American Indian Adult Tobacco Survey 

Implementation Manual 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Chronic Disease Prevention and Health Promotion
 

American Indian Adult Tobacco Survey 

Implementation Manual 
American Indian Adult Tobacco Survey Implementation Manual 

Editors: 

Janis Weber, PhD 

Stacy Thorne, MPH, CHES 

American Indian Adult Tobacco Survey Work Group: 

Karen Schmidt, MPH, Northwest Portland 

Alyssa Easton, PhD, Centers for Disease Control and Prevention 

Dawson Frank,Muscogee Creek Nation 

Nicole Hildebrandt, MPH, Northwest Portland 

Favian Kennedy, MSW, Aberdeen Area Health Board 

Lisa Kerfoot, MPH, Inter-Tribal Council of Michigan 

Jay Macedo, MA, California Rural Indian Health Board1 

Sara Mirza, MPH, Centers for Disease Control and Prevention 

Marcus Proctor, Muscogee Creek Nation 

Lorene Reano, MPA, Centers for Disease Control and Prevention2 

Cynthia Tainpeah, RN, Muscogee Creek Nation 

Stacy Thorne, MPH, CHES; Centers for Disease Control and Prevention 

Janis Weber, PhD, JCW Research & Evaluation Group, Inc. 

Doug White, MS, California Rural Indian Health Board 

1

Formerly of California Rural Indian Health Board 

2

Formerly of Centers for Disease Control and Prevention 

Acknowledgements 

Corinne Husten 

Ralph Caraballo 

Brick Lancaster 

Barbara Parks 

Kurt Schweigman 

Rebecca Garrow 

SUGGESTED CITATION 

American Indian Adult Tobacco Survey Work Group. American Indian Adult Tobacco Survey 

Implementation Manual. Janis Weber and Stacy Thorne (Eds). Atlanta: U.S. Department of 

Health and Human Services, Centers for Disease Control and Prevention; 2008. 

2
 
 Contents
 

EXECUTIVE SUMMARY.......................................................................................................................................5
 

Chapter 1: The American Indian Adult Tobacco Survey...................................................................7
 

The Need....................................................................................................................................................................7
 

The Purpose ..............................................................................................................................................................8
 

The Questionnaire ..................................................................................................................................................9
 

Survey Uses and Limitations...............................................................................................................................9
 

Chapter 2: The Questionnaire ..................................................................................................................... 11
 

Chapter 3: Implementation .......................................................................................................................... 25
 

Engage Stakeholders .......................................................................................................................................... 25
 

Institutional Review Board................................................................................................................................ 25
 

Data Ownership/Data Sharing........................................................................................................................ 25
 

Sampling Frame/Size.......................................................................................................................................... 26
 

Establishing Protocols ........................................................................................................................................ 27
 

Recruitment and Hiring of Interviewers ............................................................................................... 28
 

Determining Locations for Conducting the Survey......................................................................... 29
 

Maintaining Confidentiality and Security ............................................................................................ 29
 

Implementing the Survey .......................................................................................................................... 29
 

Unforeseen Circumstances............................................................................................................................... 30
 

Chapter 4: Interviewer Training ................................................................................................................. 31
 

Questionnaire Coding........................................................................................................................................ 32
 

Initial Contact Letter ........................................................................................................................................... 32
 

Face-to-Face Contact Script............................................................................................................................. 33
 

Telephone Contact Script.................................................................................................................................. 33
 

Informed Consent Form.................................................................................................................................... 34
 

Establishing a Rapport with Respondents.................................................................................................. 34
 

Dress................................................................................................................................................................... 34
 

Demeanor ........................................................................................................................................................ 34
 

Confidentiality....................................................................................................................................................... 34
 

Time Management .............................................................................................................................................. 34
 

Objectivity............................................................................................................................................................... 35
 

Chapter 5: Establishing a Rapport with Respondents .................................................................... 37
 

Chapter 6: Inputting, Analyzing, and Using the Data..................................................................... 39
 

Developing a Codebook and Database ...................................................................................................... 39
 

Data Input............................................................................................................................................................... 40
 

Reports..................................................................................................................................................................... 41
 

Data Uses ................................................................................................................................................................ 42
 

Chapter 7: The Budget.................................................................................................................................... 43
 

Budget Justification............................................................................................................................................. 45
 

Personnel................................................................................................................................................................. 45
 

Travel......................................................................................................................................................................... 45
 

Other Budget Items............................................................................................................................................. 45
 

3
 

Appendix A: American Indian Adult Tobacco Survey Tools and Tracking Forms for 

Recruiting Respondents ................................................................................................................................. 47
 

Appendix B: American Indian Adult Tobacco Survey Core 

and Supplemental Questions ...................................................................................................................... 57
 

Appendix C: American Indian Tobacco Survey Checklists and Forms..................................153
 

Appendix D: American Indian Adult Tobacco Survey Statistical Analysis Details .........163
 

Appendix E: American Indian Adult Tobacco Survey Resources.............................................171
 

4
 
EXECUTIVE SUMMARY
 

The American Indian Adult Tobacco Survey (AI ATS) is designed to be a guidance tool for 

American Indian tribes, tribal organizations, and other organizations that want to implement 

the AI ATS. The methods and strategies contained within provide organizations with the 

materials needed to conduct a scientifically rigorous survey. These materials include stepby-step guidance on how to conduct the AI ATS, as well as technical information and 

resources (see Appendices A–E). 

The core component of the AI ATS provides tribe-specific information and prevalence rates 

on the following: 

• Commercial cigarette smoking use by members of the community. 

• Use of other tobacco products. 

• Quit efforts. 

• Methods used in quit efforts. 

• Workplace policies on smoking. 

• Secondhand smoke exposure. 

• Opinions about harm caused by tobacco smoking. 

The AI ATS enables tribes, tribal organizations, and other organizations to assess the 

knowledge, beliefs, and attitudes of tribal members with regard to commercial tobacco use. 

Once the data are collected, it is important to analyze the data and then to develop and 

implement the appropriate interventions according to the findings. 

We hope you find the information and resources in this manual helpful. 

5
 
6
 
 

 

Chapter 1: The American Indian Adult Tobacco Survey 

The Need 

Healthy People 2010 is a comprehensive set of disease prevention and health objectives 

for the U.S. population to achieve over the first 10 years of the twenty-first century. The 

second overarching goal of Healthy People 2010 is to eliminate health disparities in several 

focus areas—primarily commercial tobacco use. Scientific studies have proven the link 

between commercial tobacco use and multiple cancers, respiratory and cardiovascular 

diseases, adverse pregnancy outcomes, and many other diseases. Thus, a direct relationship 

exists between the health of a population and the population’s use of commercial tobacco 

products.1 

Estimates on prevalence of tobacco use are typically gathered through national surveys, 

such as the National Health Interview Survey and the National Survey on Drug Use and 

Health, or state surveys, such as the Behavioral Risk Factor Surveillance System (BRFSS). 

Because of the proportionately low percentage of American Indians in the United States, 

data on commercial tobacco use among American Indians or Alaska Natives is either not 

collected or not precise because of the small number of survey participants who identify 

themselves as American Indian or Alaska Native in national surveys. These national surveys 

also do not provide commercial tobacco use data within any specific American Indian tribe. 

Some surveys, such as the BRFSS, provide American Indian cigarette smoking data by U.S. 

region, but not by tribe. 

The national surveillance data that 

are available suggest that American 

Indians and Alaska Natives have 

the highest commercial tobacco 

use prevalence among the major 

U.S. racial and ethnic groups, which 

include African Americans, Hispanics, 

Asians, American Indians or Alaska 

Natives, and whites (35.6%).2

 In fact, 

data from the few tribe-specific 

commercial tobacco surveys that 

have been conducted suggest that 

commercial tobacco use could be as 

high as 63% among some American 

Indian tribes and/or Alaska Natives.3 

Although data on American Indian/Alaska Native populations and tobacco use are 

incomplete, the data that exist suggest the presence of significant disparity in terms 

of commercial tobacco use when compared with the general U.S. population or other 

minority populations. To achieve the goal of eliminating health disparities among minority 

populations in the United States, tribes must have access to valid and reliable health 

1

 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 2 vols. Washington, D.C.: U.S. Government 

Printing Office; 2000. 

2 Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2006. MMWR. 

2007;56(44):1157–1161. 

3 The Great Lakes Intertribal Council, Inc. (GLITC). Great lakes intertribal council youth tobacco survey 2000: prevalence of 

 tobacco use. Lac du Flambeau, WI: Great Lakes EpiCenter; 2000. 

7 
indicators data, including commercial tobacco use data for specific tribes. These data 

can help guide local tobacco control program development, grant writing, and program 

evaluation. 

To that end, the Office on Smoking and Health (OSH) at the Centers for Disease Control and 

Prevention (CDC) funded a project in 2000 to develop a culturally competent, adult tobacco 

questionnaire for American Indians and Alaska Natives. Because of the cultural differences

 in these two populations, CDC decided that two instruments would have to be developed 

(American Indian Adult Tobacco Survey and Alaska Native Adult Tobacco Survey). The AI 

ATS was developed specifically to collect tribe-specific and community-specific data on 

tobacco use for American Indian populations; it may not be relevant, culturally appropriate, 

or applicable to other population groups, including Alaska Natives. The following five Tribal 

Support Centers for Tobacco Control Programs (SCTCP) served as partners in this project: 

•		 Aberdeen Area Tribal Chairmen’s Health Board (AATCHB), which represents 19 tribes in 

North Dakota, South Dakota, Iowa, and Nebraska. 

•		 California Rural Indian Health Board (CRIHB), which represents 36 tribes in northern 

California. 

•		 Muscogee Creek Nation (MCN), which serves the Creek Nation in Oklahoma. 

•		 Inter-Tribal Council of Michigan, Inc. (ITCMI), which serves 12 federally recognized 

tribes in Michigan.
 

•		 Northwest Portland Area Indian Health Board (NPAIHB), which serves more than 40 

tribes in Oregon, Washington, and Idaho. 

Tribal SCTCP staff, tribal leaders and organizations, tribal 

community members, and CDC staff worked together 

to develop and field the first AI ATS that combined 

accepted scientific practice with culturally appropriate 

strategies. As a result, the experiences and successes 

shared in this collaboration are now available to all 

tribes, tribal organizations, and other organizations. We 

encourage the widespread use of the AI ATS to assess 

commercial tobacco use in U.S. tribes and communities. 

The Purpose 

The AI ATS is a culturally appropriate survey that was 

designed as a surveillance and evaluation tool that 

can be used by tribes, tribal organizations, and other 

organizations, and National Tobacco Control Program 

Partners to provide tribal-specific information on 

tobacco use. This survey can be used to collect tribalspecific data about trends in tobacco use, cessation 

efforts, exposure to environmental tobacco smoke, 

workplace policies, and tobacco-related knowledge and practices among American Indian 

adults aged 18 years or older. This survey was developed with a face-to-face methodology 

in mind, in keeping with culturally competent methods of communications preferred by 

American Indian populations. However, telephone interviews are acceptable when an inperson interview is not possible. 

8
 
The Questionnaire 

The AI ATS uses a combination of standard core questions and a set of optional 

supplemental questions. The AI ATS also allows tribes to add their own questions. The 

questionnaire is divided into topical sections, with each section containing a set of 

questions relevant to that topic. We recommend that supplemental questions be added 

after the last question of the core questionnaire. Dividing the questionnaire into different 

selections by topic enhances data collection by creating a flow to the questions that eases 

the interview process for the interviewer and the respondent. 

We used the state-based Adult Tobacco Survey (from June 2003) for the general U.S. 

population as a template for the AI ATS. Tribal SCTCP and CDC staff collected extensive 

input and conducted testing to create this new adapted survey. They also used scientifically 

accepted methods and culturally appropriate strategies to ensure that the AI ATS would 

resonate with American Indian populations. A series of focus groups, talking circles, and 

cognitive interviews followed every iteration of the AI ATS in order to test it for scientific 

reliability and validity and cultural appropriateness. 

Survey Uses and Limitations 

The AI ATS was designed for use as a face-to-face survey to provide tribal or village-specific 

information on the prevalence of commercial tobacco use and commercial tobacco use 

behaviors, knowledge, attitudes, and beliefs. It has not been tested as a telephone survey 

tool. The AI ATS was developed specifically for American Indian populations; it may not be 

relevant, culturally appropriate, or applicable to other population groups, including Alaska 

Natives. CDC has developed a separate survey for Alaska Natives. 

The AI ATS enables tribes, tribal organizations, and other organizations to evaluate the 

knowledge, beliefs, and attitudes of tribal members with regard to commercial tobacco 

use. This manual is designed to help program managers, researchers, statisticians, 

and epidemiologists implement the AI ATS. It is divided into six chapters, which cover 

topics such as implementation, interviewer training, data collection, and budgetary 

requirements. Chapter 2 presents an overview and explanation of the AI ATS questionnaire. 

Supplementary resources, such as worksheets, the complete questionnaire, scripts and 

consent forms, and statistical details are provided in Appendices A–E. 

9
 
10
 
 

 

 

 

 

 

Chapter 2: The Questionnaire
 

The AI ATS is divided into 10 sections, nine of which contain core questions. The last section 

contains a list of possible site-specific supplemental questions. Tribes, tribal organizations, 

and other organizations implementing the AI ATS can choose any, all, or none of the 

supplemental questions. Additionally, tribes, tribal organizations, and other organizations 

implementing the AI ATS are free to include questions of their own at the end of the core 

survey. 

This chapter includes an overview of the sections and questions in the survey. Note that “R” 

in this manual refers to Respondent (the person being surveyed), and Q refers to a question. 

See Appendix B for the actual questionnaire and script for the interviewer. 

SECTION 1. The General Health section is an “ice breaker” and consists of just one 

question. It asks R to provide a general assessment of her/his health. 

1.	 General Health Status. In field testing, particularly among more traditional 

tribes, the concept of “health” encompassed more than just physical health. 

There was also hesitancy among Rs to choose one response. Interviewer 

should repeat responses until R chooses one. 

SECTION 2.	 Section 2 contains commercial cigarette use questions and are designed to 

gather information on prevalence, stages of change, quit attempts, and quit 

assistance. There is a clear distinction made between commercial tobacco use 

and sacred or ceremonial and Rs are asked only about commercial tobacco 

use in the Core Questions section. 

2. Has R ever smoked a cigarette (excluding sacred or ceremonial use)? This 

question refers to either commercially rolled cigarettes (such as Marlboro) 

containing commercial tobacco or hand-rolled cigarettes (commonly called 

“roll your own”) which contain commercial tobacco. 

3. Age at which R first smoked a cigarette (excluding sacred or ceremonial 

use)? This question should be asked only of all Rs who answered “yes” to Q2. 

R must provide an actual numerical age. 

4. Has R smoked 100 cigarettes or more in her/his lifetime? In testing, this 

question caused some confusion among respondents, particularly among 

elders. The period of time in question is a lifetime, not a single day or a week. 

The interviewer should be aware of the possibility of confusion and should 

stress “in your entire life.” 

5. R’s age at regular use of commercial tobacco? This question is intended to 

determine the age at which R began using commercial tobacco regularly, not 

age of initiation. Interviewer should stress the word regularly. No definition of 

what regularly means is provided to R. Also, interviewer must ensure that R 

provides an actual number for the age, rather than a description such as “in 

high school.” 

11 
 

 

 

 

 

 

 

 

 

6. R’s current smoking status? This question is used to categorize R as a 

current, former or “never” (<100 cigarette in lifetime) smoker. 

7. Number of days R smoked in past 30? This question is asked only to those 

who answered in the previous questions that they smoke some days. Answers 

must be quantitative (e.g., 1 day, 4 days) rather than “a couple of days a week.” 

Cognitive testing suggested that this question was confusing. To eliminate 

confusion, interviewer should provide specific dates, e.g., “in the last 30 days, 

that is, since August 10.” 

8. Number of cigarettes R smoked per day in the past 30 days? This question 

is designed to determine the average number of cigarettes R smokes per day. 

Testing of this question suggested that smokers tend to respond (and think) 

in packs rather than number of cigarettes. If R responds in number of packs, 

interviewer must probe R until number of cigarettes per day is provided. 

Cognitive testing suggested that this question was confusing as Rs tended to 

provide an aggregate number for 30 days. Interviewer should stress average 

per day on days they smoked. 

9. How soon after awakening does R smoke first cigarette of the day? This 

question is related to addiction. Interviewer must read all of the responses to 

R. If R responds qualitatively (e.g., “with my first cup of coffee”), interviewer 

should probe (i.e., “would that be [READ RESPONSES AGAIN]?”). 

10.	 How long since R last smoked a cigarette? This provides additional 

information about the category of smoker that best fits R, current, former, or 

never smoker. 

11. Did R quit for 1 day or more during past 12 months? Testing suggested 

that this question was confusing to respondents. Many initially answered “yes,” 

but then would qualify the response to indicate that the quitting was related 

to illness. Interviewer should stress because you were trying to quit smoking. 

12. a–d Did R use Nicotine Replacement Therapys or any other medication 

to assist her/him in quitting? Did R use the “cold turkey” method of 

quitting? These questions are asked only of current smokers or former 

smokers who quit in the last 5 years. 

13.	 Did R use any native or traditional methods to assist her/him in quitting? 

This question is asked only of current smokers or former smokers who quit 

in the last 5 years. Testing suggested that there may be some hesitancy in 

responding to this question, particularly among elders. Interviewer should not 

probe. Simply allow R to respond or refuse to respond. 

14. Did R use smoking cessation classes or counseling to quit? This question is 

asked only of current smokers or former smokers who quit in the last 5 years. 

12
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15–17. Readiness of R to quit smoking? These three questions are asked only of 

current smokers to determine willingness to quit. 

Does R want to quit? 

Is R seriously thinking about quitting in the next 6 months? 

Is R planning to quit in next 30 days?
 

18. Health care R received in the past 12 months? This question is asked 

of everybody. 

19. Health care professional asked R if she/he smokes? 

20.	 Health care professional advised R not to smoke? 

21. a–h Health care professional recommended aids to quit? This series of 

questions are asked of all Rs who answered “yes” to Q20. Cognitive testing 

revealed that Q21c was confusing—many American Indians suffer from 

asthma and so many respondents thought the “nasal spray” referred to 

asthma inhalers. Interviewers may have to differentiate asthma inhalers from 

NRT nasal sprays. 

22. a–c 

& 23. a–b Health care professional recommended other quit assistance, such 

as cessation classes, cessation programs, quitline, booklets, prayer 

and traditional methods? This series of questions are asked of all Rs who 

answered “yes” to Q20. 

24. Services of traditional or native healer? All Rs are asked whether they 

have seen a traditional or native healer for any kind of care. Rs may exhibit 

hesitancy about responding to this question. Interviewers should not probe. 

25. Traditional healer has asked R about smoking? All Rs who answered “yes” 

to Q24 are asked Q25. 

26. Traditional healer advises R not to smoke? All Rs who answered “yes” to 

Q24 are asked Q26. 

27. Traditional healer recommended use of traditional methods to quit? Rs 

who answered “yes” to Q26 are asked the 27 and 28 series of questions. 

SECTION 3.	 Similar to the previous section, this section contains cigar use questions 

that are designed to gather information on prevalence, stages of change, 

quit attempts, and quit assistance. There is a clear distinction made between 

commercial cigar use and sacred or ceremonial cigar use, and Rs are asked 

only about commercial cigar use in the Core Questions section. 

13
 
 

 

 

 

 

 

 

 

 

 

 

28. Has R ever smoked a cigar (excluding sacred or ceremonial use)? This 

question refers to either commercially rolled cigars containing commercial 

tobacco or hand-rolled cigars that contain commercial tobacco. 

29. Age at which R first smoked a cigar (excluding sacred or ceremonial use)? 

This question should be asked only of Rs who answered “yes” to Q28. R must 

provide an actual numerical age. 

30. Has R smoked 100 cigars in her/his lifetime? In testing, this question caused 

some confusion among respondents, particularly among elders. The period of 

time in question is a lifetime, not a single day or a week. The interviewer should 

be aware of the possibility of confusion and should stress “in your entire life.” 

31. R’s age at regular use of cigars? This question is intended to determine the 

age at which R began using cigars regularly, not age of initiation. Interviewer 

should stress the word regularly. No definition of what regularly means is 

provided to R. Also, interviewer must ensure that R provides an actual number 

for the age, rather than a description such as “in high school.” 

32. R’s current smoking status? This question is used to categorize R as a current 

smoker, former smoker, or “never” smoker (<20 cigars in lifetime). 

33. Number of days R smoked cigars in past 30? This question is added only to 

those who answered in the previous questions that they smoke on some days. 

Answers must be quantitative (e.g., 1 day, 4 days) rather than “every day,” or 

“a couple of days a week.” Cognitive testing suggested that this question was 

confusing. To eliminate confusion, interviewer should provide specific dates 

(e.g., in the last 30 days, that is, since August 10). 

34. Number of cigars R smoked per day in the past 30 days? This question 

is designed to determine the average number of cigars R smokes per day. 

Cognitive testing suggested that this question was confusing as Rs tended to 

provide an aggregate number for 30 days. Interviewer should stress average 

per day on days they smoked. 

35. How soon after awakening does R smoke first cigar of the day? This 

question is related to addiction. Interviewer must read all of the responses to 

R. If R responds qualitatively (e.g., “with my first cup of coffee”), interviewer 

should probe (i.e., “would that be [READ RESPONSES AGAIN]?”). 

36. How long since R last smoked a cigar? This provides additional information 

about the category of smoker that best fits R, current, former or never smoker. 

37. Did R quit for 1 day or more during past 12 months? Testing suggested that 

this question was confusing to respondents. Many initially answered “Yes,” but 

then would qualify the response to indicate that the quitting was related to 

illness. Interviewer should stress because you were trying to quit smoking. 

38. a–d Did R use NRTs or any other medication to assist her/him in quitting? Did 

R use the “cold turkey” method of quitting? These questions are asked only 

of current smokers or former smokers who quit in the last 5 years. 

14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

39. Did R use any native or traditional methods to assist her/him in quitting? 

This question is asked only of current smokers or former smokers who quit 

in the last 5 years. Testing suggested that there may be some hesitancy in 

responding to this question, particularly among elders. Interviewer should not 

probe. Simply allow R to respond or refuse to respond. 

40. Did R use smoking cessation classes or counseling to quit? This question is 

asked only of current smokers or former smokers who quit in the last 5 years. 

41–43.	 R’s readiness to quit smoking? These three questions are asked only of 

Current Smokers. 

Does R want to quit? 

Is R seriously thinking about quitting in the next 6 months? 

Is R planning to quit in next 30 days?
 

44. Health care professionals asked R if she/he smokes cigars? 

45. Health care professionals advised R not to smoke cigars? 

46. a–h Health care professionals recommended aids to quit? This series of 

questions are asked of all Rs who answered “yes” to Q18. Cognitive testing 

revealed that Q46c was confusing—many American Indians suffer from 

asthma and so many respondents thought the “nasal spray” referred to 

asthma inhalers. Interviewers may have to differentiate asthma inhalers from 

NRT nasal sprays. 

47. a–c & 

48. a–b Health care professionals recommended other quit assistance (cessation 

classes, cessation programs, quitline, booklets, prayer, or traditional 

methods)? This series of questions are asked of all R who answered “yes” to 

Q45. 

49. Traditional healer asks R about smoking cigars? 

50. Traditional healer advises R not to smoke cigars? 

51. Traditional healer recommends quit aids and/or programs? 

SECTION 4.	 Similar to the previous sections, Section 4 contains commercial pipe use 

questions and is designed to gather information on prevalence, stages 

of change, quit attempts, and quit assistance. As pipe ceremonies are 

very important to many tribes, there is a clear distinction made between 

commercial pipe use and sacred or ceremonial use. Rs are asked only about 

commercial pipe use in the Core Questions section. 

15
 
 

 

 

 

 

 

 

 

 

 

52. Has R ever smoked a pipe (excluding sacred or ceremonial use)? This 

question refers to smoking tobacco through the use of a pipe, but only when 

the use is not in connection with sacred or ceremonial use such as in a pipe 

ceremony. 

53. Age at which R first smoked a pipe (excluding sacred or ceremonial use)? 

This question should be asked only of all Rs who answered “yes” to Q52. R 

must provide an actual numerical age. 

54. Has R smoked a pipe at least 20 times in her/his lifetime? In testing, this 

question caused some confusion among respondents, particularly among 

elders. The period of time in question is a lifetime, not a single day or a week. 

The interviewer should be aware of the possibility of confusion and should 

stress “in your entire life.” 

55. R’s age at regular use of pipes? This question is intended to determine 

the age at which R began smoking a pipe regularly, not age of initiation. 

Interviewer should stress the word regularly. No definition of what regularly 

means is provided to R. Also, interviewer must ensure that R provides an 

actual number for the age, rather than a description such as “in high school.” 

56. R’s current smoking status. This question is used to categorize R as an 

everyday pipe smoker, a current pipe smoker, former pipe smoker, or never 

pipe smoker (<20 pipes in lifetime). 

57. Number of days R smoked a pipe in past 30? This question is asked only to 

those who answered in the previous questions that they smoke pipes some 

days. Answers must be quantitative (e.g., 1 day, 4 days) rather than “a couple 

of days a week.” Cognitive testing suggested that this question was confusing. 

To eliminate confusion, interviewer should provide specific dates (e.g., in the 

last 30 days, that is, since August 10). 

58. Number of times daily that R smoked a pipe in the past 30 days? This 

question is designed to determine the average number of times that R smokes 

a pipe per day. Cognitive testing suggested that this question was confusing 

as Rs tended to provide an aggregate number for 30 days. Interviewer should 

stress times per day. 

59. How soon after awakening does R first smoke a pipe? This question is 

related to addiction. Interviewer must read all of the responses to R. If R 

responds qualitatively (e.g., “with my first cup of coffee”), interviewer should 

probe (i.e., “would that be [READ RESPONSES AGAIN]?”). 

60. How long since R last smoked a pipe? This provides additional information 

about the category of smokers that best fits R, current, former, or never pipe 

smokers. 

61. Did R quit for at least 1 day or more during past 12 months? Testing 

suggested that this question was confusing to respondents. Many initially 

answered “yes,” but then would qualify the response to indicate that the 

16
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

quitting was related to illness. Interviewer should stress because you were 

trying to quit smoking. 

62. a–d Did R use NRTs or any other medication to assist her/him in quitting? Did 

R use the “cold turkey” method of quitting? These questions are asked only 

of current smokers or former smokers who quit in the last 5 years. 

63. Did R use any native or traditional methods to assist her/him in quitting? 

This question is asked only of current smokers or former smokers who quit 

in the last 5 years. Testing suggested that there may be some hesitancy in 

responding to this question, particularly among elders. Interviewer should not 

probe. Simply allow R to respond or refuse to respond. 

64.	 Did R use smoking cessation classes or counseling to quit? This question is 

asked only of current smokers or former smokers who quit in the last 5 years. 

65–67.	 Readiness of R to quit smoking? These three questions are asked only of 

current pipe users. 

Does R want to quit? 

Is R seriously thinking about quitting in the next 6 months? 

Is R planning to quit in next 30 days?
 

68.	 Health care professional asked R if she/he smokes pipes? 

69.	 Health care professional advised R not to smoke pipes? 

70. a–h	 Health care professional recommended aids to quit? This series of 

questions are asked of all Rs who answered “yes” to Q18. Cognitive testing 

revealed that Q70c was confusing—many American Indians suffer from 

asthma and so many respondents thought the “nasal spray” referred to 

asthma inhalers. Interviewers may have to differentiate asthma inhalers from 

NRT nasal sprays. 

71. a–c & Health care professional recommended other quit assistance such 

72. a–b as cessation classes, cessation programs, quitline, booklets, prayer 

and traditional methods? This series of questions are asked of all Rs who 

answered “yes” to Q69. 

73. Traditional healer asks R about smoking pipes? 

74. Traditional healer advises R not to smoke pipes? 

75. Traditional healer recommends traditional methods? 

17
 
 

 

 

 

 

 

 

 

 

 

SECTION 5.	 Similar to the previous section, Section 5 contains commercial chewing (spit) 

tobacco use questions and is designed to gather information on prevalence, 

stages of change, quit attempts, and quit assistance. 

76. Has R ever used chew or spit tobacco (excluding sacred or ceremonial 

use)? This question is used to determine prevalence of commercial tobacco 

abuse via chew or spit tobacco. 

77. Age at which R first used chew or spit tobacco (excluding sacred or 

ceremonial use)? This question should be asked only of all Rs who answered 

“yes” to Q76. R must provide an actual numerical age. 

78. Has R used chew or spit tobacco at least 20 times in her/his lifetime? In 

testing, this question caused some confusion among respondents, particularly 

among elders. The period of time in question is a lifetime, not a single day or 

a week. The interviewer should be aware of the possibility of confusion and 

should stress “in your entire life.” 

79. R’s age at regular use of chew or spit tobacco? This question is intended to 

determine the age at which R began using chew or spit tobacco regularly, not 

age of initiation. Interviewer should stress the word regularly. No definition of 

what regularly means is provided to R. Also, interviewer must ensure that R 

provides an actual number for the age, rather than a description such as “in 

high school.” 

80. R’s current chewing/spit tobacco use status? This question is used to 

categorize R as a current, former, or never chew tobacco user (<20 times). 

81. Number of days R used chew/spit tobacco in the past 30 days? This 

question is asked only to those who answered in the previous questions 

that they use chew/spit tobacco some days. Answers must be quantitative 

(e.g., 1 day, 4 days) rather than “a couple of days a week.” Cognitive testing 

suggested that this question was confusing. To eliminate confusion, 

interviewer should provide specific dates (e.g., in the last 30 days, that is, since 

August 10). 

82. Number of times daily that R used chew/spit tobacco in the past 30 

days? This question is designed to determine the average number of times 

that R smokes a pipe per day. Cognitive testing suggested that this question 

was confusing as Rs tended to provide an aggregate number for 30 days. 

Interviewer should stress average times per day on days they used chewing/ 

snuff tobacco. 

83. How soon after awakening does R first use chew/spit tobacco? This 

question is related to addiction. Interviewer must read all of the responses to 

R. If R responds qualitatively (e.g., “with my first cup of coffee”), interviewer 

should probe (i.e., “would that be [READ RESPONSES AGAIN]?”). 

84. Identifies the brand of chew/spit tobacco that R uses most often? 

18
 
 

 

 

 

 

 

 

 

 

 

 

 

 

85. How long since R last used chew/spit tobacco? This provides additional 

information about the category of chew/spit tobacco user that best fits R, 

current, former, or never chew/spit tobacco user. 

86. Did R quit for 1 day or more during the past 12 months? Testing 

suggested that this question was confusing to respondents. Many initially 

answered “yes,” but then would qualify the response to indicate that the 

quitting was related to illness. Interviewer should stress because you were 

trying to quit using chew/spit tobacco. 

87. a–d Did R use NRTs or any other medication to assist her/him in quitting? Did 

R use the “cold turkey” method of quitting? These questions are asked only 

of current or former chew/spit tobacco users who quit in the last 5 years. 

88. Did R use any native or traditional methods to assist her/him in quitting? 

This question is asked only of current or former chew/spit tobacco users who 

quit in the last 5 years. Testing suggested that there may be some hesitancy in 

responding to this question, particularly among elders. Interviewer should not 

probe. Simply allow R to respond or refuse to respond. 

89. Did R use tobacco cessation classes or counseling to quit? This question is 

asked only of current or former chew/spit tobacco users who quit in the last 5 

years. 

90–92.	 Readiness of R to quit smoking? These three questions are asked only of 

current chew/spit tobacco users. 

Does R want to quit? 

Is R seriously thinking about quitting in the next 6 months? 

Is R planning to quit in next 30 days?
 

93. Health care professional asked R if she/he used chew/spit tobacco? 

94. Health care professional advised R not to use chew/spit tobacco? 

95. a–h Health care professional recommended aids to quit? This series of 

questions are asked of all R who answered “yes” to Q18. Cognitive testing 

revealed that Q95c was confusing—many American Indians suffer from 

asthma and so many respondents thought the “nasal spray” referred to 

asthma inhalers. Interviewers may have to differentiate asthma inhalers from 

NRT nasal sprays. 

96. a–c & 

97. a–b	 Health care professional recommended other quit assistance such as 

cessation classes, cessation programs, quitline, booklets, prayer and 

traditional methods? This series of questions are asked of all Rs who 

answered “yes” to Q94. 

19
 
 

 

 

 

 

 

 

 

 

 

 

98. Traditional healer asked R about using chew/spit tobacco? 

99. Traditional healer advised R not to use chew/spit tobacco? 

100. Traditional healer recommended quit aids and/or programs? 

SECTION 6.	 Similar to the previous section, Section 6 contains commercial snuff (dip) 

use questions and is designed to gather information on prevalence, stages of 

change, quit attempts, and quit assistance. 

101. Has R ever used commercial snuff (dip) (excluding sacred or ceremonial 

use)? This question is used to determine prevalence of commercial tobacco 

abuse via snuff (dip). 

102. Age at which R first used commercial snuff (dip) (excluding sacred or 

ceremonial use). This question should be asked only of all Rs who answered 

“yes” to Q101. R must provide an actual numerical age. 

103. Has R used commercial snuff (dip) at least 20 times in her/his lifetime? In 

testing, this question caused some confusion among respondents, particularly 

among elders. The period of time in question is a lifetime, not a single day or 

a week. The interviewer should be aware of the possibility of confusion and 

should stress “in your entire life.” 

104. R’s age at regular use of commercial snuff (dip)? This question is intended 

to determine the age at which R began using chew or spit tobacco regularly, 

not age of initiation. Interviewer should stress the word regularly. No 

definition of what regularly means is provided to R. Also, interviewer must 

ensure that R provides an actual number for the age, rather than a description 

such as “in high school.” 

105. R’s current commercial snuff (dip) use status? This question is used to 

categorize R as a current, former, or never commercial snuff (dip) user (<20 

times). 

106. Number of days R used commercial snuff (dip) in past 30? This question 

is asked only to those who answered in the previous questions that they use 

commercial snuff (dip) some days. Answers must be quantitative (e.g., 1 day, 

4 days) rather than “a couple of days a week.” Cognitive testing suggested 

that this question was confusing. To eliminate confusion, interviewer should 

provide specific dates (e.g., in the last 30 days, that is, since August 10). 

107. Number of times daily that R used commercial snuff (dip) in the past 30 

days? This question is designed to determine the average number of times 

that R smokes a pipe per day. Cognitive testing suggested that this question 

was confusing as Rs tended to provide an aggregate number for 30 days. 

Interviewer should stress average times per day on days they used snuff 

tobacco. 

20
 
 

 

 

 

 

 

 

 

 

 

 

 

 

108. How soon after awakening does R first use commercial snuff (dip)? This 

question is related to addiction. Interviewer must read all of the responses to 

R. If R responds qualitatively (e.g., “with my first cup of coffee”), interviewer 

should probe (i.e., would that be [READ RESPONSES AGAIN]?). 

109. Did R identify the brand of commercial snuff (dip) that R uses most 

often? 

110. How long since R last used commercial snuff (dip)? This provides 

additional information about the category of commercial snuff (dip) user that 

best fits R, current, former, or never commercial snuff (dip) user. 

111. Did R quit for 1 day or more during past 12 months? Testing suggested 

that this question was confusing to respondents. Many initially answered “yes,” 

but then would qualify the response to indicate that the quitting was related 

to illness. Interviewer should stress because you were trying to quit using 

commercial snuff (dip). 

112. a–d Did R use NRTs or any other medication to assist her/him in quitting? Did 

R use the “cold turkey” method of quitting? These questions are asked only of 

current or former users of commercial snuff (dip) who quit in the last 5 years. 

113. Did R use any native or traditional methods to assist her/him in quitting? 

This question is asked only of current or former commercial snuff (dip) 

Users who quit in the last 5 years. Testing suggested that there may be 

some hesitancy in responding to this question, particularly among elders. 

Interviewer should not probe. Simply allow R to respond or refuse to respond.
 

114. Did R use tobacco cessation classes or counseling to quit? This question is 

asked only of current or former commercial snuff (dip) Users who quit in the 

last 5 years. 

115–117.	 Readiness of R to quit smoking? These three questions are asked only of 

Current commercial snuff (dip) users. 

Does R want to quit? 

Is R seriously thinking about quitting in the next 6 months? 

Is R planning to quit in next 30 days? 

118.	 Health care professional asked R if she/he use commercial snuff (dip)? 

119. Health care professional advised R not to use commercial snuff (dip)? 

120. a–h Health care professional recommended aids to quit. This series of 

questions are asked of all R who answered “yes” to Q18. Cognitive testing 

revealed that Q120c was confusing—many American Indians suffer from 

asthma and so many respondents thought “nasal spray” referred to asthma 

inhalers. Interviewers may have to differentiate asthma inhalers from NRT 

nasal sprays. 

21
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

121. a–c & 

122. a–b	 Health care professional recommended other quit assistance such as 

cessation classes, cessation programs, quitline, booklet, prayer, and 

traditional methods. This series of questions are asked of all Rs who 

answered “yes” to Q119. 

123. Did traditional healer ask R about using commercial snuff (dip)? 

124. Did traditional healer advise R not to use commercial snuff (dip)? 

125. Did traditional healer recommend quit aids and/or programs? 

SECTION 7.	 Section 7 contains secondhand smoke exposure questions. 

126–129. Household and secondhand smoke. Questions are designed to elicit how 

many people live in the respondent’s household, how many smokers live 

in the household, how many people were exposed in the last week in the 

household, and what rules exist in household about smoking inside the home. 

130–135. Workplace and secondhand smoke. Questions are designed to determine 

second-hand smoke exposure and second-hand smoke policies at the 

respondent’s workplace. 

136–141. Clean indoor air policy attitudes. Questions are designed to elicit 

respondent’s opinions regarding clean indoor air policies in public places such 

as work areas, restaurants, shopping malls, and casinos. 

142. Car and secondhand smoke. Question asks if respondent has been in a car 

with someone who was smoking within the last week. 

SECTION 8.	 Section 8 contains questions about respondent’s risk perception regarding 

commercial tobacco use and exposure to secondhand smoke. 

143–149.	 Respondent’s opinions/knowledge regarding the risk of commercial 

tobacco use and exposure to secondhand smoke to cause specific 

diseases/conditions. Cognitive testing did not reveal any problems with this 

set of questions. 

150–160. Demographics. This set of questions provides demographic information on 

the participant. Information includes age, sex, income, education, and tribal 

enrollment information. 

161.	 Interviewer enters the date of the complete interview. 

22
 
 

 

 

 

 

 

Supplemental Questions4 

S1–S6.	 Purchase Patterns. This set of questions seeks to identify specific purchase 

patterns of commercial tobacco. This can assist in identifying key factors in 

the following purchasing decisions: convenience (ordering via internet), price 

(purchase in a neighboring state or on a reservation), and association between 

gaming and commercial tobacco use (casino). 

S7–S10. Ceremonial or Sacred Use. These questions are designed to elicit 

information regarding ceremonial or sacred use by Rs. Due to the nature 

of the question and issues of sovereignty, each tribal government should 

determine whether or not this set of questions can be asked of their citizens. 

It should be noted that of the original eight tribes which participated in the 

first fielding of the American Indian Adult Tobacco Survey, none of the tribes 

agreed to these specific questions. 

S11. Brand Smoked. This question elicits information regarding popularity of 

brands of cigarettes among Rs. It also provides information on the popularity 

of menthol versus non-menthol cigarette. 

S12.	 Sexual Orientation. This question seeks to identify sexual orientation for 

analysis purposes only. Sexual orientation responses could be tested to 

determine prevalence patterns or types of cigarettes smoked. 

S13–S21. Chronic Disease. This set of questions looks at chronic diseases from which 

American Indians suffer disproportionately. These same chronic diseases are 

associated with commercial tobacco use and secondhand smoke. Questions 

seek to identify incidence, use of screenings and preventive measures, and use 

of medicines to treat the diseases. 

S22–24.	 Pregnancy. This set of questions deal with prenatal exposure to commercial 

tobacco. Smoking and secondhand smoke exposure are risk factors for 

underweight babies, increased rates of infant morbidity and mortality, 

SIDS, and chronic diseases of children born to mothers who smoked or 

were exposed to secondhand smoke during pregnancy. Rs are asked about 

prevalence and provider care/information services. 

4

 These supplemental questions were not tested cognitively. 

23 
24
 
 

 

 

Chapter 3: Implementation
 

Engage Stakeholders 

The first step in implementing an AI ATS is to engage stakeholders and get the buy-in of 

tribal leaders and community members. One of the best ways to do that is to acknowledge 

and respect that the participating tribe is a sovereign nation. 

Another key to buy-in is to make sure tribal leaders have a clear understanding of the 

survey project; you must be prepared to make presentations throughout the tribal 

community. These presentations should explain the cultural appropriateness of the AI ATS 

as well as the background, purpose, and procedures of the survey. Presentations to tribal 

councils and communities also can demonstrate how the community will participate in and 

benefit from the survey. Remind participants that the survey is tribal-owned, so they will be 

able to decide how their AI ATS findings are used. Staff members working on the survey are 

encouraged to make presentations at community meetings, use tribal and clinic newsletters, 

and work with community gatekeepers to share information about the survey project. 

Continued involvement of tribal communities in each phase of the survey will help increase 

its success. AI ATS staff should seek tribal input in survey processes and methods on an 

ongoing basis to ensure cultural appropriateness. Remember that what may be considered 

culturally appropriate for one tribe may be inappropriate for another because each tribe 

is a distinct cultural entity. Suggested practices include scheduling monthly or bi-monthly 

telephone calls or presentations at the tribal council or community level; placing regular 

articles in tribal newspapers; providing up-to-date information to tribal Web sites; and 

staffing informational booths at community events, such as health fairs, festivals, and powwows. 

Institutional Review Board 

An Institutional Review Board (IRB) reviews study protocols to ensure that researchers and 

study investigators comply with the standards that have been established for the protection 

of human subjects.5

 Institutions (e.g., universities, clinics) and researchers that conduct 

studies that require contact with human subjects (e.g., focus groups, surveys, discussions) 

must receive IRB approval. The AI ATS is a survey that involves human subjects; therefore, 

after a tribe has granted permission for the survey, you must get IRB approval as well. 

Some tribes may already have an IRB, so your project coordinator should work with tribal 

leadership to determine the proper steps they must go through to receive IRB approval 

from the tribe. In the event a tribe does not have an IRB in place, you should seek approval 

from the Indian Health Services, because of their extensive knowledge, skills, and abilities 

in working with tribes in the United States (IHS IRB can contacted by e-mail at irb@ihs.org). 

Either way, the project coordinator must work with the tribal organization to determine 

which organization is available to provide this approval. Begin the IRB approval process 

early, preferably right after a tribe gives permission to conduct the survey, because this 

process can take a long time. 

Data Ownership/Data Sharing 

Many tribes have policies and procedures in place to protect data and information 

generated by research, surveys, and other types of data collection, especially those 

5

 For more information, see the Office for Human Research Protections Web site at 

 http://www.hhs.gov/ohrp/policy/index.html. 

25 
conducted by external organizations. These policies and procedures may be overseen by 

entities, such as tribal and regional IRB or research and information subcommittees, created 

under the doctrine of sovereignty. We recommend that AI ATS project staff inquire about 

such policies and procedures and work with the respective organizations to adhere to them. 

Data-sharing agreements are an important part of any data collection, but are even more 

significant for studies among American Indian populations because of tribal sovereignty 

and issues with preventing the misuse of collected data. AI ATS project staff should work 

with tribal leaders, tribal organizations, and community members to determine the content 

of any data-sharing agreements, as well as the security of such data. This approach may 

entail working with the tribe to develop safeguards to protect the data. 

Although tribal community members should staff the survey project, you may need 

to engage researchers, analysts, and staff from outside the tribal community to help 

implement the survey. Data-sharing agreements ensure all parties understand privacy 

issues, data ownership, and corresponding concerns, such as publishing rights and 

dissemination through presentations. 

Sampling Frame/Size 

One of the goals of a scientifically sound survey is to ensure that findings from the survey 

can be generalized to the entire population for which it is intended (e.g., tribe, community, 

region). In other words, if a sample of tribal members is selected, the results should truly 

represent the majority of the tribe. In the case of small tribes (e.g., 250 members or less), 

all of the adult members of the population may need to be interviewed. This type of 

survey is called a census survey, and it provides the most reliable findings. In large tribes, a 

representative (random, population-based) sample of tribal members is best. 

A random, population-based sample of adult 

members of a tribal community means that every 

adult in the tribal community has a chance of being 

chosen to participate in the survey. (Note that 

“adult” can mean aged 18 years or older, or aged 19 

years or older, depending on the state.) The entire 

population of possible tribal participants is called 

a sampling frame. For American Indian tribes, this 

entire population of adults, or sampling frame, can 

typically be found in tribal enrollment lists. Because 

enrollment lists are carefully guarded by tribes, and 

only a few people have access to them, tribal buy-in 

and collaborative strategies are essential for getting 

access to the sampling frame. AI ATS project staff 

does not have to have direct access to the tribal 

enrollment rolls. Instead, the project coordinator 

can train tribal administrators to extract random 

samples to allow them to generate the sample 

needed for the AI ATS. 

26
 
Many software statistical computer packages can extract a random sample from a 

population list. Your project coordinator should work with tribal administrators and 

epidemiologists or statisticians to extract random population samples or other kinds of 

probability samples (e.g., cluster samples). If a tribal college exists in your area, you may 

want to work with a statistician from that institution. If the tribe or tribal organization has a 

working relationship with a research institution or a Tribal Epidemiology Unit, working with 

one of their statisticians or epidemiologists could provide the needed help. These partners 

also could help determine the number of people who must be surveyed so that the findings 

can be generalized to the overall tribal population. 

Samples also must include enough people to allow comparisons across different subgroups 

identified from the data. The tribe can provide the context and culturally appropriate 

strategies, and the scientific partner can provide the expertise to ensure scientific rigor. 

During this process, it is important that the identities of the individuals involved are 

protected. A way to safeguard participants’ identity is to give each person (adults only) on 

the tribal enrollment list a unique number and then give the numbers to the researchers so 

that the sampling could be done without revealing everyone’s identity in the tribe. 

A common challenge in determining the sampling frame and size is that the existing tribal 

enrollment lists may not be current. If possible, be prepared to help tribal administrators 

update these lists. Out-of-date enrollment lists can bias the sample, making any findings 

from your survey not truly representative of the entire tribal population. However, if the 

enrollment lists are not current, other methods of selecting a sample exist, including using 

electric and gas company records. This method can be used only if the companies that 

provide the services are owned by the tribes and are able to provide a record of every 

household in the community. You also can use software or computer programs to provide 

a geographical map of the area and the houses within that area. This map can be used to 

create a random sample that includes certain 

houses, and members of these households can 

be selected to participate in the survey. If the use 

of geographical maps to determine the random 

sample is necessary, the project coordinators 

must work closely with an epidemiologist or 

survey methodologist from the local tribal 

support center or university when choosing 

households for participation. 

Establishing Protocols 

To conduct a valid AI ATS, you must establish 

protocols for recruiting and hiring interviewers, 

determining locations for conducting the survey, 

ensuring that identifying information and 

completed surveys are secure, and implementing 

the survey. Early development of protocols and 

procedures will provide the framework for a 

successful survey. 

27
 
Recruitment and Hiring Interviewers 

Conducting a survey is a multifaceted process that requires a great deal of work on the 

part of many people. The interviewer is a vital link at the center of that process. The quality 

and usability of the information collected from respondents is directly related to the 

interviewer’s skills. AI ATS staff members and tribal partners must decide what qualifications 

are needed for interviewers. If possible, we recommend that members of the tribal 

community serve as interviewers. (See Chapter 3 for further guidance on this topic.) 

Because the AI ATS is conducted as a face-to-face interview, and interviewers may be asked 

to travel throughout the tribal community, access to transportation may be a key issue. 

Interviewers generally conduct interviews in the homes of tribal members, so background 

checks may be required. In addition, interviewers will be asked to read the questions to the 

respondents, so a certain level of literacy is required. Finally, if the tribe has social customs 

or taboos that require males to interview males or females to interview females, these 

considerations must be a part of your protocols. 

We recommend that you use a joint participatory process with the AI ATS project staff and 

tribal stakeholders to recruit interviewers. Recruitment strategies may differ from tribe to 

tribe, so culturally appropriate methods that work for the specific tribe hosting the survey 

should be established. Recruitment methods include, but are not limited to, advertising in 

tribal or clinic newsletters, and hanging posters in offices (e.g., housing agencies; Special 

Supplemental Nutrition Program for Women, Infants, and Children [WIC]; Head Start), 

churches, clinics, bingo halls, community halls, recruiting booths (e.g., at health fairs, 

festivals, pow-wows), and any other venues supported by the tribe’s membership. 

Once interviewers are hired, you will need an interviewer supervisor. (You may need more 

than one depending on how many interviewers you have.) This position is key to the 

success of the survey because the interviewer supervisor serves as the conduit through 

which interviewers can get help, work through problems and concerns, and improve 

participation rates. The interviewer supervisor also is responsible for such duties as 

•		 Determining which interviewers will go to which areas to conduct the survey. 

•		 Handling and keeping track of compensation for respondents, if such is given. 

•		 Keeping records on completion rates per interviewer for payment purposes. 

•		 Ensuring that protocols and procedures are carefully followed by all interviewers. 

•		 Arranging and maintaining security of completed surveys. 

•		 Conducting quality control procedures, which may include spot-checks of randomly 

chosen interviews. 

The interviewer supervisor should be experienced in conducting surveys. (See Appendix A 

for more recruitment tools.) Once the interviewer supervisor and interviewers have been 

hired, you should identify a site for the training class. (See Chapter 4 for details about 

interviewer training.) Use this manual to ensure that all AI ATSs are conducted consistently. 

We also suggest that you train interviewers within 1 week of when they will go out into the 

field. This strategy ensures that the training methods are still fresh in their minds. 

28
 
Determining Locations for Conducting the Survey 

The AI ATS was developed as a face-to-face survey, which means that interviewers conduct 

the survey personally, rather than over the telephone or by any other means. Protocols 

should be developed with regard to where the surveys will be conducted. Sometimes, it 

is best for interviewers to conduct the surveys in the respondents’ homes. In that case, 

the protocols must address issues of safety and privacy for both the interviewer and the 

respondent. An alternative location that is private and dedicated for conducting the survey 

also should be considered. For example, an office in the tribal clinic or administration 

building, an isolated booth or table at a coffee shop or restaurant, or even a park could 

serve as a location where the survey could be administered. 

Maintaining Confidentiality and Security 

Confidentiality of respondents’ personal information must be maintained throughout the 

survey process. No identifying information should be placed on surveys, and interviewers 

and the AI ATS project staff should sign affidavits pledging that they will respect the 

confidentiality of respondents. (See Chapter 4 for more on this topic.) If interviewers have 

lists with personal information (e.g., names, addresses) of respondents, they should be 

given a lockbox to secure that information. The lockbox should be large enough to hold 

completed surveys as well. The interviewer supervisor should dedicate a locked file drawer 

or cabinet for master lists, tribal enrollment lists, sample lists, completed surveys, signed 

informed consent forms, signed receipts of compensation, and any other identifying 

information. Only the interviewer supervisor—and perhaps one other person—should have 

access to the locked file drawer or cabinet. 

Implementing the Survey 

Finally, protocols should be developed and put into place to address the following 

important issues: 

• Coding the questionnaires. The first page of the questionnaire provides a space for 

coding items such as year, tribe, village number, interviewer supervisor number, and 

interviewer number. A system of coding should be developed and shared with AI 

ATS project staff and interviewers. If more than one tribe is being interviewed, each 

tribe or village should be given a separate and distinct number so that when the data 

are analyzed, the analyst will be able to differentiate between the tribes and villages. 

Likewise, interviewers and interviewer supervisors should be given separate and 

distinct codes. The questionnaire ID (located on first page of the survey) should be 

coded before it is given to the interviewers. 

• Contacting respondents. In the original fielding of the AI ATS, potential participants 

were first contacted by mail to determine their willingness to participate in the survey. 

(Templates of the mailing and return postcard are provided at the end of this chapter.) 

In that first mailing, respondents who agreed to participate were requested to return 

the postcard within 7 days. A master list was kept of each name and address to which 

the first mailings were sent. Fourteen days later, the master list was updated and 

those who replied were placed on a list called “Respondents.” Those who did not reply 

were sent a second mailing and postcard. The process was then repeated, and a third 

mailing was sent out 14 days after the second mailing. Appendix A contains a “Plan B” 

for people who do not respond; this plan was used by a tribe that participated in the 

original fielding of the survey. It is important that culturally competent protocols be 

put into place and are followed consistently. A presurvey check list also is provided in 

Appendix C. 

29
Unforeseen Circumstances 

As human behavior is ultimately unpredictable, unusual challenges and situations will 

come up when fielding any survey. The interviewer supervisor should be able to solve most 

challenges, especially if you hire a supervisor with experience conducting surveys. The 

interviewer supervisor should have access to one person on the AI ATS project staff who 

can make final decisions when problems arise. As many surveys will be conducted after 

normal business hours, both the interviewer supervisor and the AI ATS project staff must be 

able to reach interviewers at any time during interviewing hours. 

Once all issues have been resolved, all permissions granted (i.e., IRB and access to the 

tribal enrollment list), all protocols developed and put into place, all samples chosen, 

and all interviewers hired, the last step before entering the field to conduct the survey is 

interviewer training, which is covered in Chapter 4. 

30
 
Chapter 4: Interviewer Training
 

Before you conduct the AI ATS, you must train your interviewers. This chapter presents 

information and guidelines from the American Indian Adult Tobacco Survey Interviewer 

Training Manual—the original manual used to train American Indian interviewers who 

fielded the first AI ATS. We recommend that training take place over 2 days, and that 

this manual be used in its entirety. The second day should consist of role-playing, which 

involves trainees taking turns interviewing each other several times. This approach allows 

the trainees to become familiar with the survey and allows the instructor to observe any 

issues that may need to be resolved before an actual interview. 

Suggested Training Schedule 

Day 1 

•		 Introductions and a brief explanation of the purpose of the AI ATS for your tribe. 

•		 Instructor reads the core questionnaire and the optional questionnaire, question 

by question, and points out the coding patterns and skip-patterns that are in the 

survey. 

•		 Instructor reads and explains all forms that will be used by interviewers. Examples 

include the initial contact letter, the face-to-face contact script, the telephone contact 

script, and the informed consent form. 

•		 Dress and demeanor are discussed in the context of the cultural realities of your tribe. 

•		 The importance of confidentiality is discussed. Interviewers will learn that 

confidentiality is the most important element of the survey process. You can use 

storytelling to address this issue as it relates to your tribe. 

•		 Time management is discussed. Socializing before or during the interview is 

unacceptable. The interviewer is responsible for ensuring that interviews do not 

exceed the normal time limits. The instructor provides culturally appropriate methods 

of moving the interview along. Interviewers should learn that it is acceptable to 

socialize briefly after the survey, but only if the respondent wishes to socialize. 

•		 The importance of objectivity and consistency is discussed. Through a culturally 

relevant discussion, the instructor provides examples of words and actions used by 

the interviewers that may imply “approval” or “disapproval.” These examples can be 

explored through storytelling. Instructors should provide tips that can be used by 

interviewers to avoid such pitfalls. Interviewers also are reminded that consistency 

among interviewers is critical and cannot be achieved if interviewers change wording, 

explain questions to respondents, or ad-lib. 

Day 2 

Role-playing by the interviewers. Interviewers should practice approaching one another so 

they are comfortable conducting interviews and obtaining consent from the participants. 

They also should use this time to practice conducting the interview so they are familiar 

with the survey questions and skip patterns. Partners should be changed so that 

interviewers are able to interview a variety of respondents. The instructor should mingle to 

provide feedback, help, and constructive criticism to each interviewer. 

31
 
Questionnaire Coding 

When the interviewers receive the questionnaires, make sure they note the codes (series 

of numbers) in the top right corner. These codes will help the statistical analysts identify 

certain aspects of the survey and are used to identify information such as 1) the year the 

survey is fielded, 2) the tribe (if more than one tribe is being surveyed), 3) the community, 4) 

the interviewer supervisor, 5) the survey number, and 6) the interviewer. Should interviewers 

receive questionnaires that do not have a code on the top right corner of the first page, 

they should notify an interviewer supervisor immediately. 

The AI ATS includes the questionnaire and several scripts. The scripts ensure that the 

surveys are reliable and consistent. Other methods can be used to collect survey data that 

are reliable and valid, such as collecting preliminary information, talking with respondents, 

and asking questions. We use scripts to ensure that all interviewers will present the survey 

to the respondents in exactly the same way. For the interview training, the first lesson is to 

become familiar with the following components of the survey: 

• Core Questionnaire (see Appendix B). 

• Questionnaire (see Appendix B). 

• Initial Contact Letter (see Appendix A). 

• Face-to-Face and Telephone Contact Script (see Appendix C). 

• Informed Consent Form (see Appendix C). 

By now, you should be familiar with the core and supplemental questionnaires. The next 

sections discuss the contact letter, the scripts, and the consent form in more detail. 

Initial Contact Letter 

By the time the interviewer supervisor and interviewers become involved in the survey 

process, a list of respondents should have been created. The respondents in this survey 

have been selected so that they, as a group, represent their specific tribe(s) or communities. 

Once respondents are chosen, send out your initial 

contact letter (see Appendix A). 

The letter should be written on official letterhead, 

either from the tribe or a tribal health clinic. This 

is important because it lends official sanction and 

legitimacy to the survey and lets the respondent 

know that the survey has been approved by an 

organization that is trustworthy. The first sentence 

and second sentence of the letter let the person 

know that they have been selected to participate 

in the survey and should specifically state that 

the survey has been approved by a specific tribe 

or clinic. The general tone of the first paragraph 

should convey to the respondent the importance 

of his or her participation in the survey. Further, the 

first paragraph should acknowledge the possibility 

of traditional tobacco use and distinguish it from 

32
 
commercial use. The letter also should clearly state that serious health problems can be 

caused by the use and abuse of commercial tobacco products. 

Confidentiality is an extremely important issue that must be addressed at each stage of 

the interview process, including as part of the initial contact letter. Typically, respondents 

in any survey are concerned with issues of confidentiality. No one wants his or her name 

used without permission. Among American Indians, however, confidentiality is even more 

guarded because of the long history of research being harmful to American Indians as a 

whole, along with repercussions against informants.6

 Therefore, it is critical that respondents 

in this survey understand that their names will be kept private, and that there is no way that 

the answers they provide can be matched to their names. 

The initial contact letter also should address the issue of compensation or incentives 

for participants (if provided). Although these incentives are not mandatory, providing 

compensation can improve response rates.7

 We recommend that the value of this 

compensation not exceed an amount that a person could earn doing 2 or more hours of 

work in the community. 

The initial contact letter should ask the respondent to complete an enclosed self-addressed, 

stamped postcard and return it with information regarding the best time and place for the 

interview to take place. Upon receipt of the acceptance card, the interviewer should then 

call the respondent to set up the appointment. The interviewer should call the respondent 

again one day before the appointment to verify that the date, place, and time are still set. 

Face-to-Face Contact Script 

After all appointments have been made and verified, it is time for the interviewers to 

present themselves at the home of the respondent to begin the survey. All interviewers 

should present their contact information and questions in the same way. Interviewers 

can be provided with business cards with their names, contact information, and official 

organization logos or names on them to remind the respondents that the survey is officially 

sanctioned by tribal leadership or health clinics. 

The face-to-face contact script introduces the interviewer to the respondent. It also advises 

the respondent that the survey has been approved by his or her tribe or health clinic. The 

script reinforces the importance of the respondent’s help and stresses that survey results 

will be used to address serious health problems among American Indians (see Appendix 

C). The issue of confidentiality is stressed again at this time because of its importance for 

American Indians. Finally, the script allows the interviewers to tell respondents that if a 

question makes them feel uncomfortable, they do not have to answer that question, they 

can stop the interview at any time. 

Telephone Contact Script 

This script is used when the respondent is unable to complete the survey in person, but is 

willing to complete the survey by telephone. Essentially, this is the same script as the faceto-face contact script with some adjustments for telephone surveying (see Appendix C). 

6

 Oberly J, Macedo J. The R in Indian country: culturally appropriate commercial tobacco-use research strategies. Health 

 Promotion Practice. 2004 Oct 5;355–361. 7

 Harris M, Johnson O. Cultural anthropology. 6th ed. New York: Allyn & Bacon; 2002. 

33 
Informed Consent Form 

The informed consent form is a critical component of the AI ATS and it must be addressed 

before face-to-face or telephone interviews begin. Unless the respondent signs this form 

(face-to-face) or verbally agrees (by telephone) to the provisions contained in this form, the 

survey cannot be administered. 

The informed consent form tells the respondent about the survey process and the 

respondent’s part in the process. It addresses the purpose, benefits, procedures, 

confidentiality, risks, and benefits of the survey, as well as the rights of volunteers and the 

respondent’s agreement to participate. The informed consent form also addresses the 

compensation (if any) that will be given to the respondent. 

Establishing a Rapport with Respondents 

If the interviewers are members of the tribal community in which the AI ATS will be 

conducted, they may be familiar with many of the tribal members who will be respondents. 

They may personally know the respondent or members of the respondent’s family. If they 

find that they know a respondent who has been assigned to them, they must immediately 

report it to their interviewer supervisor so another interviewer can take their place for that 

particular respondent. This will prevent unintentional biases that may influence the data 

collection. 

Dress 

Interviewers represent their tribe and community. Neatness and cleanliness in appearance 

are essential. However, they do not want to overdress, as this might intimidate the 

respondents. Instead, it is best to dress in the same manner as the respondents. 

Demeanor 

The approach that will serve interviewers best is a positive attitude. Recall from Chapter 

1 that the scripts automatically assume that the respondents will agree to answer the 

questions. By using this positive method, we decrease the likelihood of having respondents 

refuse to answer the survey questions. Avoid any words or phrases that would give 

respondents an easy opening for refusal. Phrases such as “Are you too busy?” or “Would you 

mind answering some questions?” portray a hesitant attitude on the part of the interviewer 

and increase the chances of refusal to participate in the survey. The interviewer should stick 

to the scripts provided because these scripts use positive words and have been proven to 

increase the likelihood of participation in the survey. Consistency is key. 

Confidentiality 

The confidential aspect of the AI ATS is very important. Interviewers must make sure that 

respondents understand that their responses cannot be linked to their names and will 

be kept confidential. The interviewer must never mention the names of others they have 

interviewed. They must never mention other interviews or answers they have received. They 

must never allow a respondent to see another completed questionnaire. 

Time Management 

One of the challenges interviewers face is managing their time. The interview should take 

about 30 minutes to complete, although the amount of time may vary. In the event that you 

notice that the participants are uncomfortable, prior to the interview the interviewer might 

want to allow a short social time. Once the survey has begun, however, they must ensure 

that they ask the questions and receive an answer from the list provided. They must steer 

34
 
the respondent away from conversation and keep the respondent focused on the survey 

responses. 

In many cases, interviewers may normally work as service providers to their tribal 

community. In small communities, people may know that they are a health provider, social 

worker, or other service provider. The interviewers may find that participants will ask 

them about handling other matters for them during the interview. Make sure interviewers 

understand that this work must be conducted at another time. When they are interviewing 

participants for the AI ATS, they should be an interviewer only. The interviewers can politely 

explain to the participant that, at the current time, they are interviewing for the AI ATS, but 

that they will be glad to get back with them on other matters later. 

Objectivity 

Interviewers must remain completely objective and neutral throughout the interview 

process. People often want the interviewer’s approval when answering questions. 

Interviewers must make clear in their words and actions that they do not approve or 

disapprove of any answers. Interviewers must be vigilant to keep their tone of voice, facial 

expressions, and body language neutral. Interviewers should be careful that they do not 

convey—in any way—their attitudes, opinions, or judgments to the respondents. If they are 

asked about their opinion, they should advise the respondent that their opinion does not 

matter; only the respondent’s opinion matters in this survey. Actions such as nodding your 

head in agreement, expressing empathy, or using sounds that indicate agreement must be 

strictly avoided. 

If a respondent answers the question using something other than the scripted responses, 

the interviewers should not attempt to translate the response and should not ask the 

respondent a questions such as, “Do you mean...?” Instead, they should read the scripted 

responses again and allow the respondent to choose one of them. 

The questions and possible answers must be read exactly as they appear on the survey. The 

wording should not be changed. Remember, consistency is key. Questions and answers are 

deliberately worded in a specific way, and any change in the wording could compromise 

the integrity of the survey. The sequence of the questions also should not be changed. The 

sequence of the questions is deliberate and any changes could compromise the integrity of 

the survey. 

35
 
36
 
Chapter 5: Fielding the American Indian Adult Tobacco Survey
 

Similar to any other face-to-face survey, there are challenges to implementing the AI ATS. 

These challenges may occur during the interview process with the interviewers or the 

participants. This chapter provides examples of challenges that tribes, tribal organizations, 

and other organizations may experience while implementing the AI ATS. 

As discussed previously, before you implement the AI ATS, you must have community 

buy-in from tribal leaders, tribal councils, tribal health boards, and any other tribal 

governing body that makes decisions about collecting survey data in the community. 

Open communication must be maintained among everyone involved in the project. For 

example, if there is a delay starting the survey, you must communicate this information to 

major stakeholders or partners, such as the tribal director, tribal coordinator, or interviewer 

supervisor. You can use e-mail, conference calls, or letters to let them know why there is a 

delay and when the survey will begin. 

Maintaining a good working relationship with those involved in the AI ATS is important. 

In addition to keeping everyone updated on what is going on with the implementation 

process, the project manager (or director) must stay involved while the survey is being 

implemented. The project manager should be available to the assigned project coordinator 

and interviewer supervisor by telephone, e-mail, or face-to-face. If possible, he or she 

should conduct monthly site visits while the survey is being implemented. Being available is 

important because if problems or challenges arise, the program manager is knowledgeable 

enough to provide advice or resolve these problems. 

As discussed previously, you should have interviewers who are from or a part of the 

community in which the survey is being implemented whenever feasible. To do so, you 

must screen interviewers before they are hired. Choose people who are trustworthy, 

dependable, accountable, knowledgeable, and well-respected members of the community. 

Successful implementation of the AI ATS survey is dependent on having good interviewers. 

Good interviewers can help determine which participants are still living in the community. 

Choose interviewers that participants feel comfortable talking with about the issues that are 

discussed on the survey. This will help assure participants that the interviewer will not tell 

anyone else their answers. 

Because the AI ATS is conducted primarily in rural areas, you should take the time to match 

up interviewers with assignments near their home. This approach is a more efficient use 

of your staff than just giving them a list of names to interview without considering which 

addresses are most accessible to them. You also should ask interviewers which interviews 

they are most comfortable and capable of conducting. 

Another important factor is giving interviewers good tools that allow them to conduct 

interviews successfully. For example, give interviewers identification badges, pens, business 

cards, and lockboxes for the surveys and incentives. Because face-to-face interviews must 

be conducted the same way, all interviewers must attend training to ensure valid data are 

collected. 

In addition, if the respondents agree, the interviewer supervisor can accompany 

interviewers on one of their interviews to ensure they are conducted in a scientific and 

ethical manner and to ensure that interviewers are following the same protocol. In the event 

37
 
 

that the interviewer is not following proper protocols, the supervisor may recommend 

that they shadow or help another interviewer until they have learned the protocols in 

conducting interviews for the AI ATS. 

An important challenge in implementing a face-to-face survey is maintaining interviewer 

morale and ensuring that interviewers will complete the project. Sometimes interviewers 

are not able to complete the project because of circumstances beyond their control, or they 

may no longer interested in the project. To ensure that you can complete the project within 

the preferred timeline, create an alternate list of interviewers who are available for training if 

needed. 

Providing incentives for the interviewers—such as monetary rewards for completed 

interviews, certificates and awards, or lunch or dinner at local restaurants to discuss the 

project—are all ways to help motivate interviewers to keep the project going. Another 

method that can be used to protect the integrity of the survey is to contact the respondent 

to verify that the survey was conducted. 

Incentives also can be used to reward respondents for their participation in the survey. 

These incentives can include a gift certificate from a major or local supermarket, restaurant, 

or retail outlet store. Most gift certificates have an identification number that allows them 

to be preassigned to a specific interviewer or participant. Gift certificates may be easier for 

your accounting or finance department to process than cash. If cash is used, you must have 

a protocol in place to track how much each interviewer is given at one time. 

For example, when using cash as the incentive, the interviewer supervisor may want to 

give the interviewer a certain number of surveys along with the amount of cash that is 

equivalent for those particular surveys. Once the interviewer has completed those surveys 

and returned them to the interviewer supervisor, then he or she can receive more surveys 

and incentives. 

Whether the incentive is gift certificates or cash, the interviewer supervisor can use a 

form to track which surveys and incentives, and how many of each are going to which 

interviewers. The identification numbers used on the gift certificates will help with tracking. 

These types of tools will help you account for all incentives and ensure that interviewers and 

participants receive their incentive properly and fairly. 

38
 
 

 

Chapter 6: Inputting, Analyzing, and Using the Data
 

Once the fielding of the survey is complete, it is time to input the data and analyze the 

findings. Inputting the data accurately is a critical component of the AI ATS process. 

Developing a Codebook and Database 

One of the first steps in data entry is the development of a codebook, which will be used 

as a guide throughout the data input and analysis process. Although there are several ways 

to prepare a codebook, one of the simplest is to begin with a blank survey. Each question 

in the survey pertains to a “variable,” and these variables will be analyzed separately or 

together. 

Each variable, or question, should be given a name. For example, the name could reflect 

the intent of the question and consist of a minimum of six letters from the words in the 

question. For example, the question below asks respondents what type of smoker they 

are. The corresponding variable name could be TYPSMK—TYP from “type” and SMK from 

“smoker.” Then the name of the variable can be printed next to the question in the survey 

codebook in the following illustration: 

TYPSMK: Not including ceremonial or sacred smoking, do you now smoke cigarettes 

everyday, some days, or not at all? 

Every day (1) 

Some days (2) 

Not at all (3) 

Refused (99) 

Every possible response in the survey has a number next to it because statistical programs 

for computers read numbers for analysis; numbers will be inputted for the data rather than 

words. The format of your database can vary depending on which statistical program is 

used by the statistician. There are various types of database that can be used for analysis, 

including Epi InfoTM,8

 which is available free to the public. Other software packages with 

database platforms include Microsoft® Excel,9 Statistical Package for Social Sciences 

(SPSS®),10 and Statistical Analysis Software (SAS®).11 

Once each question/variable has been assigned a name, the database can be prepared. 

The codes that appear on the first page of the survey and all variables should head each 

column. This method allows the responses to each individual survey to be entered into the 

database across one row, as illustrated in the following example: 

SURVEY YEAR TYPSMK SEX AGE EDUC INCOME NO. 

8

 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Public Health 

 Surveillance. Epi Info, Version 3.4.3, 2007. Available at http://www.cdc.gov/epiinfo. 9

 Microsoft Corporation. Microsoft Excel, Version 2007. Available at http://office.microsoft.com/en-us/excel/default.aspx 10 Statistical Package for Social Sciences. Statistical Package for Social Sciences (SPSS), Version 16.0, 2007. Available at 

 http://www.spss.com/spss. 

11 Statistical Analysis Software. Statistical Analysis Software (SAS), Version 9.0, 2007. Available at http://www.sas.com/

 technologies/analytics/statistics/index.html. 

39 
 

 

 

 

 

 

 

 

 

 

 

 

 

Using a statistical software platform such as SPSS or SAS allows you to input response 

numbers and corresponding responses into the database. Most databases provide an area 

where the actual responses and the corresponding number codes can be entered. This 

information should be entered before any data are input. This step allows the program to 

present the findings in a more understandable format. 

For example, inputting data into a database using the sample responses below will give you 

the following results: 

YEAR SURVEY NO. TYPSMK SEX AGE EDUC 

2006 60100 2 1 35 3 

2006 60101 1 1 48 4 

2006 60102 3 2 52 5 

Once the database is prepared, data can be input. For purposes of illustration, we provide 

the followingTYPSMK responses and corresponding number codes: 

1 = Every day 

2 = Some days 

3 = Not at all 

99 = Refused to answer 

For the variable SEX, the responses and corresponding number codes are as follows: 

1 = Female 

2 = Male 

99 = Refused to answer 

For the variable AGE, the respondent’s actual age is the number code—that is, if the 

respondent is aged 19 years, the number code is 19. For the variable EDUC, we use the 

following responses and corresponding number codes: 

1 = No formal schooling 

2 = Some formal schooling, but no high school diploma or General 

 Equivalency Diploma (GED) 

3 = High school diploma or GED 

4 = Some college, but no degree 

5 = College degree 

This means that survey #60100 was a female who smokes every day, is aged 35 years, and 

has a high school diploma or GED. For a better understanding of how to complete cross 

tabs or two-by-two tables, you should hire an epidemiologist or biostatistician to help you 

input and analyze the data if you do not have this capacity in-house. Appendix D provides 

information on how to conduct statistical analysis. 

Data Input 

Survey findings are only as reliable as the data that are input. Inaccurate data inputting 

results in unreliable data. You must follow specific strategies to help ensure good data are 

40
 
being input into the database. The following strategies can help to improve the quality of 

your data. 

AI ATS project staff should recruit and hire data processors who have experience inputting 

large amounts of data with minimal error rates. If possible, data should be entered twice 

(double entry) as a way to double-check accuracy. To further ensure the quality of data 

entry, a minimum of 20% of the completed surveys should be double-checked by a data 

entry supervisor. We also recommend that the AI ATS project staff conduct “data scrubbing.” 

This process consists of randomly checking about 20% of the inputted data against the 

actual corresponding surveys and correcting any errors. If you find a large number of 

input or data entry errors, then the data should be re-entered. Finally, the data analyst or 

statistician should run an initial frequency (number of respondents) on all variables. This 

process will identify obvious errors in the database that can be corrected by pulling the 

corresponding completed survey and inputting correct data. 

Analyzing data and understanding the findings of surveys is a highly skilled undertaking. 

We strongly suggest that individuals who are skilled in statistics serve as data analysts on 

this project. If a tribe, tribal organization, or other organization does not have direct access 

to an epidemiologist or statistician, we recommend that the project coordinator work with 

a Trial Epidemiology Center at a local tribal support center or a tribal college, research 

university, or organization in which a good and trusted relationship exists. If more help is 

needed, Appendix D provides a list of resources. 

Reports 

Once analysis is completed, reports should be provided to various branches and offices 

of the tribal government and health system. Proper protocol should always be used 

when deciding to whom reports should be provided. In many cases, the tribal council or 

governing board may want to be the first entity to see a report of your survey findings. 

Depending on the tribe, tribal health system directors or Indian Health Service staff may 

receive reports. Certain tribal divisions or departments also may receive reports. Examples 

include commercial tobacco prevention and control programs, chronic disease programs 

(e.g., diabetes, asthma, cancer, heart disease), prenatal and perinatal programs (e.g., Healthy 

Start; WIC; Healthy Mothers, Healthy Babies), tribal school administrators, elder associations, 

tribal court justice associations, tribal law enforcement agencies, economic agencies 

charged with handling economic affairs on tribal lands, and tribal gaming administrators. 

Depending on tribal relationships with states and tribal governances, reports may be 

provided to inter-tribal councils, states, or federal public health agencies. 

The types of reports are myriad, so consider your audience when developing your reports. 

The project coordinator may be required to provide a short presentation of the key findings; 

prevalence data may be enough in this case. The presentation should include tables 

showing relationships between variables, such as smoking prevalence rates and sex or 

prevalence rates and employment. 

In some cases, the presentation and report may need to be customized for different 

audiences. For example, if a report is being provided to tribal gaming administrators, they 

may be more interested in findings related to opinions about secondhand smoke than 

they are about smoking prevalence rates. By contrast, tribal health systems may require a 

multifaceted, statistically comprehensive, in-depth report. 

41
 
In many cases, reports can 

take the form of presentations 

at regional, national, and 

international conferences. 

Another form of reporting occurs 

when an article is sent to a peerreviewed journal. Ultimately, the 

types and number of reports is 

decided using the proper tribal 

channels and protocols. 

Data Uses 

The AI ATS was developed to 

provide tribe-specific data on the 

prevalence of commercial tobacco 

use and commercial tobaccouse behaviors, knowledge, attitudes, and beliefs. Data generated from the AI ATS will be 

specific to each tribe and will expand the database and existing knowledge of tobacco 

use among American Indian populations overall. These data have the potential to benefit 

commercial tobacco prevention and control efforts at tribal, state, and regional levels. 

Further, data gathered from this survey can help narrow existing gaps in the knowledge of 

commercial tobacco use among different tribes and guide the development of tribe-specific 

interventions. 

Ultimately, the AI ATS can empower tribes to effectively gather data about commercial 

tobacco use for their specific communities. These data can be used to direct program 

planning and evaluation, determine health priorities, and develop specific intervention 

strategies and policies targeting local communities. Examples of ways in which the AI ATS 

data can help tribes, tribal organizations, and other organizations include the following: 

•		 Tribes can compare their tribe-specific data against national, state, regional, and 

Healthy People 2010 benchmarks. 

•		 Data collected on knowledge, attitudes, and beliefs can be used to direct programs, 

such as those that focus on cessation and awareness of the dangers of commercial 

tobacco use. 

•		 Tribal-specific questions can help determine the reach and duration of specific media 

messages. 

•		 Data on exposure to secondhand smoke can help determine where, and to what 

extent, adults and children are exposed to secondhand smoke.
 

•		 Data on cessation attempts can indicate the level of desire to quit, as well as levels of 

addiction. 

•		 Data collected from American Indians can fundamentally influence tobacco prevention 

and control funding. 

42
 
Chapter 7: The Budget
 

Budget Justification 

The amount of money needed to field an AI ATS varies widely. Costs can depend on a 

variety of factors, including area of the country, salary amounts, direct and indirect costs, 

and your organization’s existing resources. Some of the main decisions that need to be 

made when determining the budget include the following: 

• Salaries for personnel staff that will be working on this project. 

• Incentives or compensation for respondents. 

• Compensation or salary for interviewers. 

• Costs for printing, statistical software, postage, other general office supplies, and travel 

reimbursement. 

• Costs for meeting facilities for training. 

Several key factors must be considered when developing your budget, including your 

organization’s current capacity and infrastructure. The sample budget on page 44 was 

implemented by three tribes simultaneously. All categories included in this budget may 

not be needed if the resources already exist within the tribe or department conducting the 

survey. 

43
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample AI ATS Budget* 

Budget Category Explanation Total 

A. Personnel 

Program Director 30% FTE† $13,500 

Research Assistant (temp) 1,000 hours @ $10 $10,000 

 Total Personnel $23,500 

B. Fringe 

Director and Assistant 33% of FTE $7,755 

 Total Fringe $7,755 

C. Travel Mileage Lodging Per 

Diem 

5 Trips 

Each 

Small Affiliated Tribe 703 miles @ .455 = $320 $320 $165 $124 $3,045 

Large Affiliated Tribe 1,075 miles @ .455 = $489 $489 $165 $124 $3,890 

 Total Travel $6,935 

D. Other 

a. Phone/Fax/Cell $200 per month @ 4 months 

(fielding period only) $800 

b. Office Space $300 per month @ 4 months 

(fielding period only) $1,200 

c. Supplies $100 per month @ 4 months 

(fielding period only) $400 

d. Meetings Interviewer training $1,000 

e. Software One SPSS‡ license $1,900 

f. Printing Printing surveys and other 

documents $2,000 

g. Postage FedEx, USPS $1,000 

h. Interviewer Compensation 800 people @ $20/interviewer $16,000 

i. Participant Compensation 800 people @ $5/interviewee $4,000 

00 

 Total Direct Cost $65,890.00 

 Total Indirect Cost Indirect costs @ 24% $15,813.60 

 BUDGET TOTAL $87,703.60 

* For implementation in three American Indian tribes. 

† Full-time equivalent staff member. 

‡ Statistical Package for Social Sciences. 44 
Budget Justification 

Personnel 

When developing a budget, you must consider what important personnel are needed for 

planning and implementing the survey. Examples include a project director/coordinator, 

interviewer supervisor(s), and research/administrative assistant(s). The primary role of the 

project director is to oversee the project from start to finish, which includes being the 

liaison between the tribe and other key groups involved in implementing the survey. 

The project director also is responsible for supervising the research assistant and 

interviewer supervisor. When budgeting for personnel to be involved in the AI ATS project, 

make sure you take into account the need for fringe benefits, such as health benefits, 

vacation time and sick leave for key employees. 

Travel 

Travel is a part of the budget that is determined on the basis of the size and geographic 

location of the tribe being surveyed. When developing the travel portion of the budget, 

plan for travel for the program director. This travel can include group meetings with tribal 

councils or individual meetings with tribal health coordinators, directors or other key 

personnel. The program director also should budget travel funds for presentations of the 

final data to tribal council or tribal health board meetings. 

If the interviewer supervisor’s residence is outside of the tribal area being surveyed, travel 

funds should be allocated to allow the supervisor to be on site to answer interviewers’ 

questions and to receive completed surveys while the survey is being conducted. 

Other Budget Items 

Other key items to consider may already exist within your organization. Examples include 

the following: 

• Phone calls and faxes. Some participants may not live in the immediate area where 

the interviewer is located. Interviewers may have to call long distance to reach 

participants. 

• Cell phone usage. If an interviewer needs to contact a participant or interviewer 

supervisor on his or her personal cell phone, this expense may be considered a 

reimbursable expense. 

• Office supplies. Interviewers may need pens, notepads, business cards, identification 

badges, portable lockboxes, and laptop computers for survey collection purposes. 

• Software. Interviewers may need to develop letters, spreadsheets, and databases. 

They may need to help with data analysis if this is not being done by a hired 

epidemiologist or statistician. 

• Meeting space and supplies. If the survey is being conducted in an area far from 

the project director’s main office, an office space rental may be needed during the 

implementation of the survey. The interviewer supervisor and interviewers need a 

place to meet each other and to conduct interviews. 

45
 
 

• Mailing fees. This includes postage for all mailings sent to participants, as well as the 

replies from participants. 

• Printing. These include printing costs for letters, postcards, and business cards for the 

interviewers, as well as printing the surveys, training materials, and final reports. 

• Compensation for interviewers and participants. We recommend that interviewers 

be paid at least the equivalent of 3–4 hours of community work per completed 

interview. We also recommended that participants receive some form of compensation 

for their time. This compensation can be in the form of cash, gift cards, or gift 

certificates, as discussed in earlier chapters. 

46
 
Appendix A
 

American Indian Adult Tobacco Survey 

Tools and Tracking Forms for Recruiting Respondents
 

47
 
48
 
Participant Recruitment “Plan B” 

1. If you choose to send mailers in advance to selected respondents, and if three mailers 

have been sent to a potential respondent and a return postcard has not been received, 

then the AI ATS coordinator will attempt a telephone call to secure participation in the 

survey. (See the telephone script on page 50.) An EXCEL spreadsheet will be developed to 

keep track of telephone attempts and results. Following are the potential outcomes of the 

telephone call and the appropriate response: 

• RESPONDENT ANSWERS: The AI ATS coordinator will use the telephone script 

to assess interest in survey participation. If the potential respondent is interested, 

the coordinator will inform him/her that an interviewer will be contacting him/her 

within 2 days. If potential respondent is not interested, all contact attempts will cease 

and such action will be documented in the spreadsheet. If possible, collect some 

sociodemographic information on those who refuse to participate to determine if any 

patterns emerge. 

• NO ANSWER—LEAVE MESSAGE: Wait 24 hours for a return telephone call. If there is 

still no response, attempt another call. If there is still no response, move to Step 2. 

• LINE IS BUSY: The AI ATS coordinator will attempt subsequent calls until line is free. 

• NO ANSWER: The AI ATS coordinator will attempt two additional calls at different 

times of the day, which can include weeknights and weekends. The coordinator may 

ask an interviewer to make one of the calls to account for people who have caller ID 

and will not answer calls from outside areas. If there is still no answer, the coordinator 

will move to Step 2. 

• DISCONNECTED LINE: Move to step 2. 

2. If you receive no response to messages that have been left, or the line you call is 

disconnected, you should mail a fourth letter and postcard to the potential respondent. If a 

response is not received within 7 days of the mailing, move on to Step 3. 

3. The AI ATS coordinator, staff, and tribal representatives will determine whether face-toface recruitment is appropriate or whether no further attempts to contact will be made. 

49
 
 

 

 

TELEPHONE RECRUITMENT SCRIPT
 

Hello. My name is , and I work with the {tribe and/or AI ATS project 

organization}. Is this {selected potential respondent’s name}? If “no,” 

ask if {selected potential respondent} is available. If he/she is not 

available, ask if there is a better time he/she can be reached. 

If selected potential respondent comes to the telephone, reintroduce yourself and say: 

We have randomly selected your name from a list of people in the {tribe name} community 

to participate in the American Indian Adult Tobacco Survey. This survey is about tobacco use 

in the {tribe name} community and we will be asking questions about people’s knowledge, 

attitudes, and behaviors regarding commercial tobacco use. This is a confidential survey, 

which means that your name will be kept private. If you are uncomfortable with any 

question you can refuse to answer that question. The survey has been approved by the 

tribal council. The survey can be conducted in the privacy of your home or in a place where 

you feel comfortable, and a member of our tribe will be conducting the interview. The 

survey takes between 30 and 60 minutes to complete, and we will give you $ for your 

time. 

Are you interested in participating? Yes No 

If “No,” mark the “Declined” column on the tally sheet, and then say: 

Thank you for your time. 

If “Yes,” say: 

Thank you. I will ask one of the local interviewers to call you and schedule an appointment 

that works best for you. Do you have any questions? Again, my name is , 

and you can reach me at . Thank you. 

50
 
 

 

 

 INITIAL CONTACT LETTER 

(Letter will be on tribal or clinic letterhead.) 

Tribal Support Center Name 

Tribal Support Center Address 

Date 

Dear 

You have been selected to participate in a survey about the knowledge, attitudes, and 

behaviors related to commercial and traditional tobacco use. This survey has been approved 

by the and tribes and/or clinics. (The preceding sentence can be adjusted for 

each specific tribe/clinic.) Whether you use tobacco or not, your participation in this study is 

important in helping to identify tobacco use in your community. The results will be used to 

address serious health issues among Indian people as a result of commercial tobacco use. 

The data that are collected will be owned or controlled by the tribe; no other organization 

will have access to the data unless they have been granted permission by the tribe. 

This is a confidential survey, which means that your name will be kept private. 

If you participate in this survey, you will receive $ as compensation for your time. 

Enclosed you will find a self-addressed, stamped postcard. If you agree to participate, 

please return the postcard to us within 7 days of receipt of this letter. Please correct any 

information on the card pertaining to you as needed. Also, include your telephone number 

and indicate a date and time that is convenient for a tribal-member interviewer to come 

to your home to conduct the survey. A tribal member will call you to confirm the date and 

time of your survey interview. 

Thank you for your help in this matter. 

Very truly yours, 

Name, signature, address, and telephone number of agency representative 

51
 

 

 

SECOND CONTACT LETTER 

(Second contact letter. Put on tribal or clinic letterhead.) 

Tribal Support Center Name 

Tribal Support Center Address 

Date 

Dear 

Recently, the and tribes and/or clinics sent you a letter with a return 

postcard regarding a very important survey. (The preceding sentence can be adjusted 

for each specific tribe/clinic.) You have been selected to participate in a survey about the 

knowledge, attitudes, and behaviors related to commercial and traditional tobacco use. 

Because this is such an important study and its success depends on tribal members like 

you, we wanted to know if we could address any concerns or answer any questions that 

you might have. The data that is collected will be owned or controlled by the tribe; no other 

organization will have access to the data unless they have been granted permission by the 

tribe. 

This is a confidential survey, which means that your name will be kept private. 

If you participate in this survey, you will receive $ as compensation for your time. 

Enclosed you will find a self-addressed, stamped postcard. If you would like to participate, 

please return the postcard to us within 7 days of receipt of this letter. Please correct any 

information on the card pertaining to you as needed. Also, include your telephone number 

and indicate a date and time that is convenient for a tribal-member interviewer to come to 

your home to conduct the survey. A tribal member will call you to confirm the date and time 

of your survey interview. 

Please call us if we can be of further assistance. We want to include you in this very exciting 

work. 

Very truly yours, 

Name, signature, address, and telephone number of agency representative 

52
 
 

THIRD CONTACT POSTCARD
 

(Third mailing will be a postcard reminder.) 

Tribal Support Center Name 

Tribal Support Center Address 

Date 

Dear 

Recently, the (tribe or clinic) sent you a letter about participating in a 

very important survey on the knowledge, attitudes, and behaviors related to commercial 

and traditional tobacco use. (The preceding sentence can be adjusted for each specific 

tribe/clinic.) Your participation in this study is very important in helping to identify 

tobacco use in your community. The results will be used to address serious health issues 

among Indian people as a result of commercial tobacco use. This is a confidential survey, 

and if you agree to participate, you will receive $ as compensation for your time. 

If you would like to participate, please complete the postcard previously sent to you. If 

you no longer have the postcard, please call to schedule an interview. 

Please respond within 7 days of receipt of this postcard. 

Thank you for your help! 

53
 
 

 

 

SURVEY REPLY CARD
 

American Indian Adult Tobacco Survey 

Tribal (for Clinic) Reply Card
 Letterhead or Logo
 

Please return this card to indicate your willingness to help us 

with this survey. 

Name 

Address 

Telephone number 

Best times to contact you 

Date 

I prefer a tribal member to set up an appointment by telephone letter 

54
 
AMERICAN INDIAN ADULT TOBACCO SURVEY MAILER TRACKING FORM
 

Participant 

Name and 

Contact 

Information 

Date Initial 

Contact Letter/

Postcard 

Mailed 

Date 

Second 

Contact 

Letter/

Postcard 

Mailed 

Date Third 

Contact 

Letter/

Postcard 

Mailed 

Date 

Reply 

Postcard 

Received 

Date 

Participant 

Contacted 

to Set Up 

Interview 

Date and 

Time for 

Interview 

Date and 

Time 

Interview 

Reminder 

Call Mode 

Comments 

(e.g., assigned

interviewer, 

special needs

for the 

interview) 

55
 
AMERICAN INDIAN ADULT TOBACCO SURVEY MAILER TRACKING FORM
 

Call 

1 2 3 4 5 

Participant 

Name and 

Contact 

Information 

Date Initial 

Contact Letter/

Postcard 

Recieved 

Date, Day, 

Time & Result 

(No answer, 

message left, 

Interview 

date) 

Date, Day, 

Time & Result 

(No answer, 

message left, 

Interview date) 

Date, Day, 

Time & Result 

(No answer, 

message left, 

Interview date) 

Date, Day, 

Time & Result 

(No answer, 

message left, 

Interview 

date) 

Date, Day, 

Time & 

Result (No 

answer, 

message

left, 

Interview 

date) 

Comments 

(e.g., best time

to call, special 

needs for the 

interview) 

56
 
Appendix B
 

American Indian Adult Tobacco Survey
 

57
 
58
 
 

 

 

 

 

 

 

 

 

 

 

 

 

59 

SECTION 1: GENERAL HEALTH 

SECTION 2: COMMERCIAL CIGARETTE SMOKING 

SECTION 3: COMMERCIAL CIGAR USE 

SECTION 4: COMMERICAL PIPE USE 

SECTION 5: COMMERCIAL CHEWING (SPIT) TOBACCO 

SECTION 6: COMMERCIAL SNUFF (DIP) TOBACCO 

SECTION 7: SECONDHAND SMOKE 

SECTION 8: RISK PERCEPTION 

SECTION 9: DEMOGRAPHIC ITEMS 

SECTION 10: SITE SPECFIC QUESTIONS 

l__l___ll__l___l___l __l l___l l___l___l l___l___l l___l___l l___l___l l___l___l l___l___l___l 

Date of Interview Support 

Center 

Tribe Village Clinic Interview 

Supervisor 

Interviewer ID Case ID Number 

American Indian 

Adult Tobacco Survey 

Core Questions 

(October 31, 2007) 

TABLE OF CONTENTS
 

 

 

INTERVIEWER INSTRUCTIONS
 

INTERVIEWER, PLEASE READ THE FOLLOWING 

STATEMENT TO THE PARTICIPANT: 

“I would like to go over the ground rules for this interview. 

First, there are no right or wrong answers. I must read the 

questions exactly as they are written. I must read the 

responses exactly as they are written. I cannot help you 

with either the questions or the answers. If you need a 

question or response repeated, please ask, and I will be 

happy to do so. If we are distracted during the interview, we 

will stop as needed and then continue the interview.” 

“Do you have any questions before we begin?” 

“Are you ready to begin?” 

BEGIN INTERVIEW 

60
 
 

 

 

 

 

 

 

 

 

 

 

SECTION 1: GENERAL HEALTH 

1.	 Would you say that in general your health is: 

Excellent.........................................1
 

Very good ......................................2 

Good ..............................................3 

Fair ................................................4 

Poor ...............................................5 

Don’t know/not sure .........................7 

Refused ..........................................9
 

SECTION 2: COMMERCIAL CIGARETTE USE 

2.	 Not including ceremonial or sacred smoking, have you ever smoked a 

cigarette, even one or two puffs? 

Yes ................................................1
 

No .................................................2 Skip to Q18
 

Don’t know/Not sure.........................7 Skip to Q18
 

Refused ..........................................9 Skip to Q18
 

3.	 How old were you the first time you smoked a cigarette, even one or two 

puffs, NOT for ceremonial or sacred purposes? 

Age ..............................................._ _ _01–120
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

61
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.	 Not including ceremonial or sacred smoking, we want you to think of all 

the cigarettes you ever smoked in your entire life, not on a single day. 

In your entire life, have you smoked at least 100 cigarettes, about 5 

packs? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

5.	 How old were you when you started smoking regularly? 

Never smoked regularly ....................00
 

Age ..............................................._ _ _01–120
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

6.	 Not including ceremonial or sacred smoking, do you now smoke 

cigarettes every day, some days or not at all? 

Every day .......................................1 

Some days ......................................2 

Not at all.........................................3 

Don’t know/Not sure.........................7 

Refused ..........................................9 

Code 30 for Q7 

and Skip to Q8 

Skip to Q10 

Skip to Q10 

Skip to Q10 

7. During the past 30 days, on how many days did you smoke cigarettes? 

None ..............................................00 Skip to Q10
 

Number of days ..............................._ _01–30
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

62
 
 

 

 

 

 

 

 

 

 

 

8. On the days that you smoked during the last 30 days, about how 

many cigarettes did you smoke a day? 

Number of cigarettes ........................_ _ _001–180 

Don’t know/Not sure.........................777
 

Refused ..........................................999 

(Note to interviewer: One pack = 20 cigarettes. Verify 61 or more 

cigarettes.) 

9.	 When you smoke, how soon after you wake up do you have your first 

cigarette? 

Within 5 minutes..............................1 

6–30 minutes...................................2 

31–60 minutes .................................3 

After 60 minutes ..............................4 

Don’t know/Not sure.........................7 

Refused ..........................................9 

63
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1. QUIT SMOKING ATTEMPTS
 

10.	 About how long has it been since you last smoked a cigarette? Would 

you say it was... 

Never smoked regularly........................................................ 01 Skip to Q18
 

Within the past month (1 month ago) .................................. 02 Go to Q11
 

Within the past 3 months (>1 month but 3 months ago) ........ 03 Skip to Q12
 

Within the past 6 months (>3 months but 6 months ago)....... 04 Skip to Q12
 

Within the past year (>6 months but 1 year ago) .................. 05 Skip to Q12
 

Within the past 5 years (>1 year but 5 years ago)................. 06 Skip to Q12 

Within the past 10 years (>5 years but 10 years ago)............ 07 Skip to Q18
 

Over 10 years ago............................................................... 08 Skip to Q18 

Don’t know/Not sure............................................................ 77 Skip to Q18
 

Refused ............................................................................. 99 Skip to Q18
 

11. During the past 12 months, have you stopped smoking for one day or 

longer because you were trying to quit smoking? 

Yes ................................................1 

No .................................................2 Skip to Q15 

Don’t know/Not sure.........................7 Skip to Q15 

Refused ..........................................9 Skip to Q15
 

64
 
 

 

 

 

 

 

 

 

 

 

 

 

2.2. METHODS OF QUITTING (Smoking) 

Ask Q12a-14 of: 

(1) CURRENT SMOKERS who made a quit attempt in the past year (Q11 = 1 “Yes”) 

or 

(2) FORMER SMOKERS who quit in the last 5 years (Q10 = 03–06) 

12a.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you use a nicotine patch to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

12b.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you use nicotine gum to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

12c.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you use any other medications like Zyban, Chantix, or nicotine 

lozenges to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

65
 
 

 

 

 

 

 

 

 

 

 

 

 

 

12d.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you quit “cold turkey” (stopped all at once)? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

13.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you use any native or traditional methods? For example, did you 

go to a sweat lodge, use herbs, or pray? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

14.	 [FORMER SMOKERS]: When you quit smoking, 

[CURRENT SMOKERS]: The last time you tried to quit smoking, 

Did you use any other assistance, such as smoking cessation classes 

or counseling? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

INTERVIEWER CHECKPOINT 

FORMER SMOKERS who quit in the past 5 years (Q10 = 03–06) 

SKIP TO Q18. 

66
 
 

 

 

 

 

 

 

 

 

 

 

2.3. Readiness to Quit Smoking 

Current Smokers ONLY: (Q6 = 1 or 2) 

15. Do you want to quit smoking cigarettes? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

16.	 Are you seriously thinking about quitting smoking cigarettes within the 

next six months? 

Yes ................................................1 

No .................................................2 Skip to Q18
 

Don’t know/Not sure.........................7 Skip to Q18
 

Refused ..........................................9 Skip to Q18
 

17.	 Are you planning to quit smoking cigarettes within the next 30 days? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

67
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.4. PHYSICIAN AND HEALTH PROFESSIONAL ADVICE 

TO QUIT SMOKING 

18. In the past 12 months, have you seen a doctor, nurse, therapist, or 

counselor to get a checkup or any kind of care for yourself? 

Yes ............................................1
 

No .............................................2 Skip to Q24 

Don’t know/Not sure ....................7 Skip to Q24
 

Refused......................................9 Skip to Q24
 

19. During the past 12 months did any doctor, nurse, therapist, or 

counselor ask if you smoke? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

20. During the past 12 months did any doctor, nurse, therapist, or 

counselor advise you not to smoke? 

Yes ............................................1
 

No .............................................2 Skip to Q24 

Don’t know/Not sure ....................7 Skip to Q24
 

Refused......................................9 Skip to Q24 

68
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking, did they also do any of the following? 

21a. Prescribe or recommend a nicotine patch to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

21b. Prescribe or recommend nicotine gum to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

21c. Prescribe or recommend nasal spray to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

21d. Prescribe or recommend an inhaler to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

69
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21e.	 Prescribe or recommend pills such as nicotine lozenges to help you 

quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

21f. Prescribe or recommend pills such as Zyban to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

21g.	 Prescribe or recommend pills such as Chantix to help you quit 

smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

21h.	 Suggest that you set a specific date to stop smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking, did they also do any of the following? 

22a.	 Suggest that you use a smoking cessation class to help you quit 

smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

22b.	 Suggest that you use a smoking cessation program to help you quit 

smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

22c. Suggest that you use a smoking cessation quit line or telephone 

counseling to help you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

71
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking, did they also... 

23a.	 Provide you with booklets, videos, or other materials to help you 

stop smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

23b.	 Suggest that you use ceremonial prayer or traditional methods to help 

you quit smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

24.	 In the past 12 months, have you seen a traditional or native healer 

to get any kind of care for yourself? 

Yes ............................................1
 

No .............................................2 Skip to Q28 

Don’t know/Not sure ....................7 Skip to Q28 

Refused......................................9 Skip to Q28 

72
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.	 Excluding ceremonial or sacred use, during the past 12 months did a 

traditional healer ask if you smoke? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

26. Excluding ceremonial or sacred use, during the past 12 months did a 

traditional healer advise you not to smoke? 

Yes ............................................1
 

No .............................................2 Skip to Q28 

Don’t know/Not sure ....................7 Skip to Q28 

Refused......................................9 Skip to Q28
 

27.	 In the past 12 months, when a traditional healer advised you to quit 

smoking, did they suggest you use traditional methods (i.e., herbs, 

sweat lodge, or prayer) to assist in quitting? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

73
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 3: CIGAR USE 

28. Not including ceremonial or sacred smoking, have you ever smoked a 

cigar, even one or two puffs? 

Yes ................................................1
 

No .................................................2 Skip to Q52
 

Don’t know/Not sure.........................7 Skip to Q52
 

Refused ..........................................9 Skip to Q52
 

29.	 How old were you the first time you smoked a cigar, even one or 

two puffs, NOT for ceremonial or sacred purposes? 

Age ................................................_ _ _01–120
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

30.	 Not including ceremonial or sacred smoking, we want you to think of 

all the cigars you ever smoked in your entire life. In your entire life, 

have you smoked at least 20 cigars? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

31. How old were you when you started smoking cigars regularly? 

Never smoked regularly ....................00
 

Age ................................................_ _ _01–120
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

74
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.	 Not including ceremonial or sacred smoking, do you now smoke 

cigars every day, some days or not at all? 

Every day .......................................1 Code 30 for Q33 

and Skip to Q34 

Some days ......................................2
 

Not at all.........................................3 Skip to Q36 

Don’t know/Not sure.........................7 Skip to Q36
 

Refused ..........................................9 Skip to Q36
 

33.	 During the past 30 days, on how many days did you smoke cigars? 

None ..............................................00 Skip to Q36
 

Number of days ..............................._ _01–30
 

Don’t know/Not sure.........................77
 

Refused ..........................................99
 

34.	 On the days that you smoked during the last 30 days, about how 

many cigars did you smoke a day? 

Number of cigars.............................._ _ _001–180 

Less than one cigar a day..................666
 

Don’t know/Not sure.........................777
 

Refused ..........................................999
 

35.	 When you smoke, how soon after you wake up do you have your first 

cigar? 

Within 5 minutes..............................1 

6–30 minutes ..................................2 

31–60 minutes ................................3 

After 60 minutes ..............................4 

Don’t know/Not sure.........................7 

Refused ..........................................9 

75
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.1. QUIT SMOKING ATTEMPTS (CIGARS) 

36.	 About how long has it been since you last smoked a cigar? Would you 

say it was... 

Never smoked cigars regularly ............................................ 01 Skip to Q52
 

Within the past month (1 month ago) ................................ 02 Go to Q37
 

Within the past 3 months (>1 month but 3 months ago) ...... 03 Skip to Q38
 

Within the past 6 months (>3 months but 6 months ago) ..... 04 Skip to Q38
 

Within the past year (>6 months but 1 year ago) ................ 05 Skip to Q38 

Within the past 5 years (>1 year but 5 years ago)............... 06 Skip to Q38 

Within the past 10 years (>5 years but 10 years ago) .......... 07 Skip to Q52
 

Over 10 years ago............................................................. 08 Skip to Q52
 

Don’t know/Not sure.......................................................... 77 Skip to Q52
 

Refused ........................................................................... 99 Skip to Q52
 

37.	 During the past 12 months, have you stopped smoking cigars for one 

day or longer because you were trying to quit smoking? 

Yes ................................................1 

No .................................................2 Skip to Q41
 

Don’t know/Not sure.........................7 Skip to Q41 

Refused ..........................................9 Skip to Q41
 

76
 
 

 

 

 

 

 

 

 

 

 

3.2. METHODS OF QUITTING (Cigars) 

Ask Q38a–40 of: 

(3) CURRENT CIGAR SMOKERS who made a quit attempt in the past year (Q37 = 

1 “Yes”) or 

(4) FORMER CIGAR SMOKERS who quit in the last 5 years (Q36 = 03–06) 

38a.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you use the nicotine patch to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

38b.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you use nicotine gum to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

77
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

38c.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you use any other medications like Zyban, Chantix, or nicotine 

lozenges to help you quit? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

38d.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you quit “cold turkey” (stopped all at once)? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

39.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you use any native or traditional methods? For example, did you 

go to a sweat lodge, use herbs, or pray? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

78
 
 

 

 

 

 

 

 

 

 

 

 

40.	 [FORMER CIGAR SMOKERS]: When you quit smoking cigars, 

[CURRENT CIGAR SMOKERS]: The last time you tried to quit 

smoking cigars, 

Did you use any other assistance, such as smoking cessation classes 

or counseling? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

INTERVIEWER CHECKPOINT 

FORMER CIGAR SMOKERS who quit in the past 5 years 

(Q36 = 03–06) SKIP TO Q52 

3.3. Readiness to Quit Smoking Cigars 

Current Cigar Smokers ONLY: (Q32 = 1 or 2) 

41.	 Do you want to quit smoking cigars? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

79
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42.	 Are you seriously thinking about quitting smoking commercial cigars 

within the next 6 months? 

Yes ................................................1 

No .................................................2 If Q18 = 2–9 & Q24 = 1 

Skip to Q49; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q52 

Don’t know/Not sure.........................7 If Q18 = 2–9 & Q24 = 1 

Skip to Q49; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q52 

Refused ..........................................9 If Q18 = 2–9 & Q24 = 1 

Skip to Q49; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q52 

43.	 Are you planning to quit smoking cigars within the next 30 days? 

Yes ................................................1
 

No .................................................2 

Don’t know/Not sure.........................7 

Refused ..........................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 1 SKIP TO Q49 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 2–9 SKIP TO Q52 

3.4. PHYSICIAN AND HEALTH PROFESSIONAL ADVICE 

TO QUIT SMOKING CIGARS 

44. During the past 12 months did any doctor, nurse, therapist, or 

counselor ask if you smoke cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

80
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

45. During the past 12 months did any doctor, nurse, therapist, or 

counselor advise you not to smoke cigars? 

Yes ............................................1
 

No .............................................2 If Q24 = 1 

Skip to Q49; If Q24 = 2–9 

Skip to Q52 

Don’t know/Not sure ....................7 If Q24 = 1 

Skip to Q49; If Q24 = 2–9 

Skip to Q52 

Refused......................................9 If Q24 = 1 

Skip to Q49; If Q24 = 2–9 

Skip to Q52 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking cigars, did they also do any of the 

following? 

46a.	 Prescribe or recommend a nicotine patch to help you quit smoking 

cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

46b.	 Prescribe or recommend nicotine gum to help you quit smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

81
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46c. Prescribe or recommend nasal spray to help you quit smoking cigars? 

Yes ............................................1 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

46d. Prescribe or recommend an inhaler to help you quit smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

46e.	 Prescribe or recommend pills such as nicotine lozenges to help you 

quit smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

46f. Prescribe or recommend pills such as Zyban to help you quit smoking 

cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9 

82
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46g.	 Prescribe or recommend pills such as Chantix to help you quit smoking 

cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

46h. Suggest that you set a specific date to stop smoking cigars? 

Yes ............................................1 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking cigars, did they also do any of the 

following? 

47a. Suggest that you use a smoking cessation class to help you quit 

smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

47b. Suggest that you use a smoking cessation program to help you quit 

smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

83
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

47c. Suggest that you use a smoking cessation quit line or telephone 

counseling to help you quit smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit smoking cigars, did they also... 

48a.	 Provide you with booklets, videos, or other materials to help you 

stop smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

48b.	 Suggest that you use ceremonial prayer or traditional methods to help 

you quit smoking cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: If Q24 = 02–99 SKIP TO Q52 

84
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49. During the past 12 months did a traditional healer ask if you smoke 

cigars? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

50. During the past 12 months did a traditional healer advise you not to 

smoke cigars? 

Yes ............................................1
 

No .............................................2 Skip to Q52
 

Don’t know/Not sure ....................7 Skip to Q52
 

Refused......................................9 Skip to Q52
 

51.	 In the past 12 months, when a traditional healer advised you to quit 

smoking cigars, did they suggest you use traditional methods (i.e., 

herbs, sweat lodge, or prayer) to assist in quitting? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

85
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 4: COMMERCIAL PIPE USE 

52. Not including ceremonial or sacred smoking, have you ever smoked a 

pipe, even one or two puffs? 

Yes ............................................1
 

No .............................................2 Skip to Q76 

Don’t know/Not sure ....................7 Skip to Q76 

Refused......................................9 Skip to Q76 

53.	 How old were you the first time you smoked a pipe, even one or 

two puffs, NOT for ceremonial or sacred purposes? 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99
 

54.	 Not including ceremonial or sacred smoking, we want you to think of 

all the times you have smoked a pipe in your entire life, not on a 

single day. In your entire life, have you smoked a pipe at least 20 

times? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

86
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55.	 Excluding ceremonial or sacred use, how old were you when you 

started smoking commercial pipes regularly? 

Never smoked regularly ................00
 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99
 

56.	 Not including ceremonial or sacred smoking, do you now smoke 

commercial pipes every day, some days or not at all? 

Every day ...................................1 

Some days..................................2 

Not at all ....................................3 

Don’t know/Not sure ....................7 

Refused......................................9 

Code 30 for Q57 and 

Skip to Q58 

Skip to Q60 

Skip to Q60 

Skip to Q60 

57.	 Excluding ceremonial or sacred use, during the past 30 days, on 

how many days did you smoke a pipe? 

None .......................................00 Skip to Q60
 

Number of days........................._ _1–30
 

Don’t know/Not sure ..................77
 

Refused ...................................99 

58.	 Excluding ceremonial or sacred use, on the days that you smoked a 

pipe during the last 30 days, about how many times a day did you 

smoke? 

Number of times ......................._ _ _001–180 

Less than one pipe a day ............666
 

Don’t know/Not sure ..................777
 

Refused ...................................999
 

87
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59.	 Excluding ceremonial or sacred use, when you smoke, how soon after 

you wake up do you have your first pipe? 

Within 5 minutes .......................1 

6–30 minutes ............................2 

31–60 minutes ..........................3 

After 60 minutes .......................4 

Don’t know/Not sure ..................7 

Refused ...................................9 

4.1. QUIT SMOKING ATTEMPTS (PIPES) 

60.	 Excluding ceremonial or sacred use, about how long has it been since 

you last smoked a pipe? Would you say it was.... 

Never smoked pipes regularly .......................................... 01 Skip to Q76 

Within the past month (1 month ago) ............................. 02 Go to Q61 

Within the past 3 months (>1 month but 3 months ago) ... 03 Skip to Q62 

Within the past 6 months (>3 months but 6 months ago) .. 04 Skip to Q62 

Within the past year (>6 months but 1 year ago) ............. 05 Skip to Q62 

Within the past 5 years (>1 year but 5 years ago)............ 06 Skip to Q62 

Within the past 10 years (>5 years but 10 years ago) ....... 07 Skip to Q76 

Over 10 years ago.......................................................... 08 Skip to Q76 

Don’t know/Not sure....................................................... 77 Skip to Q76
 

Refused ........................................................................ 99 Skip to Q76
 

88
 
 

 

 

 

 

 

 

 

 

 

 

 

61.	 Excluding ceremonial or sacred use, during the past 12 months, have 

you stopped smoking pipes for one day or longer because you were 

trying to quit smoking? 

Yes ............................................1 

No .............................................2 Skip to Q65 

Don’t know/Not sure ....................7 Skip to Q65 

Refused......................................9 Skip to Q65 

4.2. METHODS OF QUITTING (Pipes) 

Ask Q62-64 of: 

(5) CURRENT PIPE SMOKERS who made a quit attempt in the past year (Q61 = 1 

“Yes”) or 

(6) FORMER PIPE SMOKERS who quit in the last 5 years (Q60 = 03–06) 

62a.	 [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you use a nicotine patch to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

89
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

62b.	 [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you use nicotine gum to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

62c. [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you use any other medications like Zyban, Chantix, or nicotine 

lozenges to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

90
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

62d.	 [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you quit “cold turkey” (stopped all at once)? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

63.	 [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you use any native or traditional methods? For example, did you 

go to a sweat lodge, use herbs, or pray? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

64.	 [FORMER PIPE SMOKERS]: Excluding ceremonial or sacred use, 

when you quit smoking pipes, 

[CURRENT PIPE SMOKERS]: Excluding ceremonial or sacred use, 

the last time you tried to quit smoking pipes, 

Did you use any other assistance, such as smoking cessation classes 

or counseling? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

91
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTERVIEWER CHECKPOINT: 

FORMER PIPE SMOKERS who quit in the past 5 year 

(Q60 = 03–06) SKIP TO Q76 

4.3. Readiness to Quit Smoking Pipes 

Current Pipe Smokers ONLY: (Q56 = 1 or 2) 

65. Excluding ceremonial or sacred use, do you want to quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

66.	 Excluding ceremonial or sacred use, are you seriously thinking about 

quitting smoking pipes within the next six months? 

Yes ............................................1 

No .............................................2 If Q18 = 2–9 & Q24 = 1 

Skip to Q73; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q76 

Don’t know/Not sure ....................7 If Q18 = 2–9 & Q24 = 1 

Skip to Q73; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q76 

Refused......................................9 If Q18 = 2–9 & Q24 = 1 

Skip to Q73; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q76 

67.	 Excluding ceremonial or sacred use, are you planning to quit smoking 

pipes within the next 30 days? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

92
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTERVIEWER CHECKPOINT 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 1 SKIP TO Q73 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 2–9 SKIP TO Q76 

4.4. PHYSICIAN AND HEALTH PROFESSIONAL ADVICE 

TO QUIT SMOKING (PIPES) 

68.	 Excluding ceremonial or sacred use, during the past 12 months did 

any doctor, nurse, therapist, or counselor ask if you smoke commercial 

pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

69.	 Excluding ceremonial or sacred use, during the past 12 months did 

any doctor, nurse, therapist, or counselor advise you not to smoke 

commercial pipes? 

Yes ............................................1
 

No ............................................2 If Q24 = 1 Skip to Q73; If 

Q24 = 2–9 Skip to Q76 

Don’t know/Not sure ....................7 If Q24 = 1 Skip to Q73; If 

Q24 = 2–9 Skip to Q76 

Refused......................................9 If Q24 = 1 Skip to Q73; If 

Q24 = 2–9 Skip to Q76 

93
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excluding ceremonial or sacred use, in the past 12 months, when a 

doctor, nurse, therapist, or counselor advised you to quit smoking 

commercial pipes, did they also do any of the following? 

70a.	 Prescribe or recommend a nicotine patch to help you quit smoking 

pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70b.	 Prescribe or recommend nicotine gum to help you quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70c. Prescribe or recommend nasal spray to help you quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70d.	 Prescribe or recommend an inhaler to help you quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

94
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

70e.	 Prescribe or recommend pills such as nicotine lozenges to help you 

quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70f. Prescribe or recommend pills such as Zyban to help you quit smoking 

pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

70g.	 Prescribe or recommend pills such as Chantix to help you quit smoking 

pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

70h.	 Suggest that you set a specific date to stop smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

95
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excluding ceremonial or sacred use, in the past 12 months, when a 

doctor, nurse, therapist, or counselor advised you to quit smoking 

pipes, did they also do any of the following? 

71a.	 Suggest that you use a smoking cessation class to help you quit 

smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

71b. Suggest that you use a smoking cessation program to help you quit 

smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

71c. Suggest that you use a smoking cessation quit line or telephone 

counseling to help you quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

96
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excluding ceremonial or sacred use, in the past 12 months, when a 

doctor, nurse, therapist, or counselor advised you to quit smoking 

pipes, did they also... 

72a.	 Provide you with booklets, videos, or other materials to help you 

stop smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

72b.	 Suggest that you use ceremonial prayer or traditional methods to help 

you quit smoking pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

73.	 During the past 12 months did a traditional healer ask if you smoke 

pipes? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

97
 
 

 

 

 

 

 

 

 

 

 

 

74.	 During the past 12 months did a traditional healer advise you not to 

smoke pipes? 

Yes ............................................1
 

No .............................................2 Skip to Q76 

Don’t know/Not sure ....................7 Skip to Q76
 

Refused......................................9 Skip to Q76 

75.	 Excluding ceremonial or sacred use, when a traditional healer advised 

you to quit smoking, did they suggest you use traditional methods 

(i.e., herbs, sweat lodge, or prayer) to assist in quitting? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

98
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 5: COMMERCIAL CHEWING (SPIT) 

TOBACCO 

76.	 Not including ceremonial or sacred use, have you ever used chewing 

or spit tobacco, even one time? 

Yes ............................................1
 

No .............................................2 Skip to Q101 

Don’t know/Not sure ....................7 Skip to Q101 

Refused......................................9 Skip to Q101 

77.	 How old were you the first time you used chewing or spit tobacco, even 

one time, NOT for ceremonial or sacred purposes? 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99
 

78.	 Not including ceremonial or sacred use, we want you to think of all the 

times you have used chewing tobacco in your entire life, not on a single 

day. In your entire life, have you used chewing tobacco at least 20 

times? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

99
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

79. How old were you when you started using chewing tobacco regularly? 

Never chewed regularly ................00
 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99 

80.	 Not including ceremonial or sacred use, do you now use chewing 

tobacco every day, some days, or not at all? 

Every day ...................................1 Code 30 for Q81 and 

Skip to Q82 

Some days..................................2 

Not at all ....................................3 Skip to Q85
 

Don’t know/Not sure ....................7 Skip to Q85
 

Refused......................................9 Skip to Q85 

81.	 During the past 30 days, on how many days did you use chewing or 

spit tobacco? 

None .......................................00 Skip to Q85
 

Number of days........................._ _01–30
 

Don’t know/Not sure ..................77
 

Refused ...................................99
 

100
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82.	 On the days that you used chewing tobacco during the last 30 days, 

about how many pouches did you use a day? 

A half a pouch or less.................1 

More than half a pouch but less 

than a whole pouch ...................2 

One to one and a half pouches ....3 

More than one and half pouches
 

but less than two pouches ..........4 

Two to two and half pouches .......5 

More than two and a half pouches
 

but less than three pouches ........6 

Three to three and a half 

pouches ...................................7 

More than three and half pouches 

but less than four pouches..........8 

More than four pouches ..............9
 

Don’t know/Not sure ..................77
 

Refused ...................................99
 

101
 
 

 

 

 

 

 

 

 

 

 

 

 

83.	 When you use chewing tobacco, how soon after you wake up do you 

have chewing tobacco? 

Within 5 minutes .......................1 

6–30 minutes............................2 

31–60 minutes..........................3 

After 60 minutes .......................4 

Don’t know/Not sure ..................7 

Refused ...................................9 

84.	 What brand of chewing tobacco do you use most often? (MARK ONLY 

ONE.) 

Red Man 01 Beech-Nut 04 

Levi Garrett 02 Taylors Pride 05 

Smokey Mountain 03 Other (specify): ________ 06 

Whatever is convenient 07 

Don’t know/Not sure.............................................77
 

Refused ..............................................................99
 

102
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.1. QUIT CHEWING TOBACCO ATTEMPTS 

85.	 About how long has it been since you last used chewing tobacco? 

Would you say... 

Never chewed regularly................................................... 01 Skip to Q101
 

Within the past month (1 month ago) ............................. 02 Go to Q86 

Within the past 3 months (>1 month but 3 months ago) ... 03 Skip to Q87
 

Within the past 6 months (>3 months but 6 months ago) .. 04 Skip to Q87
 

Within the past year (>6 months but 1 year ago) ............. 05 Skip to Q87 

Within the past 5 years (>1 year but 5 years ago)............ 06 Skip to Q87
 

Within the past 10 years (>5 years but 10 years ago) ....... 07 Skip to Q101
 

Over 10 years ago.......................................................... 08 Skip to Q101 

Don’t know/Not sure....................................................... 77 Skip to Q101
 

Refused ........................................................................ 99 Skip to Q101
 

86.	 During the past 12 months, have you stopped using chewing tobacco 

for one day or longer because you were trying to quit chewing tobacco? 

Yes ............................................1 

No .............................................2 Skip to Q90
 

Don’t know/Not sure ....................7 Skip to Q90
 

Refused......................................9 Skip to Q90
 

103
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.2. METHODS OF QUITTING (CHEWING TOBACCO)
 

Ask Q87-89 of: 

(7) CURRENT CHEW USERS who made a quit attempt in the past year (Q86 = 1 

“Yes”) or 

(8) FORMER CHEW USERS who quit in the last 5 years (Q85 = 03–06) 

87a.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you use a nicotine patch to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

87b.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you use nicotine gum to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

104
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

87c.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you use any other medications like Zyban, Chantix, or nicotine 

lozenges to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

87d.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you quit “cold turkey” (stopped all at once)? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

88.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you use any native or traditional methods? For example, did you 

go to a sweat lodge, use herbs, or pray? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

105
 
 

 

 

 

 

 

 

 

 

 

89.	 [FORMER CHEW USERS]: When you quit chewing tobacco, 

[CURRENT CHEW USERS]: The last time you tried to quit chewing 

tobacco, 

Did you use any other assistance, such as smoking cessation classes 

or counseling? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

INTERVIEWER CHECKPOINT: 

FORMER CHEW USERS who quit in the past 5 years (Q85 = 03– 

06) SKIP TO Q101 

5.3. Readiness to Quit Chewing Tobacco 

Current Chew Users ONLY: (Q80 = 1 or 2) 

90.	 Do you want to quit using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

106
 
 

 

 

 

 

 

 

 

 

 

 

 

91. Are you seriously thinking about quitting chewing tobacco within the 

next six months? 

Yes ............................................1 

No .............................................2 If Q18 = 2–9 & Q24 = 1 

Skip to Q98; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q101 

Don’t know/Not sure ...................7 If Q18 = 2–9 & Q24 = 1 

Skip to Q98; If Q18 = 2–9 & 

Q24 = 2–9 Skip to Q101 

Refused......................................9 If Q18 = 2-9 & Q24 = 1 

Skip to Q98; If Q18 = 2-9 & 

Q24 = 2-9 Skip to Q101 

92. Are you planning to quit chewing tobacco within the next 30 days? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 1 SKIP TO Q98 

HEALTH CARE: IFQ18 = 2–9 & Q24 = 2–9 SKIP TO Q101 

107
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.4. PHYSICIAN AND HEALTH PROFESSIONAL ADVICE 

TO QUIT CHEWING TOBACCO 

93.	 During the past 12 months did any doctor, nurse, therapist, or 

counselor ask if you use chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

94.	 During the past 12 months did any doctor, nurse, therapist, or 

counselor advise you not to use chewing tobacco? 

Yes ............................................1
 

No ............................................2 If Q24 = 1 Skip to Q98; If 

Q24 = 2–9 Skip to Q101 

Don’t know/Not sure ....................7 If Q24 = 1 Skip to Q98; If 

Q24 = 2–9 Skip to Q101 

Refused......................................9 If Q24 = 1 Skip to Q98; If 

Q24 = 2–9 Skip to Q101 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using chewing tobacco, did they also do any of 

the following? 

95a.	 Prescribe or recommend a nicotine patch to help you quit using 

chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

108
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

95b. Prescribe or recommend nicotine gum to help you quit using chewing 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

95c. Prescribe or recommend nasal spray to help you quit using chewing 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

95d.	 Prescribe or recommend an inhaler to help you quit using chewing 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

95e. Prescribe or recommend pills such as nicotine lozenges to help you 

quit using chewing tobacco? 

Yes ............................................1 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

109
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

95f. Prescribe or recommend pills such as Zyban to help you quit using 

chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

95g.	 Prescribe or recommend pills such as Chantix to help you quit using 

chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

95h.	 Suggest that you set a specific date to stop using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

110
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using chewing tobacco, did they also do any of 

the following? 

96a.	 Suggest that you use a smoking cessation class to help you quit using 

chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

96b.	 Suggest that you use a smoking cessation program to help you quit 

using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

96c. Suggest that you use a smoking cessation quit line or telephone 

counseling to help you quit using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

111
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using chewing tobacco, did they also... 

97a.	 Provide you with booklets, videos, or other materials to help you 

stop using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

97b.	 Suggest that you use ceremonial prayer or traditional methods to help 

you quit using chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: If Q24 = 2–9 SKIP TO Q101 

98.	 During the past 12 months did a traditional healer ask if you use 

chewing tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

112
 
 

 

 

 

 

 

 

 

 

 

 

99.	 During the past 12 months did a traditional healer advise you not to 

use chewing tobacco? 

Yes ............................................1
 

No .............................................2 Skip to Q101 

Don’t know/Not sure ....................7 Skip to Q101 

Refused......................................9 Skip to Q101
 

100.	 In the past 12 months, when a traditional healer advised you to quit 

using chewing tobacco, did they suggest you use traditional methods 

(i.e., herbs, sweat lodge, or prayer) to assist in quitting? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9
 

113
 
 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 6: COMMERCIAL SNUFF (DIP) USE 

101.	 Not including ceremonial or sacred used, have you ever used snuff or 

dip tobacco, even one time? 

Yes ............................................1
 

No .............................................2 Skip to Q126
 

Don’t know/Not sure ....................7 Skip to Q126
 

Refused......................................9 Skip to Q126
 

102.	 How old were you the first time you use snuff or dip tobacco, even one 

time, NOT for ceremonial or sacred purposes? 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99
 

103.	 Not including ceremonial or sacred use, we want you to think of all the 

snuff or dip tobacco you ever used in your entire life, not on a single 

day. In your entire life, have you used snuff or dip at least 20 times? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

114
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

104.	 How old were you when you started using snuff or dip tobacco 

regularly? 

Never used regularly ....................00
 

Age ..........................................._ _ _01–120
 

Don’t know/Not sure ....................77
 

Refused......................................99
 

105.	 Not including ceremonial or sacred use, do you now use snuff or dip 

everyday, some days or not at all? 

Every day ...................................1 Code 30 for Q106 and 

Skip to Q107 

Some days..................................2 

Not at all ....................................3 Skip to Q110 

Don’t know/Not sure ....................7 Skip to Q110
 

Refused......................................9 Skip to Q110 

106.	 During the past 30 days, on how many days did you use snuff 

tobacco? 

None .......................................00 Skip to Q110
 

Number of days........................._ _01–30
 

Don’t know/Not sure ..................77
 

Refused ...................................99
 

107.	 On the days that you used snuff tobacco during the last 30 days, about 

how many times a day did you use snuff tobacco? 

Number of times ......................._ _ _001–180 

Less than once a day .................666
 

Don’t know/Not sure ..................777
 

Refused ...................................999
 

115
 
 

 

 

 

 

 

 

 

 

 

 

 

 

108. When you use snuff tobacco, how soon after you wake up do you have 

snuff? 

Within 5 minutes .......................1 

6–30 minutes............................2 

31–60 minutes..........................3 

After 60 minutes .......................4 

Don’t know/Not sure ..................7 

Refused ...................................9 

109. What brand of snuff or dip do you use most often? (MARK ONLY 

ONE.) 

Kodiak 01 Grizzly 06 

Skoal 02 Navy 07 

Copenhagen 03 Tube Rose 08 

Skoal Bandits 04 Other (specify):______ 09 

Hawken 05 Whatever is convenient 10 

Don’t know/Not sure.............................................77
 

Refused ..............................................................99
 

116
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.1. QUIT ATTEMPTS (SNUFF USE) 

110.	 About how long has it been since you last used snuff tobacco? Would 

you say it was... 

Never used regularly ...................................................... 01 Skip to Q126 

Within the past month (1 month ago) ............................. 02 Go to Q111 

Within the past 3 months (>1 month but 3 months ago) ... 03 Skip to Q112 

Within the past 6 months (>3 months but 6 months ago)...04 Skip to Q112 

Within the past year (>6 months but 1 year ago) ............. 05 Skip to Q112 

Within the past 5 years (>1 year but 5 years ago)............ 06 Skip to Q112 

Within the past 10 years (>5 years but 10 years ago) ....... 07 Skip to Q126 

Over 10 years ago.......................................................... 08 Skip to Q126 

Don’t know/Not sure....................................................... 77 Skip to Q126 

Refused ........................................................................ 99 Skip to Q126
 

111.	 During the past 12 months, have you stopped using snuff for one 

day or longer because you were trying to quit using snuff? 

Yes ............................................1 

No .............................................2 Skip to Q115
 

Don’t know/Not sure ....................7 Skip to Q115
 

Refused......................................9 Skip to Q115
 

117
 
 

 

 

 

 

 

 

 

 

 

 

 

6.2. METHODS OF QUITTING (Snuff Tobacco) 

Ask Q112-114 

(9) CURRENT SNUFF USERS who made a quit attempt in the past year (Q111 = 1 

“Yes”) or 

(10) FORMER SNUFF USERS who quit in the last 5 years (Q110 = 03–06) 

112a. [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you use the nicotine patch to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

112b. [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you use nicotine gum to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

118
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

112c. [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you use any other medications like Zyban, Chantix, or nicotine 

lozenges to help you quit? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

112d. [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you quit “cold turkey” (stopped all at once)? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

113.	 [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you use any native or traditional methods? For example, did you 

go to a sweat lodge, use herbs or pray? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

119
 
 

 

 

 

 

 

 

 

 

114.	 [FORMER SNUFF USERS]: When you quit using snuff tobacco, 

[CURRENT SNUFF USERS]: The last time you tried to quit using 

snuff tobacco, 

Did you use any other assistance, such as smoking cessation classes 

or counseling? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

INTERVIEWER CHECK POINT: 

FORMER SNUFF USERS who quit in the past 5 years 

(Q110 = 03–06) SKIP TO Q126 

6.3. Readiness to Quit Snuff Tobacco 

Current Snuff Users ONLY: (Q105 = 1 or 2) 

115.	 Do you want to quit using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

120
 
 

 

 

 

 

 

 

 

 

 

 

 

116.	 Are you seriously thinking about quitting using snuff tobacco within the 

next six months? 

Yes ............................................1 

No .............................................2	 If Q18 = 2–9 & Q24 = 1 

 Skip to Q123; If Q18 = 2–9

 & Q24 = 2–9 Skip to Q126 

Don’t know/Not sure ....................7 If Q18 = 2–9 & Q24 = 1 

Skip to Q123; If Q18 = 2–9 

& Q24 = 2–9 Skip to Q126 

Refused......................................9 If Q18 = 2–9 & Q24 = 1 

Skip to Q123; If Q18 = 2–9 

& Q24 = 2–9 Skip to Q126 

117.	 Are you planning to quit using snuff tobacco within the next 30 days? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 1 SKIP TO Q123 

HEALTH CARE: IF Q18 = 2–9 & Q24 = 2–9 SKIP TO Q126 

121
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.4. PHYSICIAN AND HEALTH PROFESSIONAL ADVICE 

TO QUIT USING SNUFF TOBACCO 

118.	 During the past 12 months did any doctor, nurse, therapist, or 

counselor ask if you use snuff tobacco? 

Yes ...........................................1
 

No ............................................2 

Don’t know/Not sure ...................7 

Refused.....................................9 

119.	 During the past 12 months did any doctor, nurse, therapist, or 

counselor advise you not to use snuff tobacco? 

Yes ...........................................1 

No ............................................2 If Q24 = 1 Skip to Q123; If 

Q24 = 2–9 Skip to Q126 

Don’t know/Not sure ...................7 If Q24 = 1 Skip to Q123; If 

Q24 = 2–9 Skip to Q126 

Refused.....................................9 If Q24 = 1 Skip to Q123; If 

Q24 = 2–9 Skip to Q126 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using snuff tobacco, did they also do any of the 

following? 

120a. Prescribe or recommend a nicotine patch to help you quit using snuff 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

122
 
 

 

 

 

 

 

 

 

 

120b. Prescribe or recommend nicotine gum to help you quit using snuff 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

120c. Prescribe or recommend nasal spray to help you quit using snuff 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

123
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

120d. Prescribe or recommend an inhaler to help you quit using snuff 

tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

120e. Prescribe or recommend pills such as nicotine lozenges to help you 

quit using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

120f. Prescribe or recommend pills such as Zyban to help you quit using 

snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

120g. Prescribe or recommend pills such as Chantix to help you quit using 

snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

124
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

120h. Suggest that you set a specific date to stop using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using snuff tobacco, did they also do any of the 

following? 

121a. Suggest that you use a smoking cessation class to help you quit using 

snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

121b. Suggest that you use a smoking cessation program to help you quit 

using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

121c. Suggest that you use a smoking cessation quit line or telephone 

counseling to help you quit using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

125
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the past 12 months, when a doctor, nurse, therapist, or counselor 

advised you to quit using snuff tobacco, did they also... 

122a. Provide you with booklets, videos, or other materials to help you 

stop using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

122b. Suggest that you use ceremonial prayer or traditional methods to help 

you quit using snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

INTERVIEWER CHECKPOINT 

HEALTH CARE: If Q24 = 2–9 SKIP TO Q126 

123.	 During the past 12 months did a traditional healer ask if you use 

snuff tobacco? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

126
 
 

 

 

 

 

 

 

 

 

 

 

124.	 During the past 12 months did a traditional healer advise you not to 

use snuff tobacco? 

Yes ............................................1
 

No .............................................2 Skip to Q126 

Don’t know/Not sure ....................7 Skip to Q126 

Refused......................................9 Skip to Q126 

125.	 In the past 12 months, when a traditional healer advised you to quit 

using snuff tobacco, did they suggest you use traditional methods 

(i.e., herbs, sweat lodge, or prayer) to assist in quitting? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

127
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 7: SECONDHAND SMOKE EXPOSURE 

126.	 Not including yourself, how many people live in your household? 

0.............................................0 

1.............................................1 

2.............................................2 

3.............................................3 

4.............................................4 

5 or more.................................5 

Don’t know/Not sure ..................7 

Refused ...................................9 

127.	 Not including yourself, how many of the people who live in your 

household smoke cigarettes, cigars, or pipes? 

0.............................................0 

1.............................................1 

2.............................................2 

3.............................................3 

4.............................................4 

5 or more.................................5 

Don’t know/Not sure ..................7 

Refused ...................................9 

128.	 During the past 7 days, that is, since (FILL IN THE DAY), on how 

many days did anyone smoke cigarettes, cigars, or pipes anywhere 

inside your home? 

Number of days ............................._ _00–07
 

Don’t know/Not sure ......................77
 

Refused ........................................99
 

128
 
 

 

 

 

 

 

 

 

 

 

 

 

 

129.	 What rules do you have about smoking inside your home? 

Smoking is ..... 

Not allowed anywhere or at anytime inside your home ......1 

Allowed in some places or at some times inside the home...2 

Allowed everywhere and at anytime inside the home .........3 

Don’t know/Not sure .......................................................7 

Refused ........................................................................9 

WORKPLACE POLICY AND EXPOSURE 

I am now going to ask you some questions about workplace policies 

on smoking. The first question is about where you work. 

130. Do you work outside of the home? 

Yes ............................................1 

No .............................................2 Skip to Q136 

Don’t know/Not sure ....................7 Skip to Q136 

Refused......................................9 Skip to Q136 

131.	 While working at your job, are you indoors most of the time? 

Yes.............................................1
 

No .............................................2 Skip to Q136 

Don’t know/Not sure ....................7 Skip to Q136 

Refused......................................9 Skip to Q136 

129
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

132.	 As far as you know, in the past 7 days, that is, since (FILL IN THE 

DAY), has anyone smoked inside the building where you work? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

133. Which of the following best describes smoking inside the building 

where you work? 

Not allowed anywhere or at anytime inside your building ...... 1 

Allowed in some places or at some times inside the building .. 2 

Allowed everywhere and at anytime inside the building......... 3 

Don’t know/Not sure ......................................................... 7 

Refused ........................................................................... 9 

134. Does your workplace have an official policy, such as signs, 

personal contracts, or written statements about smoking? 

Yes ............................................1
 

No .............................................2 Skip to Q136 

Don’t know/Not sure ....................7 Skip to Q136 

Refused......................................9 Skip to Q136 

135. Is the policy enforced? 

Always .....................................1 

Sometimes ...............................2 

Rarely......................................3 

Never ......................................4 

Don’t know/Not sure ..................7 

Refused ...................................9 

130
 
 

 

 

 

 

 

 

 

 

ATTITUDES ABOUT CLEAN INDOOR AIR POLICIES 

I am now going to ask you some questions about policies on 

smoking. For the following areas do you think smoking should be 

allowed in all areas, some areas or not at all? 

136. In the indoor work areas do you think smoking should be... 

Allowed in all areas ............................................1 

Allowed in some areas .......................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

137. In the indoor areas of restaurants do you think smoking should 

be... 

Allowed in all areas ............................................1 

Allowed in some areas .......................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

138. In the indoor areas of shopping malls do you think smoking 

should be... 

Allowed in all areas ............................................1 

Allowed in some areas .......................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

131
 
 

 

 

 

 

 

 

139. In the indoor areas of tribal buildings do you think smoking 

should be... 

Allowed in all areas ............................................1 

Allowed in some areas .......................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

140. In the indoor areas of community centers do you think smoking 

should be... 

Allowed in all areas ............................................1 

Allowed in some areas .......................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

141. In the indoor areas of casinos or bingo halls do you think 

smoking should be... 

Allowed in all areas ............................................1 

Allowed in some areas ........................................2 

Not allowed at all ..............................................3 

Don’t know/Not sure ............................................7 

Refused .............................................................9 

132
 
 

 

 

 

 

Now I am going to ask you about being in a car with someone else 

who smokes... 

142. In the past 7 days that is since (FILL IN THE DAY), have you 

been in a car with someone who was smoking? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

133
 
 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 8: RISK PERCEPTION
 

143.	 Think about someone who has smoked a pack of cigarettes a day for 

more than 20 years. Now suppose that I tell you there is NO health 

benefit to that person quitting smoking. Do you... 

Strongly agree...............................1 

Agree ...........................................2 

Disagree.......................................3 

Strongly disagree...........................4 

Don’t know/Not sure ......................7 

Refused ........................................9 

144.	 Do you think that breathing smoke from other people’s cigarettes is: 

Very harmful to one’s health.....................1 

Somewhat harmful to one’s health ............2 

Not very harmful to one’s health ...............3 

Not harmful to one’s health ......................4 

Don’t know/Not sure ...............................7 

Refused .................................................9 

145.	 Do you believe that breathing smoke from other people’s cigarette 

causes lung cancer in adults? 

Yes............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

134
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

146.	 Do you believe that breathing smoke from other people’s cigarette 

causes heart disease in adults? 

Yes.............................................1
 

No .............................................2 

Don’t know/Not sure ...................7 

Refused.....................................9 

147.	 Do you believe that breathing smoke from other people’s cigarette 

causes colon cancer in adults? 

Yes............................................1
 

No ............................................2 

Don’t know/Not sure ...................7 

Refused.....................................9 

148.	 Do you believe that breathing smoke from other people’s cigarette 

causes respiratory problems in children? 

Yes............................................1
 

No ............................................2 

Don’t know/Not sure ...................7 

Refused.....................................9 

149.	 Do you believe that breathing smoke from other people’s cigarettes 

causes sudden infant death syndrome (also called SIDS or crib death)? 

Yes...........................................1
 

No ...........................................2 

Don’t know/Not sure ...................7 

Refused.....................................9 

135
 
 

 

 

 

 

 

 

 

 

 

 

 

SECTION 9: DEMOGRAPHICS 

150. What is your age? 

Age in years.................................._ _ _18–120
 

Don’t know/Not sure ......................77
 

Refused ........................................99
 

151. (Do not ask if not necessary): Write down sex of respondent 

Male.............................................1 

Female .........................................2 

Don’t know/Not sure ......................7 

Refused ........................................9
 

152. How many children aged 17 or younger live in your household? 

Number of children...........................01–76 If number of 

Children = 0 

Skip to Q154 

Don’t know/Not sure........................77
 

Refused .........................................99 

136
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

153. What are the ages of the children from oldest to youngest?

 1st child.......................................................... 01

 2nd child ......................................................... 02
 

3rd child.......................................................... 03

 4th child.......................................................... 04 

5th child.......................................................... 05 

6th child.......................................................... 06 

7th child.......................................................... 07

 8th child.......................................................... 08

 9th child.......................................................... 09
 

10th child ........................................................ 10
 

Don’t know/Not sure ........................................77
 

Refused.......................................................... 99
 

154. Which of the following would you say your race is (choose all 

that apply)? 

American Indian, Alaska Native ............1 

White................................................2 

Black of African American ....................3 

Hispanic or Latino...............................4 

Asian ......................................................... 5 

Native Hawaiian or Pacific Islander ........ 6
 

Don’t know/Not sure ...........................7 

Refused ............................................9 

137
 
 

 

 

 

 

 

 

_____________________________ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

155. Are you enrolled in a tribe? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9 

156. If so which one? 

Don’t know/Not sure .....................7 

Refused ......................................9 

157. Are there any other tribes that you feel a part of, but are not 

enrolled in? 

Yes ............................................1
 

If yes, please specify _________________________ 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9 

158. Do you live with a spouse, partner, or significant other? 

Yes ...........................................1
 

No ............................................2 

Don’t know/Not sure ...................7 

Refused .....................................9 

138
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

159.	 What is the highest level of school you completed or the highest 

degree you received? (Please stop me when I get to your answer 

selection) 

Never attended school or only attended kindergarten 01
 

Grades 1 through 8 (Elementary) .......................... 02
 

Grades 9 through 11 (Some high school) ............... 03
 

Grade 12 (High school graduate) ........................... 04 

GED .................................................................. 05 

Some college, no degree ...................................... 06 

AA, Technical/Vocational....................................... 07
 

AA, Academic...................................................... 08
 

BA, BS (college graduate)..................................... 09
 

Some graduate or professional school .................... 10
 

Graduate or professional degree ............................ 11 

Don’t know/Not sure ............................................ 77
 

Refused ............................................................. 99
 

160.	 What is your household yearly income from all sources? (Please stop 

me when I get to your answer selection) 

$0-$10,000 ....................................................01
 

$10,001 to $15,000.........................................02
 

$15,001 to $20,000.........................................03
 

$20,001 to $25,000.........................................04 

$25,001 to $30,000.........................................05 

$30,001 to $35,000.........................................06 

$35,001 to $40,000.........................................07
 

$40,001 to $45,000.........................................08
 

Greater than $45,000 ......................................09
 

Don’t know/Not sure ........................................77
 

Refused..........................................................99
 

139
 
 

161. Interviewer: Enter date of completed interview: 

___ ___/___ ___/___ ___ ___ ___
 

(Month) (Day) (Year) 

Thank you! 

[END OF INTERVIEW) 

140
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 10: SUPPLEMENTAL QUESTIONS
 

Purchase Patterns 

S1.	 In the past 12 months have you ever bought cigarettes in a 

neighboring state? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

S2.	 In the past 12 months, have you ever bought cigarettes on an Indian 

Reservation? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9 

S3.	 In the past 12 months, did you have access to a computer and the 

internet all the time, sometimes, or not at all? 

All the time.................................................. 1
 

Sometimes .................................................. 2 

Not at all .................................................... 3 

Don’t know/Not sure .....................................7
 

Refused.......................................................9
 

141
 
 

 

 

 

 

 

 

 

 

 

 

 

S4.	 In the past 12 months, have you ever bought cigarettes on the 

internet? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

S5.	 In the past 12 months, have you ever bought cigarettes in a tribal 

smoke shop? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9 

S6.	 In the past 12 months, have you ever bought cigarettes in a tribal 

casino? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

142
 
 

 

 

 

 

 

 

 

 

 

 

 

 

Ceremonial or Sacred Use 

S7.	 Do you use tobacco for ceremonial prayer traditional reasons? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

S8.	 When you used tobacco for ceremonial or prayer or traditional reasons, 

what type of tobacco did you use? (Choose all that apply) 

Native tobacco ...................................................... 1
 

Commercial tobacco such as Marlboro, GCP, etc. ........ 2 

Don’t know/Not sure .............................................. 7 

Refused................................................................ 9
 

S9.	 Have you ever smoked a pipe for ceremonial prayer or traditional 

reasons? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused......................................9
 

143
 
 

 

 

 

 

S10.	 When you smoked a pipe for ceremonial prayer or traditional reasons, 

what type of tobacco did you use? (Choose all the apply) 

Native tobacco ..............................................1 

Commercial tobacco such as Marlboro, GCP, etc 2 

Other (Specify) __________________ ............ 3 

Don’t know/Not sure ......................................7 

Refused .......................................................9
 

144
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Brand Smoked 

S11.	 What brand of cigarettes do you smoke most often? (MARK ONLY 

ONE.) 

Natural American Spirit.................................. 01
 

Benson & Hedges.......................................... 02 

Camel ......................................................... 03
 

Carlton........................................................ 04
 

Generic ....................................................... 05 

Geronimo .................................................... 06 

Kent ........................................................... 07 

Kool............................................................ 08
 

Lucky Strike................................................. 09 

Marlboro...................................................... 10
 

Merit........................................................... 11
 

More ........................................................... 12 

Native Brand................................................ 13 

Newport ...................................................... 14 

Noble .......................................................... 15
 

Omaha Brand............................................... 16 

Pall Mall ...................................................... 17 

Salem ......................................................... 18 

Santa Fe...................................................... 19
 

Seneca Brand............................................... 20 

Virginia Slims ............................................... 21
 

Other (specify) _____________ ...................... 22
 

Don’t know/Not sure...................... ............... 77
 

Refused ....................................................... 99
 

145
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demographics 

S12.	 Which of the following best describes how you think of yourself? 

Heterosexual or straight .................................1
 

Gay or lesbian...............................................2
 

Bisexual .......................................................3 

Other (specify) _____________ ......................4
 

Don’t know/Not sure ......................................7 

Refused .......................................................9
 

Asthma 

S13.	 Have you ever been told by a doctor, nurse, or other health 

professional that you had asthma? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9
 

S14.	 Do you still have asthma? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9
 

146
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diabetes 

S15.	 Have you ever been told by a doctor, nurse, or other health 

professional that you have diabetes? 

Yes, but I am female and was told this only 

when I was pregnant..................................... 1 

Yes ............................................................. 2
 

No .............................................................. 3 

No, but I have been told that I am prediabetes 

or border line ............................................... 4 

Don’t know/Not sure .....................................7 

Refused ...................................................... 9
 

Hypertension Awareness 

S16.	 Have you ever been told by a doctor, nurse, or other health 

professional that you have high blood pressure? 

Yes, but I am female and was told this 

only when I was pregnant...............................1 

Yes ..............................................................2 

No ...............................................................3 

Don’t know/Not sure ......................................7 

Refused .......................................................9
 

147
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S17. Are you currently taking medicine for your high blood pressure? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9 

Cholesterol Awareness 

S18.	 Blood cholesterol is a fatty substance found in the blood. Have you 

ever had your cholesterol checked? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9
 

S19.	 About how long has it been since you last had your blood cholesterol 

checked? 

Within the past year (anytime less than 

12 months ago)........................................... 1 

Within the past 2 years (1 year but less than 

2 years ago) ............................................... 2 

Within the past 5 years (2 years but less than 

5 years ago) ............................................... 3 

5 or more years ago..................................... 4
 

Don’t know/Not sure .................................... 7 

Refused ..................................................... 9
 

148
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S20.	 Have you ever been told by a doctor, nurse, or other health 

professional that your blood cholesterol is high? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9
 

Cardiovascular Disease/Stroke 

S21a. Has a doctor, nurse, or other health professional ever told you that 

you have had a heart attack, also called a myocardial infarction? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9
 

S21b. At what age did you have your first heart attack? 

Age (76 = 76+)..........................01–76
 

Don’t know/Not sure ....................77
 

Refused .....................................99
 

S21c. Has a doctor, nurse, or other health professional ever told you that you 

have angina or coronary heart disease? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9
 

149
 
 

 

 

 

 

 

 

 

 

 

 

 

 

S21d. Has a doctor, nurse, or other health professional ever told you that 

you have had a stroke? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused .....................................9
 

S21e. At what age did you have your first stroke? 

Age (76 = 76+)..........................01–76
 

Don’t know/Not sure ...................77
 

Refused ....................................99
 

Pregnancy 

S22.	 During any of your prenatal care visits, did a doctor, nurse, or health 

care worker talk with you about how smoking during pregnancy could 

affect your baby? 

Yes ............................................1
 

No .............................................2 

Don’t know/Not sure ....................7 

Refused ......................................9 

150
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

S23.	 In the 3 months before you got pregnant, how many cigarettes did 

you smoke on an average day (pack = 20 cigarettes)? 

None (0 cigarettes) ....................................... 1 

Less than 1 cigarette.....................................2
 

1 to 5 cigarettes ........................................... 3
 

6 to 10 cigarettes ......................................... 4 

11 to 20 cigarettes........................................ 5 

21 to 40 cigarettes........................................ 6 

41 cigarettes or more.................................... 7
 

Don’t know/Not sure .....................................77
 

Refused ...................................................... 99
 

S24.	 In the last 3 months of your pregnancy, how many cigarettes did you 

smoke on an average day (pack = 20 cigarettes)? 

None (0 cigarettes) ........................................1 

Less than 1 cigarette......................................2
 

1 to 5 cigarettes ............................................3
 

6 to 10 cigarettes ..........................................4 

11 to 20 cigarettes.........................................5 

21 to 40 cigarettes.........................................6 

41 cigarettes or more.....................................7
 

Don’t know/Not sure ......................................77
 

Refused ...................................................... 99
 

151
 
152
 
Appendix C
 

American Indian Adult Tobacco Survey
 

Checklists and Forms
 

153
 
154
 
 

PRESURVEY CHECKLIST 

Step 1: Greet respondent and provide business card. q

Step 2: Get Consent Form signed. 

Step 2.1: Read consent form to respondent. q

Step 2.2: Provide copy of consent form to respondent. q

Step 2.3: Sign consent form (both interviewer and respondent). q

Step 2.4: Place consent form in manila envelope, seal, 

and sign across the seal. q

Step 3: Proceed to interview. q

Step 4: Read “Instructions to be Read to Respondent.” q

Step 5: Conduct interview. q

Step 6: Thank respondent. q

Step 7: Compensation. 

Step 7.1: Provide compensation. q

Step 7.2: Complete receipt. q

Step 7.3: Provide copy of receipt to respondent. q

Step 8: Complete the Survey. 

Step 8.1: Place survey in manila envelope, seal, and sign across the seal. q

Step 9: Thank respondent. q

155
 
FACE-TO-FACE CONTACT SCRIPT
 

My name is , and I represent . My name and contact information 

are contained in this card. Your participation in this study will help to identify tobacco use in 

your community. Your answers will be combined with those from other people in your tribal 

community. They will be used to address serious health problems among Indian people 

related to commercial tobacco use. This is a confidential survey, which means that your 

name will be kept private. If you are uncomfortable with any question, you can refuse to 

answer that question. If there are questions that you prefer not to answer, you can refuse to 

answer those questions. You can stop this interview at any time. The survey takes about 30 

minutes to complete. We begin with the question... 

156
 
 

TELEPHONE CONTACT SCRIPT
 

I am calling on behalf of . You agreed to participate in a study to identify 

tobacco use problems in your community and in all tribal communities. This survey has 

been approved by and tribes and/or clinics. (The preceding sentence can 

be adjusted for each specific tribe/clinic.) Your answers will be combined with those from 

other people in your tribal community. The results will be used to address serious health 

problems among Indian people related to commercial tobacco use. This is a confidential 

survey, which means that your name will be kept private. If you are uncomfortable with any 

question, you can refuse to answer that question. You can stop this interview at any time. 

The survey takes about 30 minutes to complete. Before we begin, please take a moment to 

write down my name and telephone number should you have any questions after we have 

completed the survey. (At this point, give name and contact number). We begin with the 

question... 

157
 
 

 

AMERICAN INDIAN ADULT TOBACCO SURVEY INFORMED 

CONSENT FORM
 

Purpose 

The (Tribe/Health Program Name) and the Support 

Centers for Tobacco Control Programs (SCTCP) are conducting a survey of the knowledge, 

attitudes, and behaviors related to commercial and traditional tobacco use. This survey 

is being done among American Indian adults. Your participation will help us to identify 

tobacco use problems and needs specific to your community. It also will help to improve 

services and programs aimed at preventing or decreasing commercial tobacco use and its 

health effects. 

Procedures 

We will recruit about (insert N for each respective tribe/health program) 

adults, 18 years of age or older to participate in the survey. The interview will take about 30 

minutes to complete. The interview will include general demographic questions as well as 

questions related to tobacco (commercial and possibly traditional) use. 

Confidentiality 

You will not be identified with the information you give because the survey is confidential. 

No one but the interviewer will know how you answered the questions on the survey. The 

interviewer has signed a pledge to keep all information about you confidential. Your name 

will be eliminated from all documents associated with the survey, and a number will be 

assigned to the survey questionnaire. The linked list of names and numbers will be kept in a 

locked secure place until the questionnaire has been successfully entered into the computer. 

The identifying information will be destroyed immediately after the data have been entered. 

The questionnaires (without any names on them) will be destroyed after the data are 

analyzed. Only project staff will have access to the study data. We will not use your name 

when we report results of the survey. The information we collect from you will be combined 

with information from other tribal members to help develop a profile of community 

smoking and health behaviors and attitudes. 

Risks and Benefits 

If you feel uncomfortable with some of the questions included in this survey, you can refuse 

to answer any question you are not comfortable with, or skip questions you do not want 

to answer. You can stop the interview at any time. The likely benefits of this survey to you 

as an individual are minimal; however, the overall impact for your tribal community will be 

significant because new information on tobacco use will become available to address an 

important health problem. 

158
 
 

 

 

 

 

 

 

RIGHTS AS A VOLUNTEER
 

Your participation in the American Indian Adult Tobacco Survey is voluntary. If you decide 

not to take part or to stop the interview, you will not lose any services to which you are 

otherwise entitled.
 

If you have any questions about this survey project, you may call . You 

also may call the Project Coordinator, at . 

If you have questions about your rights as a respondent, you may call 

at . 

Respondent Agreement 

The American Indian Adult Tobacco Survey has been explained to me. I voluntarily consent 

to participate. I have had an opportunity for my questions to be answered. I know that I 

may refuse to participate, or I can stop the interview at any time without any loss of health 

care benefits to which I am otherwise entitled. I understand that if I have questions about 

this survey project or my rights as a respondent, I may contact the local community contact 

or the Project Coordinator. 

I understand that I will receive $ for my time and contribution. 

Respondent Signature Date 

Interviewer Signature Date 

Copies: q Respondent q Project Coordinator 

159
 
American Indian Adult Tobacco Survey 

Interviewer Activity Tracking 

Date Survey 

number 

Consent Form 

(x) Mileage Interviewer’s Initials 

Supervisor’s 

Initials 

Total 

ATS Coordinator Signature: 

Date: 

160
 
 

American Indian Adult Tobacco Survey 

GIFT CERTIFICATE TRACKING FORM 

INTERVIEWER NUMBER: INTERVIEWER NAME: 

Gift Certificate Number Date Survey Number Interviewer’s Initial 

161
 
162
 
Appendix D
 

American Indian Adult Tobacco Survey

 Statistical Analysis Details
 

163
 
164
 
Data Analysis 

Data analysis transforms large masses of data into usable information by using statistical 

techniques to describe, organize, and interpret a data sample and to make inferences 

about a larger population. The purpose of analyzing data from the American Indian Adult 

Tobacco Survey (AI ATS) is to generate enough understanding about an American Indian 

community’s attitudes, beliefs, and behaviors regarding commercial tobacco use. 

Data analysis also can provide an understanding of several other tobacco-related topics, 

such as community beliefs and attitudes about secondhand smoke and its impact on tribal 

members. Data analysis software is essential for working with large data sets such as the 

AI ATS. When selecting software, consider cost, availability of tutorials and training, and 

network compatibility with other partners that need to access the AI ATS data. 

Data Screening 

After data entry has been completed and before data from a large sample are analyzed, 

take steps to ensure that the data are free of interviewer and data entry errors, and that 

the data accurately represent the responses of the sample participants. Data screening is 

time-consuming, but data cannot be analyzed until they have been properly screened. For 

example, making sure values that should be coded as missing data (e.g., “refused”) do not 

get averaged into true values can save a lot of time and embarrassment in the future. 

Examining Frequency Distributions 

By running frequencies of each field, values that fall outside of the normal range of 

responses are quickly identified. For example, several fields on AI ATS are binary, requiring 

the respondent to select either “Yes” (coded as 1) or “No” (coded as 2). Even a quick 

examination of the frequencies of such questions would reveal problems if a 3 or 4 were 

entered because no values are assigned to those numbers. Any red flag in the frequency 

distribution will prompt the data analyst to retrieve the actual survey to determine if the 

error was made by the interviewer or by the person who did the data entry. Values that are 

in the possible range of responses, but are considered extreme by the analyst may be errors 

or true outliers. Those values also should be checked against the actual survey to determine 

their legitimacy. 

Histograms, Stem-and-Leaf Diagrams, Boxplots, and Scatter Plots 

Frequency distributions of a data set can be illustrated in histograms, stem-and-leaf 

diagrams, and, boxplots. You need to be familiar with the type of data that need to be 

graphed to select an appropriate method to depict the data. 

Histograms are an excellent way to graph data to check for 

outliers and see the shape of the distribution. When conducting 

further statistical analysis on continuous (numerical), interval, 

or ratio data, keep in mind that many statistical procedures 

require the distribution of data to be normal. Histograms can be 

constructed with a superimposed normal curve, which overlays 

the frequency distribution to provide an estimate of how closely 

the distribution follows the rules of a normality. Histograms are an 

excellent way to view the frequency distributions of single variables or fields of a survey. 

165
 
Stem-and-leaf diagrams provide similar information to a histogram, with one 

important addition. They clearly identify the scores that fall outside of the normal 

range. Data analysts who are unsure of whether a specific score should be 

considered an outlier can create a stem-and-leaf diagram. 

Boxplots display the frequencies of different groups within 

the sample. With the AI ATS, differences in respondents’ 

varied smoking status (i.e., everyday smoker, someday 

smoker, former smoker, and nonsmoker) are of great 

epidemiological concern. By graphing a boxplot of the four types of 

smoking status, the data analyst can view the frequency distributions 

of any given variable for the different types by examining the 

shape of the boxplot. That shape shows how widely distributed a subgroup’s values are in 

relationship to other groups. 

Scatter plots are perhaps the best medium for examining the 

relationship between two variables and discovering outliers that 

are improbable or impossible. Sometimes, outliers are not apparent 

until two or more variables are viewed simultaneously and in 

relation to one another. Examining the relationship between two 

variables (bivariate outliers) can reveal outliers that a univariate 

frequency distribution will not reveal. 

Understanding Different Types of 

Data 

Another antecedent to data analysis 

is determining the type of data and 

appropriate measurement for each 

variable being described on the survey. 

There are four levels of data: nominal, 

ordinal, interval, and ratio. Data analysts 

must understand the type of data they 

are working with in order to select the 

appropriate method for analysis and 

graphical representation. The data that 

are produced by the AI ATS can be 

considered either discrete or continuous. 

Discrete data include those variables 

that have values that are separate 

and distinct, whereas continuous data 

are numerical (i.e., questions in which 

any number, such as age or weight, is 

acceptable). Mathematical procedures 

should not be performed on discrete 

data (i.e., questions that have a set 

number of responses, such as yes or 

no). Nominal data are any data that are 

categorical, such as the respondent’s 

tribal affiliation, clinic site, type of 

166
 
tobacco smoked, or sex. These variables have no numbers associated with them in the real 

world; they are assigned arbitrary numbers simply for the purposes of data coding. 

Quantitative analysis methods, such as determining the percentage or frequency of 

each value, need to be used to understand the distribution. Calculating means, medians, 

and other methods appropriate for continuous data would be inappropriate because 

nominal data are discrete. For nominal data, such as sex, it would be more appropriate to 

understand the percentage of female respondents in the total sample, or the percentage of 

females versus males who feel a particular way about a particular topic. 

Ordinal data are any categorical data that can be arranged hierarchically. The AI ATS 

presents several questions that produce ordinal data. For instance, the questions that collect 

information about opinions on rules of smoking in indoor environments have established 

a three-tiered hierarchy of discrete categorical data. For a specific environment—such as a 

community center or casino—respondents can decide whether they believe smoking should 

be “allowed in all places,” “allowed in some places,” or “not allowed at all.” 

For the purposes of the AI ATS, interval and ratio categories will be treated as a single 

category. Data that are considered interval or ratio data are continuous, and they progress 

at equal intervals. Excellent examples of interval/ratio data that appear on the AI ATS 

include the respondent’s age, number of cigarettes smoked per day, and the number of 

people who smoke in the household. The statistical procedures that can be performed on 

the data are limited to whether the data are nominal, ordinal, or interval/ratio. 

Measures of Central Tendency 

The measure of central tendency is often 

considered the most important value 

to represent a continuous variable. For 

instance, professionals working in tobacco 

control are often concerned about the 

average or median age of smoking 

initiation of a population because this 

information provides an understanding 

of the length of time a group has been 

addicted to nicotine, and it indicates 

how early prevention efforts should be 

initiated. The age of smoking initiation of all of the respondents in a sample represents a 

distribution of scores, where each score is the age of initiation of a single respondent. 

Three methods commonly used to locate the central tendency of a distribution include the 

mean (arithmetic average), median, and mode. The easiest measure of central tendency 

is the mode. The mode is used to determine the value that occurs most frequently for 

a nominal variable. The mode is calculated by tallying the total frequency of each value. 

Although the mode may not be that helpful in understanding much of the AI ATS data, 

it may be helpful in describing the brands of cigarettes that are the most preferred by 

respondents who smoke. 

When attempting to understand the central tendency of continuous data for uni-modal 

data (or data not highly skewed), the mean is usually the most appropriate measure. 

Methods of screening data using histograms and normal curves can provide a quick 

167
 
reference for determining whether data for a variable in question approximates a normal 

distribution. The mean can be calculated by summing all the values and dividing by the 

number of scores present. The mean is very sensitive to extreme scores, so caution should 

be used before reporting a mean value of a distribution when extreme scores are present. 

In the case of extreme scores—where the outliers have been identified as accurate values 

and not errors in data entry—the median may be a more appropriate measure of central 

tendency. The median is the middle-most score in a set of scores where half of all scores 

are above and half are below. When there are a limited number of extreme scores, the 

median is a more accurate measure of central tendency because it is less influenced by 

extreme scores. The median also can be computed by any data analysis software package. 

The median can be seen in a frequency table under the column for cumulative percent. The 

score closest to the cumulative percentage of half is closest to the median score, where 

approximately 50% of all other scores are above or below. 

Variability 

In addition to understanding the average of a set of scores, such as the average age of 

smoking initiation, it is important to know how widely dispersed the scores are around the 

average. The way in which scores differ from one another is known as variability. Samples 

that demonstrate relatively tight dispersions around the mean indicate that the respondents 

are homogeneous in regard to that particular variable. For the purposes of the AI ATS, the 

first measure of variability that is important to understand is the range. The range is the 

distance between the highest and lowest value and can help identify rogue values in the 

data screening process. 

The standard deviation is the most frequently used measure to assess how closely scores 

are dispersed about the mean, and it is the primary measure of variability to be considered 

for analyzing AI ATS data. The standard deviation is the average distance from the mean of 

all the scores in a distribution. Consequently, the greater the standard deviation, the more 

widely the scores are distributed around the mean. Separate distributions may have the 

same mean, but greatly differing standard deviations. 

Differences in Distributions 

Distributions in any given sample can differ from each other. It is important to consider 

how data are distributed because many data analysis procedures require the data meet 

certain criteria before they can be accurately used to assess data. Many procedures, such 

as Pearson’s r correlation, t-tests, and analysis of variance (ANOVA), require that the data 

be normally distributed. Therefore, a data analyst should understand the shape of the 

distribution before using these data analysis methods. 

Differences in distributions can be categorized in the following four ways: average value, 

variability, skewness, and kurtosis. 

• Average Value: When examining the age of smoking initiation of different 

subpopulations, disparities between subgroups can become a public health concern. 

Since American Indian (AI) smoking initiation rates have begun to be monitored by 

tribes and states, the age of AI smoking initiation has been shown to be significantly 

lower than that of the general U.S. population. These differences demonstrate 

differences in average values or mean ages of smoking initiation among racial and 

ethnic groups. 

168
 
• Variability: The way in which observations in a data set are distributed across various 

categories. 

• Skewness: A measure of how symmetrical the distribution is on both sides of the 

mean. Data that are normally distributed are symmetrical about the mean. If a measure 

of skewness is performed to assess how well a distribution approximates a normal 

distribution, then the skewness ratio should be between -2 and 2. A skewness ratio 

outside of this range suggests that the data are not normal, and caution should be 

used when performing procedures that require normal distributions. 

• Kurtosis: A reference to the peakedness of the distribution. Normal distributions 

ideally have peaks that are bell-shaped and fit relatively well into the normal curve 

overlay in a frequency histogram. If a measure of kurtosis is performed to assess 

how well the peakedness of a distribution approximates a normal distribution, then 

the kurtosis ratio should be between -2 and 2. A kurtosis ratio outside of this range 

suggests that the data are not normal, and caution should be used when performing 

procedures that require normal distributions. 

Univariate Analysis 

Univariate analysis is the process of analyzing one variable at a time. If a data analyst has 

successfully gone through the process of screening the data, then he/she already possesses 

the technical knowledge required to perform univariate analysis. Once the data have been 

screened, frequency tables and basic descriptive statistics can be performed for the fields 

that will be included in the AI ATS report. We recommend that you use univariate analysis 

procedures to describe the sample population. For example, people reading the AI ATS 

report need to know the basic demographic distribution of the sample (e.g., age, sex, 

income, tribal affiliation, education). Using computer software to construct a frequency 

table and bar chart of the sample population’s education distribution would be a good way 

to communicate important information to the people who want to use the AI ATS data. 

In addition, remember the following: 

•		 When appropriate, it will be useful to calculate the mean and its standard deviation for 

those fields that have been identified as key indicators. 

•		 When presenting tables and charts, keep in mind that simpler is better. Complex table 

and charts can confuse readers. 

Bivariate Analysis 

Bivariate analysis adds an element of comparison. For the purposes of generating a basic AI 

ATS bivariate report, contingency tables (also known as cross tabulations) may be the most 

extensive statistical procedure required. Contingency tables allow the relationship among 

variable to be compared. 

169
 
 

Graphing Data 

When presenting data to the tribal boards or members, a variety of charts and graphs such 

as bar charts, line graphs, pie charts, or histograms can be used to show the results in the 

final reports or presentations. Next is a brief description of how and when to use each type 

of graph or chart. 

Bar Chart 

•		 Used when comparing different groups within a sample. 

•		 Clustered bar charts can be good for displaying how data have changed over time. 

	 Data should be discrete and can consist of nominal or ordinal data (e.g., 

differences in smoking status and sex). 

Line Graph 

•		 Used when depicting trends in data over equal intervals. 

•		 Multiple line charts can show trends of two or more categories over time. 

Pie Chart 

•		 Used when showing the proportion of a category. 

•		 Can only be used with nominal data. 

Histogram 

•		 Breaks data into intervals. 

170
 
Appendix E
 

American Indian Adult Tobacco Survey 

Resources
 

171
 
172
 
 

 

 

 

 

Centers for Disease Control and Prevention 

Office on Smoking and Health 

Epidemiology Branch 

Stacy Thorne, MPH, CHES 

4770 Buford Hwy, MS K50 

Atlanta, GA 30341 

Phone: (770) 488-5366 

Fax: (770) 488-5848 

Centers for Disease Control and Prevention: Tobacco Information Page 

http://www.cdc.gov/tobacco 

Indian Health Service 

Division of Epidemiology and Disease Prevention 

5300 Homestead Rd, NE 

Albuquerque, NM 87110 

Phone: (505) 248-4132 

http://www.ihs.gov/medicalprograms/epi/index.cfm 

Tobacco Education and Prevention Technical Support Center (TEPTS) 

California Rural Indian Health Board (CRIHB) 

4400 Auburn Blvd., 2nd Floor 

Sacramento, CA 95841 

Phone: (916) 929-9761 

Fax: (916) 929-7246 

AI/AN National Network for Tobacco Prevention and Control 

Michigan Inter-Tribal Council 

2956 Ashmun St. 

Sault Ste. Marie, MI 49783 

Phone: (906) 632 -6896 

Fax: (906) 635-4212 

Northern Plains Tobacco Prevention Project 

Aberdeen Area Tribal Chairmen’s Health Board 

1770 Rand Road 

Rapid City, SD 57701 

Phone: (605) 721-1922 

Fax: (605) 721-1932 

Tobacco Prevention Program 

Muscogee (Creek) Nation 

121 W. Broadway 

Okemah, OK 74859 

Phone: (918) 623-1189 

Fax: (918) 623-2077 

173
 
 

 

 

 

 

 

Northwest Portland Area Indian Health Board 

527 SW Hall, Suite 300 

Portland, Oregon 97201 

Phone: (503) 228-4185 

Fax: (503) 228-8182 

Janis Weber, Ph.D.
 

JCW Research & Evaluation Group, Inc.
 

139 Roberta Rd. 

Ormond Beach, FL 32176 

Phone: (904) 612-0457 

Fax: (386) 441-4593 

Tribal Epidemiology Centers: 

Navajo Tribal Epidemiology Center (NTEC) 

PO Box 1390 

Window Rock, AZ 86515 

FedEx: Tribal Administration Bldg #2, Downstairs 

Window Rock, AZ 86515 

Phone: (928) 871-6254 

Fax : (928) 871-6255 

Northern Plains Tribal Epi Center (NPTEC) 

Aberdeen Area Tribal Chairman Health Board 

1770 Rand Road 

Rapid City, SD 57702 

Phone: (605) 721-1922 

Fax: (605) 721-1932 

Southern Plains Inter-Tribal Epidemiology Center (SPITEC) 

PO Box 57377 

Oklahoma City, OK 73157-7377 

FedEx: 3625 NW 56th Street, 

Oklahoma City, OK 73112-4559 

Phone: (405) 951-6004 x104 

Fax: (405) 951-3902 

Urban Indian Health Institute (UIHI) 

PO Box 3364 

Seattle, WA 98114 

FedEx: 1225 S Weller St., Suite 510, 

Seattle WA 98144 

Phone: (206) 812-3030 

Fax: (206) 812-3044 

174
 
 

 

 

 

 

 

 

United South and Eastern Tribes, Inc (USET TEC) 

Tribal Epidemiology Center 

711 Stewarts Ferry Pike, Suite 100 

Nashville, TN 37214 

Phone: (615) 872-7900 

Fax: (615) 872-7417 

Division of Epidemiology and Disease Prevention (DEDP) 

National Office 

5300 Homestead NE 

Albuquerque, NM 87110 

Phone: (505) 248-4132 

Fax: (505) 248-4393 

Alaska Native Tribal Epidemiology Center (ANTEC) 

4000 Ambassador Drive-DCHS 

Anchorage, AK 99508 

Phone: (907) 729-2923 

Fax: (907) 729-4569 

Rocky Mountain Tribal Epidemiology Center (RMTEC) 

M/W Tribal Leaders Council 

222 N 32nd Street, Suite 401 

Billings, MT 59101 

Phone: (406) 252-2550 

Fax: (406) 254-6355 

Albuquerque Area Southwest (AASTEC) 

Tribal Epidemiology Center 

5015 Prospect Avenue NE 

Albuquerque, NM 87110 

Phone: (505) 764-0036 

Fax: (505) 764-0446 

Great Lakes Inter-Tribal Council (GLITC) 

PO Box 9 

Lac du Flambeau, WI 54538 

FedEx: 2932 Hwy 47 North 

Lac du Flambeau, WI 54538 

Phone: (715) 588-3324 

Fax: (715) 588-7900 

Inter Tribal Council of Arizona, Inc. (ITCA) 

Tribal Epidemiology Center 

2214 N Central Ave, Suite 100 

Phoenix, AZ 85004 

Phone: (602) 258-4822 

Fax: (602) 258-4825 

175
 
 

 

Northwest Tribal Epidemiology Center (NWTEC) 

Northwest Portland Area Indian Health Board 

527 SW Hall, Suite 300
 

Portland, OR 97201
 

Phone (503) 228-4185
 

Fax (503) 228-8182
 

Direct Line: (503) 416-3283
 

California Tribal Epidemiology Center (CTEC) 

California Rural Indian Health Board (CRIHB) 

4400 Auburn Blvd., 2nd Floor
 

Sacramento, CA 95841
 

Phone: (916) 929-9761
 

Fax: (916) 929-7246
 

176
 

CS120304