not]{.underline} include persons who are away on full-time
active military duty with the armed forces, students living away from
home in their own apartment, or any other family member who may be in a
nursing home or other institution.\]

SCQHE4NumberOfAdults

\|\_\_\_\|\_\_\_\|

\# OF ADULT HH MEMBERS

+-----------------------------------------------------------------------+
| BOX HE-1                                                              |
|                                                                       |
| IF THERE ARE NO ADULT HH MEMBERS, GO TO END STATEMENT.                |
|                                                                       |
| IF ONLY 1 ADULT IN HH, GO TO HE-9.                                    |
|                                                                       |
| OTHERWISE, RUN RESPONDENT SELECTION ALGORITHM.                        |
|                                                                       |
| IF RESPONDENT WAS SAMPLED, GO TO HE-9.                                |
|                                                                       |
| IF 2 ADULTS IN HH, GO TO HE-9.                                        |
|                                                                       |
| IF 3 ADULTS IN HH, GO TO HE-5.                                        |
|                                                                       |
| OTHERWISE IF MORE THAN 3 ADULTS IN HH AND RESPONDENT WAS NOT SAMPLED, |
| GO TO HE-6.                                                           |
+-----------------------------------------------------------------------+

HE-5. The computer has randomly determined that one of the adults in the
household other than yourself should participate in the rest of the
interview. To help us select this person, may I please have the first
name of the {older/younger} of these two adults? May I please have
{his/her} age?

SCQHEGender

SCQHEAge

\[PROBE FOR GENDER (IF NOT OBVIOUS).\]

\[IF NEEDED: I only need something that I can use to refer to {him/her}.
Could you please give me {his/her} initals or something else that would
allow me to identify {him/her}?\]

NAME:

> GENDER: MALE 1 AND AGE: \|\_\_\_\|\_\_\_\|
>
> FEMALE 2

DK (HE-8)

RF (END STATEMENT 2)

  -----------------------------------------------------------------------
  GO TO HE-10.

  -----------------------------------------------------------------------

HE-6. The computer has randomly determined that one of the \[HE-4 answer
minus 1\] adults other than yourself should participate in the rest of
the interview. To help us select this person, do you know who has had
the most recent birthday among these adults?

SCQHE6KnowBirthdays

YES 1

NO 2 (HE-8)

HE-7. Other than yourself then, may I please have the first name of the
adult who has had the most recent birthday? May I please have {his/her}
age?

SCQHEGender

SCQHEAge

\[PROBE FOR GENDER (IF NOT OBVIOUS).\]

\[IF NEEDED: I only need something that I can use to refer to {him/her}.
Could you please give me {his/her} initals or something else that would
allow me to identify {him/her}?\]

NAME:

> GENDER: MALE 1 AND AGE: \|\_\_\_\|\_\_\_\|
>
> FEMALE 2

  -----------------------------------------------------------------------
  GO TO HE-10.

  -----------------------------------------------------------------------

HE-8. So that the computer can choose someone to interview, may I please
have have the first names and ages of the

> \[FILL \# FROM HE-4 MINUS 1\] adults currently living in this
> household? Please do not include yourself. May I please have {his/her}
> age?
>
> \[IF NEEDED: Include people who [usually]{.underline} stay in this
> household, but are temporarily away on business, vacation, or in the
> hospital. Do [not]{.underline} include persons who are away on
> full-time active military duty with the armed forces, students living
> away from home in their own apartment, or any other family member who
> may be in a nursing home or other institution.\]
>
> \[IF NOT OBVIOUS, ASK: \"Is {NAME} male or female?\"\]

SCQAskAge

SCQGender

> \[IF R ANSWERS DK OR RF TO IDENTIFYING HH MEMBERS, EXIT INTERVIEW.\]

\[IF NEEDED: I only need something that I can use to refer to {him/her}.
Could you please give me {his/her} initals or something else that would
allow me to identify {him/her}?\]

+-------------------------------------+---+--------------+--------------+
| [FIRST NAME]{.underline}            |   | [GENDER]     | [AGE]        |
|                                     |   | {.underline} | {.underline} |
+-------------------------------------+---+--------------+--------------+
|                                     |   | MALE 1       | \|\_\_       |
|                                     |   |              | \_\|\_\_\_\| |
|                                     |   | FEMALE 2     |              |
+-------------------------------------+---+--------------+--------------+
|                                     |   | MALE 1       | \|\_\_       |
|                                     |   |              | \_\|\_\_\_\| |
|                                     |   | FEMALE 2     |              |
+-------------------------------------+---+--------------+--------------+
|                                     |   | MALE 1       | \|\_\_       |
|                                     |   |              | \_\|\_\_\_\| |
|                                     |   | FEMALE 2     |              |
+-------------------------------------+---+--------------+--------------+

+-----------------------------------------------------------------------+
| BOX HE-2                                                              |
|                                                                       |
| RUN SELECTION ALGORITHM ON HH MEMBERS LISTED IN HE-8 TO SELECT        |
| EXTENDED RESPONDENT. THEN, GO TO HE-10.                               |
+-----------------------------------------------------------------------+

HE-9. {May I please have your first name? May I please have your
age?/The computer has randomly determined that the other adult in this
household should participate in the rest of the interview. I would like
to get the first name of this person so I can ask him or her to
participate in the study. May I please have the first name of the other
adult? May I please have {his/her} age?}

SCQHEYourGender

SCQHEYourAge

SCQHEPersonGender

SCQHEPersonAge

\[PROBE FOR GENDER (IF NOT OBVIOUS).\]

\[IF NEEDED: I only need something that I can use to refer to
{you/him/her}. Could you please give me {your/his/her} initals or
something else that would allow me to identify {you/him/her}?\]

NAME:

> GENDER: MALE 1 AND AGE: \|\_\_\_\|\_\_\_\|
>
> FEMALE 2

HE-10. Besides the number I called, do you have other telephone numbers
in your household that are for regular telephone usage? Please exclude
telephone numbers that are dedicated for business use, faxes, or modems
and all cell phones.

MorePhones

YES 1

NO 2

+-----------------------------------------------------------------------+
| BOX HE-3                                                              |
|                                                                       |
| IF EXTENDED RESPONDENT = SCREENER RESPONDENT,                         |
|                                                                       |
| GO TO XINTRO_1.                                                       |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

HE-11. {(HH MEMBER) has been selected to participate in the next part of
the study.} May I please speak to

(HH MEMBER}?

AVAILABLE 1 (XINTRO_1)

NOT AVAILABLE 2 (MAKE APPOINTMENT)

\[XINTRO_1\] {\[Hello\], my name is \[INTERVIEWER'S NAME\] and I am
calling for a nationwide research study being conducted for the National
Cancer Institute. This study is about health issues related to cancer.}
You have been selected to participate in this important research study.
{We know your time is important, so as a token of our appreciation, we
will provide you with \[INCENTIVE AMOUNT\] once we complete the
interview.} The interview will take about 25-30 minutes depending on
your answers, but your participation is voluntary and you can refuse to
answer any questions or withdraw from the study at any time. All
information obtained will be kept confidential to the extent the law
allows. If you want, we can do part of the interview and finish it at
another time.

  -----------------------------------------------------------------------
  GO TO NEXT SECTION.

  -----------------------------------------------------------------------

**END STATEMENT 1. Thank you, but we are only interviewing private
residences. Good-bye.**

**END STATEMENT 2. These are all the questions I have for you at this
time. Thank you very much for your cooperation. Good-bye.**

[]{#__RefHeading___Toc113854656 .anchor}Group Assignment (GA)

GA-0A. \[AUTOFILL. ASK ONLY IF NECESSARY: May I please have your age?\]

SPAge

\|\_\_\_\|\_\_\_\|\_\_\_\| (GA-0C)

AGE

DK (GA-0B)

RF (GA-0B)

GA-0B. Are you...

IMGAgeRange

less than 18 years old, 1 (END STATEMENT 2)

between 18 and 34, 2

35 to 39, 3

40 to 44, or 4

45 or older? 5

DK 9 (END STATEMENT 2)

RF 8 (END STATEMENT 2)

GA-0C. \[ASK IF NOT OBVIOUS: Are you male or female?\]

SPGender

MALE 1

FEMALE 2

GA-0D. WHICH LANGUAGE IS THIS INTERVIEW GOING TO BE CONDUCTED IN?

GA0Language

> ENGLISH 1

SPANISH 2

{We are interested in conducting this survey over the Internet in the
future./We are giving some respondents the option to complete the
questionnaire on the Internet.} So, I need to ask you a few questions
about your access to the Internet.

\[INTERNET REFERS TO ALL SERVICES OFFERED BY AN INTERNET SERVICE
PROVIDER. IT INCLUDES THE USE OF E-MAIL, THE WORLD WIDE WEB, BULLETIN
BOARDS, CHAT GROUPS, DISCUSSION GROUPS, NEWS GROUPS, ON-LINE ORDERING
FACILITIES, FILE TRANSFER (FTP), WEB TV, REAL AUDIO, ETC.\]

GA-1. Do you ever go on-line to use the Internet or World Wide Web, or
to send and receive e-mail?

GA1UseInternet

YES 1

NO 2 (NEXT SECTION)

GA-2. Where do you go on-line from to use the Internet? \[PROBE:
Anywhere else?\]

\[CODE ALL THAT APPLY.\]

GA2WhereUseInternet (1-5)

GA2WhereUseInternet_OS

HOME 11

WORK 12

SCHOOL 13

A PUBLIC LIBRARY 14

A COMMUNITY CENTER 15

SOMEONE ELSE'S HOUSE 16

SOME OTHER PLACE (SPECIFY) 91

+-----------------------------------------------------------------------+
| BOX GA-1                                                              |
|                                                                       |
| IF GA-2 HAS ONLY 1 RESPONSE, GO TO BOX GA-2.                          |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

GA-3. Where do you use the Internet from [most]{.underline} often?

GA3WhereUseInternetMost

HOME 1

WORK 2

SCHOOL 3

A PUBLIC LIBRARY 4

A COMMUNITY CENTER 5

SOMEONE ELSE'S HOUSE 6

\[PLACE SPECIFIED IN GA-2\] 7

+-----------------------------------------------------------------------+
| BOX GA-2                                                              |
|                                                                       |
| IF GA-2 = 11 (HOME), ASK GA-4A.                                       |
|                                                                       |
| OTHERWISE, ASK GA-4B.                                                 |
+-----------------------------------------------------------------------+

GA-4A. When you use the Internet at home, do you [mainly]{.underline}
access it through . . .

GA4AAccessInternet

GA4AAccessInternet_OS

a telephone modem, 1

a cable or satellite modem, 2

a DSL modem, 3

a wireless device such as a PDA, or 4

some other way? (SPECIFY) 91

  -----------------------------------------------------------------------
  GO TO BOX GA-3.

  -----------------------------------------------------------------------

GA-4B. When you use the Internet at \[FILL GA-3\], do you
[mainly]{.underline} access it through . . .

GA4BAccessInternet

a telephone modem or 1

some other way? 2

+-----------------------------------------------------------------------+
| BOX GA-3                                                              |
|                                                                       |
| IF INTERVIEW IS IN SPANISH (GA-0D=2), GO TO NEXT SECTION.             |
|                                                                       |
| IF RANDOMLY ASSIGNED TO TELEPHONE, GO TO NEXT SECTION.                |
|                                                                       |
| IF RANDOMLY ASSIGNED TO CHOICE, CONTINUE.                             |
|                                                                       |
| MODGRP                                                                |
+-----------------------------------------------------------------------+

GA-5. To make participation in this study as convenient as possible for
you, you have the choice of completing the rest of the questions over
the telephone or on the Internet. Which would you prefer?

GA5ModeChoice

TELEPHONE 1 (NEXT SECTION)

INTERNET 2

GA-6. We would like to e-mail the information you need to access the
questionnaire on the Internet. What is your e-mail address?

EMAIL: (END 2)

DOESN'T HAVE AN EMAIL ADDRESS (GA-7)

DK (GA-7)

RF (GA-7)

GA-7. It is easier to give you the information for accessing the
Internet questionnaire in writing, because you will need some detailed
instructions. In order to mail you the information, I need your name and
address.

DK (GA-08)

RF (GA-08)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FIRST NAME

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

LAST NAME

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS1

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS2

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY

> \|\_\_\|\_\_\| \|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\| -
> \|\_\_\|\_\_\|\_\_\|\_\_\|

STATE ZIP CODE

> GA7HHState
>
> GA7HHZipCode

  -----------------------------------------------------------------------
  GO TO END2.

  -----------------------------------------------------------------------

GA-8. Then, let me give you the information you need to access the web
site over the phone. Do you have a pencil and paper? First, let me give
you the web site address. It is \[INSERT URL\]. On the home page, you
will be asked to log in with a unique name and password. Your login name
is \[FILL LOGIN\] and your password is \[FILL PASSWORD\]. The survey
will be available to you starting tomorrow evening.

**\[END2\] Thank you for your time today. Please call us at
1-888-314-1133 if you have any questions about accessing the web site to
complete the rest of the questions. If we haven't received your survey
in 2 weeks, we will call you back to make sure you haven't had any
problems getting onto the web site.**

This page left blank intentionally.

[]{#__RefHeading___Toc113854657 .anchor}HEALTH Communication (HC)

+-----------------------------------------------------------------------+
| BOX HC-1                                                              |
|                                                                       |
| IF RESPONDENT DOES NOT WATCH TV (HC-01a=95) THEN SKIP QUESTIONS       |
| HC-02a, HC-03b, HC-03c, HC-08, HC-09 AND HC-13g.                      |
|                                                                       |
| IF RESPONDENT DOES NOT LISTEN TO THE RADIO (HC-01b=95) THEN SKIP      |
| QUESTIONS HC-02b, AND HC-13e.                                         |
|                                                                       |
| IF RESPONDENT DOES NOT USE THE INTERNET (GA-1=2 OR HC01c=95) THEN     |
| SKIP QUESTIONS HC-01c, HC-02c, HC-10, HC-11, HC-13f, AND              |
|                                                                       |
| HC-14 THROUGH HC-16.                                                  |
|                                                                       |
| IF RESPONDENT CANNOT READ (HC-03a=9) THEN SKIP QUESTIONS HC-04,       |
| HC-05, HC-13c AND HC-13d.                                             |
+-----------------------------------------------------------------------+

MEDIA EXPOSURE

Before the questions specifically about cancer, there are some questions
about how you get information in general.

HC-01. On a typical weekday, about how many hours do you...

\[IF GREATER THAN ZERO, BUT LESS THAN ONE HOUR, ENTER 1.\]

\[IF NOT APPLICABLE, ENTER 95.\] [HOURS]{.underline}

a\. watch television? \|\_\_\_\|\_\_\_\|

HC01aWatchTV

b\. listen to the radio? \|\_\_\_\|\_\_\_\|

HC01bListenRadio

c\. use the Internet for personal reasons? I\_\_\_I\_\_\_I

HC01cUseInternet

HC-02. During a typical weekend, including both Saturday and Sunday,
about how many hours do you....

\[IF GREATER THAN ZERO, BUT LESS THAN ONE HOUR, ENTER 1.\]

[HOURS]{.underline}

a\. watch television? \|\_\_\_\|\_\_\_\|

HC02aWeekendWatchTV

b\. listen to the radio? \|\_\_\_\|\_\_\_\|

HC02bWeekendRadio

c\. use the Internet for personal reasons? I\_\_\_I\_\_\_I

HC02cWeekendInternet

HC-03. In the past seven days, how many days did you\...

[DAYS]{.underline}

\[IF NOT APPLICABLE, ENTER 9\]

a\. read a newspaper? \|\_\_\_\|\_\_\_\|

HC03aReadNewspaper

b\. watch the national news on television? \|\_\_\_\|\_\_\_\|

HC03bNationalNews

c\. watch the local news on television? \|\_\_\_\|\_\_\_\|

HC03cLocalNews

EXPOSURE TO HEALTH INFORMATION

The next few questions are about various ways you might get health
information.

HC-04. Some newspapers or general magazines publish a special section
that focuses on health. In the past 12 months, have you read health
sections of the newspaper or of a general magazine?

HC04ReadHealthSection

YES 1

NO 2 (HC-08)

HC-05. About how often have you read such health sections in the past 12
months? Would you say.....

HC05HowOftenHealthSection

once or more per week, or 1

less than once per week? 2

  -----------------------------------------------------------------------
  HC-06 AND HC-07 DELETED.

  -----------------------------------------------------------------------

HC-08. Some local television news programs include special segments of
their newscasts that focus on health issues. In the past 12 months, have
you watched health segments on the local news?

HC08HealthOnNews

YES 1

NO 2 (HC-10)

HC-09. How often have you watched health segments on local news in the
past 12 months? Would you say....

HC09HowOftenHealthOnNews

once or more per week, or 1

less than once per week? 2

HC-10. Some people notice information about health on the Internet, even
when they are not trying to find out about a health concern they have or
someone in the family has. Have you read such health information on the
Internet in the past 12 months?

HC10NoticeInfo

YES 1

NO 2 (HC-13)

HC-11. About how often have you read this sort of information in the
past 12 months? Would you say...

HC11HowOftenNoticeInfo

once or more per month, or 1

less than once per month? 2

  -----------------------------------------------------------------------
  HC-12 DELETED.

  -----------------------------------------------------------------------

HC-13. How much would you trust information about health or medical
topics \[FILL SOURCE\]? Would you say a lot, some, a little or not at
all? (How about from \[FILL SOURCE\])?

\[ASK IN RANDOM ORDER.\] HCGRP

+--------------------------------------+------+------+-------+--------+
|                                      | **[A | **   | **[A  | **[NOT |
|                                      | LO   | [SOM | L     | AT     |
|                                      | T]{. | E]{. | ITTLE | ALL]{. |
|                                      | unde | unde | ]{.un | underl |
|                                      | rlin | rlin | derli | ine}** |
|                                      | e}** | e}** | ne}** |        |
+--------------------------------------+------+------+-------+--------+
| a\. from a doctor or other health    | 1    | 2    | 3     | 4      |
| care professional                    |      |      |       |        |
|                                      |      |      |       |        |
| HC13aTrustDoctor                     |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| b\. from family or friends           | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13bTrustFamily                     |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| c\. in newspapers                    | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13cTrustNewspaper                  |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| d\. in magazines                     | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13dTrustMagazines                  |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| e\. on the radio                     | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13eTrustRadio                      |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| f\. on the Internet                  | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13fTrustInternet                   |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| g\. on television                    | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| HC13gTrustTV                         |      |      |       |        |
+--------------------------------------+------+------+-------+--------+

INTERNET USAGE FOR HEALTH

HC-14. Here are some ways people use the Internet. Some people have done
these things, but other people have not.

In the past 12 months, have you done the following things while using
the Internet?

+------------------------------------------------------+-------+-------+
|                                                      | *     | **[NO |
|                                                      | *[YES | ]{.un |
|                                                      | ]{.un | derli |
|                                                      | derli | ne}** |
|                                                      | ne}** |       |
+------------------------------------------------------+-------+-------+
| a\. Looked for health or medical information for     | 1     | 2     |
| yourself?                                            |       |       |
|                                                      |       |       |
| HC14aHealthInfoSelf                                  |       |       |
+------------------------------------------------------+-------+-------+
| b\. Looked for health or medical information for     | 1     | 2     |
| someone else?                                        |       |       |
|                                                      |       |       |
| HC14bHealthInfoOther                                 |       |       |
+------------------------------------------------------+-------+-------+
| c\. Bought medicine or vitamins on-line?             | 1     | 2     |
|                                                      |       |       |
| HC14cBuyMedicine                                     |       |       |
+------------------------------------------------------+-------+-------+
| d\. Participated in an on-line support group for     | 1     | 2     |
| people with a similar health or medical issue?       |       |       |
|                                                      |       |       |
| HC14dSupportGroup                                    |       |       |
+------------------------------------------------------+-------+-------+
| e\. Used e-mail or the Internet to communicate with  | 1     | 2     |
| a doctor or a doctor's office?                       |       |       |
|                                                      |       |       |
| HC14eTalkDoctor                                      |       |       |
+------------------------------------------------------+-------+-------+
| f\. Looked for information about physical activity   | 1     | 2     |
| or exercise?                                         |       |       |
|                                                      |       |       |
| HC14fExerciseInfo                                    |       |       |
+------------------------------------------------------+-------+-------+
| g\. Looked for information about diet or nutrition?  | 1     | 2     |
|                                                      |       |       |
| HC14gDietInfo                                        |       |       |
+------------------------------------------------------+-------+-------+
| h\. Looked for information about protecting yourself | 1     | 2     |
| from the sun?                                        |       |       |
|                                                      |       |       |
| HC14hSunInfo                                         |       |       |
+------------------------------------------------------+-------+-------+
| i\. Looked for information about quitting smoking?   | 1     | 2     |
|                                                      |       |       |
| HC14iSmokingInfo                                     |       |       |
+------------------------------------------------------+-------+-------+
| k\. Done anything else health-related on the         | 1     | 2     |
| Internet?                                            |       |       |
|                                                      |       |       |
| (SPECIFY)                                            |       |       |
|                                                      |       |       |
| HC14kAnythingElseOnline                              |       |       |
|                                                      |       |       |
| HC14kAnythingElseOnline_OS                           |       |       |
+------------------------------------------------------+-------+-------+

  -----------------------------------------------------------------------
  HC-14j DELETED.

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| BOX HC-2                                                              |
|                                                                       |
| IF DID NOT LOOK FOR HEALTH INFO FOR SELF OR SOMEONE ELSE ON INTERNET  |
| (HC-14a=2 AND HC-14b=2),                                              |
|                                                                       |
| THEN GO TO NEXT SECTION.                                              |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

HC-15. Have you ever talked to a doctor, nurse, or other health care
provider about any kind of health information you have gotten from the
Internet?

HC15TalkedDoctor

YES 1

NO 2 (NEXT SECTION)

HC-16. When you talked with a health care provider, how interested were
they in hearing about the information you found on-line? Were they...

HC16DoctorInterested

very interested, 1

somewhat interested, 2

a little interested, or 3

not at all interested? 4

[]{#__RefHeading___Toc113854661 .anchor}Cancer Communication (CA)

TOUCHED BY CANCER

The next few questions are about your personal experience with cancer.

CA-01. Have you ever been told by a doctor that you had cancer?

CA01EverHadCancer

YES 1

NO 2 (CA-06)

YES, BUT IT WAS A MIS-DIAGNOSIS 3 (CA-06)

CA-02. What type of cancer was it, or in what part of the body did the
cancer start? \[PROBE: Anything else?\]

\[CODE ALL THAT APPLY.\]

CA02TypeofSPsCancer (01-05)

CA02TypeofSPsCancer_OS

BLADDER CANCER 10

BONE CANCER 11

BREAST CANCER 12

CERVICAL CANCER (CANCER OF THE CERVIX) 13

COLON CANCER 14

ENDOMETRIAL CANCER (CANCER OF THE UTERUS) 15

HEAD AND NECK CANCER 16

HODGKIN'S LYMPHOMA 17

LEUKEMIA/BLOOD CANCER 18

LIVER CANCER 19

LUNG CANCER 20

MELANOMA 21

NON-HODGKIN'S LYMPHOMA 22

OTHER SKIN CANCER 23

ORAL CANCER 24

OVARIAN CANCER 25

PANCREATIC CANCER 26

PHARYNGEAL (THROAT) CANCER 27

PROSTATE CANCER 28

RECTAL CANCER 29

RENAL (KIDNEY) CANCER 30

STOMACH CANCER 31

OTHER (SPECIFY) 91

CA-03. At what age or in what year were you first told that you had
cancer?

CA03WhenDiagnosedCancer_Unit

CA03WhenDiagnosedCancer

\[ENTER UNIT.\]

\|\_\_\_\|

UNIT

AGE 1

YEAR 2

\[ENTER {AGE/YEAR}.\]

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

AGE/YEAR

CA-04. Did you undergo treatment for your cancer?

CA04UndergoCancerTreatment

YES 1

NO 2 (CA-06)

CA-05. How long ago did you finish your treatment?

CA05HowLongFinishTreatment\_ Unit

CA05HowLongFinishTreatment

\[ENTER UNIT.\]

\|\_\_\_I

UNIT

MONTHS 1

YEARS 2

STILL IN TREATMENT 3 (CA-06)

\[ENTER NUMBER.\]

\|\_\_\_\|\_\_\_\|

NUMBER

CA-06. Have any of your family members ever had cancer?

CA06FamilyEverHadCancer

\[IF INDICATE "DOESN'T HAVE FAMILY," CODE AS "NO FAMILY."\]

YES 1

NO 2 (CA-08)

NO FAMILY 3 (CA-08)

CA-07. What type of cancer was it? \[PROBE: Anything else?\]

\[CODE ALL THAT APPLY.\]

CA07TypeFamilyCancer (01-08)

CA07TypeFamilyCancer_OS

BLADDER CANCER 10

BONE CANCER 11

BREAST CANCER 12

CERVICAL CANCER (CANCER OF THE CERVIX) 13

COLON CANCER 14

ENDOMETRIAL CANCER (CANCER OF THE UTERUS) 15

HEAD AND NECK CANCER 16

HODGKIN'S LYMPHOMA 17

LEUKEMIA/BLOOD CANCER 18

LIVER CANCER 19

LUNG CANCER 20

MELANOMA 21

NON-HODGKIN'S LYMPHOMA 22

OTHER SKIN CANCER 23

ORAL CANCER 24

OVARIAN CANCER 25

PANCREATIC CANCER 26

PHARYNGEAL (THROAT) CANCER 27

PROSTATE CANCER 28

RECTAL CANCER 29

RENAL (KIDNEY) CANCER 30

STOMACH CANCER 31

OTHER (SPECIFY) 91

**INFORMATION SEEKING ABOUT CANCER**

Next are some questions about looking for information on cancer. Please
consider all sources of information such as the Internet, the library,
friends, and health care professionals.

CA-08. Have you ever looked for information about cancer from any
source?

CA08SeekCancerInfo

YES 1

NO 2

CA-09. Not including your doctor or other health care provider, has
someone else ever looked for information about cancer

for you?

CA09OtherSeekCancerInfo

YES 1

NO 2 (BOX CA-1)

CA-10. Who was that? \[PROBE: Anyone else?\]

\[CODE ALL THAT APPLY.\]

CA10WhoSeekCancerInfo (1-4)

CA10WhoSeekCancerInfo_OS

SPOUSE 10

OTHER FAMILY MEMBER 11

FRIEND 12

CO-WORKER 13

INFORMATION SPECIALIST (E.G., LIBRARIAN) 14

OTHER (SPECIFY) 91

+-----------------------------------------------------------------------+
| BOX CA-1                                                              |
|                                                                       |
| IF RESPONDENT HAS NOT LOOKED FOR INFORMATION                          |
|                                                                       |
| FROM ANY SOURCE ON CANCER, NEITHER INDIVIDUALLY                       |
|                                                                       |
| NOR THROUGH SOMEONE ELSE (CA-08=2 AND CA-09=2), THEN GO TO CA-17.     |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
|                                                                       |
| IF SOMEONE ELSE LOOKED FOR INFORMATION (CA-09=1), THEN INCLUDE        |
| BRACKETED PHRASE IN CA-11 INTRODUCTION.                               |
+-----------------------------------------------------------------------+

Think about the most recent time you looked for cancer-related
information from any source {either on your own or by someone else
looking for you}.

CA-11. About how long ago was that?

CA11LookCancerInfo_Unit

CA11LookCancerInfo

\[ENTER UNIT.\]

\|\_\_\_\|

UNIT

DAYS AGO 1

WEEKS AGO 2

MONTHS AGO 3

YEARS AGO 4

\[ENTER NUMBER.\]

\|\_\_\_\|\_\_\_\|

NUMBER

+-----------------------------------------------------------------------+
| BOX CA-2                                                              |
|                                                                       |
| IF SP HAS NOT LOOKED FOR INFORMATION ABOUT CANCER THEMSELF (CA-08=2), |
| THEN GO TO CA-17.                                                     |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

CA-12. The most recent time you wanted information on cancer, where did
you go first?

CA12WhereLookCancerInfo

CA12WhereLookCancerInfo_OS

\[IF SP HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST RECENT
SEARCH.\]

BOOKS 1

BROCHURES, PAMPHLETS, ETC. 2

CANCER ORGANIZATION 3

FAMILY 4

FRIEND/CO-WORKER 5

HEALTH CARE PROVIDER 6

INTERNET 7

LIBRARY 8

MAGAZINES 9

NEWSPAPERS 10

SOMEONE WITH CANCER 11

TELEPHONE INFORMATION NUMBER (1-800 NUMBER) 12

OTHER (SPECIFY) 91

CA-13. What type of information were you looking for in your most recent
search?

\[CODE ALL THAT APPLY.\]

CA13WhatLookCancerInfo (1-6)

CA13WhatLookCancerInfo_OS

A SPECIFIC CANCER 10

CANCER ORGANIZATIONS 11

CAUSES OF CANCER / RISK FACTORS FOR CANCER 12

COPING WITH CANCER / DEALING WITH CANCER 13

DIAGNOSIS OF CANCER 14

INFORMATION ON CANCER IN GENERAL 15

PAYING FOR MEDICAL CARE / INSURANCE 16

PREVENTION OF CANCER 17

PROGNOSIS / RECOVERY FROM CANCER 18

SCREENING / TESTING / EARLY DETECTION 19

SYMPTOMS OF CANCER 20

TREATMENT / CURES FOR CANCER 21

WHERE TO GET MEDICAL CARE 22

OTHER (SPECIFY) 91

BARRIERS TO CANCER INFORMATION SEEKING

CA-14. Based on the results of your most recent search for information
on cancer, how much do you agree or disagree with the following
statements?

\[IF SP HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST RECENT
SEARCH.\]

+---------------------------------+--------+--------+--------+--------+
|                                 | ST     | SO     | SO     | ST     |
|                                 | RONGLY | MEWHAT | MEWHAT | RONGLY |
|                                 | [      | [      | [DIS   | [DIS   |
|                                 | AGREE] | AGREE] | AGREE] | AGREE] |
|                                 | {.unde | {.unde | {.unde | {.unde |
|                                 | rline} | rline} | rline} | rline} |
+---------------------------------+--------+--------+--------+--------+
| a\. It took a lot of effort to  | 1      | 2      | 3      | 4      |
| get the information you needed. |        |        |        |        |
| Would you say you\...           |        |        |        |        |
|                                 |        |        |        |        |
| CA14aALotEffort                 |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| b\. You felt frustrated during  | 1      | 2      | 3      | 4      |
| your search for the             |        |        |        |        |
| information. (Would you say     |        |        |        |        |
| you\...)                        |        |        |        |        |
|                                 |        |        |        |        |
| CA14bFrustrated                 |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| c\. You were concerned about    | 1      | 2      | 3      | 4      |
| the quality of the information. |        |        |        |        |
| (Would you say you\...)         |        |        |        |        |
|                                 |        |        |        |        |
| CA14cConcernedQuality           |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| d\. The information you found   | 1      | 2      | 3      | 4      |
| was too hard to understand.     |        |        |        |        |
| (Would you say you\...)         |        |        |        |        |
|                                 |        |        |        |        |
| CA14dTooHardUnderstand          |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+

+-----------------------------------------------------------------------+
| BOX CA-3                                                              |
|                                                                       |
| IF RESPONDENT DOESN'T USE INTERNET (GA-1=2), GO TO CA-17.             |
|                                                                       |
| IF RESPONDENT'S MOST RECENT SEARCH WAS ON THE                         |
|                                                                       |
| INTERNET (CA-12=7), GO TO CA-16.                                      |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

CANCER INFO ON THE INTERNET

CA-15. Have you ever visited an Internet web site to learn specifically
about cancer?

CA15InternetForCancer

YES 1

NO 2 (CA-17)

CA-16. {Thinking about [all]{.underline} the times you've looked for
cancer information on the Internet,} {How/how} [useful]{.underline} was
the cancer-related information you got from the Internet? Would you say
. . .

CA16UsefulInternetForCancer

very useful, 1

somewhat useful, 2

a little useful, or 3

not at all useful? 4

INFORMATION EFFICACY

CA-17. Overall, how confident are you that you could get advice or
information about cancer if you needed it? Would you

say...

CA17ConfidentGetCancerInfo

completely confident, 1

very confident, 2

somewhat confident, 3

a little confident, or 4

not confident at all? 5

SOURCE PREFERENCES

CA-18. {The next time you have a strong need to get information about
cancer, where will you go first?/Imagine that you had a strong need to
get information about cancer. Where would you go first?}

CA18WhereGoFirst

CA18WhereGoFirst_OS

BOOKS 1

BROCHURES, PAMPHLETS, ETC. 2

CANCER ORGANIZATION 3

FAMILY 4

FRIEND/CO-WORKER 5

HEALTH CARE PROVIDER 6

INTERNET 7

LIBRARY 8

MAGAZINES 9

NEWSPAPERS 10

TELEPHONE INFORMATION NUMBER (1-800 NUMBER) 11

SOMEONE WITH CANCER 12

OTHER (SPECIFY) 91

  -----------------------------------------------------------------------
  CA-19 AND CA-20 DELETED.

  -----------------------------------------------------------------------

SOURCE RECOGNITION AND USE

CA-21. Before being contacted for this study, had you ever heard of\...

+--------------------------------------------+-------+-----+-----------+
|                                            | *     | **  |           |
|                                            | *[YES | [NO |           |
|                                            | ]{.un | ]{. |           |
|                                            | derli | und |           |
|                                            | ne}** | erl |           |
|                                            |       | ine |           |
|                                            |       | }** |           |
+--------------------------------------------+-------+-----+-----------+
| c\. the National Cancer Institute?         | 1     | 2   | (CA-21e)  |
|                                            |       |     |           |
| CA21cNCI                                   |       |     |           |
+--------------------------------------------+-------+-----+-----------+
| d\. the National Cancer Institute's Cancer | 1     | 2   |           |
| Information Service?                       |       |     |           |
|                                            |       |     |           |
| CA21dCIS                                   |       |     |           |
+--------------------------------------------+-------+-----+-----------+
| e\. the 1-800-4-Cancer information number? | 1     | 2   |           |
|                                            |       |     |           |
| CA21eCancerHotline                         |       |     |           |
+--------------------------------------------+-------+-----+-----------+
| h\. the 1-800-ACS-2345 cancer information  | 1     | 2   |           |
| number?                                    |       |     |           |
|                                            |       |     |           |
| CA21hACS800Number                          |       |     |           |
+--------------------------------------------+-------+-----+-----------+
| i\. Cancer Control of America?             | 1     | 2   |           |
|                                            |       |     |           |
| CA21iCancerControl                         |       |     |           |
+--------------------------------------------+-------+-----+-----------+

  -----------------------------------------------------------------------
  CA-21a, CA-21b, CA-21f AND CA-21g DELETED.

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| BOX CA-4                                                              |
|                                                                       |
| IF HAVE NEVER HEARD OF CIS OR 800-NUMBER (CA-21d AND CA-21e = 2)      |
|                                                                       |
| THEN GO TO NEXT SECTION.                                              |
|                                                                       |
| OTHERWISE, ASK CA-22 FOR EACH "YES" ANSWER IN CA-21d AND CA-21e       |
| BEFORE MOVING ON TO NEXT ITEM IN CA-21.                               |
+-----------------------------------------------------------------------+

CA-22. Have you ever contacted it for information?

CA22dContactedSource

CA22eContactedSource

YES 1

NO 2

+-----------------------------------------------------------------------+
| BOX CA-5                                                              |
|                                                                       |
| IF RESPONDENT HAS EVER LOOKED FOR CANCER INFORMATION (CA-08=1) AND    |
| ANSWERED "NO" TO CA-22e, THEN CONTINUE.                               |
|                                                                       |
| OTHERWISE, GO TO NEXT SECTION.                                        |
+-----------------------------------------------------------------------+

CA-23. Is there a particular reason you didn't contact it?

CA23eWhyNotContactedSource

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

This page left blank intentionally.

[]{#__RefHeading___Toc113854668 .anchor}PROSTATE CANCER (PC)

+-----------------------------------------------------------------------+
| BOX PC-1                                                              |
|                                                                       |
| IF RESPONDENT IS MALE, IS 45 OR OLDER, AND HAS NOT HAD PROSTATE       |
| CANCER, CONTINUE. OTHERWISE, GO TO NEXT SECTION                       |
+-----------------------------------------------------------------------+

The next few questions are about getting tested for cancer. A
Prostate-Specific Antigen test, also called a PSA test, is a blood test
used to check men for prostate cancer.

PC-01. Have you ever heard of a PSA or prostate-specific antigen test?

PC01EverHeardPSATest

YES 1

NO 2 (NEXT SECTION)

PC-02. Have you ever had a PSA test?

PC02HadPSATest

YES 1

NO 2 (INTRO TO PC-04)

HAD BLOOD TEST, BUT DK IF CHECKED PSA 3 (INTRO TO PC-04)

PC-03. When did you have your most recent PSA test?

PC03WhenPSATest

A YEAR AGO OR LESS 1

MORE THAN 1 BUT NOT MORE THAN 2 YEARS AGO 2

MORE THAN 2 BUT NOT MORE THAN 5 YEARS AGO 3

OVER 5 YEARS AGO 4

The next few questions are about discussions that health care providers
might have had with you about the PSA test.

PC-04. Has a health care provider such as a doctor or nurse ever talked
to you about a PSA test?

PC04ProviderTalkedPSA

YES 1

NO 2 (NEXT SECTION)

PC-05. Thinking about the last time a health care provider talked to you
about a PSA test, which of the following statements best describes your
health care provider's recommendation about PSA tests?

PC05ProviderRecommendPSA

That you should have a PSA test, 1

that you should NOT have a PSA test, or 2

your health care provider did not make a recommendation 3

PC-06. Thinking about the last time a health care provider talked to you
about a PSA test, did your health care provider encourage you to ask
questions or express any concerns you had about PSA testing? Would you
say.....

PC06QuestionsAboutPSA

yes, definitely, 1

yes, somewhat, or 2

no, not at all? 3

DID NOT HAVE ANY QUESTIONS OR CONCERNS ABOUT PSA 4

  -----------------------------------------------------------------------
  PC-07 DELETED.

  -----------------------------------------------------------------------

This page left blank intentionally.

[]{#__RefHeading___Toc113854669 .anchor}CERVICAL CANCER (CV)

+-----------------------------------------------------------------------+
| BOX CV-1                                                              |
|                                                                       |
| IF RESPONDENT IS FEMALE AND HAS NOT HAD CERVICAL CANCER, CONTINUE.    |
| OTHERWISE, GO TO NEXT SECTION                                         |
+-----------------------------------------------------------------------+

The next few questions are about getting tested for cancer. A Pap smear
is a test for cancer of the cervix.

CV-01. Have you ever had a Pap smear?

CV01HadPapSmear

YES 1

NO 2 (CV-07)

CV-02. When did you have your most recent Pap smear?

CV02WhenPapSmear

A YEAR AGO OR LESS 1

MORE THAN 1 BUT NOT MORE THAN 3 YEARS AGO 2

MORE THAN 3 BUT NOT MORE THAN 5 YEARS AGO 3

OVER 5 YEARS AGO 4

CV-03. What was the main reason that you had this Pap smear?

CV03WhyPapSmear

CV03WhyPapSmear_OS

ROUTINE ANNUAL PAP SMEAR OR PART OF

ROUTINE PHYSICAL EXAM 1

LAST PAP SMEAR WAS NOT NORMAL 2

A SPECIFIC PROBLEM 3

SOMETHING SHE HEARD / SAW / READ 4

SHE HAD NEVER HAD ONE AND THOUGHT SHE SHOULD 5

PREGNANCY / FOLLOW-UP TO BIRTH 6

OTHER
(SPECIFY)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

CV-04. You said your most recent Pap smear was {INSERT TIME FRAME FROM
CV-02}. How long before [that]{.underline} Pap smear was the previous
one?

CV04PapSmearBeforeLast

A YEAR OR LESS BEFORE 1

MORE THAN 1 BUT NOT MORE THAN 3 YEARS BEFORE 2

MORE THAN 3 BUT NOT MORE THAN 5 YEARS BEFORE 3

OVER 5 YEARS BEFORE 4

THIS WAS FIRST PAP SMEAR 5

CV-05. Have you had a hysterectomy?

CV05Hysterectomy

\[IF NEEDED: A hysterectomy is an operation to remove the uterus
(womb).\]

YES 1 (CV-07)

NO 2

CV-06. When do you expect to have your next Pap smear?

CV06WhenNextPapSmear

A YEAR OR LESS FROM NOW 1

MORE THAN 1 BUT NOT MORE THAN 3 YEARS FROM NOW 2

MORE THAN 3 BUT NOT MORE THAN 5 YEARS FROM NOW 3

OVER 5 YEARS FROM NOW 4

AM NOT PLANNING TO HAVE ANOTHER 5

IF I HAVE SYMPTOMS 6

WHEN DOCTOR / HEALTH PROVIDER RECOMMENDS 7

CV-07. How often do you think a woman your age should have a Pap smear?

CV07HowOftenPapSmear

MORE THAN TWICE A YEAR 1

TWICE A YEAR / EVERY SIX MONTHS 2

ONCE A YEAR 3

EVERY TWO YEARS 4

EVERY THREE YEARS 5

MORE THAN EVERY THREE YEARS 6

NEVER 7

CV-08. Most medical organizations now recommend a Pap smear every three
years for healthy adult women. Have you heard about this change in
guidelines?

CV08GuidelinesChange

YES 1

NO 2

+-----------------------------------------------------------------------+
| BOX CV-2                                                              |
|                                                                       |
| IF RESPONDENT DOES NOT PLAN TO HAVE ANOTHER PAP SMEAR (CV-06=5) OR    |
| HAS HAD A HYSTERECTOMY (CV-05=1) , GO TO CV-10.                       |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

CV-09. Would you agree to have Pap smears every three years if your
health care provider recommended it?

CV09LessFrequentPapSmear

YES 1

NO 2

CV-10. Have you ever been treated for venereal warts or condyloma?

CV10TreatedWarts

YES 1

NO 2

CV-11. Have you ever heard of HPV? HPV stands for Human Papillomavirus.

CV11HeardHPV

YES 1

NO 2 (NEXT SECTION)

CV-12. Have you ever been told by a health care provider that you had
HPV infection?

CV12EverHadHPV

YES 1

NO 2

CV-13. Next are some questions on your opinion about HPV.

+--------------------------------------------+-------+--------+------+
|                                            | *     | **     |      |
|                                            | *[YES | [NO]{. |      |
|                                            | ]{.un | underl |      |
|                                            | derli | ine}** |      |
|                                            | ne}** |        |      |
+--------------------------------------------+-------+--------+------+
| a\. Do you think that HPV causes cervical  | 1     | 2      |      |
| cancer?                                    |       |        |      |
|                                            |       |        |      |
| CV13aHPVCauseCancer                        |       |        |      |
+--------------------------------------------+-------+--------+------+
| b\. Do you think that HPV is a sexually    | 1     | 2      |      |
| transmitted disease?                       |       |        |      |
|                                            |       |        |      |
| CV13bHPVSTD                                |       |        |      |
+--------------------------------------------+-------+--------+------+
| c\. Do you think that HPV infection is     | 1     | 2      |      |
| rare?                                      |       |        |      |
|                                            |       |        |      |
| CV13cHPVRare                               |       |        |      |
+--------------------------------------------+-------+--------+------+
| d\. Do you think that HPV will often go    | 1     | 2      |      |
| away on its own without treatment?         |       |        |      |
|                                            |       |        |      |
| CV13dHPVGoAway                             |       |        |      |
+--------------------------------------------+-------+--------+------+
| e\. Do you think HPV can cause abnormal    | 1     | 2      |      |
| Pap smears?                                |       |        |      |
|                                            |       |        |      |
| CV13eHPVCauseAbnormalPap                   |       |        |      |
+--------------------------------------------+-------+--------+------+
| f\. Do you think that HPV can affect a     | 1     | 2      |      |
| woman's ability to get pregnant?           |       |        |      |
|                                            |       |        |      |
| CV13fHPVAffectPregnancy                    |       |        |      |
+--------------------------------------------+-------+--------+------+

This page left blank intentionally.

[]{#__RefHeading___Toc113854670 .anchor}BREAST CANCER (BC)

+-----------------------------------------------------------------------+
| BOX BC-1                                                              |
|                                                                       |
| IF RESPONDENT IS FEMALE, 35 YEARS OR OLDER AND HAS NOT HAD BREAST     |
| CANCER, CONTINUE.                                                     |
|                                                                       |
| OTHERWISE, GO TO NEXT SECTION.                                        |
+-----------------------------------------------------------------------+

The next few questions are about breast cancer.

BC-01. A mammogram is an x-ray of each breast to look for breast cancer.
Have you ever had a mammogram?

BC01HadMammogram

YES 1

NO 2 (BC-03)

BC-02. When did you have your most recent mammogram to check for breast
cancer?

BC02WhenMammogram

A YEAR AGO OR LESS 1

MORE THAN 1 BUT NOT MORE THAN 2 YEARS AGO 2

MORE THAN 2 BUT NOT MORE THAN 5 YEARS AGO 3

OVER 5 YEARS AGO 4

  -----------------------------------------------------------------------
  BC-03 DELETED.

  -----------------------------------------------------------------------

This page left blank intentionally.

[]{#__RefHeading___Toc113854671 .anchor}COLON CANCER (CC)

The next few questions are about colon cancer.

CC-01. Can you think of any tests that detect colon cancer? \[PROBE:
Anything else?\]

CC01TestsForColonCancer (1-7)

CC01TestsForColonCancer_OS

\[CODE ALL THAT APPLY. IF R DOES NOT KNOW NAME OF TEST, ENTER
DESCRIPTION OF TEST IN OTHER, SPECIFY.\]

\[DO NOT NAME OR DEFINE TESTS FOR THE RESPONDENT.\]

BARIUM ENEMA 10

BIOPSY 11

STOOL BLOOD TEST/FECAL OCCULT BLOOD TEST 12

COLONOSCOPY 13

DIGITAL RECTAL EXAM 14

ENDOSCOPY 15

PROCTOSCOPY 16

SIGMOIDOSCOPY 17

OTHER (SPECIFY) 91

NO/NOTHING 0

  -----------------------------------------------------------------------
  CC-02 AND CC-03 DELETED.

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| BOX CC-1                                                              |
|                                                                       |
| IF RESPONDENT IS LESS THAN 45 YEARS OLD OR HAS HAD COLON CANCER,      |
|                                                                       |
| GO TO NEXT SECTION.\                                                  |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

CC-04. Has a doctor, nurse or other health professional ever advised you
to get a test to check for colon cancer?

CC04AdviseCheckColonCancer

YES 1

NO 2

CC-05. A stool blood test, also known as a Fecal Occult Blood Test, is a
test done to check for colon cancer. It is done at home using a set of 3
cards to determine whether the stool contains blood. Have you ever done
this test using a home kit?

CC05HadStoolBlood

YES 1

NO 2 (CC-07)

CC-06. When did you do your most recent stool blood test using a home
kit to check for colon cancer?

CC06WhenStoolBlood

A YEAR AGO OR LESS 1

MORE THAN 1 BUT NOT MORE THAN 2 YEARS AGO 2

MORE THAN 2 BUT NOT MORE THAN 5 YEARS AGO 3

OVER 5 YEARS AGO 4

CC-07. A sigmoidoscopy and a colonoscopy are both tests that examine the
bowel by inserting a tube in the rectum. Have you ever had either a
colonoscopy or a sigmoidoscopy?

CC07HadSigCol

YES 1

NO 2 (NEXT SECTION)

CC-08. When did you have your most recent sigmoidoscopy or colonoscopy
to check for colon cancer?

CC08WhenSigCol

A YEAR AGO OR LESS 1

MORE THAN 1 BUT NOT MORE THAN 5 YEARS AGO 2

MORE THAN 5 BUT NOT MORE THAN 10 YEARS AGO 3

OVER 10 YEARS AGO 4

[]{#__RefHeading___Toc113854672 .anchor}*Mental Model of Cancer: COLON
(MM)*

+-----------------------------------------------------------------------+
| BOX MM-1                                                              |
|                                                                       |
| RESPONDENTS WILL BE RANDOMLY ASSIGNED TO RECEIVE MENTAL MODEL         |
| QUESTIONS ON COLON, LUNG OR SKIN CANCER.                              |
|                                                                       |
| MMGRP                                                                 |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO COLON CANCER, CONTINUE.                  |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO COLON CANCER BUT HAS HAD COLON CANCER,   |
| GO TO THE NEXT SECTION.                                               |
|                                                                       |
| IF RESPONDENT IS NOT ASSIGNED TO COLON CANCER, GO TO THE NEXT         |
| SECTION.                                                              |
+-----------------------------------------------------------------------+

MM-01. How likely do you think it is that you will develop colon cancer
in the future? Would you say your chance of getting colon cancer is . .
.

MM01ChanceGetCancerC

very low, 1

somewhat low, 2

moderate, 3

somewhat high, or 4

very high? 5

MM-02. Compared to the average person your age, would you say that you
are . . .

MM02RelativeChanceCancerC

more likely to get colon cancer, 1

less likely, or 2

about as likely? 3

MM-03. How often do you worry about getting colon cancer? Would you say
. . .

MM03FreqWorryCancerC

rarely or never, 1

sometimes, 2

often, or 3

all the time? 4

MM-04. What are some things that people can do to reduce their chances
of getting colon cancer?

MM04ReduceCancerC (01-08)

MM04ReduceCancerC_OS

\[CODE ALL THAT APPLY.\]

DON'T DRINK ALCOHOL 10

Don't smoke 11

Eat fiber 12

Eat fruits and vegetables 13

Eat healthy / better nutrition 14

Exercise 15

Get screened for cancer / get tested for cancer 16

Have regular check-ups 17

OTHER (SPECIFY) 91

MM-05. Do you agree or disagree with the following statements?

+---------------------------------------------------+--------+--------+
|                                                   | **[AG  | **     |
|                                                   | REE]{. | [DISAG |
|                                                   | underl | REE]{. |
|                                                   | ine}** | underl |
|                                                   |        | ine}** |
+---------------------------------------------------+--------+--------+
| a\. There's not much you can do to lower your     | 1      | 2      |
| chances of getting colon cancer. Would you say    |        |        |
| you...                                            |        |        |
|                                                   |        |        |
| MM05aCannotLowerChanceC                           |        |        |
+---------------------------------------------------+--------+--------+
| b\. There are so many different recommendations   | 1      | 2      |
| about preventing colon cancer that it's hard to   |        |        |
| know which ones to follow. (Would you say you)... |        |        |
|                                                   |        |        |
| MM05bTooManyRecommendationsC                      |        |        |
+---------------------------------------------------+--------+--------+
| c\. Colon cancer develops over a period of        | 1      | 2      |
| several years. (Would you say you...)             |        |        |
|                                                   |        |        |
| MM05cCancerOverYearsC                             |        |        |
+---------------------------------------------------+--------+--------+
| d\. There are ways to slow down or disrupt the    | 1      | 2      |
| development of colon cancer. (Would you say       |        |        |
| you....)                                          |        |        |
|                                                   |        |        |
| MM05dSlowDownCancerC                              |        |        |
+---------------------------------------------------+--------+--------+
| e\. Colon cancer is most often caused by a        | 1      | 2      |
| person's behavior or lifestyle. (Would you say    |        |        |
| you....)                                          |        |        |
|                                                   |        |        |
| MM05eBehaviorCauseCancerC                         |        |        |
+---------------------------------------------------+--------+--------+
| f\. It seems like almost everything causes colon  | 1      | 2      |
| cancer. (Would you say you...).                   |        |        |
|                                                   |        |        |
| MM05fEverythingCausesCancerC                      |        |        |
+---------------------------------------------------+--------+--------+
| h\. You are reluctant to get checked for colon    | 1      | 2      |
| cancer because you fear you may have it. (Would   |        |        |
| you say you...)                                   |        |        |
|                                                   |        |        |
| MM05hCheckCancerAfraidC                           |        |        |
+---------------------------------------------------+--------+--------+
| i\. Getting checked regularly for colon cancer    | 1      | 2      |
| increases the chances of finding cancer when it's |        |        |
| easy to treat. (Would you say you...)             |        |        |
|                                                   |        |        |
| MM05iCheckEarlyDetectC                            |        |        |
+---------------------------------------------------+--------+--------+
| l\. People with colon cancer would have pain or   | 1      | 2      |
| other symptoms prior to being diagnosed. (Would   |        |        |
| you say you\...)                                  |        |        |
|                                                   |        |        |
| MM05lPainPriorToDxC                               |        |        |
+---------------------------------------------------+--------+--------+

  -----------------------------------------------------------------------
  MM-05g, MM-05j AND MM-05k DELETED.

  -----------------------------------------------------------------------

MM-06. What are the common symptoms of colon cancer?

MM06SymptomsOfCancerC (01-09)

MM06SymptomsOfCancerC_OS

\[CODE ALL THAT APPLY.\]

Blood in stool 10

Change in bowel habits 11

Consipation 12

Diarrhea 13

Loss of appetite 14

Rectal bleeding 15

Stomach pain 16

Swelling 17

Tiredness / Fatigue 18

Vomiting 19

OTHER (SPECIFY) 91

MM-07. Overall, how many people who develop colon cancer do you think
survive at least 5 years? Your best guess is fine. Would you say.....

MM07HowManySurviveC

less than 25 percent, 1

about 25 percent, 2

about 50 percent, 3

about 75 percent, or 4

nearly all? 5

[]{#__RefHeading___Toc113854673 .anchor}Skin PROTECTION (SP)

The next few questions are about things people might do to protect
themselves from the sun.

SP-01. When you go outside for more than 1 hour on a warm, sunny day,
how often do you\...

\[IF R DOES NOT GO OUTSIDE ON A SUNNY DAY FOR MORE THAN ONE HOUR, CODE
95.\]

+---------------------------+-----+----+-------+-----+----+----------+
|                           | **[ | *  | **    | **[ | *  | **DOES   |
|                           | ALW | *[ | [SOME | RAR | *[ | NOT GO   |
|                           | AYS | OF | TIMES | ELY | NE | OUT**    |
|                           | ]{. | TE | ]{.un | ]{. | VE |          |
|                           | und | N] | derli | und | R] | **[ON    |
|                           | erl | {. | ne}** | erl | {. | SUNNY    |
|                           | ine | un |       | ine | un | DA       |
|                           | }** | de |       | }** | de | Y]{.unde |
|                           |     | rl |       |     | rl | rline}** |
|                           |     | in |       |     | in |          |
|                           |     | e} |       |     | e} |          |
|                           |     | ** |       |     | ** |          |
+---------------------------+-----+----+-------+-----+----+----------+
| a\. wear sunscreen? Would | 1   | 2  | 3     | 4   | 5  | 95       |
| you say                   |     |    |       |     |    | (SP-02)  |
|                           |     |    |       |     |    |          |
| SP01aSunscreen            |     |    |       |     |    |          |
+---------------------------+-----+----+-------+-----+----+----------+
| b\. stay in the shade?    | 1   | 2  | 3     | 4   | 5  |          |
| (Would you say...)        |     |    |       |     |    |          |
|                           |     |    |       |     |    |          |
| SP01bShade                |     |    |       |     |    |          |
+---------------------------+-----+----+-------+-----+----+----------+
| c\. wear a hat that       | 1   | 2  | 3     | 4   | 5  |          |
| shades your face, ears    |     |    |       |     |    |          |
| and neck? (Would you      |     |    |       |     |    |          |
| say...)                   |     |    |       |     |    |          |
|                           |     |    |       |     |    |          |
| SP01cHat                  |     |    |       |     |    |          |
+---------------------------+-----+----+-------+-----+----+----------+
| d\. wear a long-sleeve    | 1   | 2  | 3     | 4   | 5  |          |
| shirt? (Would you say...) |     |    |       |     |    |          |
|                           |     |    |       |     |    |          |
| SP01dLongSleeveShirt      |     |    |       |     |    |          |
+---------------------------+-----+----+-------+-----+----+----------+
| e\. wear long pants?      | 1   | 2  | 3     | 4   | 5  |          |
| (Would you say...)        |     |    |       |     |    |          |
|                           |     |    |       |     |    |          |
| SP01eLongPants            |     |    |       |     |    |          |
+---------------------------+-----+----+-------+-----+----+----------+

SP-02. How many times in the past 12 months have you used indoor tanning
devices such as a sun lamp, a sun bed, or a tanning booth?

SP02TanningDevices

0 TIMES 1

1-2 TIMES 2

3-10 TIMES 3

11-24 TIMES 4

25 TIMES OR MORE 5

SP-03. How many times in the past 12 months have you used sunless
tanning products? These are products that you either have sprayed on or
which you apply to darken the color of your skin.

SP03TanningProducts

0 TIMES 1

1-2 TIMES 2

3-10 TIMES 3

11-24 TIMES 4

25 TIMES OR MORE 5

  -----------------------------------------------------------------------
  SP-04 DELETED.

  -----------------------------------------------------------------------

This page left blank intentionally.

[]{#__RefHeading___Toc113854674 .anchor}*Mental Model of Cancer: skin
(MM)*

+-----------------------------------------------------------------------+
| BOX MM-1                                                              |
|                                                                       |
| RESPONDENTS WILL BE RANDOMLY ASSIGNED TO RECEIVE MENTAL MODEL         |
| QUESTIONS ON COLON, LUNG OR SKIN CANCER.                              |
|                                                                       |
| MMGRP                                                                 |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO SKIN CANCER, CONTINUE.                   |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO SKIN CANCER, BUT HAS HAD SKIN CANCER, GO |
| TO THE NEXT SECTION.                                                  |
|                                                                       |
| IF RESPONDENT IS NOT ASSIGNED TO SKIN CANCER, GO TO THE NEXT SECTION. |
+-----------------------------------------------------------------------+

The next few questions are about skin cancer.

MM-01. How likely do you think it is that you will develop skin cancer
in the future? Would you say your chance of getting skin cancer is . . .

MM01ChanceGetCancerS

very low, 1

somewhat low, 2

moderate, 3

somewhat high, or 4

very high? 5

MM-02. Compared to the average person your age, would you say that you
are . . .

MM02RelativeChanceCancerS

more likely to get skin cancer, 1

less likely, or 2

about as likely? 3

MM-03. How often do you worry about getting skin cancer? Would you say .
. .

MM03FreqWorryCancerS

rarely or never, 1

sometimes, 2

often, or 3

all the time? 4

MM-04. What are some things that people can do to reduce their chances
of getting skin cancer?

MM04ReduceCancerS (01-06)

MM04ReduceCancerS_OS

\[CODE ALL THAT APPLY.\]

Do not use tanning beds / tanning salons 10

Get screened for cancer / get tested 11

Have regular check ups 12

Stay out of the sun 13

Wear protective clothing / hat 14

Wear sunscreen 15

OTHER (SPECIFY) 91

MM-05. Do you agree or disagree with the following statements?

+-----------------------------------------------------+-------+-------+
|                                                     | **[   | *     |
|                                                     | AGREE | *[DIS |
|                                                     | ]{.un | AGREE |
|                                                     | derli | ]{.un |
|                                                     | ne}** | derli |
|                                                     |       | ne}** |
+-----------------------------------------------------+-------+-------+
| a\. There's not much you can do to lower your       | 1     | 2     |
| chances of getting skin cancer. Would you say       |       |       |
| you...                                              |       |       |
|                                                     |       |       |
| MM05aCannotLowerChanceS                             |       |       |
+-----------------------------------------------------+-------+-------+
| b\. There are so many different recommendations     | 1     | 2     |
| about preventing skin cancer that it's hard to know |       |       |
| which ones to follow. (Would you say you)...        |       |       |
|                                                     |       |       |
| MM05bTooManyRecommendationsS                        |       |       |
+-----------------------------------------------------+-------+-------+
| c\. Skin cancer develops over a period of several   | 1     | 2     |
| years. (Would you say you....)                      |       |       |
|                                                     |       |       |
| MM05cCancerOverYearsS                               |       |       |
+-----------------------------------------------------+-------+-------+
| d\. There are ways to slow down or disrupt the      | 1     | 2     |
| development of skin cancer. (Would you say you....) |       |       |
|                                                     |       |       |
| MM05dSlowDownCancerS                                |       |       |
+-----------------------------------------------------+-------+-------+
| e\. Skin cancer is most often caused by a person's  | 1     | 2     |
| behavior or lifestyle. (Would you say you....)      |       |       |
|                                                     |       |       |
| MM05eBehaviorCauseCancerS                           |       |       |
+-----------------------------------------------------+-------+-------+
| f\. It seems like almost everything causes skin     | 1     | 2     |
| cancer. (Would you say you....).                    |       |       |
|                                                     |       |       |
| MM05fEverythingCausesCancerS                        |       |       |
+-----------------------------------------------------+-------+-------+
| h\. You are reluctant to get checked for skin       | 1     | 2     |
| cancer because you fear you may have it. (Would you |       |       |
| say you...)                                         |       |       |
|                                                     |       |       |
| MM05hCheckCancerAfraidS                             |       |       |
+-----------------------------------------------------+-------+-------+
| i\. Getting checked regularly for skin cancer       | 1     | 2     |
| increases the chances of finding cancer when it's   |       |       |
| easy to treat. (Would you say you...)               |       |       |
|                                                     |       |       |
| MM05iCheckEarlyDetectS                              |       |       |
+-----------------------------------------------------+-------+-------+
| l\. People with skin cancer would have pain or      | 1     | 2     |
| other symptoms prior to being diagnosed. (Would you |       |       |
| say you\...)                                        |       |       |
|                                                     |       |       |
| MM05lPainPriorToDxS                                 |       |       |
+-----------------------------------------------------+-------+-------+

  -----------------------------------------------------------------------
  MM-05g, MM-05j AND MM-05k DELETED.

  -----------------------------------------------------------------------

MM-06. What are the common symptoms of skin cancer?

MM06SymptomsOfCancerS (01-06)

MM06SymptomsOfCancerS_OS

\[CODE ALL THAT APPLY.\]

Abnormal growths 10

Blisters 11

Blotches 12

Lesions 13

Mole / change in mole 14

Pigment discoloration 15

Rash 16

Redness of skin 17

OTHER (SPECIFY) 91

MM-07. Overall, how many people who develop skin cancer do you think
survive at least 5 years? Your best guess is fine. Would you say.....

MM07HowManySurviveS

less than 25 percent, 1

about 25 percent, 2

about 50 percent, 3

about 75 percent, or 4

nearly all? 5

[]{#__RefHeading___Toc113854675 .anchor}Tobacco Use (TU)

TOBACCO SCREENER

Next are some questions about your use of cigarettes.

TU-01. Have you smoked at least 100 cigarettes in your entire life?

\[IF NEEDED: 5 Packs = 100 Cigarettes.\]

TU01Smoke100

YES 1

NO 2 (TU-17)

TU-02. Do you now smoke cigarettes . . .

TU02SmokeNow

every day, 1

some days, or 2 (TU-4)

not at all? 3 (TU-11)

DK 9 (TU-17)

RF 8 (TU-17)

TU-03. On the average, how many cigarettes do you now smoke a day?

TU03SmokeDayAlways

\[IF NEEDED: 1 Pack = 20 Cigarettes.\]

\[IF LESS THAN ONE A DAY, ENTER 0. IF 76 OR MORE, ENTER 76.\]

\|\_\_\_\|\_\_\_\|

NUMBER OF CIGARETTES

  -----------------------------------------------------------------------
  GO TO TU-7.

  -----------------------------------------------------------------------

TU-04. On how many of the past 30 days did you smoke cigarettes?

TU04SmokePast30Days

I\_\_\_I\_\_\_I

DAYS

TU-05. On the average, on those {FILL WITH TIME PERIOD FROM TU-04} days,
how many cigarettes did you usually smoke each day?

TU05SmokeDaySometimes

\[IF NEEDED: 1 Pack = 20 Cigarettes.\]

\[IF LESS THAN ONE A DAY, ENTER 0. IF 76 OR MORE, ENTER 76.\]

\|\_\_\_\|\_\_\_\|

NUMBER OF CIGARETTES

QUIT ATTEMPTS

+-----------------------------------------------------------------------+
| BOX TU-1                                                              |
|                                                                       |
| IF SMOKED 12 OR MORE OF THE PAST 30 DAYS (TU-04=\>12), GO TO TU-07.   |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

TU-06. During the past 12 months, have you tried to quit smoking
completely?

TU06TriedQuit

YES 1

NO 2

  -----------------------------------------------------------------------
  GO TO TU-10.

  -----------------------------------------------------------------------

TU-07. Have you ever stopped smoking for one day or longer because you
were trying to quit smoking?

TU07StoppedSmokeTryQuit

YES 1

NO 2 (TU-09)

TU-08. How many times during the past 12 months have you stopped smoking
for one day or longer because you were trying to quit smoking?

TU08TimesStoppedSmoke

I\_\_\_I\_\_\_I\_\_\_I

TIMES

  -----------------------------------------------------------------------
  TU-09 DELETED.

  -----------------------------------------------------------------------

TU-10. Are you seriously considering quitting smoking within the next 6
months?

TU10ConsiderQuit

YES 1

NO 2

+-----------------------------------------------------------------------+
| BOX TU-2                                                              |
|                                                                       |
| IF SMOKE EVERY DAY OR SOME DAYS (TU-02=1 OR 2),                       |
|                                                                       |
| GO TO TU-17.                                                          |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

FORMER SMOKERS

TU-11. About how long has it been since you completely quit smoking
cigarettes?

TU11WhenQuitSmoke

TU11WhenQuitSmoke_Unit

I\_\_\_I\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| \|\_\_\_\|

TIME UNIT

\[ENTER UNIT.\]

DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

TU-12. Have you ever smoked cigarettes every day for at least 6 months?

TU12SmokeEveryDay6Months

YES 1

NO 2 (BOX TU-3)

TU-13. When you last smoked every day, how many cigarettes did you
usually smoke each day?

TU13SmokeDayFormer

\[IF NEEDED: 1 Pack = 20 Cigarettes.\]

\[IF LESS THAN ONE A DAY, ENTER 0. IF 76 OR MORE, ENTER 76.\]

\|\_\_\_\|\_\_\_\|

NUMBER OF CIGARETTES

+-----------------------------------------------------------------------+
| BOX TU-3                                                              |
|                                                                       |
| IF QUIT SMOKING OVER 1 YEAR AGO, GO TO TU-17. IF QUIT SMOKING 1 YEAR  |
| AGO OR LESS, CONTINUE.                                                |
+-----------------------------------------------------------------------+

TU-14. Around this time 12 months ago, were you smoking cigarettes.....

TU14HowOftenFormerSmoker

every day, 1

some days, or 2

not at all? 3

  -----------------------------------------------------------------------
  TU-15 AND TU-16 DELETED.

  -----------------------------------------------------------------------

ALL RESPONDENTS

> TU-17. If a new cigarette were advertised as less harmful than current
> cigarettes, how interested would you be in trying it? Would you say .
> . .

TU17WouldTryLessHarmfulCig

very interested, 1

somewhat interested, or 2

not interested? 3

TU-18. Next are some questions about new types of tobacco products that
have been recently introduced. Have you ever heard of a tobacco product
called....(How about...)

+------------------------------------------------------+-------+-------+
|                                                      | *     | **[NO |
|                                                      | *[YES | ]{.un |
|                                                      | ]{.un | derli |
|                                                      | derli | ne}** |
|                                                      | ne}** |       |
+------------------------------------------------------+-------+-------+
| a\. Eclipse?.                                        | 1     | 2     |
|                                                      |       |       |
| TU18aHeardEclipse                                    |       |       |
+------------------------------------------------------+-------+-------+
| b\. Quest?                                           | 1     | 2     |
|                                                      |       |       |
| TU18bHeardQuest                                      |       |       |
+------------------------------------------------------+-------+-------+
| c\. Marlboro UltraSmooth?                            | 1     | 2     |
|                                                      |       |       |
| TU18cHeardMarlboro                                   |       |       |
+------------------------------------------------------+-------+-------+
| d\. Ariva?                                           | 1     | 2     |
|                                                      |       |       |
| TU18dHeardAriva                                      |       |       |
+------------------------------------------------------+-------+-------+
| e\. Revel?                                           | 1     | 2     |
|                                                      |       |       |
| TU18eHeardRevel                                      |       |       |
+------------------------------------------------------+-------+-------+

  -----------------------------------------------------------------------
  TU-18f, TU-18g, TU-18h AND TU-18i DELETED.

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  ASK TU-19 FOR EACH "YES" ANSWER IN TU-18 BEFORE ASKING NEXT ITEM IN
  TU-18.

  -----------------------------------------------------------------------

TU-18jI. Have you heard of any other types of new tobacco products?
These would include products like Accord, Advance, Omni, Exalt and
Stonewall.

TU18jIWhetherHeardOther

YES 1

NO 2 (BOX TU-5)

+-----------------------------------------------------------------------+
| BOX TU-5                                                              |
|                                                                       |
| IF TU-18a THROUGH TU-18jI = NO, THEN GO TO NEXT SECTION.              |
+-----------------------------------------------------------------------+

TU-18jII. What other new products have you heard of?

\[CODE ALL THAT APPLY.\]

TU18jIIHeardOtherProduct (1-5)

TU18jIIHeardOtherProduct_OS

ACCORD 10

ADVANCE 11

OMNI 12

EXALT 13

STONEWALL 14

OTHER
(SPECIFY)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

  -----------------------------------------------------------------------
  ASK TU-19 INDIVIDUALLY FOR EACH ITEM LISTED IN TU-18jII.

  -----------------------------------------------------------------------

TU-19. How did you hear about {FILL TU-18a-jII}? \[PROBE: Anything
else?\]

\[CODE ALL THAT APPLY.\]

TU19HowHeard[^1]

FROM A DOCTOR OR HEALTH CARE PROVIDER 10

FROM FAMILY OR FRIENDS 11

IN A NEWSPAPER 12

IN A MAGAZINE 13

ON THE RADIO 14

ON THE INTERNET 15

ON TELEVISION 16

SAW IT IN A STORE 17

OTHER (SPECIFY)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

TU-20. You said you have heard of {FILL WITH LIST OF ITEMS MENTIONED IN
TU-18a-jII}. Have you ever tried {this product/any of these products}?

TU20TriedNewProduct

YES 1

NO 2 (NEXT SECTION)

+-----------------------------------------------------------------------+
| BOX TU-5a                                                             |
|                                                                       |
| IF RESPONDENT HAS ONLY HEARD OF 1 PRODUCT,                            |
|                                                                       |
| GO TO TU-21.                                                          |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

TU-20a. Which {one/ones}?

\[CODE ALL THAT APPLY.\]

TU20aTriedWhichProduct (01-02)

ACCORD 10

ADVANCE 11

ARIVA 12

ECLIPSE 13

EXALT 14

MARLBORO ULTRASMOOTH 15

OMNI 16

QUEST 17

REVEL 18

STONEWALL 19

{FILL WITH OTHER, SPECIFY IN TU-18jII} 20

+-----------------------------------------------------------------------+
| BOX TU-5b                                                             |
|                                                                       |
| IF ONE PRODUCT NAMED IN TU-20a, ASK TU-21 THROUGH TU-24 FOR THIS      |
| PRODUCT.                                                              |
|                                                                       |
| IF MORE THAN ONE PRODUCT NAMED IN TU20a, SELECT ONE PRODUCT AT RANDOM |
| FROM GROUP 1 AND ONE FROM GROUP 2. ASK TU-21 THROUGH TU-24 FOR THE    |
| RANDOMLY SELECTED PRODUCTS IN EACH GROUP.                             |
|                                                                       |
| GROUP 1: ECLIPSE, QUEST, MARLBORO ULTRASMOOTH, ACCORD, ADVANCE AND    |
| OMNI.                                                                 |
|                                                                       |
| GROUP 2: ARIVA, REVEL, EXALT AND STONEWALL.                           |
+-----------------------------------------------------------------------+

TU-21. Do you now use {FILL}......

TU21NowUseNewProductGrp1

TU21NowUseNewProductGrp2

every day 1

some days, or 2

not at all? 3

+-----------------------------------------------------------------------+
| BOX TU-6                                                              |
|                                                                       |
| IF FORMER USER OF NEW PRODUCT (TU-21=3), THEN USE PAST TENSE IN TU-22 |
| AND TU-23.                                                            |
|                                                                       |
| IF CURRENT USER OF NEW PRODUCT (TU-21=1 OR 2), THEN USE PRESENT TENSE |
| IN TU-22 AND TU-23.                                                   |
+-----------------------------------------------------------------------+

TU-22. {Now that you are using/When you tried or used} {FILL}, {did/do}
you smoke.....

TU22HowOftenNewProductGrp1

TU22HowOftenNewProductGrp2

less of your usual brand of cigarettes, 1

about the same number of your usual brand of cigarettes, or 2

more of your usual brand of cigarettes? 3

I DID NOT SMOKE USUAL BRAND OF CIGARETTES AT ALL /

I COMPLETELY SWITCHED TO THIS PRODUCT 4

TU-23. What is the main reason you {use/tried or used} {FILL}?

TU23WhyUseNewProductGrp1

TU23WhyUseNewProductGrp1_OS

TU23WhyUseNewProductGrp2

TU23WhyUseNewProductGrp2_OS

INSTEAD OF QUITTING, AS A WAY TO REDUCE HEALTH RISKS 1

AS A WAY OF CUTTING DOWN THE NUMBER OF CIGARETTES/

OTHER CIGARETTES SMOKED 2

TO HELP YOU QUIT SMOKING 3

BECAUSE OF THE TASTE 4

BECAUSE LOWER COSTS/CHEAPER THAN CIGARETTES/

OTHER CIGARETTES/OTHER TYPES OF TOBACCO PRODUCTS 5

OUT OF CURIOSITY 6

BECAUSE NOT AS STRONG/LESS NICOTINE/LIGHTER/LESS TAR

THAN CIGARETTES/OTHER CIGARETTES 7

BECAUSE LESS HARMFUL TO USE AROUND

FAMILY/FRIENDS/CHILDREN THAN CIGARETTES/OTHER

CIGARETTES 8

BECAUSE CAN USE IN PLACES WHERE CAN'T SMOKE

CIGARETTES/OTHER CIGARETTES 9

OTHER (SPECIFY)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

TU-24. As far as you know, is {FILL}......

TU24HowHarmfulNewProductGrp1

TU24HowHarmfulNewProductGrp2

less harmful than conventional cigarettes, 1

equally harmful, or 2

more harmful than conventional cigarettes? 3

  -----------------------------------------------------------------------
  REPEAT ITEMS TU-21 THROUGH TU-24 FOR ITEM IN GROUP 2 IFAPPLICABLE.

  -----------------------------------------------------------------------

[]{#__RefHeading___Toc113854680 .anchor}*Mental Model of Cancer: LUNG
(MM)*

+-----------------------------------------------------------------------+
| BOX MM-1                                                              |
|                                                                       |
| RESPONDENTS WILL BE RANDOMLY ASSIGNED TO RECEIVE MENTAL MODEL         |
| QUESTIONS ON COLON, LUNG OR SKIN CANCER.                              |
|                                                                       |
| MMGRP                                                                 |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO LUNG CANCER, CONTINUE.                   |
|                                                                       |
| IF RESPONDENT IS ASSIGNED TO LUNG CANCER, BUT HAS HAD LUNG CANCER, GO |
| TO THE NEXT SECTION.                                                  |
|                                                                       |
| IF RESPONDENT IS NOT ASSIGNED TO LUNG CANCER, GO TO THE NEXT SECTION. |
+-----------------------------------------------------------------------+

The next few questions are about lung cancer.

MM-01. How likely do you think it is that you will develop lung cancer
in the future? Would you say your chance of getting lung cancer is . . .

MM01ChanceGetCancerL

very low, 1

somewhat low, 2

moderate, 3

somewhat high, or 4

very high? 5

MM-02. Compared to the average person your age, would you say that you
are . . .

MM02RelativeChanceCancerL

more likely to get lung cancer, 1

less likely, or 2

about as likely? 3

MM-03. How often do you worry about getting lung cancer? Would you say .
. .

MM03FreqWorryCancerL

rarely or never, 1

sometimes, 2

often, or 3

all the time? 4

MM-04. What are some things that people can do to reduce their chances
of getting lung cancer?

\[CODE ALL THAT APPLY.\]

MM04ReduceCancerL (01-06)

MM04ReduceCancerL_OS

Avoid asbestos 10

Avoid polluted air 11

Don't smoke / quit smoking 12

Eat healthy 13

Exercise 14

Get screened for cancer / get tested 15

Have regular check ups 16

Stay away from second-hand smoke 17

OTHER (SPECIFY)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

MM-05. Do you agree or disagree with the following statements?

+------------------------------------------------------+------+-------+
|                                                      | **[  | *     |
|                                                      | AGRE | *[DIS |
|                                                      | E]{. | AGREE |
|                                                      | unde | ]{.un |
|                                                      | rlin | derli |
|                                                      | e}** | ne}** |
+------------------------------------------------------+------+-------+
| a\. There's not much you can do to lower your        | 1    | 2     |
| chances of getting lung cancer. Would you say you... |      |       |
|                                                      |      |       |
| MM05aCannotLowerChanceL                              |      |       |
+------------------------------------------------------+------+-------+
| b\. There are so many different recommendations      | 1    | 2     |
| about preventing lung cancer that it's hard to know  |      |       |
| which ones to follow. (Would you say you)...         |      |       |
|                                                      |      |       |
| MM05bTooManyRecommendationsL                         |      |       |
+------------------------------------------------------+------+-------+
| c\. Lung cancer develops over a period of several    | 1    | 2     |
| years. (Would you say you...)                        |      |       |
|                                                      |      |       |
| MM05cCancerOverYearsL                                |      |       |
+------------------------------------------------------+------+-------+
| d\. There are ways to slow down or disrupt the       | 1    | 2     |
| development of lung cancer. (Would you say you....)  |      |       |
|                                                      |      |       |
| MM05dSlowDownCancerL                                 |      |       |
+------------------------------------------------------+------+-------+
| e\. Lung cancer is most often caused by a person's   | 1    | 2     |
| behavior or lifestyle. (Would you say you....)       |      |       |
|                                                      |      |       |
| MM05eBehaviorCauseCancerL                            |      |       |
+------------------------------------------------------+------+-------+
| f\. It seems like almost everything causes lung      | 1    | 2     |
| cancer. (Would you say you....).                     |      |       |
|                                                      |      |       |
| MM05fEverythingCausesCancerL                         |      |       |
+------------------------------------------------------+------+-------+
| h\. You are reluctant to get checked for lung cancer | 1    | 2     |
| because you fear you may have it. (Would you say     |      |       |
| you...)                                              |      |       |
|                                                      |      |       |
| MM05hCheckCancerAfraidL                              |      |       |
+------------------------------------------------------+------+-------+
| i\. Getting checked regularly for lung cancer        | 1    | 2     |
| increases the chances of finding cancer when it's    |      |       |
| easy to treat. (Would you say you...)                |      |       |
|                                                      |      |       |
| MM05iCheckEarlyDetectL                               |      |       |
+------------------------------------------------------+------+-------+
| l\. People with lung cancer would have pain or other | 1    | 2     |
| symptoms prior to being diagnosed. (Would you say    |      |       |
| you\...)                                             |      |       |
|                                                      |      |       |
| MM05lPainPriorToDxL                                  |      |       |
+------------------------------------------------------+------+-------+

  -----------------------------------------------------------------------
  MM-05g, MM-05j AND MM-05k DELETED.

  -----------------------------------------------------------------------

MM-06. What are the common symptoms of lung cancer?

\[CODE ALL THAT APPLY.\]

MM06SymptomsOfCancerL (01-14)

MM06SymptomsOfCancerL_OS

Bronchitis 10

Chest pain 11

Coughing 12

Depression 13

Difficulty breathing / Shortness of breath / Wheezing 14

Excessive phlegm / mucus 15

Fatigue / tiredness 16

Loss of appetite 17

Pneumonia 18

Spitting up blood 19

Swelling of neck and/or face 20

Weakness 21

Weight loss 22

OTHER (SPECIFY)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

MM-07. Overall, how many people who develop lung cancer do you think
survive at least 5 years? Your best guess is fine. Would you say.....

MM07HowManySurviveL

less than 25 percent, 1

about 25 percent, 2

about 50 percent, 3

about 75 percent, or 4

nearly all? 5

This page left blank intentionally

[]{#__RefHeading___Toc113854681 .anchor}ENERGY BALANCE (EB)

NUTRITION

These next few questions are about how often you ate or drank different
kinds of foods during the past 30 days, for example, twice a week, three
times a month, and so forth. Include all foods you ate or drank, both at
home and away from home.

EB-01. During the past 30 days, how often did you drink 100% fruit juice
such as orange, apple, and grape juices? Do not include fruit drinks
like Kool-Aid or Hi-C.

EB01FruitJuice

EB01FruitJuice_Unit

\[ENTER NUMBER.\]

\[IF NEVER, ENTER 95.\]

\|\_\_\_\|\_\_\_\| \|\_\_\_\|

TIMES UNIT

\[ENTER UNIT.\]

PER DAY 1

PER WEEK 2

PER MONTH 3

PER YEAR 4

EB-02. During the past 30 days, how often did you eat fruit? Include
fresh, canned, or frozen fruit.

EB02Fruits

EB02Fruits_Unit

\[ENTER NUMBER.\]

\[IF NEVER, ENTER 95.\]

\|\_\_\_\|\_\_\_\| \|\_\_\_\|

TIMES UNIT

\[ENTER UNIT.\]

PER DAY 1

PER WEEK 2

PER MONTH 3

PER YEAR 4

EB-03. During the past 30 days, how often did you eat potatoes? Do not
include things like fried potatoes, french fries, or rice.

EB03Potatoes

EB03Potatoes_Unit

\[ENTER NUMBER.\]

\[IF NEVER, ENTER 95.\]

\|\_\_\_\|\_\_\_\| \|\_\_\_\|

TIMES UNIT

\[ENTER UNIT.\]

PER DAY 1

PER WEEK 2

PER MONTH 3

PER YEAR 4

EB-04. During the past 30 days, how often did you eat vegetables [other
than potatoes]{.underline}? Include things like salad, cooked dried
beans, corn, and broccoli.

EB04Vegetables

EB04Vegetables_Unit

\[ENTER NUMBER.\]

\[IF NEVER, ENTER 95.\]

\|\_\_\_\|\_\_\_\| \|\_\_\_\|

TIMES UNIT

\[ENTER UNIT.\]

PER DAY 1

PER WEEK 2

PER MONTH 3

PER YEAR 4

EB-05. How many servings of fruits and vegetables do you think a person
should eat each day for good health?

EB05NumberServings

\[IF R GIVES RANGE, PROBE FOR AN EXACT NUMBER. IF DON'T KNOW, DO NOT
PROBE.\]

\|\_\_\_\|\_\_\_\|

SERVINGS

EXERCISE

The next few questions are about your exercise, recreation, and physical
activity patterns.

EB-06. In a typical week, how many days do you do any moderate-intensity
physical activity or exercise comparable to walking as if you were in a
hurry?

EB06TimesModerateExercise

I\_\_\_I\_\_\_I

DAYS

NONE 95 (EB-08)

EB-07. On the days that you do any moderate physical activity or
exercise, how long are you typically doing these activities?

EB07HowLongModerateExercise

EB07HowLongModerateExercise_Unit

I\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| \|\_\_\_\|

NUMBER UNIT

\[ENTER UNIT.\]

MINUTES 1

HOURS 2

EB-08. How many days a week of physical activity or exercise are
recommended for the average adult to stay healthy?

EB08RecommendDaysExercise

I\_\_\_I\_\_\_I

DAYS

NONE 95 (EB-10)

EB-09. On those days, how long should the average adult be physically
active to stay healthy?

EB09RecommendTimeExercise

EB09RecommendTimeExercise_Unit

I\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| \|\_\_\_\|

NUMBER UNIT

\[ENTER UNIT.\]

MINUTES 1

HOURS 2

EB-10. As far as you know, does physical activity or exercise increase
the chances of getting some types of cancer, decrease the chances of
getting some types of cancer, or does it not make much difference?

EB10ExerciseLowerRiskCancer

INCREASES CHANCES OF CANCER 1

DECREASES CHANCES OF CANCER 2

MAKES NO DIFFERENCE 3

WEIGHT LOSS

EB-11. Have you tried to lose any weight in the past year?

EB11LostWeight

YES 1

NO 2

EB-12. Are you aware of low carbohydrate, high protein diets such as the
Atkins Diet, the Zone, Sugar Busters, or the South Beach Diet?

EB12AwareLowCarb

YES 1

NO 2 (BOX EB-1)

EB-13. Have you tried a low carbohydrate, high protein diet in the past
12 months?

EB13TriedLowCarb

YES 1

NO 2

  -----------------------------------------------------------------------
  EB-14 DELETED.

  -----------------------------------------------------------------------

EB-15. Do you think that a low carbohydrate, high protein diet is a
healthy way to lose weight?

EB15LowCarbDietHealthy

YES 1

NO 2

+-----------------------------------------------------------------------+
| BOX EB-1                                                              |
|                                                                       |
| RESPONDENTS RANDOMIZED TO RECEIVE EITHER NUTRITION OR EXERCISE SERIES |
| IN                                                                    |
|                                                                       |
| EB-16 THROUGH EB-21.                                                  |
|                                                                       |
| NEGRP                                                                 |
+-----------------------------------------------------------------------+

DIET AND EXERCISE INFORMATION

EB-16. When you hear or read a new recommendation about
{nutrition/physical activity or exercise}, are you more likely to pay
attention to it or to ignore it?

EB16PayAttentionDiet

EB16PayAttentionExer

PAY ATTENTION TO IT 1

IGNORE IT 2 (EB-18)

EB-17. Think about the last time you heard a new recommendation about
{nutrition/physical activity or exercise}. Which of the following things
did you do in response to the new recommendation?

EB17ChangeBehaviorDiet

EB17ChangeBehaviorExer

I changed what I do, 1

I did not change what I do, or 2

I waited to get more information. 3

EB-18. How much do you agree or disagree with the following statement?
There are so many different recommendations about {nutrition/physical
activity or exercise} that it's hard to know which ones to follow. Would
you say you ....

EB18TooManyRecommendDiet

EB18TooManyRecommendExer

strongly agree, 1

somewhat agree, 2

somewhat disagree, or 3

strongly disagree? 4

+-----------------------------------------------------------------------+
| BOX EB-2                                                              |
|                                                                       |
| IF RESPONDENT WAS RANDOMIZED TO RECEIVE NUTRITION SERIES, GO TO       |
| EB-20.                                                                |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

EB-19. People who are overweight can lose a significant amount of weight
by doing 30 minutes of moderate activities such as brisk walking on most
days of the week. Would you say you. . . .

EB19Lose30Minutes

strongly agree, 1

somewhat agree, 2

somewhat disagree, or 3

strongly disagree? 4

EB-20. Now think about {nutrition/physical activity or exercise} and
cancer. Within the past 12 months, have you seen, heard, or read
anything about {nutrition/physical activity or exercise} and cancer?

EB20HeardDiet

EB20HeardExer

YES 1

NO 2 (EB-22)

+-----------------------------------------------------------------------+
| BOX EB-3                                                              |
|                                                                       |
| IF RESPONDENT DOES NOT WATCH TV (HC-01a=95) THEN                      |
|                                                                       |
| SKIP EB-21a.                                                          |
|                                                                       |
| IF RESPONDENT CANNOT READ (HC-03a=9) THEN                             |
|                                                                       |
| SKIP EB-21b AND EB-21c.                                               |
|                                                                       |
| IF RESPONDENT DOES NOT USE THE INTERNET (GA-1=2) THEN                 |
|                                                                       |
| SKIP EB-21d.                                                          |
+-----------------------------------------------------------------------+

EB-21. Thinking about the past 12 months only, how much have you heard
about {nutrition/physical activity or exercise} and cancer \[FILL
SOURCE\]? Would you say a lot, some, a little or not at all? (How about
from \[FILL SOURCE\])?

\[ASK IN RANDOM ORDER.\] HCGRP

+--------------------------------------+------+------+-------+--------+
|                                      | **[A | **   | **[A  | **[NOT |
|                                      | LO   | [SOM | L     | AT     |
|                                      | T]{. | E]{. | ITTLE | ALL]{. |
|                                      | unde | unde | ]{.un | underl |
|                                      | rlin | rlin | derli | ine}** |
|                                      | e}** | e}** | ne}** |        |
+--------------------------------------+------+------+-------+--------+
| a\. on television?                   | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| EB21aTVDiet                          |      |      |       |        |
|                                      |      |      |       |        |
| EB21aTVExer                          |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| b\. in newspapers                    | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| EB21bNewspaperDiet                   |      |      |       |        |
|                                      |      |      |       |        |
| EB21bNewspaperExer                   |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| c\. in magazines                     | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| EB21cMagazineDiet                    |      |      |       |        |
|                                      |      |      |       |        |
| EB21cMagazineExer                    |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| d\. on the Internet                  | 1    | 2    | 3     | 4      |
|                                      |      |      |       |        |
| EB21dInternetDiet                    |      |      |       |        |
|                                      |      |      |       |        |
| EB21dInternetExer                    |      |      |       |        |
+--------------------------------------+------+------+-------+--------+
| e\. from a doctor or other health    | 1    | 2    | 3     | 4      |
| care professional?                   |      |      |       |        |
|                                      |      |      |       |        |
| EB21eDoctorDiet                      |      |      |       |        |
|                                      |      |      |       |        |
| EB21eDoctorExer                      |      |      |       |        |
+--------------------------------------+------+------+-------+--------+

HEIGHT AND WEIGHT

The next questions are about your health now.

EB-22. About how tall are you without shoes?

EB22Height_Feet

EB22Height_Inches

\[ENTER FEET.\]

> \|\_\_\_\|\_\_\_\|
>
> FEET

\[ENTER INCHES. ROUND FRACTIONS OF INCHES [DOWN]{.underline} TO WHOLE
INCH.\]

\|\_\_\_\|\_\_\_\|

INCHES

EB-23. About how much do you weigh without shoes?

EB23Weight

\[ROUND FRACTIONS [UP]{.underline} TO WHOLE NUMBER.\]

\|\_\_\_\|\_\_\_\|\_\_\_\|

POUNDS

This page left blank intentionally.

[]{#__RefHeading___Toc113854687 .anchor}HEALTH STATUS (HS)

HS-01. In general, would you say your health is\...

HS01GeneralHealth

excellent, 1

very good, 2

good, 3

fair, or 4

poor? 5

DEPRESSION

Number range CHAPTERNext are some questions about feelings you may have
experienced over the past 30 days.

HS-02. During the past 30 days, how often did you feel \[FEELING\]?
Would you say all of the time, most of the time, some of the time, a
little of the time, or none of the time?

+----------------------------+-------+-------+-------+--------+-------+
|                            | **ALL | *     | *     | **A    | *     |
|                            | OF    | *MOST | *SOME | LITTLE | *NONE |
|                            | [THE  | OF    | OF    | OF     | OF    |
|                            | TIME  | [THE  | [THE  | [THE   | [THE  |
|                            | ]{.un | TIME  | TIME  | T      | TIME  |
|                            | derli | ]{.un | ]{.un | IME]{. | ]{.un |
|                            | ne}** | derli | derli | underl | derli |
|                            |       | ne}** | ne}** | ine}** | ne}** |
+----------------------------+-------+-------+-------+--------+-------+
| a\. so sad that nothing    | 1     | 2     | 3     | 4      | 5     |
| could cheer you up         |       |       |       |        |       |
|                            |       |       |       |        |       |
| HS02aSad                   |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+
| b\. nervous                | 1     | 2     | 3     | 4      | 5     |
|                            |       |       |       |        |       |
| HS02bNervous               |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+
| c\. restless or fidgety    | 1     | 2     | 3     | 4      | 5     |
|                            |       |       |       |        |       |
| HS02cRestless              |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+
| d\. hopeless               | 1     | 2     | 3     | 4      | 5     |
|                            |       |       |       |        |       |
| HS02dHopeless              |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+
| e\. that everything was an | 1     | 2     | 3     | 4      | 5     |
| effort                     |       |       |       |        |       |
|                            |       |       |       |        |       |
| HS02eEffort                |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+
| f\. worthless              | 1     | 2     | 3     | 4      | 5     |
|                            |       |       |       |        |       |
| HS02fWorthless             |       |       |       |        |       |
+----------------------------+-------+-------+-------+--------+-------+

+-----------------------------------------------------------------------+
| BOX HS-1                                                              |
|                                                                       |
| IF RESPONDENT HAD ANY OF THE FEELINGS IN HS-02                        |
|                                                                       |
| ALL, MOST, OR SOME OF THE TIME, CONTINUE.                             |
|                                                                       |
| OTHERWISE, GO TO HS-04.                                               |
+-----------------------------------------------------------------------+

HS-03. The last few questions were about a number of feelings you had
during the [past 30 days]{.underline}. Altogether, how much did these
feelings interfere with your life or activities? Would you say . . .

HS03DepressionInterfere

a lot, 1

some, 2

a little, or 3

not at all? 4

HEALTH COVERAGE

HS-04. Do you have any kind of health care coverage, including health
insurance, prepaid plans such as HMOs, or government plans such as
Medicare?

HS04HealthInsurance

YES 1

NO 2

HS-05. [During the past 12 months]{.underline}, not counting times you
went to an emergency room, how many times did you go to a doctor, nurse
or other health care provider to get care for yourself?

HS05FreqGoProvider

1 TIME 1

2 TIMES 2

3 TIMES 3

4 TIMES 4

5-9 TIMES 5

10 OR MORE TIMES 6

NONE 95

[]{#__RefHeading___Toc113854690 .anchor}social NETWORKS (SN)

Next are some questions about your participation in community
organizations. By community organization we mean any group that you
might participate in such as church, sports leagues, self-help groups,
service clubs, or professional organizations.

SN-01. How many community organizations are you currently a member of?

SN01CommunityOrgs

\|\_\_\_\|\_\_\_\|

> NUMBER

NONE 95 (SN-03)

SN-02. {Does this/Do any of these} community organization{s} provide you
with information on health?

SN02CommOrgsHealthInfo

YES 1

NO 2

SN-03. Do you have friends or family members that you talk to about your
health?

SN03TalkHealthFriends

YES 1

NO 2 (SN-05)

SN-04. How frequently do you talk to these friends or family members
about health? Would you say.....

SN04FreqTalkHealthFriends

very frequently, 1

somewhat frequently, or 2

not very frequently? 3

SN-05. How many people live near you who you can rely on in case you
need a ride to visit your health care provider?

SN05RideToProvider

\[ENTER NUMBER.\]

\[IF NONE, ENTER 95.\]

\|\_\_\_\|\_\_\_\|

> NUMBER

SN-06. Not including funerals and weddings, how often do you attend
religious services? Would you say....

SN06ReligiousServices

every week, 1

once or twice a month,. 2

a few times a year, or 3

never? 4

This page left blank intentionally.

[]{#__RefHeading___Toc113854691 .anchor}demographics (DM)

It's getting close to the end of the survey. There are just a few more
questions.

DM-01. Are you currently . . .

DM01MainActivity

employed for wages, 1

self-employed, 2

out of work for more than one year, 3

out of work for less than one year, 4

a homemaker, 5

a student, 6

retired, or 7

unable to work? 8

DM-02. Are you . . .

DM02MaritalStatus

married, 1

divorced, 2

widowed, 3

separated, 4

never been married, or 5

living with a partner? 6

DM-03. What is the highest level of school you completed?

DM03Education

NEVER ATTENDED SCHOOL OR ONLY ATTENDED\
    NUSERYSCHOOL/KINDERGARTEN 1

GRADES 1 THROUGH 5 (ELEMENTARY) 2

GRADES 6 THROUGH 8 (MIDDLE) 3

GRADES 9 THROUGH 12 (SOME HIGH SCHOOL BUT NO DIPLOMA) 4

HIGH SCHOOL GRADUATE (HIGH SCHOOL DIPLOMA OR

EQUIVELENT, E.G., GED, FOREIGN EQUIVALENT) 5

VOCATIONAL OR TRADE SCHOOL GRADUATE 6

SOME COLLEGE, BUT NO DEGREE 7

ASSOCIATE DEGREE IN COLLEGE 8

BACHELOR'S DEGREE 9

MASTER'S DEGREE 10

PROFESSIONAL SCHOOL OR DOCTORATE DEGREE (MD, DDS,

JD, DVM, Ph.D., EdD, etc) 11

DM-04. Are you Hispanic or Latino?

DM04Hispanic

YES 1

NO 2

DM-05. Which one or more of the following would you say is your race?
Are you American Indian or Alaska Native, Asian, Black or African
American, Native Hawaiian or other Pacific Islander, or White?

DM05Race (1-5)

\[CODE ALL THAT APPLY. IF R SAYS "HISPANIC," PROBE FOR ONE OF THE LISTED
RACE CATEGORIES.\]

WHITE 11

BLACK 12

ASIAN 13

AMERICAN INDIAN OR ALASKA NATIVE 14

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 15

DM-06. Where you born in the United States?

DM06BornInUSA

YES 1 (BOX DM-1)

NO 2

DM-07. In what year did you come to live in the United States?

DM07YearCameToUSA

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_I

YEAR

+-----------------------------------------------------------------------+
| BOX DM-1                                                              |
|                                                                       |
| IF RESPONDENT IS HISPANIC OR WAS NOT BORN IN THE UNITED STATES        |
| (DM-04=1 OR DM-06=2), CONTINUE.                                       |
|                                                                       |
| OTHERWISE, GO TO DM-09.                                               |
+-----------------------------------------------------------------------+

DM-08. How comfortable do you feel speaking English? Would you say....

DM08ComfortWithEnglish

completely comfortable, 1

very comfortable, 2

somewhat comfortable, 3

a little comfortable, or 4

not at all comfortable? 5

ENGLISH IS NATIVE LANGUAGE 6

DOES NOT SPEAK ENGLISH 95

DM-09. Do you currently rent or own your home?

DM09RentOrOwn

OWN 1

RENT 2

OCCUPIED WIHTOUT PAYING MONETARY RENT 3

  -----------------------------------------------------------------------
  DM-10 DELETED.

  -----------------------------------------------------------------------

DM-11. Including yourself, how many people live in your household?

DM11NumberInHH

I\_\_\_I\_\_\_I (IF "1", GO TO DM-14)

NUMBER

DM-12. How many people in your household are related to you by blood,
marriage, or adoption?

DM12NumberInHHRelated

I\_\_\_I\_\_\_I

NUMBER \[IF 0, GO TO DM-14\]

DM-13. How many of these family members are under the age of 18?

DM13NumberUnder18

I\_\_\_I\_\_\_I

NUMBER

DM-14. {Thinking about members of your family living in this household,
what/What} is your {combined} annual income, meaning the total pre-tax
income from all sources earned in the past year?

DM14Income

\$ I\_\_\_I\_\_\_I\_\_\_I\_\_\_I\_\_\_I\_\_\_I\_\_\_I\_\_\_I

**IF DK OR RF, ASK:** Is your annual household income from all
sources.....

YES NO

a\. less than \$25,000? 1 2 (GO TO DM-14e)

DM14aIncome25Thousand

b\. less than \$20,000? 1 2 (DM-15)

DM14bIncome20Thousand

c\. less than \$15,000? 1 2 (DM-15)

DM14cIncome15Thousand

d\. less than \$10,000? 1 (DM-15) 2 (DM-15)

DM14dIncome10Thousand

e\. less than \$35,000? 1 (DM-15) 2

DM14eIncome35Thousand

f\. less than \$50,000 (\$35,000 to less than \$50,000)? 1 (DM-15) 2

DM14fIncome50Thousand

g\. less than \$75,000 (\$50,000 to less than \$75,000)? 1 (DM-15) 2

DM14gIncome75Thousand

h\. less than \$100,000? (\$75,000 to less than \$100,000)? 1 (DM-15) 2

DM14hIncome100Thousand

i\. less than \$200,000? (\$100,000 to \$200,000)? 1 (DM-15) 2

DM14iIncomeOver100Thousand

j\. \$200,000 or more? 1 2

DM14jIncomeOver200Thousand

DM-15. At the end of the month, how much money are you able to put
aside? Your best estimate is fine.

DM15MoneySetAside

NOTHING 1

\$100 OR LESS 2

\$101 TO \$250 3

\$251 TO \$500 4

\$501 TO \$1,000 5

MORE THAN \$1,000 6

This page left blank intentionally.

[]{#__RefHeading___Toc113854692 .anchor}DEBRIEFING QUESTIONS (DB)

There are just a few final questions for you about your participation in
this study.

+-----------------------------------------------------------------------+
| BOX DB-1                                                              |
|                                                                       |
| IF THE RESPONDENT COMPLETED THE QUESTIONNAIRE BY TELEPHONE, GO TO BOX |
| DB-2.                                                                 |
|                                                                       |
| IF RESPONDENT COMPLETED THE QUESTIONNAIRE BY INTERNET, CONTINUE.      |
+-----------------------------------------------------------------------+

**INTERNET COMPLETERS**

DB-01. You were given a choice of whether to do this questionnaire over
the phone or over the Internet. Why did you decide to do this survey
over the Internet?

DB01WhyChoseInternet

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DB-02. Did you receive an e-mail with information about how to complete
the survey over the Internet?

DB02ReceivedEmail

Yes 1 (DB-04)

No 2

DB-03. Did you receive a letter with information about how to complete
the survey over the Internet?

DB03ReceivedLetter

Yes 1

No 2

DB-04. Did you have any difficulties accessing the survey?

DB04AccessDifficulties

Yes 1

No 2 (DB-06)

DB-05. What difficulties did you have?

DB05SpecifyDifficulties

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DB-06. How satisfied were you with the speed of your connection to the
survey? Would you say.....

DB06HowSatisfiedWithSpeed

very satisfied, 1

somewhat satisfied, 2

somewhat dissatisfied, or 3

very dissatisfied? 4

DB-07. Did you complete this survey all in one sitting, or did you do it
in more than one sitting?

DB07TookBreak

I completed the survey all in one sitting 1

I completed the survey in more than one sitting 2

DB-08. During the time that you have been completing this survey, were
you also doing other things such as talking to someone, reading a
newspaper, or caring for children?

DB08WhetherDistracted

Yes 1

No 2 (DB-10)

DB-09. What other things were you doing?

DB09Distractions

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DB-10. Where were you when you completed this survey?

DB10WhereCompleted

DB10WhereCompleted_OS

Home 11

Work 12

School 13

A public library 14

Some other place (specify) 91

  -----------------------------------------------------------------------
  GO TO DB-15

  -----------------------------------------------------------------------

**TELEPHONE COMPLETERS**

+-----------------------------------------------------------------------+
| BOX DB-2                                                              |
|                                                                       |
| IF RESPONDENT HAS BEEN RANDOMIZED TO SKIP THE DEBRIEFING QUESTIONS,   |
|                                                                       |
| GO TO THE NEXT SECTION.                                               |
|                                                                       |
| DBGRP                                                                 |
|                                                                       |
| IF RESPONDENT HAS BEEN RANDOMIZED TO ANSWER THE DEBRIEFING QUESTIONS  |
| AND IS IN THE TELEPHONE-ONLY GROUP, GO TO DB-15.                      |
|                                                                       |
| IF RESPONDENT HAS BEEN RANDOMIZED TO ANSWER THE DEBRIEFING QUESTIONS  |
| AND IS IN THE CHOICE GROUP, CONTINUE.                                 |
+-----------------------------------------------------------------------+

DB-11. You were given a choice of whether to do this questionnaire over
the phone or over the Internet. Why did you decide to do this survey
over the telephone?

\[CODE ALL THAT APPLY.\]

DB11WhyChoseTelephone (1-3)

DB11WhyChoseTelephone_OS

COMPUTER NOT WORKING 10

DIDN'T THINK I WOULD DO IT 11

DON'T HAVE TIME TO DO IT ON THE INTERNET 12

DON'T USE THE INTERNET VERY OFTEN 13

DON'T USE THE INTERNET VERY WELL 14

OTHER, SPECIFY
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
91

  -----------------------------------------------------------------------
  DB-12 DELETED.

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| BOX DB-3                                                              |
|                                                                       |
| IF RESPONDENT ORIGINALLY CHOSE TELEPHONE (GA-05=1), GO TO DB-15.      |
|                                                                       |
| IF RESPONDENT ORIGINALLY CHOSE INTERNET (GA-05=2), THEN CONTINUE.     |
+-----------------------------------------------------------------------+

DB-13. Did you receive an e-mail with information about how to complete
the survey over the Internet?

DB13ReceivedEmail

YES 1 (DB-15)

NO 2

DB-14. Did you receive a letter with information about how to complete
the survey on the Internet?

DB14ReceivedLetter

YES 1

NO 2

**ALL RESPONDENTS**

DB-15. What do you think about the length of this survey? Would you say.
. . .

DB15LengthOfSurvey

The survey was too short, 1

The survey was too long, or 2

The survey was a good length?. 3

+-----------------------------------------------------------------------+
| BOX DB-4                                                              |
|                                                                       |
| IF RESPONDENT IS NOT RECEIVING AN INCENTIVE, GO TO THE NEXT SECTION.  |
|                                                                       |
| OTHERWISE, CONTINUE.                                                  |
+-----------------------------------------------------------------------+

DB-16. How likely is it that you would have participated in this survey
if you were not receiving {FILL AMOUNT}? Would you say......

DB16InfluenceOfIncentive

very likely, 1

somewhat likely, 2

somewhat unlikely, or 3

very unlikely? 4

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[]{#__RefHeading___Toc113854693 .anchor}CONTACT INFORMATION (CI)

+-----------------------------------------------------------------------+
| BOX CI-1                                                              |
|                                                                       |
| IF RESPONDENT HAS NOT BEEN SELECTED FOR AN INCENTIVE, GO TO END       |
| STATEMENT 2.                                                          |
|                                                                       |
| INCGRP                                                                |
+-----------------------------------------------------------------------+

We would like to send you a check for {FILL AMOUNT} as a thank you for
your participation in this study.

CI-01. What would be the best name and address to put on the check?

DK (END STATEMENT2)

RF (END STATEMENT2)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FIRST NAME

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

LAST NAME

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS1

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS2

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY

> \[PROGRAMMER: DISPLAY FULL STATE NAME AFTER INTERVIEWER ENTERS 2-DIGIT
> STATE ABBREVIATION.\]
>
> \|\_\_\|\_\_\| \|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\| -
> \|\_\_\|\_\_\|\_\_\|\_\_\|

STATE ZIP CODE

> CI1HHState
>
> CI1HHZipCode

**END STATEMENT 2. If you have questions about cancer or want some
information about cancer, you can call**

**1-800-4-CANCER or go to the National Cancer Institute\'s web site at:
www.cancer.gov.**

**Those are all of the questions that I have for you. Thank you for your
time.**

This page left blank intentionally.

[]{#__RefHeading___Toc113854694 .anchor}APPENDIX A: ITEM TU-19 VARIABLE
LIST

TU19aHowHeardEclipse (1-4)

TU19aHowHeardEclipse_OS

TU19bHowHeardQuest (1-4)

TU19bHowHeardQuest_OS

TU19cHowHeardMarlboro (1-4)

TU19cHowHeardMarlboro_OS

TU19dHowHeardAriva (1-4)

TU19dHowHeardAriva_OS

TU19eHowHeardRevel (1-5)

TU19eHowHeardRevel_OS

TU19jHowHeardAccord (1-5)

TU19jHowHeardAccord_OS

TU19jHowHeardAdvance (1-5)

TU19jHowHeardAdvance_OS

TU19jHowHeardOmni (1-5)

TU19jHowHeardOmni_OS

TU19jHowHeardExault (1-5)

TU19jHowHeardExault_OS

TU19jHowHeardStonewall (1-3)

TU19jHowHeardStonewall_OS

TU19jHowHeardOther (1-2)

TU19jHowHeardOther_OS

This page left blank intentionally.

[]{#__RefHeading___Toc113854695 .anchor}APPENDIX B: VARIATION IN
TELEPHONE VS. WEB VERSIONS OF INSTRUMENT

+---------+------------------------------------------------------------+
| *       | **How the web version differed from the telephone          |
| *Item** | version**                                                  |
+=========+============================================================+
| HEALTH  |                                                            |
| COMMUN  |                                                            |
| ICATION |                                                            |
+---------+------------------------------------------------------------+
| HC-01a  | -   Soft check not conducted.                              |
|         |                                                            |
|         | -   Respondents were not allowed to enter \"95\".          |
|         |                                                            |
|         | -   Range =0-24.                                           |
|         |                                                            |
|         | -   No skip based on \"0\"                                 |
+---------+------------------------------------------------------------+
| HC-01b  | -   Soft check not conducted.                              |
|         |                                                            |
|         | -   Respondents were not allowed to enter \"95\".          |
|         |                                                            |
|         | -   Range =0-24.                                           |
|         |                                                            |
|         | -   No skip based on \"0\"                                 |
+---------+------------------------------------------------------------+
| HC-01c  | -   Respondents were not allowed to enter \"95\".          |
|         |                                                            |
|         | -   Range =0-24.                                           |
|         |                                                            |
|         | -   No skip based on \"0\".                                |
|         |                                                            |
|         | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| HC-02a  | -   Soft check not conducted.                              |
|         |                                                            |
|         | -   Range =0-48.                                           |
|         |                                                            |
|         | -   If both HC-01a=0 and HC-02a=0 then enter skip pattern. |
+---------+------------------------------------------------------------+
| HC-02b  | -   Soft check not conducted.                              |
|         |                                                            |
|         | -   Range =0-48.                                           |
|         |                                                            |
|         | -   If both HC-01b=0 and HC-02b=0 then enter skip pattern. |
+---------+------------------------------------------------------------+
| HC-02c  | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| HC-03a  | -   Respondents were not allowed to enter \"9\".           |
|         |                                                            |
|         | -   Range = 0-7.                                           |
|         |                                                            |
|         | -   No skips based on \"0\".                               |
+---------+------------------------------------------------------------+
| HC-03b  | -   Respondents were not allowed to enter \"9\".           |
|         |                                                            |
|         | -   Range = 0-7.                                           |
+---------+------------------------------------------------------------+
| HC-03c  | -   Respondents were not allowed to enter \"9\".           |
|         |                                                            |
|         | -   Range = 0-7.                                           |
+---------+------------------------------------------------------------+
| CANCER  |                                                            |
| COMMUN  |                                                            |
| ICATION |                                                            |
+---------+------------------------------------------------------------+
| CA-02   | -   Only the following response options showed to          |
|         |     respondents: Breast cancer, cervical cancer, colon     |
|         |     cancer, lung cancer, melanoma, other skin cancer,      |
|         |     prostate cancer, other (specify).                      |
+---------+------------------------------------------------------------+
| CA-07   | -   Only the following response options showed to          |
|         |     respondents: Breast cancer, cervical cancer, colon     |
|         |     cancer, lung cancer, melanoma, other skin cancer,      |
|         |     prostate cancer, other (specify).                      |
+---------+------------------------------------------------------------+
| CA-13   | -   No response categories provided.                       |
+---------+------------------------------------------------------------+
| COLON   |                                                            |
| CANCER  |                                                            |
+---------+------------------------------------------------------------+
| CC-01   | -   No response categories provided.                       |
+---------+------------------------------------------------------------+
| MENTAL  |                                                            |
| MODEL   |                                                            |
| OF      |                                                            |
| CANCER  |                                                            |
| (COLON, |                                                            |
| SKIN    |                                                            |
| AND     |                                                            |
| LUNG)   |                                                            |
+---------+------------------------------------------------------------+
| MM-04   | -   No response categories provided.                       |
+---------+------------------------------------------------------------+
| MM-06   | -   No response categories provided.                       |
+---------+------------------------------------------------------------+
| TOBACCO |                                                            |
| USE     |                                                            |
+---------+------------------------------------------------------------+
| TU-03   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| TU-05   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| TU-11   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| TU-13   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| ENERGY  |                                                            |
| BALANCE |                                                            |
+---------+------------------------------------------------------------+
| EB-01   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-02   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-03   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-04   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-05   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| EB-06   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-07   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| EB-08   | -   If never, respondents entered \"0\" rather than        |
|         |     \"95.\"                                                |
+---------+------------------------------------------------------------+
| EB-09   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| EB-22   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| EB-23   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| SOCIAL  |                                                            |
| N       |                                                            |
| ETWORKS |                                                            |
+---------+------------------------------------------------------------+
| SN-01   | -   Respondent entered \"0\" for none instead of \"95.\"   |
|         |                                                            |
|         | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| SN-05   | -   Respondent entered \"0\" for none instead of \"95.\"   |
|         |                                                            |
|         | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| DEMOG   |                                                            |
| RAPHICS |                                                            |
+---------+------------------------------------------------------------+
| DM-11   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+
| DM-14   | -   Soft check not conducted.                              |
+---------+------------------------------------------------------------+

[^1]: The list of variable names for this item can be found in Appendix
    A