Vital and

Health Statistics

Cognitive Research

on Response Error

in Survey Questions

on Smoking

Series 6:

Cognition and Survey Measurement

No, 5

This report describes three studies investigating the accuracy of subjects’ selfreportaboutcigarettesmoking, The first study examined the way in which

smokers answer questions about the number of cigarettes they smoke, The

second study addressed the issue of social desirability effects by manipulating

the context in which subjects were asked whether they smoked, and if so, how

much, In the third study, participantsfrom a 1981–82 study of people who

completed a stop-smoking program were interviewed concerning their smoking

histories,

U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyatbville, Maryland

September 1992

DHHS Publication No, [PHS) 92-1080
Copyright Information

Permlswm has been obtained from the copyright holders to reproduce f!gure 1

m this report. Further reproduction of th!s figure !s proh!blted without Specific

permwwn of the capynght holders. All other material contained in the reporl E

m the pubhc domam and may be used and reprinted without special

permmon; cl!atjon as to source, however, E appreciated.

Suggested Citation

Means B, Habina K, Swan GE, Jack L. Cognitive research on response error in

survey questions on smohmg. National Center for Health Statistics. Vital Health

stat 6(5). 1992.

Library of Cong’ress Cataloging-in-Publication Data

Cogmtwe research on response error m sutvey questjons on smokmg.

p. cm. – (V]tal and health statistics. Series 6, Cognktlon and survey

measurement : no. 5) (DHHS pubhcation : no. (PHS) 92-1080)

“SRI Project 6719, final report, September 1991” –Added t.p.

Pre,oared for the National Center for Health Statistics by SRI International:

prepared by Barbara Means et al.

Februa!y 1991 .“

Includes brbkographlcal references (p. 91–94). [SBN

0-8406-0456-4

1. Crgarette smokers – United States–Attitudes- Evaluation. 2. Health

surveys- Umted States– Evaluation. 3. %lf-percepffon. 1. Means, Barbara,

1949– Il. Natlonisl Center for Health Statistics (U.S.) [1[.SRI International. IV.

Series. V. Series: DHHS pubhcation : no. (PHS) 92–10S0.

[DNLM: 1, Health Surveys – United States. 2. Reproducfiblhty of Results.

3. Smoking –epldernlology. 4. Smokmg -psychology. W2 A N14&f no. 5]

RC567.C59 1992

616.865’001’9–dc20

DNLM/DLC

for L!brary of Congress 91-43535

CIP
National Center for Health Statistics

Manning Feinleib, M.D., Dr. P.H., Director

Jack R. Anderson, Acting Deputy Director

Jacob J. Feldman, Ph. D., Associate Directorfor AnaZysis

and Epidemiology

Gail F. Fisher, Ph.D., Associate Director~orPlanning and

ExtramuralPrograms

Peter L. Hurley, Associate Directorfor Hfal and Healfh

Statistics Sysfems

Robert A, Israel, Associafe Direcforfor International

Statistics

Stephen E. Nieberding, Associate Directorfor

Management

Charles J. Rothwell, Associafe Direcforfor Data

Processingand Services

Monroe G, Sirken, Ph.D., Associate Direcforfor Research

and Methodology

David L. Larson, Assisfanf DirectoCAflanfa

Office of Research and Methodology

Monroe G. Sirken, Ph. D., Associafe Director

Kenneth W. Harris, SpecialAssistant for Program

Coordinationand Statistical Sfandards

Lester R, Curtin, Ph. D., Chie$ StatisticalMethods Staff

James T. Massey, Ph. D., Chiej SurveyDesign Staff

Andrew A. White, Ph.D., Chiej$Stafisfical Technology

Sfaff

This research was part of a larger project cntidcd, “National Laboratory for

Collaborative Rmxmch in Cognition and SUrvey Measurement,” conducted by

the National Ccrrtcr for Health Statistics (NCHS) under grant SES-S612320 from

the National Science Foundation (NSF). Monroe G. Sirken, Ph.D., was the

principal investigator for this grmrt, mrd Murray Aborn, Ph.D., was the NSF

program director.

This research was performed under Department of Health and Human

Services contract 200-8S-7074 from NCHS to SRI InternatiorrrJ. Barbara Means,

Ph.D., was the principal investigator. Jarcd B. Jobe, Ph.D., was the NCHS

project officer and is the technical editor and reviewer for .%xics 6. James L.

Esposito, Ph.D., was the altcrmttc project officer.
Preface

Many individuals contributed to the research described in this report. We wish to thank the National

Center for Health Statistics’ technical monitors for the

project, Dr. Jared B. Jobe and Dr. James L. Esposito, for

their suggestions, guidance, and support throughout the

effort. We also wish to acknowledge the contribution of

Dr. Elizabeth F. Loftus of the University of Washington,

who consulted with us on the design of these studies.

Study 1 owes much to the work of Dr. Saul Shiffrnan of the

University of Pittsburgh, who first suggested using handheld computers for logging smoking and shared his research protocols with us. We are also grateful to two other

members of the University of Pittsburgh Smoking Research Group: James Sucker programmed the user interface for logging cigarettes onto the computer, and Jean

Paty shared his procedures for training subjects and for

handling data with us and served as technical consultant

throughout the data collection. In testing subjects, Alison

Dame assisted in studies 1 and 3, Anna Carroll assisted in

studies 1 and 2, and George Clark assisted in study 3.
Symbols

--- Data not available

,.. Categoty not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

* Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction ,. .,,... . . . . . . . . . . ...!.. . . . . .

Importance ofsurveys of smoking behavior

Focus of the present study . . . . . . . . . . . . . .

. . . . . . . . . . ...! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . !. . . . . . . . . . . . . . . ,,,.,.! ,., . . . . . . . . . . . . . . . . . . . . . . . . . .

., !..... . ...!... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..!..! . . . . . . . . . . . . . . . . . . . . . . . . .

Review ... ,..!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...!. . . . . . . . . . . . . . . . . . . .

Issues in smoking research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cognitive issues in smoking surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Frequency estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Study l: Estimating frequencyof cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results .,, ,..,, ,, ..,,,. . . . . . . . . !!. ,. . . ...! !. !..... . . . . . . . . . . ...!.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Study 2: Social desirability andreports of smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Design , ...,..,!, . . . . . . . . . . . . . . . . . . . . . . ,.! 0..... . . . . . . . . . . ..0.!... . . . . . . . . . ,. .,.,.. . . . . . . . . ,. .,....

Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. s.....

Study 3: Long-term recall ofsmoking activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...!. . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

1, Study l: Recruiting and screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Study l: Initial interview protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111, Study l: Second interview protocols, by condition.....,,.......,.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV, Study 2: Interview protocols, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V, Study 3: Respondents locating and recruitment procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VI, Study 3: Intexwiew protocols, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendix figure

L Recruitment and sampling ofsmokers from the mid-Peninsula and South Bay regions of the San Francisco

Bay Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of text figures

l,Modelo fthequestion-answering process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2, Cotinine and record ofamount smoked during the 17 hoyrspriortosa1iva sample . . . . . . . . . . . . . . . . . . . . . . . . .

...

111

1

1

1

2

2

3

5

7

8

9

10

15

17

17

18

19

19

22

24

25

31

33

36

38

48

69

80

81

37

4

13

v
3. Potential causes forunderreporting of behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Cotinine Ievel for smokers and nonsmokers, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Comparison of responses to open-ended and structured-response itemson reasons for stopping smoking . . . . . .

6. Deviation between recalled and actual date of stopping smoking,.,,,,,. . . . . !,, ..,.. . . . . . . . . .,, ,,,.. .,.,,

List of text tables

A. Mean absolute difference between reported and logged smoking frequency, by strategy condition and recall

interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,., . . . . . . . . . . . . . . . . . . . . . . . . ...!... . . . . . . . . . . . . . . . . .,

B. Mean absolute deviation as a proportion of smoking frequency, by condition and recall interval . . . . . . . . . . . .

C. Mean absolute difference between reported and logged smoking frequency, by subject confidence level and

recall interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Mean confidence Ievel by strategy condition and recall interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Mean absolute difference between reported and logged smoking frequency by smoking level and recall

interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , , , , , ,. . . , , , ,

F. Response distribution ofestimation strategies reported by free-strategy respondents . . . . . . . . . . . . . . . . . . . . . .

G. Number and percent of reported smoking status and mean frequency among self-reported smokers, by

interview condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., .,,.., . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . . . . . . ... .,.,,

H. Number and percent ofreported smoking status, by social environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

J. Differences between conversations and survey interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

K. Contrasts between experimental and standard interview conditions . . . . . . . . . . . . . . . . . . . . . . . . 0.,,,,.. . . . . . .

L, Number andpercent ofsmoking levels reported in1982compared with levels reported inl989-9O.,..,.,,.,

M. Level ofagreement andmemo~for features ofcigarettes smoked inl982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

N. Relationship be~eenthe 19S2and 1989-90 reports ofassessing objective andsubjective aspects oftlle social

environment for smoking . . . . . . . . . . . . . . . . . . . ...0..,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

0. Consistency between 1982 questionnaire and 1989-90 inte~ie\v items onreasons forquitting and restarting

smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, . . . . . . ., .,..,,, .,

P. Consistency between 1982 questionnaire and 1989-90 intewiew reports ofmethods used inattempts to stop

smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Q. Consistency betieen intemiew smoking histogand 1982-83followup data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

R. Number andpercent ofsmoking levels reported in1982compared \vith1989-90 among experimental intemiew

respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S. Number and percent of smoking levels reported in 1982 compared with 1989–90 among standard interview

respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., .,.,

T. Consistency between 1982 questionnaire and 1989-90 interview reports of cigarette features, by interview

condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

U, Consistency indescription ofobjective andsubjective aspects ofsociaI environment, byintemiew condition . .

W. Consistency between 1982 questionnaire and 1989–90 interview items on reasons for quitting smoking in

1981–82and reasons for prior relapses, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Y, Consistency beWeen1982 questionnaire and1989-90 inte~iew items onmethods used tot~to stop smoking,

by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, .,..

Z. Deviations between recalled and actual date ofstopping smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AA. Consistency beween1982 questionnaire and1989-90 intewiew reports ofreasons forquitting smoking, reasons

for relapses, and methods tried, by quit status . . . . . . . . . . . . . . . . . . . . ...!... . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

BB. Consistency beWeen1982 questionnaire and1989-90 intemiew reports ofreasons forquitting smoking, reasons

for relapses, andmethods tried, by current smoking status .,... . . . . . . . . . . . . . . ...! . . . . . . . . . . . . . . . . . . . . . .

18

20

2!J

31

11

11

11

12

12

14

19

21

23

24

25

26

26

26

26

27

27

28

28

28

30

30

30

31

31
Introduction

Since 19S4, the National Center for Health Statistics

(NCHS) has been fostering interdisciplinary efforts between cognitive psychology and survey research through

its National Laboratory for Collaborative Research in

Cognition and Survey Measurement. Studies conducted

under this research program are exploring whether cognitive psychology principles and techniques can be applied

to improve the validity of responses to survey questions.

Moreover, interdisciplinary work can benefit cognitive

psychology by increasing the empirical data base available

to refine and evaluate theories of human memory, decisionmalcing, and estimation.

In funding external research projects under this program, NCHS has sought to encourage the application of

cognitive psychology to some of the most difficult and

significant concerns facing those who develop and analyze

health surveys. The project reported here addressed one

such topic area —the validity of surveys regarding cigarette

smoking.

Importance of surveys of smoking

behavior

In the United States, smoking contributes to more

than 300,000 premature deaths annually (l). Smoking is

regmded as the largest preventable health problem facing

the American public. Epidemiologic data show that exposure to tobacco smoke is linked to a heightened risk for a

multitude of health conditions related to cardiovascular

and pulmonary disease and to cancer (l). Because many

of the epidemiologic models of smoking-illness relationships specify a dose-response effect, greater precision in

collecting self-reports of smoke exposure and long-term

smoking history is a key to refining current models and

developing new ones, Researchers, thus, are not simply

looking for a gross picture of the percent of smokers

within the U.S. population but are seeking to assess the

amount of smoking and different patterns of lifetime

exposure to smoke and associated biological, environmental, and behavioral correlates. Research that could help

unravel the behavioral correlates of smoking, successful

smoking cessation, and relapse would have great import

for the Nation’s health.

Focus of the present study

Three types of smoking questions identified as commonly used in health surveys were selected as topics for

this research project:

. Reports of smoking status (Do you smoke cigarettes?)

. Reports of smoking frequency (How many cigarettes

do you smoke in a typical day? How many yesterday?)

. Reports of long-term smoking patterns.

Each of these smoking questions was addressed in an

experiment in which varying methods of questioning were

investigated and their effects on the validity of subject

reports assessed.

Study 1– Estimating frequency of cigarette smoking–

concerns subjects’ ability to provide accurate reports of

the number of cigarettes they smoked on specific, recent

days.

Study 2– Social desirability and reports of smoking —examines the effects of different contexts and question wording on subjects’ reports of smoking status

(admission that they smoke) and on the typical daily

cigarette consumption reported by those who say they

smoke.

Study 3 –Long-term recall of smoking activity– investigates subjects’ ability to recall when they stopped and

started smoking over an extended period, including events

that occurred 8 years or more in the past.

Each of these studies is reported in a separate chapter

following the review of issues in smoking research and

cognitive aspects of survey methodology.
Review

Issues in smoking research

Most of the data used in epidemiologic studies of

smoking consist of self-reports collected through face-toface or telephone interviews or through self-administered

questionnaires. For this reason serious concern arose from

studies that appeared in the 1980’s, showing that such

reports are unreliable and that smoking appears to be

underreported when self-reports are compared with biochemical markers of smoking.

Biochemical markers providing objective measures of

exposure to tobacco smoke include assays of thiocyanate,

carbon monoxide, nicotine, and cotinine. These tests vary

in the extent to which they are sensitive and specific to

nicotine, in their biological half-lives, in the ease with

which the biological assay can be performed, and in the

associated cost of the assay (2). Among the biochemical

markers of smoking, cotinine (which can be measured in

serum, saliva, or urine) has come to be regarded as the

most promising marker for accuracy, reliability, and cost

(3). Because saliva and serum cotinine are highly correlated and saliva collection is less invasive, the latter has

become the preferred measure in field studies. Nevertheless, no biochemical marker should be uncritically accepted as perfect. All of the markers have difficulty

distinguishing light smokers from those passively exposed

to smoke, and there are many unanswered questions

concerning how nicotine is metabolized (4).

Reports of smoking status

The strongest evidence of underreporting of smoking

comes from studies on reports of smoking status (smoker

versus nonsmoker) among adolescents or individuals in

situations where there is strong pressure to stop smoking,

for example, individuals under treatment for smokingrelated health problems or those in a stop-smoking program. Sillet, Wilson, Malcolm, and Ball (5) worked with

patients who survived a myocardial infarction and were in

a prevention program that included either advice against

smoking or an explicit stop-smoking program using nicotine chewing gum. Sillet et al. estimated that 22 percent of

the subjects who said they did not smoke in one trial and

40 percent in another were actually smokers. (It is quite

possible that the biochemical assays were affected by the

nicotine in the chewing gum.) Wilcox, Hughes, and Roland (6) worked with patients in an infarction clinic. All of

2

the smokers had been strongly warned to stop smoking.

However, an estimated 17 percent of those who said they

had stopped smoking were in fact smokers, according to

their cotinine levels,

Jarvis et al, (3) studied smoking status reports among

hospital outpatients, the majority of whom were suffering

from smoking-related diseases, Subjects were asked at the.

clinic about their smoking and subsequently gave blood,

urine, and saliva samples for biochemical assay. An estimated 19 percent of those who said they were nonsmokers had biochemical markers indicative of smoking, In

contrast, among 159 hospital employees enrolled in smoking cessation programs, Abrams, Follick, Biener, et al. (7)

found only one individual who reported not smoking but

had a cotinine level indicative of smoking.

Other evidence of underreporting of smoking status

comes from several studies in which responses during a

telephone interview were compared with those in subsequent home interviews. Luepker, Pallonen, Murray, and

Pirie @) found that the population estimate for smokers

among Minneapolis-St. Paul young adults (aged 17–21)

was 27.3 percent based on home interviews compared

with 24.2 percent based on telephone interviews. Smoking

prevalence as defined by the level of cotinine in saliva

samples taken during the home interview was even

higher -28.6 percent.

It is possible that some cases interpreted as dissembling are actually passive smokers. Wall, Johnson, Jacob,

and Benowitz (9) found detectable levels of cotinine in the

saliva of one in four passive smokers, Jarvis, Russell,

Feyerabend, et al. (10) found cotinine levels equivalent to

smoking 80 cigarettes a year among nonsmoking schoolchildren with two smoking parents. The levels of cotinine

detected, however, were below the designated cutoff for

classifying subjects as smokers in the studies reporting that

some individuals conceal their smoking, In summary, the

literature suggests a modest (l-4 percent) underreporting

of smoking status among a general population but significant underreporting (on the order of 15–20 percent)

among those who are being heavily pressured to quit.

Smoking frequency estimates

Few studies have been able to assess the validity of

reports of smoking frequency among respondents who

identify themselves as smokers. In part, this lack of data

reflects the unavailability of a solid standard against which
to judge the accuracy of self-reports. Although biochemical markers are good at discriminating smokers from

nonsmokers, they do not yield estimates that are precise

enough to accurately identify the number of cigarettes

smoked in a specific period, Variables such as the kind of

cigarette smoked, the way in which the cigarette is smoked

(for example, depth of inhalation), and the way the

individual metabolizes nicotine will lead to varying cotinine levels among individuals who have smoked the same

number of cigarettes, Reported correlations between cotinine and smoking frequency have ranged from 0.24to 0.43

(7,11-14). Although cotinine levels have not been used to

estimate smoking frequencies, recent studies have investigated the ability of cotinine to distinguish among levels of

smoking (for example, active smokers versus light smokers

versus passive smokers versus unexposed nonsmokers),

Cotinine appears to be more sensitive to differences in

nicotine exposure at lower levels of exposure, but with

heavier smokers (20-25 cigarettes a day), cotinine levels

have been reported to hit a ceiling (12,13,15). Abrams,

Follick, Biener, et al. (7) reported a correlation between

cotinine level and self-reported smoking frequency of 0.47

among those who smoke fewer than 25 cigarettes a day

compared with a nonsignificant -0.05 among those who

smoke 25 cigarettes or more. (It is also possible that part

of this difference stems from greater accuracy of selfreported smoking frequencies among the lighter smokers.)

Given this level of relationship, cotinine levels have

not been used as a“ standard for identifying individuals

who misreport their smoking frequency in the way that

they have been used to mark “deceivers” with regard to

smoking status (7), There are, however, several other

sources of evidence that suggest reports of smoking frequency are flawed, although the data do not indicate

whether they are biased or in what direction. In a study of

Australian veterans interviewed on two occasions,

O’Toole, Battistutta, Long, and Crouch (16) found poor

intra-subject agreement across interviews concerning the

reported number of cigarettes smoked. Others have found

that reported frequencies show a decided digit bias, with

respondents tending to report numbers ending in O, especially in multiples of 20 (17,18).

The general literature on responses to sensitive questions also implies a need for caution in interpreting

reported smoking frequencies. Summarizing a series of

survey validity studies, Bradburn (19) reported that people

report doing socially desirable acts, such as voting or

contributing to charity, more often than they actually do

them and underreport less desirable behaviors, such as

olcohol consumption, Extrapolating from these studies,

reports of smoking frequency would be expected to be

underestimates of subjects’ actual smoking levels.

Long-term smoking patterns

Like smoking frequency, long-term smoking patterns

have proved difficult to validate. The O’Toole et al. study

(16) also found poor agreement for reports given on two

occasions of the age that smoking was initiated and the

age it was stopped. Although validation data were not

available in that study, the lack of reliability in the reports

implies that validity was necessarily limited. In a study

comparing reports of smoking over periods of 20 and 32

years, Krall, Valadian, Dwyer, and Gardner (20) found

poor recall of cigarette dose, with underestimates of past

smoking frequency (17 percent for 20-year recall and

37 percent for 32-year recall) more common than overestimates (9 and 6 percent, respectively).

Given the fact that lifetime cigarette consumption is

often marked by numerous fluctuations in the amount

smoked, alterations in cigarette brand, and self-initiated

changes in smoking habits, smokers are not expected to be

able to provide accurate retrospective reports for extended periods. However, there are no good alternatives

to self-report for long-term patterns. The use of biochemical tests to try to capture all of these changes over a long

period is simply infeasible. Moreover, such tests cannot

measure the relationships among life events that may well

be the key to changes in smoking behavior. Self-reports

have the potential for providing data on these variables

over longer periods if the recall problem can be adequately addressed.

Cognitive issues in smoking

surveys

Generating responses to survey items

The traditional model of the process of responding to

survey items considers the survey question as a “stimulus,”

which leads the respondent to produce a readily available

“response.” As long as the question is asked in the same

way, this naive model assumes that all respondents are

responding to the same stimulus, and that the requested

information is available and will be provided, except

where there is some motivation to deceive or refuse

cooperation. Even before the recent surge of interest in

cognitive processes underlying responses to survey questions (21), it was quite apparent to survey researchers that

this naive model was a misleading simplification. Cannell,

Miller, and Oksenberg (22), for example, offered a model

of question-answering that included comprehension of the

question as well as the cognitive processes of decisions

concerning needed information, retrieval, and organization (figure 1), Although their model lumped together

some quite different cognitive processes (for example,

assessments of information needed and retrieval processes), it was an important step forward in recognizing

the complexity of the process of answering questions and

the many possible sources of respondent error.

More recently, models have been seen with more

detail developed to capture the processes involved in

answering specific kinds of questions, as exemplified by

the model of answering event frequency questions offered

by Lessler, Salter, and Tourangeau (23). Recent writing

on this topic points out the relevance of a sizable number

of cognitive processes, previously studied in laborato~

3
6

w

Choice or modification of response based on

cues from —

a. Interviewer (status, appearance, behavior)

r

b. The question and preceding questions

c. Respondents own beliefs, values, attitudes, +

and goals

7

Giving of inaccurate response characterized by –

a. Conformity bias

b. Desirability bias

c. Acquiescence bias

d. Incompleteness

e. Other types of inadequacies

1

1

Comprehension of a.

the question

b.

c.

2 Cognitive processing

Assessments and decisions

concerning the information needed

for an accurate answer

Retrieval of cognition (attitudes,

beliefs, experiences, facts)

Organization of the retrieved

cognition and formulation of

the response on this basis

3 4

*

Evaluation of the Evaluation of the

response in terms response in terms

of its accuracy of other goals

I

I

5

1

Giving of a response

judged to be accurate

by respondent

SOURCE CannelL C. F., MWr, P. V., & Oksenberg, L. Research on interviewing techniques. In: S. Leinhardt, (Ed.), Sociological Methodology 1981. San Francisco: Jossey-Bass, 1981.

Figure 1. Model of the question-answer process
experiments, with relevance to the activity of answering

survey questions (24),

Comprehension processes will affect the way in which

the question is understood by the respondent. It is known

from laboratory studies that comprehension can be far

from straightforward, and that different respondents may

interpret the same verbal statement in quite different

woys, Respondents will use their prior knowledge and

experience (which varies from respondent to respondent

and may correlate with demographic group) to try to

understand what is being asked. They will also use cues

discerned from their assessment of the interviewer, the

purpose of the interview, and the meaning of previous

questions.

iliemory retrieval processes are clearly important, as

respondents attempt to find the information requested (as

they understand it) in memory. It is known that the kind of

cues available at the time of attempted recall and their

similarity to the cues present when the information was

originally encoded and stored in memory will affect the

recall process (25). In addition, laboratoV studies reveal

that much of memory is a process of reconstruction, with

the mind taking what can be retrieved from storage and

“filling in the gaps” to produce a sensible picture. Because

people are often unaware of this process of reconstruction, respondents are typically unable to discriminate

information stored in memory from that which has been

reconstructed at the time the questions were asked. Although the process of “gap filling” will usually produce

responses that are not only more complete but also more

accurate, there can also be cases when it leads to serious

distortions (26),

Estimation processes are also involved in answering

many survey questions, Even when the survey item involves reports of past events rather than projections of

future events, the respondent will often be unable or

unwilling to recall all events in the target category and

instead will generate a frequency response from the information available, This process may involve conscious deliberation or may occur unconsciously.

Judgment processes are required by many survey questions, for example, in political polls when respondents are

asked to indicate how acceptable a given course of action

would be to them. It is now recognized that many opinion

polls ask respondents for their views on issues and options

they have never considered before. Nevertheless, most

people will form some judgment at the time they are

questioned in order to provide an answer,

Response formulation occurs after the respondent has

recalled or generated the needed information or judgment. This refers to the processes involved in transforming

the internally represented response into a response for

presentation to the interviewer. Just as response error can

occur within the process of comprehending the question, it

can also result from problems of translation from what the

respondent meant to say to what he actually does say (and

how the interviewer interprets that response).

Various forms of evaluation occur throughout the

question-answering process, Early in the process, the respondent evaluates the amount of effort that will be

required to answer a question accurately, the importance

of generating a precise answer, the potential risk to giving

a true answer, and so forth. Later, after retrieving information from memory or forming an estimation or judgment and tentatively forming a response, the respondent

will evaluate the potential response in terms of whether it

meets the requirements of the interviewer, whether it

fulfills his or her own goals for self-presentation, and so

forth,

Although all of these processes are candidates for

studies of cognitive processes in surveys, the work reported here focuses on the processes of memory retrieval,

estimation (specifically of event frequencies), and evaluation (of a potential response’s desirability),

Frequency estimation

When similar events occur repeatedly in an individual’s life, people begin to build up “scripts” or “schemas”

to capture the invariant features of similar episodes, such

as going to a restaurant or visiting a doctor’s office (27,28).

Researchers in autobiographical memory have elaborated

this idea and proposed that individual episodes that share

many characteristics can, over time, become fused into a

script or schema that then becomes part of the person’s

knowledge (29). Neisser (30) describes memory traces for

specific episodes as molecular memories nested within

more molar memories for generic events. As time passes,

the contents of the molar memory (the features that are

invariant across events) become much more accessible

than the distinguishing features of individual events. Similarly, Reiser, Black, and Kalamarides (31) describe personal memory as consisting of a schema for a certain type

of event with individual events associated with it. An event

of the latter sort is marked for characteristics that distinguish it from the generic or prototype event in the semantic knowledge structure,

These ideas have implications for survey questions

asking individuals to recall all of the events of a certain

type that occurred within a reference period. On the basis

of the cognitive research, respondents are not expected to

have trouble producing the script or schema for the class

of events but to have difficulty recalling and describing

individual incidents. This prediction was in fact confirmed

in a study of recall of medical visits by Means, Nigam,

Zarrow, et al. (32).

This result suggests that if respondents are given

questions about the frequency with which a certain class of

event occurred within the reference period (for example,

“HOW many times did you see a doctor or other medical

care provider during the past year?”), recalling all of the

individual incidents would be difficult, and they will prefer

answering on the basis of general information. Sometimes

the latter strategy can be quite useful (“Well, I know I see

5
the allergist once a month, so that must be 12 times.”).

Often, however, respondents will not have information

that is very useful in generating estimates.

There is a small but growing literature on how people

answer questions about the frequency of personal events,

and it suggests that memory of individual events will be

used only when the number of events involved is quite

small (33,34). With categories of events that occur more

frequently (and this would certainly include the act of

smoking a cigarette for most smokers), people seem to use

either general information about their habits or a more

“direct” estimation strategy, perhaps relying upon some

implicit, automatic evaluation of the strength of the

schema or molar memory for that type of event,

How people form frequency estimates for smoking on

recent days is the focus for the first study described in the

next chapter. The second study considers socialdesirability effects in reports of smoking status and smoking frequency, The third and final study investigates recall

of long-term smoking patterns and evaluates an experimental procedure for aiding retrieval of past incidents of

smoking cessation and relapse.

●
Study 1: Estimating

frequency of cigarette

smoking

It is common practice in standardized surveys to ask

people to report how frequently they do something– use a

particular product, exercise, or read a book. The implicit

assumption underlying the development of such survey

items is that people can retrieve the relevant incidents

from episodic memory and tally them to arrive at an

occurate response. Given this assumption, survey methodologists have tended to focus their concern on sources of

response error associated with episodic recall, that is,

retrieval failures and telescoping effects (placing events in

the wrong time frame).

Recently, this implicit assumption regarding the processes involved in answering frequency questions has been

challenged, particularly for behaviors that are high in

frequency (33), A set of alternative strategies for answering frequency questions – subject to biases quite different

from the omission and telescoping errors found in episodic

recall —has been identified.

Blair and Burton (33) explored the issue of alternative

frequency estimation strategies in a recent series of studies, They administered survey questions about frequency

of behaviors such as dining in a restaurant or using an

automatic teller machine. Immediately after answering the

frequency question, the respondent was questioned about

the method used to arrive at the response. Episodic recall

was the most frequently reported strategy when there

were three incidents or fewer in the event category, but

use of this strategy declined rapidly as event frequency

rose, For those who ate in a restaurant 10 times or more,

for example, no one reported basing his or her frequency

estimate on episodic recall, Instead, responses were based

either on what Blair and Burton called “direct” estimates

or on procedures for decomposing the reference period

and computing rates. For a very frequent, commonplace

behavior (such as writing checks) nearly two-thirds of their

respondents reported using direct estimates under normal

interviewing procedures. Using a similar methodology,

Means and Loftus (34) found that respondents depend

primarily on recalling each visit individually only when

there were fewer than three, when asked how many

medical visits of a specific type (for example, visits for

allergies) they had during the last year.

The psychological literature suggests that the alternative approach of making direct “gut reaction” estimates is

subject to biases quite different from the omission and

telescoping errors found in episodic recall. Tversky and

Kahneman (35) suggest that a commonly used heuristic

for producing these estimates is availability judgments.

Easy-to-retrieve events are assumed to have a high rate of

occurrence. Because factors other than frequency affect

retrievability, this heuristic can lead to bias. For example,

in one Tversky and Kahneman study, respondents were

asked to consider a letter (K, L, N, R, or V) and asked

whether the letter is more likely to appear in the first or

third position in English words. Although these letters are

in fact more likely to appear in the third position, it is

easier to retrieve words starting with a given letter than

words in which the letter appears in the third position.

Each letter was judged by the majority of respondents to

be more frequent in the first position of words than in the

third position, and the bias was quite strong: The mean

estimate for the ratio of the two frequencies was 2:1.

Given the relationship between event salience and retrievability and the low salience of individual smoking episodes, the Tversky and Kahneman work would suggest

that using an availability strategy would tend to lead to

underestimates of smoking rates.

On the other hand, findings reported by Bruce and

Read (36) suggest that however biased direct estimates

based on availability may be, they are better than estimates based on attempted episodic recall for highfrequency events. In that study (conducted with F. Craik),

respondents saw lists of words from different semantic

categories (for example, animals). After viewing a list,

respondents were asked first to give an initial frequency

estimate (presumably based on availability) for each category (for example, “How many animals were on the

list?”). This first frequency estimate was followed by cued

recall, that is, the experimenter provided category labels

and instructed the respondent to recall as many instances

as possible of that category from the word list. This cued

recall was followed by a second frequency estimate. Second estimates were typically less accurate than the initial

estimates. Bruce and Read interpret the results to indicate

that although respondents had failed to recall all instances, they used their partial recall as a guide in making

the second estimate. The literature does not indicate

whether the same effect would be found for memory of a

behavior (as opposed to briefly viewed verbal material).

Another approach to estimating frequency reported

by respondents interviewed by Blair and Burton (33) and

in a similar study reported by Bradburn, Rips, and Shevell

7
(37) entails decomposing the reference period, computing

a frequency for one or more parts of it, and then multiplying or adding part frequencies to arrive at an estimate for

the whole. AIthough respondents have reported using this

strategy in several studies, evidence concerning the relative accuracy of frequency estimates derived in this way is

lacking.

Yet another form of decomposition strategy was investigated by Menon and Sudman (38). In that study, the

reference period was decomposed in terms of domains of

activity, with respondents trying to recall the number of

incidents of a certain type connected with each domain

(for example, going out to dinner with a business associate, with a date, and so forth). This form of decomposition

was compared with a strategy based on recall of a typical

rate, with adjustment made to consider any unusual circumstances during the reference period. For a regularly

occurring personal event such as washing one’s hair,

estimates based on rate-of-occurrence knowledge were

most commonly used when respondents were given a

choice of strategies and were more accurate than answers

based on decomposition when strategies were imposed. In

contrast, for an irregular behavior such as snacking, decomposing the questions into subdomains (for example, “I

snack when I study, at the movies,” and so forth) led to

more accurate answers than estimates based on knowledge about usual rates and rate changes.

Because it represents behavior that tends to be habitual, repetitious, and almost unconscious, smoking is a very

difficult activity to assess by means of a frequency question. In this study, we explored and manipulated the types

of strategies individuals used in attempting to answer

frequency questions about cigarette smoking behavior. In

this way, we were able to assess the relative accuracy of

these different strategies.

Design

Issues and hypotheses

In this study, we investigated whether manipulating

the strategy that respondents use to develop answers to

questions about smoking frequency would affect the accuracy of those estimates. From a theoretical standpoint, we

wanted to understand the limits of people’s ability to

judge the frequency of a commonly occurring event and

the estimation strategies that proved most effective. We

did not begin this research with a prediction as to which

strategy would lead to the most accurate estimates. We

did hypothesize, however, that attempts at episodic recall

might be reasonably effective when the number of events

to be recalled (smoking rate) was relatively low (that is,

when each incident of smoking retained some salience),

but would be ineffective when the number of events was

large (when the act of smoking has become habitual),

Additive decomposition, on the other hand, is a strategy

that seems well suited for estimating events of a wide

range of frequencies.

From a practical standpoint, researchers are constantly seeking better measures of smoking frequency.

Several studies report problems with underreporting of

smoking (2,18). It is also clear that respondents demcmstrate a digit bias, typically reporting a daily smoking rate

ending in zero. Concern over the accuracy of self-report

data about smoking has led researchers to resort to the

more cumbersome and expensive practice of obtaining

biochemical measures of constituents of cigarette smoking

in many studies, In addition to the expense and greater

intrusiveness of these measures, it is problematic that the

biochemical measures themselves are not calibrated well

enough to provide highly accurate estimates of an individual’s daily smoking rate. The measures are far more

effective at discriminating smokers from nonsmokers than

they are at differentiating among different degrees of

smoking activity.

In this study, we tested an alternative means of

obtaining measures of smoking activity: Respondents

logged cigarettes onto a hand-held computer and we used

this log to assess the accuracy of self-reports of smoking

level, giving different instructions for making that estimate, To provide a baseline performance representing

respondents in typical health surveys, one group of respondents gave smoking frequency estimates without any

instructions as to the method they should use, For this

group –the free-strategy condition –the style and pacing

of the interview preceding the smoking frequency question

were made as much as possible like that of a large-scale

survey such as the National Health Interview Survey

(NHIS). Comparing this group’s estimates of their smoking with computer records established an estimate of the

level of accuracy now obtained in national surveys (assuming there were no deliberate attempts to underreport).

This allowed us to gauge the size of the reporting problem

in current surveys and to assess the accuracy of the three

imposed-estimation strategies – episodic, additive decomposition, and availability. Given the length and pacing of

the typical health survey, our hypothesis was that most

respondents, when given a choice of strategies, would use

something resembling an availability judgment as a basis

for answering the smoking frequency question.

Experimental design

To permit assessment of recall accuracy, respondents

recorded each cigarette they smoked on a hand-held

computer for a period of 6 days. Afterwards, they were

given unexpected questions about the number of cigarettes they smoked on specific days during that assessment

period. Using a four-group, between-respondents design,

we allowed one group to answer the frequency question,

using any method they liked, while the others were constrained to employ a particular estimation strategy. These

frequency estimation strategies include:

● Additive decomposition –the typical weekday is divided into different types of activities such as

“commuting, “ “in the office,” and “after dinner,” The

subject is asked to report the number of cigarettes
●

●

typically consumed in each of these portions of the

day, After all separate estimates are made, they are

summed to arrive at a total day’s estimate.

Availability-the subject is instructed to answer the

smoking frequency question quickly with a “gut

reaction” without trying to think of specific instances

of smoking,

Episodic recall –the subject is instructed to take a

selected weekday and to work through the day recalling all instances of smoking, The subject is then asked

to use the recalled instances to arrive at a daily total.

A saliva sample was taken from each respondent for

biochemical analysis for cotinine, a nicotine indicator.

Method

Respondents

A convenience sample of 12S respondents was recruited through advertisements in local newspapers and

on bulletin boards. Individuals who responded to the

advertisement were questioned about their age, smoking

frequency, and any current attempts to change their smoking behavior, Those who met the study participation

criteria (between the ages of 1S and 65 years who smoked

at least 5 cigarettes daily and were not trying to quit) were

otlered $45 for participating.1 They were told that we were

interested in the relationships among smoking behaviors,

nicotine dose, and saliva cotinine. We explained the requirements for participation –to carry a small computer

and log in every cigarette smoked over a period of 6 days.

We also informed them that we were not asking them to

alter their normal smoking habits during the assessment

period and that their records would be confidential. The

recruiting procedures and sample response rates are described in detail in appendix L

Of the 12S respondents tested, 2 were eliminated from

the data set for failure to comply consistently with instructions for logging their cigarettes onto the computer. The

final sample included 43 males and S3 females, ranging in

aqe& from 18 to 63 years, with a mean age of 37.60 years.

Procedures

Respondents completed a brief initial interview at

SRI and logged each cigarette smoked into a hand-held

computer over a 6-day period.z They then returned to SRI

for a second interview, at which time they were asked

‘The first 24rcspondm[sparticipatingin the studywere.offered$25,

with I potential bonus of $5 for good compliance. After several respondurts dropped out of the study because they found the smoking proceriurctoo onerous,giventhe ICW1of remuneration,we increasedthe fec

by $20.

‘Rcspundcnts were instructed to log all their cigarettes from the time

they M the first interview until they returned for their second interview

[i dirys kttcr. However, only data for full days (starting the day after the

initi;d interview) were used in the analyses.

about the number of cigarettes smoked on specific days

and provided a saliva sample for biochemical analysis.

During the first interview, which was always held on a

Friday, the interviewer asked the respondent to show his

or her cigarettes so the brand could be recorded. Subjects

were also asked a number of questions about their smoking style (for example, “How much of each cigarette do

you smoke?”), These questions were designed to focus

their attention on the concept of nicotine dosage and to

deflect their attention away from the issue of the number

of cigarettes smoked.

After answering these questions about smoking behaviors, respondents were shown the hand-held computer

(a PSION Organiser II, Model CM, measuring 3/4 inch by

3 inches by 5 1/2 inches) and were instructed on its use.

The procedure for logging in cigarettes was kept as simple

as possible. Respondents were required to press one

button to turn the computer on and another to log in a

cigarette just before they smoked it. Pushing this button

activated a time and date stamp within the computer. The

respondent did not see a display of the time or any tally

for cigarette consumption. Respondents were also required to respond to occasional “beeps” from the computer to verify that they were carrying it.

In the event the respondent logged in a cigarette and

was interrupted before smoking it, or smoked a cigarette

and forgot to log it in at the time, a 3- by 5-inch card was

issued with the computer for entering such errors in

logging the number of cigarettes onto the computer,

Respondents practiced using the computer during the

initial interview. They were also given a set of written

instructions and a telephone number to call if they had

any questions or problems, They signed a form, pledging

to carg the computer with them and to log in all cigarettes

smoked, starting upon leaving the interview that was held

on a Friday until they returned for their second interview

6 days later. Respondents were told that the $45-

participation fee was dependent on a faithful recording of

the number of cigarettes smoked. In addition, they were

informed that they would receive a bonus of $5 if they

were good about responding to computer prompts. Appendix II contains a complete description of the training

provided for using the computers along with the experimenter protocol for the first interview.

After logging their smoking for 6 days, respondents

returned to SRI on the next Thursday for their final

interview. They returned the computer and were asked to

tell the interviewer how many cigarettes they smoked on

the preceding day, using the procedures appropriate for

their assigned treatment group. Before being asked to

estimate the number of cigarettes they smoked, respondents in the three imposed-strategy conditions were told

that we wanted them to use a particular method for

estimating their smoking frequency. The method was described and examples of its application were given. The

respondent practiced applying the method to two other

behavior categories (for example, frequency of getting into

9
one’s car on a typical day) before using it to estimate the

number of cigarettes smoked on the previous day.

Respondents in the free-strategy condition received

neither instructions concerning any method for answering

the frequency question nor practice items. Instead, they

were asked some filler demographic questions taken from

NHIS before being given the smoking frequency question.

Estimation strategies were not mentioned until after this

question was answered. During this part of the freestrategy condition interview, the interviewer maintained a

questioning pace comparable to that used by NHIS interviewers. Interviewers gave respondents as much time as

they needed to answer, but they read the questions rapidly, thus implying that the interview should be completed

expeditiously.

After the first smoking frequency question was answered, respondents in all conditions were asked to describe how they arrived at their answer. They were then

shown a checklist of possible frequency estimation strategies – including additive decomposition, availability, and

exhaustive episodic recall – and were asked to choose the

strategy that best matched what they did. These strategyresponse options were:

●

●

●

●

●

●

●

Think of each individual event for the entire day and

add up the total number.

Divide the day up into parts (such as during work and

after work); rely on knowledge about how often I

usually smoke during each part; and then add up the

total number.

Give the first number that comes to mind, a gut

reaction or guess.

Rely on knowledge about my usual daily total for

smoking.

Make an inference from a fact I remember (for

example, opening a new pack).

A combination of the above. (Speci@ which ones and

how they were combined.)

None of the above. (Describe how you did arrive at a

number.)

After the respondents provided their frequency estimates for cigarette smoking and reported the strategy they

used, they were given a confidence estimate for their

frequency response. They indicated, on a 5-point scale,

how confident they were that their frequency estimate was

accurate. Respondents were then asked to use the same

strategy to provide smoking frequency estimates for the

preceding Monday and Saturday.

In the next portion of the interview, a saliva sample

was taken for later analysis of cotinine content, This was

followed by the debriefing, in which the interviewer asked

respondents whether there were any occasions when they

smoked a cigarette but did not log it into the computer or

record it on the error card, The interviewer also asked

about any difficulties the respondent had in using the

computer. Finally, respondents were asked whether they

had expected to be required to recall the number of

cigarettes smoked on specific days. The experimenter

protocols for the four strategy conditions are contained in

appendix III.

Results

Smoking levels

For each full day of logging cigarettes onto the handheld computer (that is, Saturday, Sunday, Monday, Tuesday, and Wednesday), the number of cigarettes logged was

recorded (as corrected by notations on the error card or

specific omissions reported during the debriefing interview).3 The mean of these five totals was taken as an

indicator of the respondent’s overall smoking level. During the 5 full days when their smoking was logged, the

mean smoking level across all subjects was 20,25 cigarettes

per day, and the median was 19.40 cigarettes per day. The

lightest smoker averaged 2.25 cigarettes per day, and the

heaviest smoker averaged 54 cigarettes per day during the

assessment period. This mean varied little by experimental

condition, ranging from a low of 19.91 in the availability

condition to a high of 21.07 in the episodic condition.

The number of cigarettes smoked appeared fairly

stable over the assessmentiperiod. The mean for Saturday

smoking was 20,54 compared with 20.21 for Monday and

19.73 for Wednesday. For individual respondents, the

correlation between the number of cigarettes smoked on

Monday and those smoked on Wednesday was quite high

(r= 0.82), whereas correlations with Saturday smoking

were somewhat lower (0.77 for Saturday with Monday and

0.75 for Saturday with Wednesday) and consistent with

self-report data that weekend smoking patterns are different from those on weekdays.

Estimation strategy condition

For each respondent, we computed the size of the

deviation between the number of cigarettes recalled for

each target day and the recorded number of cigarettes for

that day (the computer record as amended by any notations on the error card or needed adjustments cited in the

debriefing). Few significant differences between estimation strategy conditions were found,

Absokte error-Table A shows the mean absolute

difference between the number of cigarettes reported

during the interview and the number on the behavioral

record for each of the 3 target days by condition. The

mean difference between reported and logged smoking

frequency increases with retention interval, The average

absolute deviation is 4.10 cigarettes for the previous day’s

smoking (Wednesday), 5.02 for 3 days prior (Monday),

3The number of corrections on the error card was fairly small, averaging

0.50 cigarettes per respondent pcr day. Similarly, during the debriefing,

respondents reported that they failed to record an average of lCSSthan

0.40 cigarettes over the entire assessment period.

10
Table A. Mean absolute difference between reported and logged

smoking frequency, by strategy condition and recall interval

[Numberof observations appeers in parentheses]

Ffeca// interval

Yesterday 3 days prior 5 days prior

Strategy condition (Wednesday) (Monday) (Saturday)

Total, . . . . . . . . . . . . . 4.10 5.02

(118) (121)

Free . . . . . . . . . . . . . . 4.38 5.50

(29) (30)

Availability . . . . . . . . . 4,13 6.13

(31) (31)

Addltlve decomposition . . 4.18 3.90

(28) (29)

Episodic . . . . . . . . . . . 3.73 4.48

(30) (31)

5.80

(118)

7.00

(28)

6.63

(30)

4,76

(29)

4.87

(31)

and 5,S() for 5 days prior (Saturday). Taking the freestrategy condition as an estimate of the accuracy to be

expected from frequency reports obtained in national

surveys, we found absolute deviations of 4.38 for the

previous day’s smoking, 5.50 for 3 days prior, and 7.00 for

5 days prior.

Because the difficulty of the reporting task varies,

depending upon the number of cigarettes a person

smokes, we created a proportional measure of report

accuracy —the absolute value of the deviation of the report divided by the subject’s daily average. This measure

of report accuracy is shown for each condition and retention interval in table B. The pattern of means suggests

that accuracy declines as retention interval increases and

that imposed strategies, particularly the episodic approach, tend to produce more accurate reports.

The largest discrepancy between interview report and

recorded Wednesday smoking was found for the freestrategy group (0.26 cigarettes) and the smaIlest for the

episodic group (0.1S), but none of the differences between

imposed strategies and the free-strategy condition was

statistically significant. ln reporting Monday smoking, the

free-strategy and availability groups had larger deviations

(0,32 and 0.33, respectively) than did the additive decomposition or episodic groups (0.21 and 0.24, respectively).

Similarly, recall for Saturday’s smoking was off by an

average of 0.37 in the free-strategy condition compared

with a mean deviation of 0.26 for the episodic group.

Table B. Mean absolute deviation as a proportion of smoking

frequency, by condition and recall interval

[Numberof observationsappears in parentheses]

Reca// interva/

Strategy Yesterday 3 days prior 5 days prior

condition (Wednesday) (Monday) (Saturday)

Free., ............ 0.28 0.32 0.37

(30) (30) (28)

Availability ., . . . . . . . . 0.20 0.33 0.33

(31) (31) (30)

Additive decomposition , . 0.20 0.21 0.34

~1: (30) f:;

Eplsodlc .,.,....,.. 0.24

(30) (31) (31)

Table C. Mean absolute difference between reported and logged

smoking frequency by subject confidence level and recall

interval

[Number of observations appears in parentheses]

Reca// interva/

Confidence level Yesterday 3 days prior 5 days prior

I=offby more than 10 . . 10.00

(2)

2= off by no more

than 10 . . . . . . . . . . . 6.11

(19)

3=offby40r 5....... 4.33

(46)

4=offby20r 3.,..... 3.08

(40)

5 =off by no more

than . . . . . . . . . . . . 2.00

(lo)

14.00

(3)

6.05

(21)

6.41

(37)

3.04

(47)

4.33

(12)

16.33

(3)

5.50

(22)

6.58

(43)

4,73

(41)

3.75

(6)

Despite the appearance of the means, none of the differences was statistically significant.

Confidence levels

After providing their estimate of how many cigarettes

they smoked on a given day, respondents were asked to

rate their confidence in the accuracy of their estimate on a

5-point scale:

. 1 = off by more than 10 cigarettes

. 2 = off by no more than 10 cigarettes

. 3 = off by 4 or 5 cigarettes

. 4 = off by 2 or 3 cigarettes

. 5 = off by no more than 1 cigarette

Table C shows the relationship between these confidence estimates and accuracy of frequency reports. The

data suggest that those with higher confidence in their

estimates are in fact more accurate, F(4,116) = 3,94,

p < (),()1for Wednesday, F(4,116) = 5.39, p c 0.01 for Monday, and F(4,116) = 3.94, p <0.01 for Saturday, but the

relationship is not so strong to suggest that confidence

estimates could be used to generate corrections or weights

for frequency estimates. The correlation between confidence level and the absolute difference between reported

and recorded smoking was –0.33 for Wednesday smoking,

-0.30 for Monday, and -0.21 for Saturday smoking.

Table D shows the confidence data by treatment

condition. The confidence scores are very similar across

the four strategy conditions, suggesting that respondents’

sense of their estimation accuracy was not affected by the

method by which they had derived the estimate. Contrary

to intuition, the day for which respondents were providing

confidence estimates also had little effect, Respondents

tended to evaluate their degree of error as either 2 to 3 or

4 to 5 cigarettes, regardless of whether they were providing an estimate for the previous day or 5 days ago.

(Results might, of course, have been different if the day

for which they provided the estimates had been a

between-respondents rather than a within-respondents

variable.)

11
Table D. Mean confidence level by strategy condition snd recall

interval

[Number of observations appears in parentheses]

Reca// irrterva/

Yesterday 3 days prior 5 days prior

Sfrategy condition (Wednesday) (Monday) (Saturday)

Free . . . . . . . . . . . . . . 3.10 3.47 3.37

(31) (30) (30)

Availability. . . . . . . . . . 3.26 3.19 3.29

(31) (31) (31)

Additivedecomposition . . 3.29 3.54 3.11

(31) (28) (28)

Episodic . . . . . . . . . . . 3.53 3.31 3.25

(32) (32) (32)

Confidence level key

1 = off by more than 10 cigarenes

2= off by no more than 10 cigarettes

3= off by 4 or 5 cigarettes

4= off by 2 or 3 cigarettes

5= off by no more than 1 cigarette

Smoking level

Based on their mean daily smoking frequency across

the 5 full days for which they logged cigarettes, respondents were divided into two smoking levels. Lighter smokers were defined as those with a mean daily cigarette

consumption below the median of 19.40 cigarettes,

Heavier smokers were defined as those with a smoking

level above the median. An analysis of variance was run on

each of the estimation accuracy variables (Wednesday,

Monday, and Saturday deviation scores), with smoking

level and condition as independent variables, For all 3

target days, a significant effect of smoking level was

obtained, F(1,120) =5.57 for Monday, F(1,121) = 7.45 for

Wednesday, and F(1,117) = 12,84 for Saturday. Table E

shows the mean absolute deviation scores for the two

smoking level groups for each of the target days. As

expected, lighter smokers’ estimates were off by fewer

cigarettes than were heavier smokers’ estimates. For reports of the previous day’s smoking, light smokers erred by

a mean of 2.95 cigarettes compared with 5,26 for heavy

smokers. For Saturday smoking the differences were 4.14

and 7.27, respectively. Neither the main effect for strategy

condition nor the interaction between condition and

smoking level attained significance for any of the 3 target

days.

Table E. Mean absolute difference between reported and logged

smoking frequency by smoking level and recall interval

[Number of observation appears in parentheses]

Recall interval

Smoking level Yesterday 3 days prior 5 days prior

Lightsmokers:

Lessthan 19.4 cigarettes

“perday .,, . . . . . . . . 2.95 3.73 4.14

(80) (59) (57)

Heavy smokers:

Morathan 19.4 cigarettes

perday . . . . . . . . . . . 5,261 6.19i 7.271

(62) (63) (62)

10iffers from Kght smokers at p c 0.01,

12

Cotinine

Saliva samples were submitted to the University of

Minnesota, Division of Epidemiology, for cotinine assay.

Levels ranged from 12 nicotine grams per milliliter

(ng/mL) to 768 ng/mL, with a mean of 297,5 ng/mL and a

standard deviation of 141.1 ng/mL.

Correlations were computed between respondents’

cotinine levels and a number of the measures of smoking

frequency. Correlations are very similar, whether cotinine

is correlated with reported or logged smoking. Correlations with measures of the previous day’s smoking were

0.31 for cigarettes logged onto the computer (as corrected

by the error card) and 0.30 for self-reported smoking. The

correlation between cotinine level and average daily number of cigarettes recorded during the 5-day assessment

period was 0.29. Because cotinine has a half-life of 17

hours, a correlation was also computed between cotinine

leveI and the number of cigarettes recorded in the 17

hours preceding the interview. This correlation (0,44)

compares favorably with reported correlations between

cotinine and self-reported smoking in the literature, which

range from 0.24 to 0.43 (7,11–14). Figure 2 shows the

cotinine level pIotted against the mean smoking level

during the assessment period.

Although cotinine is related to smoking frequency, the

relationship does not appear strong enough to make

cotinine a good index of an individual smoker’s frequency

of cigarette consumption. The data in figure 2 suggest

that a good relationship exists between cotinine and smoking level for light smokers (fewer than 17 cigarettes in the

previous 17 hours) and also for heavier smokers (more

than 24 cigarettes in the last 17 hours), but little relationship exists among those with in-between rates of smoking

(17-24 cigarettes in the 17 hours preceding the saliva test),

This pattern was confirmed in a trend analysis that identified a significant cubic component in the cotinine data,d

We compared the cotinine levels for respondents

classified as lighter and heavier smokers on the basis of

their logged smoking over the 5 days during which cigarettes were recorded. An average level of 325 ng/mL was

obtained for smokers with smoking rates above the median compared with 266 for those smoking below the

median rate, t(l18) = –2.32, p c 0.05. When respondents

are classified as above or below the median on both logged

smoking and cotinine level, the two classifications match

41nspection of the scatter plot in tigurc 2 suggested the possibility that

the significant cubic fit could have resulted from the influence of onc

observation –a cotininc value of 768 ng/mL. Review of this vahrc in

relation to other values for cotinine in this sample indicated that,

although it was a large value, it was not an outlicr, as measured by the

criterion of Tukcy (39). Nevertheless, wc rcpcatcd the analysis reported

above after excluding this observation. Results of this second trend

analysis confirmed the earlier conclusion: The addition of the cubic

component resulted in a significant improvement in the fit to the data.
800

700

600

500

=

E

%=

3

& 400

a)

.-c

,-C

S

u

300

200

100

0

.

● ✎

●

●

●

‘O

●

●

●

s

●

●

o

● ●

o

● o ● .

● ..* ● O*

● 8

●

f ● I I I f I 1

0 5 10 15 20 25 30

Number of cigarettes smoked in the last 17 hours

Figure 2. Cotinine and record of amount smoked durkrg the 17 hours prior to saliva sample

13
for 60 percent of the 120 respondents for whom both

measures were available, #=4. Sl, p<0.05.5

Strategies used in free condition

One of our interests in conducting this study was to

ascertain the strategies that unconstrained respondents

use to answer questions about smoking frequency. Each

respondent was asked to describe the strategy used to

estimate the number of cigarettes smoked the previous

day and then to select the best description of it from the

strategy response options previously listed. Table F shows

the distribution of responses for free-strategy respondents,

These. respondents (41 percent) were most likely to

report using a combination of strategies. By far, the most

popular combination of strategies involved “making an

inference from a fact I remembered” and “using knowledge about my usual daily totaL” The first of these was

also the most frequently reported single strategy. Inferences tended to be of the sort “I was sick and I always

smoke very little when I’m. ill” or “I went drinking, so I

probably smoked more than usual.” Only two respondents

(7 percent) reported answering the question with an episodic strategy, suggesting that in normal survey interviews

respondents answer smoking frequency questions primarily through semantic memory and inferential processes

rather than by recalling individual events. There are two

different types of additive decomposition strategies, Both

strategies involve breaking the reference period into segments, but one then entails using knowledge about typical

frequency within a segment, whereas the other requires

trying to recall all incidents within each segment (using

episodic memory). Respondents were trained on the first

of these in our additive

some respondents in the

using the latter approach.

decomposition condition, but

free-strategy group reported

‘Cotininc results were not available for five respondents. Four saliva

samples were irradcquate for analysis, and the interviewer failed to take

a saliva mmple from one respondent.

Table F. Response distribution of estimation strategies reported

by free-strategy respondents

Strategy Frequency Percent

Think of each individual event . . . . . . 2 7

Divide day up into parts and think of

each event within each part . . , . . . . 0 0

Divids day up into parts and use

knowledge about usual smoking for

each part. . . . . . . . . . . . . . . . . . . 3

First number that came to mind . . . . .

10

2 7

Using knowledge about my usual daily

total . . . . . . . . . . . . . . . . . . . . . . 3 10

Making an inference from a fact I

remembered . . . . . . . . . . . . . . . . 7 24

Combination of strategies , . . . . . . . . al 2 41

aFrequencyofspecificcombmat!onstrategies

2+4:1 1,5,61

2+6:1 2,4,51

4+5:1 3,4,5,6:1

5+6:6

Compliance measures

Respondents reported very high compliance with the

experimental procedures for logging cigarettes. The mean

number of cigarettes respondents said they smoked without entering them in the computer or on the error card

was just 0.36 over the entire assessment period. Although

error cards appeared to be useful adjuncts, respondents

appeared to have no trouble entering most of their cigarettes accurately on the computer. On the average, respondents made a mean of 2.4 entries onto their error

cards over the 5 days the data were analyzed.

Another measure of respondent compliance was their

rate of responding to the computer prompts, On the

average, they responded to 73 percent of their prompts,

Even in cases of missed prompts, most respondents reported that they used the computer consistently when

logging cigarettes but had trouble hearing the prompt

signals when the computer was in a case or handbag, when

they were in a noisy environment, or when they walked

into another room. Only two respondents were judged, on

the basis of missed prompts and erratic recording of

cigarettes, as having failed to comply with experimental

procedures. (These respondents are not included in any of

the analyses of reporting accuracy.)

In addition, several respondents were excluded from

specific analyses for noncompliance or deviation from

standard procedures. These decisions were based on the

electronic diary records, notes on the error cards, or

statements by respondents during the procedural debriefing section of the second interview. Respondents were

excluded from a specific day’s analyses for leaving the

electronic diary where they did not have continuous access, for being too busy, or just forgetting to record

cigarettes for an extended period on a certain day, On the

first day (Saturday), four respondents had such erratic

schedules that they did not begin to comply with the

procedure consistently until the second day, These respondents were eliminated from the analyses of the first

day but were included in analyses of report accuracy for

Monday and Wednesday. Two respondents stated that

they got tired of entering cigarettes and stopped entering

every cigarette on the last day. In total, eight respondents

were excluded from 1 day and two were excluded from 2

days for noncompliance with the data collection procedure. Comparisons of reported usage of the electronic

diary with the computer record and inspection of smoking

patterns across days suggested that respondents whose

compliance was somewhat erratic were quite candid in

reporting their omissions during the debriefing,

It was more difficult for many respondents to comply

with the instructions for estimation strategy. Instructions

to episodically recall every instance of smoking a cigarette

were particularly hard to follow, especially for more remote target days and for heavy smokers. A review of the

interview protocols suggested that of respondents in the

episodic-strategy group, 19 (59 percent) really used episodic recall, 12 (38 percent) used episodic recall for some

14
but not all smoking instances during the day, and despite

repeated instructions from the interviewer, 1 (3 percent)

did not use episodic recall at all.

Compliance with the other instructions for estimation

stratcg~ was much higher. None of the additive decomposition respondents was judged as not complying with the

strategy instructions in reporting the previous day’s or

hlonday’s smoking, and six (1S percent) had some trouble

executing the strategy for Saturday (a day with less structure for many people). None of the availability respondents was judged as failing to give a response based on

availability (a gut reaction).

Reactivity

Most respondents (79 percent) reported they had not

changed the number of cigarettes they were smoking while

in the study, Of those who reported changes, 15 said their

smoking increased somewhat and 12 said it decreased.

Among respondents who reported a change in daily smoking, the mean reported change was 3.11 cigarettes a day.

When asked whether they had expected to be questioned about how many cigarettes they had smoked on a

particular day during the time they were logging cigarettes

cmto the computer, 93 percent of the respondents reported they had not expected recall questions. Three

respondents reported they tried to keep track of how

many cigarettes they were smoking, two kept track mentally, and one made notes on the error card.

Discussion

In this study, the self-reports of respondents in the

free-strategy condition and their rapid response rate suggest that they were not using effortful episodic memory

strategies to answer questions about how many cigarettes

they had smoked on specific days, On the other hand,

their self-reports indicated that they were not simply

giving “gut reaction” frequency estimates based on availability, as seen in studies conducted by Tversky and

Kahtmman (35). Rather, they appeared to be using information about their general smoking habits (for example,

“I usually smoke a bit less than a pack a day”), often in

combination with an easily recalled fact about a specific

incident (“I was sick that day”), These findings are similar

to those reported by Menon and Sudman (38). Unlike the

artificial laboratory tasks in which availability heuristics

have been demonstrated (for example, “How many words

begin with the letter R?”), our frequency estimation task

involved personal habits about which respondents are

likely to have information stored in memory.

For questions about typical smoking levels, this relitince on general self-knowledge would be quite appropriate. For questions about smoking on specific days,

however, we had expected a more detailed, effortful analysis of the day (that is, either episodic recall or an additive

decomposition procedure) to lead to more accurate responses. Although the group means suggest an advantage

for episodic and additive decomposition strategies, at least

for longer retention intervals, none of the imposedstrategy conditions was statistically superior to the freestrategy condition. At the same time, our results failed to

confirm the poorer performance for episodic recall that

would be expected on the basis of the Bruce and Read

(36) study in which respondents gave poorer frequency

estimates for words on a list after trying to recall the

words.

A second of our imposed strategies – additive decomposition – appeared easier than the episodic strategy for

respondents to execute (although still more time consuming than the strategies respondents selected when unconstrained) and produced significant increments in

estimation accuracy when used by lighter smokers (those

smoking less than 19.4 cigarettes on an average day). This

strategy has promise for studies in which researchers are

concerned with accurate self-reports of smoking frequency

for individuals. When population estimates are the main

concern, no advantage accrues to the more elaborate

questioning technique in terms of the resulting group

estimate.

Although a perfect measure of smoking frequency is

probably unattainable, we have confidence that the corrected computer logs, as used in this study, offer the best

index available to date. Respondents reported that they

were able to consistently comply with the logging requirements, and the corrected log data related sensibly to other

measures of smoking frequency. In particular, the correlation between cigarettes logged over the previous 17 hours

and measured saliva cotinine was higher than that typically found between cotinine and self-reports of smoking

frequency. In an earlier study using similar logging procedures with hand-held computers, Shiffman (40) found an

even higher correlation between cotinine level and logged

smoking during the last 17 hours (0.55). The cigarette

logging procedures used here thus provide a good standard against which to judge the accuracy of respondent

memory for smoking and a practical methodology for

studies of smoking behavior.

The final issue is whether recording their cigarettes on

the computer made subjects more aware of each cigarette

they smoked, with subsequent benefits for their ability to

accurately recall smoking levels, In the absence of data on

the degree of accuracy in smoking frequency reports of

people who have not maintained any record of their

smoking, we cannot rule out this possibility. However,

several aspects of the data suggest that any such effect is

not large in magnitude. First, to the extent that logging

cigarettes makes instances of smoking more memorable,

we would expect the effect to be stronger in the initial days

of study participation rather than in the later days. (Subject reports suggest that logging cigarettes became very

automatic over the course of the 5 days of study participation.) We can see from the relative accuracy of reports

over different time lags (table A), however, that there is

not an initial effect of the cigarette logging procedure that

15
is strong enough to counteract the effect of time (report rettes compared with 4,10 for the subjects using computers

accuracy being better for l-day recall than for 3-day recall, in the present study. Thus, although any kind of record

which is better than that for 5-day recall). maintenance or study participation may make subjects

Second, we can compare the report accuracy of sub- more conscious of smoking, the computer-logging procejects who recorded their smoking on computers to subjects dure does not appear to improve report accuracy any

in our pilot study who deposited all of their cigarette stubs more than do other methods for maintaining behavioral

in canisters. The pilot subjects’ reports for the previous records,

day’s smoking were in error by an average of 3,44 ciga16
Study 2: Social

desirability and reports

of smoking

In view of findings in the literature on reports of

socially undesirable behaviors (41), we would expect underreporting of smoking to become increasingly frequent

as smoking becomes socially less acceptable. Recent restrictions on smoking in the workplace and on domestic

flights and a California ballot proposition to levy a very

large cigarette tax to make smokers “pay for their

smoking-induced requirement for health care” are signs of

the social trend toward adverse opinions of smoking.

Given these trends, we can expect social desirability effects and the consequent underreporting of smoking to

increase.

As discussed in the review section of this report, there

are two types of underreporting of smoking. First, there

are underreports of smoking status —the case in which a

person who smokes asserts that he or she is a nonsmoker.

Second, there is underreporting of smoking frequency–

the case in which a smoker admits to smoking but underreports the number of cigarettes consumed. Biochemical

verification has been used to detect the first type of

underreporting but has not yet been calibrated to a degree

where it has demonstrated utility for detecting and correcting the second type of underreporting.

Bradburn, Sudman, and Associates (41) assert that

responses to sensitive questions are generated in two

stages:

First, the respondents decide whether or not to

report that they have engaged in the type of behavior being asked about. This decision is influenced

by the facts of the situation . . . and about their own

feelings about whether they want to tell the interviewer about it. If the decision is negative —either

because they have not in fact done anything or do

not remember doing it, or because they do not want

to talk about it – the series of questions is terminated. If the decision is positive, the form of the

question does play a very important role in influencing how much behavior is reported. (p. 168)

Figure 3 provides an illustration of this model of the

response-generation process as well as the various sources

of response error at different stages within it. Respondents may fail to report a negatively valenced behavior

that they have in fact engaged in, either because they do

not remember committing the act or because they do not

want to reveal this fact to the interviewer. The latter

phenomenon, which we term a social-acceptability effect, is

a function of the perceived risk of revealing the behavior.

In some instances, this may involve perceived risk of

actual negative consequences (for example, fear that information given to a census taker will be turned over to

the IRS or immigration, services). In most instances, however, the risk involves a feared loss of prestige or acceptability in the eyes of the interviewer. According to the

model of Bradburn and Sudman, this kind of effect would

lead to underreports of smoking status.

For respondents who admit to having engaged in

negative behavior, a second kind of social-desirability effect

may exert itself as the individual formulates an estimate of

the frequency with which the act has been committed. At

this stage, the respondent may be influenced by the

wording of the question and the response nom that the

wording implies.

Study 2 examined the effects of two approaches to

manipulating social desirability. The first manipulation

was an attempt to load the wording of the smoking

questions such that smoking seems like a common and

understandable act. This “response-norm” condition is an

example of a technique commonly used in survey research

(42). We predicted that this manipulation would have no

effect on the decision to admit being a smoker, but that

among admitted smokers, it would affect the smoking

frequencies reported.

The second technique sought to put the smoking

questions in a context that would lessen the respondent’s

felt need to present something positive or to avoid presenting negative information to the interviewer. In this

“social-acceptability” condition, the respondent was first

given the opportuni~ to tell the interviewer about his or

her positive health practices before being asked about

smoking. This manipulation was inspired by a study by

Crespi and Swinehart (43) in which overreporting of a

socially positive behavior (figure 3) for a 2-month interval

was reduced if respondents were first asked about the

behavior over a 6-month interval (presumably increasing

the probability that they would have just told the interviewer something positive about themselves).

Design

Issues and hypotheses

Adopting the Bradburn and Sudman (41) two-stage

model of response generation, we predicted that our

17
(e.g., Level of precision

assumed adequate, understanding of target domain)

.....,::,.<::;.?,:* ~,:,:.: .:+:$~,p,,:,;:,::t,,,

....::.!::.:.,:: ................::,.,,:,.::,:,:.:,:. .,. ..,{,,,,,, .::... ... ,. .. ... .,,::,,;,,,,,.

(e.g., Retrieval failures,

::+:..:: ;~ :,<.::: :;::~..;::,:: ,:,,,,,,

?

(a.g., Loaded (e.g., Need

Figure 3. Potential causes for underreporting of behaviors

social-acceptability manipulation would affect reports of

smoking status because respondents who have established

themselves in a positive light should, if they do in fact

smoke, feel less pressure to present themselves as nonsmokers. Once smokers have identified themselves as such

to the interviewer, the frequency of smoking they report

should be influenced by manipulations of question wording such as that used in our response-desirability

condition.

Experimental design

Respondents were asked about their smoking status

and frequency within one of three different interview

conditions. In the first condition (response norm), the

question about smoking status was preceded by a preamble implying that smoking is just one of many behaviors

people engage in to reduce stress. This preamble was

designed to provide an “excuse” for smoking and to

present it as well within the social norm.

In the second condition (social acceptability), we

attempted to manipulate the respondent’s sense of social

acceptability by providing an opportunity for telling the

interviewer about positive health habits before being

asked about smoking, The third (neutral) condition was

designed to be representative of a standard smoking

survey. The only questions preceding those on smoking

concerned demographic information.

Thus there were three conditions in a simple betweenrespondents design with random assignment of respondents to interview groups,

18

Method

Respondents

Respondents were recruited from a variety of locations in the San Francisco Bay mid-Peninsula area, Criteria used in selecting locations were the proportion of

smokers among individuals there, and the likelihood that

people would have 15 minutes to spend completing our

interview, Locations included restaurants, bowling alleys,

public transportation waiting areas, shopping malls, and u

racetrack. A total of 16S respondents participated, including 100 men and 6S women, ranging in age from 15 to 73

years, with a mean age of 40.9 years. Insofar as possible,

administration of the three treatment conditions was balanced at each site visit,

Procedures

Respondents were individually interviewed at the

types of locations described. The study was described as

an investigation funded by NCHS as part of its mission to

maintain information on people’s health-related habits.

Respondents were offered $10 for their participation.1

In the neutral condition, a set of initial demographic

questions was followed immediately by asking the respondent whether he or she smoked, Those who said they were

smokers were asked how many cigarettes they smoked on

a typical day.

In the response-norm condition, a brief set of opening

demographic questions was followed by the preamble,

“When we interview people about their health habits, we

find that many people’s habits are shaped by stress. When

they encounter tension on the job or at home, they

respond by taking a drink, smoking a cigarette, or eating

something fattening. Do you find that there are times

when stress triggers such behaviors for you?” They were

then asked directly whether they smoke.

In the social-acceptabili~ condition, the demographic

items were followed by giving respondents a lengthy list of

health habits and asking them to pick two or three things

that they do as much or more than most people. Followup

questions were asked for whichever items the respondent

picked. After talking about their good health practices,

these respondents were then asked whether they smoke

and, if so, how much.

The remainder of the interview for all respondents

included questions about the prevalence of smokers in

their family, among their friends, and at work; and for

smokers, about what they do in a public setting with no

posted rules about smoking. At the conclusion of the

lInitially, respondents were not oftkrcd a participation fee. After finding

that a high proportion of those approached dcclirreci to participate, wc

first began offering State lottery tickets worth $1 .tnd subwqucn[ly

offered a $10-participation fee. Overall, S2 respondents par[icipfitcd for

lottery tickets, 1 respondent declined payment, and S5 ptirticipatccl for

$10.
Table G. Number and percent of reported smoking status and mean frequency among self-reported smokers, by interview condition

Smoking status

Nonsmoker Smoker Mean frequency

among self-reported

krterview condition Number Percent Number Percent smokers

Neutral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 65 19 35

Response norm . . . . . . . . . . . . . . . . . . . . . . . . 34 61 22 39

Soclalacceptabillty . . . . . . . . . . . . . . . . . . . . . 35 61 22 39

15.37

13.82

17.82

NOTE One subject refused to answer the smoking etatus question.

interview, all respondents were asked to provide a saliva

somple for cotinine testing, They were told that we wanted

to compare cotinine levels for those who smoke with the

levels for those who do not smoke.

E~Terimental protocols for this study appear as appendix IV.

Results

This experiment failed to find significant effects for

the experimental interview conditions.

Smoking status

Among the 168 respondents interviewed, 63 (38 percent) said that they were smokers. This percent varied

little by interview condition (table G). Compared with the

neutral-interview group, in which 35 percent of the respondents said they were smokers, the two manipulations

of response desirability had only small effects, with

39 percent of those in both the response-norm and socialocceptability groups saying they were smokers, None of

these differences was statistically significant.

Smoking frequency

Among the 63 respondents who said they were smokers, the mean reported frequency for smoking on the

previous day was 15.68 cigarettes, This number also did

not vary significantly by condition. The mean reported

frequency was 15.37 in the neutral condition, 13.82 in the

response-norm condition, and 17.82 in the socialacceptability condition (table G). Thus the Bradburn and

Sudman (41) model, which would predict a higher reported frequency in the response-norm group in which

question wording was manipulated, did not receive support,

Saliva cotinine

Among the 168 respondents, 18 (11 percent) refused

to give a saliva sample for cotinine analysis. Although

there are many plausible reasons for refusal, one possibility is that those who were dissembling their smoking status

(falsely claiming to be nonsmokers) might be more inclined than others to refuse to provide the sample. For

this reason, we compared the refusal rate across conditions and found very small differences. The refusal rate

was 9.26 percent in the neutral condition, 12.50 percent

in the response-norm condition, and 10.53 in the socialacceptability condition, The groups did not differ significantly from each other.

The distribution of cotinine values for those who said

they were smokers and for those who said they were

nonsmokers is shown in figure 4. An inspection of the

distribution suggests that a cutoff value of 40 ng/mL will

yield a classification with the fewest biochemically based

categorizations disagreeing with self-reports. Given this

cutoff, three individuals who said they were nonsmokers

showed cotinine values expected of smokers. hong

these, one was in the neutral-interview condition and two

were in the social-acceptabili~ condition,

Smokers versus nonsmokers

Interview questions concerning the smoking habits of

the respondents’ families, friends, and coworkers were

analyzed to determine whether smokers and nonsmokers

experience different environments with respect to the

prevalence and acceptability of cigarette smoking.

As shown in table H, this is indeed the case, Smokers

report a greater proportion of smokers among the people

they live with (X2= 19.24, p < 0.01), work with (X2=7.52,

p S 0.06), and see as friends (X2= 18.22, p< 0.01).

Discussion

Although it is fairly well accepted that cigarette smoking has become an activity with strong social connotations,

the manipulations of the context within which the smoking

status and frequency questions were asked in this study

had no significant effects. We might interpret this finding

as an indication that the manipulations were simply not

strong enough, supposing that more extensive differences

in wording or interviewer behaviors would have elicited

more variability across conditions. Another possible explanation for the null result, however, would implicate the

particular sample that was used.

To obtain a high proportion of smokers, we intentionally solicited respondents in locations where a large proportion of people smoke. In so doing, we may have

inadvertently selected environments in which the usual

social pressures against smoking are minimal or nonexistent. In this case there would be little underreporting

linked to social-desirability effects for either of the experimental conditions to mitigate. The difference between

19
60

r

Smokers Ezzl Nonsmokers

Cotinine level (rig/ml)

Figure 4. Cotinine level for smokers and nonsmokers

smokers and nonsmokers in the reported proportion of higher percent of smokers among those around them, The

other smokers among the people they interact with sug- manipulations used in this study could be better tested if

gests that although society in general is becoming more included in a large survey that would provide adequate

negative about smoking, there is a wide range in the numbers of smokers for testing the social-desirability hyperceived social acceptability of this habit, with smokers potheses without resorting to strategies for oversampling

tending to congregate together or at least perceiving a smokers.

20
Table H. Number and percent of reported smoking status, by social environment

Smokers Nonsmokers

Social environment Number Percent Number Percent

Number of other smokers in household

Osmokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 49 82 79

I smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 40 17 16

2smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 11 3 3

3smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o 0 1 1

4smokere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 1 1

Proportion of coworkers who smoke

None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 14 8 12

Ftlw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 45 46 68

Half . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 24 6 9

Most. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Ie e 12

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0 0

Proportion of friends who smoke

None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 8 20 19

Few . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 41 59 57

Half, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 19 15 14

Most, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 29 7 7

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 3 3

21
Study 3: Long-term

recall of smoking

activity

Accurate reporting of smoking behavior over a period

of time is important for understanding the varying patterns of smoking engaged in by one individual historically,

differences in smoking patterns across individuals, the

effect of smoking cessation efforts on smoking patterns,

and the resultant effect of these patterns on illnesses such

as lung cancer and heart disease (44). Smoking research

performed by SRI and others (2,45,46) indicates that

lifetime tobacco use is often characterized by numerous

fluctuations in the amount smoked, alterations in brand of

cigarettes, and other changes in smoking habits. Moreover, the past 2 decades have seen increasing frequency of

serious attempts to quit smoking, roughly half of which are

sustained for a year or more (47).

Much or all of the data used in epidemiologic investigations of smoking prevalence have consisted of selfreports gathered through face-to-face or telephone

interviews or through self-administered questionnaires.

The use of biochemical tests to try to measure all of the

changes in individual smoking patterns that occur over an

extended period of time is simply infeasible. Moreover,

biochemical tests cannot capture the relationships among

life events that may well be the key to understanding

changes in smoking behavior. Given the reliance of smoking research on self-report, the accuracy of information

recalled and provided is, and will continue to be, a major

concern.

In the interests of testing dose-response hypotheses

concerning lifetime smoking, surveys often ask respondents to indicate when they first started smoking, when, if

ever, they finally stopped smoking, and what intervening

periods of abstinence occurred. The NHIS, for example,

asks smokers to report all serious attempts to stop smoking during the past year, including the dates and duration

of each. The National Heart, Lung, and Blood Institute

(NHLBI) Survey of Past Smoking Behavior asked respondents to report all extended periods of smoking cessation,

by month, over a 10-year period. Such questions make

severe demands on people’s ability to recall dates for past

events. Survey research incorporating validation of subject

reports has found that even events as serious as hospitalizations are frequently underreported after as little as 1

year has passed; for example, 16 percent of hospitalizations 41–50 weeks ago and 42 percent of hospitalizations

51-53 weeks ago were not reported in a study by Cannell,

Miller, and Oksenberg (22). Thus the accuracy of selfreports of periods of smoking and smoking cessation over

extended time periods must be suspect.

Given that surveys are going to include such difficult

memory tasks, the typical survey interview does not appear

to be structured in a way that is most conducive to recall.

It is well established that a person’s ability to retrieve an

event from long-term memory is heavily dependent on the

cues available at the time of attempted recall: The greater

the similarity between cues present when the person tries

to recall an event and the cues present when the event was

encoded, the more likely the subject is to be successful in

retrieving the event from long-term memory (25), Necessarily, survey interviews are generally administered at a

time and place quite unlike those surrounding the target

events. Additional impediments to retrieval of past events

are raised by the standard survey’s stricture against

“irrelevant” discussion of the topic of the survey item.

This prohibition discourages the respondent from reconstructing the context in which the event occurred – an

activity that is important for generating useful retrieval

cues,

In addition, the order in which surveys pose questions

about a topic is often less than optimal for stimulating

event retrieval. In a study of memory for use of health

facilities during the past year, Means, Nigam, Zarrow, et

al, (32) found that the reason motivating a visit was the

best remembered aspect of it. Subject protocols suggested

that the preferred method of recalling events was in terms

of a narrative structure, with an identifiable problem,

actions, and a resolution, Whereas the problem or reason

for an event appears to be a good recall cue; the time

when it occurred is a poor one.

In a study of longer-term autobiographical memory,

Wagenaar (48) found that information about when an

event occurred was the poorest cue for retrieving other

information about it. Over a period of 6 years, Wagenaar

recorded two personal events each day in terms of four

cues —who, what, when, and where. Later he administered

recall tests to himself to investigate the effectiveness of the

various cue types. Generally he found that when was the

least effective of the four as an initial recall cue. The

potency of the other cues seemed to be a function of their

uniqueness within the corpus of events to be remembered,

The cue what was best, followed by where and l~lw.

Wagenaar interprets his data in terms of a file cabinet

metaphor, with the cue when acting somewhat differently

22
from other types of event information. As a recall search

cue (“file header”), when is very general, essentially a

season of a year. (Thus, given a date and instructed to

think of the target event, a person would think of all

personal events within 3 months of the provided date.)

Once a specific event is accessed, however, Wagenaar

suggests that much more specific date information is

available (l-week rather than 3-month precision). This

finding suggests that dating of personal events will be

better if subjects first access the “file” for the particular

event, and that questions other than when will increase the

likelihood of accessing that file.

This memory research raises questions about the

efficacy of the order in which event topics are addressed in

many survey interviews. In the smoking supplement for

the NHIS, for example, the interviewer initiates the topic

by asking about frequency and dating of periods of smoking and smoking abstinence.

● How many times within the last year have you made a

serious attempt to stop smoking cigarettes?

● When did you last make a serious attempt to quit

smoking?

. When you tried to quit, how long did you stay off

cigarettes?

. Of all the times you have tried to quit smoking, what

was the longest period you stayed off cigarettes?

. When did you make the serious attempt to quit

smoking?

Respondents were asked how and why they changed

their smoking behavior only after answering these questions. A very different question order would be recommended based on the research literature on

autobiographical memory.

A second feature of the typical survey interview that

appears less than optimal from a cognitive psychology

viewpoint is that the subject is repeatedly asked to shift

focus. In the smoking history section of the NHIS shown

in this report, for example, the respondent is asked first to

think about all attempts to stop smoking, then about the

most recent attempt to stop smoking, and then about the

longest cessation period. The survey’s use of shifting

reference periods can be expected to disrupt natural

retrieval strategies, if we are correct in our interpretation

that an event story or narrative form, in which the subject

develops a coherent narrative of a single event, is preferred for autobiographical recall, much as a story structure facilitates recall of prose material (49).

Table J. Differences between conversations and survey interviews

Table J summarizes the differences between the conditions that laboratory research suggests are most conducive to recall of past events and those that apply in most

standard survey interviews.

The study to be reported here explores an alternative

approach to obtaining personal history information. The

study is designed to have applications for the design of

interviews dealing with personal history over an extensive

time frame, Although the specific application used in this

study concerns smoking history, the same techniques

could be used in surveys concerning long-term residential

patterns, employment history, or any other category of

significant life event.

Respondents in this study were all individuals who

were involved in a formal program to stop smoking sometime in 1981 or 1982. After stopping as part of that

program and remaining abstinent for 3 months, they

joined an SRI study of factors contributing to smoking

relapse (for convenience, we will refer to this as “the 1982

SRI study”). Some participants subsequently resumed

smoking, whereas others remained abstinent, Our interview questions concern their smoking patterns just before

participating in the stop-smoking program and previous

and subsequent attempts to stop smoking.

Respondents were assigned randomly to either a standard or an experimental interview group. In developing

the experimental interviews, we sequenced interview questions in a way that would be compatible with memory

retrieval processes —first asking questions about the reasons why the respondent did something, followed by how

he or she did it, the result, and, finally, when the event

occurred. In this way the respondent is allowed to describe

the essentials of an episode before being asked to place it

in a time frame.

In addition, in our experimental condition we sought

to employ a more natural, conversational approach to

interacting with the respondent without sacrificing objectivity. For structured-response items, the interviewer first

elicited open-ended responses to the questions and then

asked the respondent to look at the list of standard

responses and select those that were relevant. The interviewer acknowledged information that the respondent had

already provided and used that information to form individualized probes. For example, a respondent who said he

could not remember when an attempt to quit occurred

might be probed, “Well, you said you are pretty sure you

smoked at least up until the spring of 1979 when you were

still working as a gardener, and you are pretty sure you

Conversations Survey interviews

Participants identify a topic of mutual interest Survey designers identify topics in advance

Topics evolve dynamically but follow rules of continuity Topics may switch suddenly, with no logical continuity

Person can reject or rsframe the question Respondent must answer question as it is written in advance

Participant’s talk Is adapted to information the other participant has Interviewer uses standard wording so that respondent’s prior responses have no effect

provided

Procedures are used to obtain clarification when ambiguity is encountered Requests for clarification are responded to with repetition of the same question

23
Table K. Contrasts between experimental and standard interview conditions

Feature Experimental interview Standard /nterview

Question order: Why tried to stop smoking, how tried to stop smoking How many times tried to stop, when was most recent

why restarted, when stopped and started stop, duration of longest stop, howtried to stop

smoking, why ever tried to stop, why ever restarted

Continuity: Each episode described completely before respondent Focus of questions shifts as on NHIS

is questioned about other episodes

Standardization: Balance sought between conversational axioms and Questions completely standardized; subjects

standardization; questions about reasons and methods given standard response set for all Items

asked first in open-ended format followed by provision

of standard response options

Relevance: Subjects encouraged to talk about any details that might Subjects discouraged from rambling

help them remember the event

participated in the SRI project in February 1982, That

leaves a period of 3 years: What about when you were

singing in the choir, were you smoking then?” In this way

we encouraged respondents to talk about the details of

their past that have connections to changes in their smoking behavior and could serve as retrieval cues to help them

remember the events in their smoking history.

The study design compared this experimental interview approach with a standard survey interview, in which

questions were sequenced into a way similar to the order

used in the NHIS smoking supplement, and the interviewer adhered strictly to the interview protocol. In this

standard condition, respondents were not asked about

topics with open-ended questions before the standard

response options were given. Digressions were discouraged. If a respondent said that he or she could not

remember something such as the date of an attempt to

stop smoking, he or she was simply urged, “Well, try to

give me your best estimate,” Table K summarizes the

differences behveen the experimental and standard interview conditions.

This study is unusual because we are able to compare

these two conditions in terms of the accuracy of the

information obtained from respondents, This is possible

because the respondents were all participants in the 1982

SRI study of smoking behavior and relapse (45,50) funded

by the NHLBI. As part of that study, extensive smoking

histories were obtained from all participants. They completed a written questionnaire asking about all periods of

smoking cessation and attempts to quit during the previous 10 years. These participants were then followed up for

a 12-month period, during which they were regularly

asked about their smoking status and twice had saliva

samples taken and analyzed for tobacco by-products. The

records from the earlier study provide a standard to which

the respondents’ retrospective reports in our interviews

could be compared,

Method

Respondents

A total of 76 individuals, all of whom had participated

in the 1982 SRI study of smoking relapse, served as

24

respondents. Of these, 20 were interviewed behveen 1988

and 1989 during a pilot phase of our research, and 56 were

interviewed between 1989 and 1990 during the main data

collection. Much, but not all, of the interview protocol

remained the same between the two study phases, permitting pooling of data for some items. Respondents were

randomly assigned to interview groups. Respondent locating and recruiting procedures are described in appendix V.

Procedures

All respondents were interviewed individually in their

home, on their job, or another setting convenient to them.

A total of four researchers served as interviewers; each

conducted approximately equal numbers of experimental

and control interviews.

In the experimental-intewiew condition, the interviewer began by asking the respondent about the attempt

to quit immediately before joining the 1982 SRI smoking

relapse study. These respondents were first asked about

why they wanted to stop smoking at that time in their life.

They were then asked questions about how much they had

been smoking before joining the stop-smoking program,

the number of family members and friends who smoked at

that time, and the extent to which these people made it

easier or harder to stop smoking. As part of this program,

only after addressing all of these questions about this

attempt to stop smoking were they asked to try to recall

the month and year they stopped. These questions were

followed by less detailed inquiries about why and how they

had tried to stop smoking on any other occasions between

1977 and 1983. For each period of smoking cessation, they

were first asked why they had tried to stop, followed by

questions about methods used, and then dates. Finally,

they were asked about changes in smoking status after

participating in the 1982 SRI study.

In the standard-interview condition, respondents were

first asked to estimate the month and year when they had

stopped smoking prior to participating in the SRI smoking

relapse study, They were then questioned about the details surrounding their participation in the stop-smoking

program, After answering these questions, they were

asked to consider all their other smoking cessations of a

week or more between 1977 and 1983. They were first
asked how many cessations had occurred and then the

month and year when each period of abstinence started

and stopped, Next, they were asked to report all the

methods they had ever used to try to quit smoking during

this period and all of the reasons why they had ever

resumed smoking after trying to stop.

The form of the questions used with the standardinterview group (asking about methods and reasons for all

of their attempts to quit at once) was identical to that used

cm the questionnaire respondents completed in 1982. In

contrast, the experimental group was asked to consider

the motives and methods for each event individually. In

addition, the experimental respondents were first asked to

describe their reasons or methods in their own words and

were only subsequently given the standardized response

categories that had been used on the 1982 questionnaire.

(Responses were aggregated across 1977-82 attempts to

quit for comparison with their 1982 responses.) Thus any

variance related to similarity of method should favor the

standard-interview group. In both conditions, the interview concluded with questions about the respondent’s

current smoking status and the amount smoked or date of

final quit, whichever was relevant. Experimenter protocols

for the two conditions are provided in appendix VI.

Results

Long-term recall for smoking behaviors

Given the extended period of time between the events

to be remembered and the date of our interviews (an

average of S years), the first issue of interest is the overall

accuracy of reports of different types of information.

These data provide some guidelines that can assist researchers in estimating the feasibility of obtaining valid

responses to different types of questions that might be

included in a retrospective smoking history interview.

Dates of smoking cessation – Memory accuracy for the

month and date in which the respondent stopped smoking

before joining the SRI study was estimated for the 56

respondents in the main part of the study. (In the pilot

phase, respondents were told the year in which this

stop-smoking attempt occurred.) For each respondent, the

remembered month and year when he or she stopped

smoking before joining SRI’s study were compared with

the date on record.1

Overall, respondents were able to date this attempt to

stop smoking (which had occurred some 6 to 9 years prior

to the interview) within 7.47 months of its actual occurrence. Dating errors usually involved respondents remembering the event as occurring more recently than it

actually did (“forward telescoping”), with the average

date remembered being 4.91 months too recent.

After participating in the program to stop smoking in

1981 or 1982, a majority of the respondents remained

abstinent, according to both records from the followup

conducted for approximately 1 year and their own account

in 1989 or 1990. There were 37 respondents (49 percent),

however, who resumed smoking; although a majority of

these have since quit. The smoking history provided by

each respondent in our interview was compared with the

recorded dates and followup data collected for the earlier

study, roughly 6 and 12 months after quitting in 1981 or

1982. In this way we were able to assess the respondents’

memory for their smoking behavior in the year following

their 1981 or 1982 smoking cessation. Among the 56

respondents in the main study, 80 percent of the reports

given in the 1989–90 interviews were consistent with the

1982 study records for the 6-month followup; 8S percent

were consistent for the 12-month followup.

Amount smoked–The questionnaire completed as

part of the 1982 SRI smoking relapse study included a

self-reported item on the amount smoked prior to participating in the stop-smoking program. The item format and

the mean level of agreement behveen 1982 and 1989-90

reports are shown in table L, 44 percent of the respondents gave an identical response on both occasions, with

lFor two respondents who reported they could not remember a date at

all, a value equal to the total sample mean plus one standard deviation

was imputed,

Table L. Number and percent of smoking levels reported in 1982 compared with levels reported in 1989-90

[Percents appear In parentheses]

1989–90 reported level

1982 reportedlevel 1 2 3 4 5 6

l= Lessthan l/2pack perday. . . . . . . . . . . .

(0,0; (4.0: (5.3; (1.3; (0.00! (0.0:

2=1/2-l pack per day . . . . . . . . . . . . . . . .

(1,3; (4.0; (13.3’3! (0.00! (1.3; (0.0;

3=1–1/2pack perday . . . . . . . . . . . . . . . .

(0.0; (10.6; (22.6-; (4.0: (0.0; (0.0:

4=1-1 /2–2packs perday . . . . . . . . . . . . . .

(0.00! (0.0; (2.6; (12.0: (2.6; (1.3;

5==2-2-1/2 packs perday. . . .

(0.00! (0.0; (0.0; (4.0; (4.007 (2.6;

6 = More than 2-1/2 packs per day . . . . . .

(0.0$ (0.00! (0.0: (0.0; (1.34 (1.3:)

NOTE:The 1982 questionnaire for one subject could not be located.

25
Table M. Level of agreement and memory for features of

cigarettes smoked in 1982

Percent Chance level Correctlevel

Cigarettefeature agreement of agreemant of agreemenP

Brand smoked . . . . . . . . . . . . 0.46 . . .

Length (options: regular, king,

. . .

100mm, or120 mm) . . . . . . . . 0.41 0.25 0.21

Mentholated (options: yes, no) . . 0.84 0.50 0.68

lights” (options: yes, no) . . . . . 0.75 0.50 0.49

aCOrrection for chance agreement on items with Kmited options. Corrected

agreement = (percent agreement-chance percent agreement) or (l-chance percent agreement). The flrat dwided by the second.

NOTE The 19a2 queatlonnaira for one subject could not be located.

another 47 percent reporting a category adjacent to the

one they had picked in 1982. Among respondents whose

1982 and 1989 reports disagreed, the 1989 reports of 1982

smoking levels were more likely to exceed those reported

in 1982 (36 percent of reports above the diagonal) than to

be lower (20 percent of reports below the diagonal).

Cigarette brand and characteristics – During our interviews, we asked respondents about the brand of cigarette

they were smoking prior to stopping and joining the

earlier SRI study, the length of the cigarettes, whether

they were mentholated, and whether they were “lights.”

The extent to which reports of this information agreed

with reports provided in 1982 is displayed in table M.

Memory for type of cigarette smoked 8 years ago

appears poor, Less than half the respondents could remember the brand they had smoked, and when corrected

for guessing, memory for cigarette length was accurate

among less than a quarter of the sample. One factor that

may have contributed to the relatively low agreement

between 1989 and 1982 reports is that some of the stopsmoking programs in which respondents participated directed them to change their cigarette brand as part of the

effort to break the smoking habit. The cigarettes described

on the 1982 questionnaire may have been the last brand

smoked during the smoking cessation program rather than

the individual’s customary brand before starting the

program.

Social environment for smoking–A number of questions on the 1982 questionnaire were aimed at assessing

the social pressures to smoke or not to smoke. Some of

these items were objective (for example, the number of

smokers living in the home and the proportion of coworkers who smoked), whereas others were quite subjective

(rating the extent to which friends helped or hindered the

attempt to stop smoking). Table N shows the level of

agreement between the 1982 and 1989–90 reports of these

variables. Not surprisingly, memory was better for objective aspects of the social environment surrounding the

stop-smoking attempt, where 69 percent of the reports

matched, than for the subjective environment, where

44 percent of the reports matched (t(49) = 14.93, p c 0,01).

Reasons for quitting and restarting– Other items on the

1982 questionnaire asked subjects why they had wanted to

quit smoking and why they had restarted after previous

attempts to quit. These questions and the relationship

Table N. Relationship between the 1982 and 1989-90 reports of

assessing objective and subjective aspects of the social

environment for smoking

Object/ve Subjective

social social

Item environmerfP environmenfi

Number possiblec . . . . . . . . . . . . . . 4.35 2.55

Number of matches . . . . . . . . . . . ,. 3.01 1.11

Percent matches . . . . . . . . . . . . . . . 0.69 0.44

alncludes whether respondent Lved alone, number of adulla in household, number of smokers

In household, proportion of friends who smoked, and proportion of coworkers who smoked.

bl”cludes ratings of degree of support received from household members, frlands, and

coworkers, each on a 4-point scale.

cNumber possible variea, depending upon whether the respondent lived alone and was

employed at the time the questionnaire was completed.

NOTE: The 1982 questionnaire for one subject could not be Iocatsd,

Table O. Consistency between 1982 questionnaire and 1989-90

interview items on reasons for quitting and restarting smoking

Reasons Reasons

Item for qukhhp forrestarting

Number possiblec . . . . . . . . . . . . . . 7.38 4.01

Number of matches . . . . . . . . . . . . . 4,63 1.72

Percent matches . . . . . . . . . . . . . . . 0.64 0.44

Number of falsa alarms. . . . . . . . . . . 1.06 0.97

Corrected percent matchesd . . . . . . . 0.46 0.13

alncludes whether respondent lived alone, number of adults In household, number of smokers

in household, proportion of friends who smoked, and proportion of coworkere who smoked.

blncl”des rafingaof degree of aupporl recaivad from household members, friends, and

coworkers, each on a 4-point scale.

cNumbar possible varies, depanding on numbar of opffona marked on 19S2 questionnaire.

d(Matches. False Alarms)/Possible.

NOTE The 1982 questionnaire for one subject could not be located.

between the 1982 and 1989–90 reports are shown in

table O. Although 64 percent of the reasons for quitting

reported in 1982 were also reported in 1989-90, consistency looks much less impressive once we correct these

scores for the respondents’ inclination to agree with all the

response options (as indicated by the number reported in

1989-90 that had not been marked in 1982). The resulting

corrected match rate of 46 percent is still considerably

better than that found on the similarly formatted question

on reasons for resuming smoking after earlier (pre-1982

questionnaire) attempts to stop, Here, the corrected

match rate is only 13 percent.

Methods used–AU respondents knew that they had

joined a formal stop-smoking program before participating

in the SRI study, although only 57 percent of them could

remember the organization offering the program, Respondents were also asked about methods used in earlier

attempts to quit, Table P shows the question format

Table P. Consistency between 1982 questionnaire and 1989-90

interview reports of methods used in attempts to stop smoking

Item Methods usecF

Number possibleb . ., ., .,.,..... . . . . . . . . 1.85

Number of matches . . . . . . . . . . . . . . . . . . . . . 0.77

Percent matches . . . . . . . . . . . . . . . . . . . . . . . 0.47

Number of false alarms . . . . . . . . . . . . . . . . . . . 0.25

Corrected percent matchesc. . . . . . . . . . . . . . . . 0.29

aOptions comprise drugstore remedy, health association program, commercial program,

individual counseling andlor private therapy, group therapy, hypnosis, and qt.ut on own,

bNumbsr possible varies, depending on number of options marked on 1982 questionnaire.

c(Matchea - False Alarms) /Possible.

26
Table Q. Consistency between interview smoking history and

1982-83 followupdata

[Standard errors appear in parentheses]

First fo//owup Second followup

Percent Percent

Interview condition Number agree Number agree

Experimental Interview. . . 33 0.94 34 0.97

(0.04) (0.03)

Standard interview , . . . . 24 0.75 28 0.75

(0.09) (0.08)

NOTE: Followup data were not available for some subjects,

(taken from the 1982 questionnaire) and recall performance. False positives (reporting options in 1989–90 that

were not selected in 1982) were much less common on this

item (about one respondent in four reported an additional

method), The corrected recall rate of 29 percent was

better than that for reasons for relapsing but not as good

as that for reasons for quitting in 1982.

Interview conditions

Dates of smoking cessation –The experimental interview technique was designed to help respondents generate

a context for remembering incidents in their smoking

histories, A key prediction was that respondents would be

better able to place an event in time if they first had the

opportunity to recall the reason for wanting to stop

smoking and the context in which the event occurred

rather than being asked first about when the event had

happened.

This hypothesis was confirmed: There were large

differences between the two interview groups in the precision with which this event was dated. Respondents in the

experimental-interview condition erred by an average of

just 4.99 months (absolute deviation) compared with an

average of 10.74 for those in the standard-interview condition, t(40) = 2.01, p <0.05. Thus the experimental technique appeared highly effective in helping respondents to

place this event in time, cutting the dating error by more

than half.

In terms of net error, respondents in both conditions

produced date estimates that were, on the average, too

recent. The tendency appeared more pronounced among

standard interview respondents, whose group estimate was

6.37 months too recent, than among experimental respondents, whose group estimate was 2.98 months too recent,

but the difference was not statistically significant.

Table Q compares the two interview conditions in

terms of the consistency of reports with the recorded

followup data. Experimental-interview respondents gave

more accurate histories for the period after the stopsmoking program. Their reported smoking status at the

time of the two followup visits matched the followup data

in 94 percent of cases for the first followup compared with

75 percent for standard-interview respondents, z = 1.95, p

<0.10. Similarly, the smoking status reported in the interview for the time of the second followup matched that on

record for 97 percent of experimental-interview respondents compared with 75 percent of those in the standardinterview condition, z =2.53, p c 0.05.

Amount smoked – Tables R and S show the degree of

consistency between 1982 and 1989–90 reports of the

amount smoked prior to the smoking cessation in 1981–82.

Experimental respondents chose the same response option on both occasions 37 percent of the time compared

with 51 percent for standard-interview respondents. This

difference was not statistically significant.

Cigarette brand and characteristics –The two groups

were also similar in terms of the consistency of their 1982

and 1989–90 reports of the cigarette brand they used to

smoke. These data are shown in table T. Although the

experimental group’s mean appears higher for reports of

cigarette length, and the standard-interview respondents

show a higher mean for reports of whether the cigarettes

were mentholated, neither difference was statistically

significant.

Social environment for smoking- For the objective

items about social environment, responses of the

experimental-interview group matched those on their

1982–83 questionnaire 71 percent of the time, whereas

those of the standard-condition respondents matched

66 percent of the time (a nonsignificant difference). For

the subjective items, the experimental-interview group’s

responses matched 40 percent of the time compared with

Table R. Number and percent of smoking levels reported in 1982 compared with 1989-90 among experimental interview respondents

[Percents appear In parentheses]

1989-90 reported level

1982 reported level 1 2 3 4 5 6

l= Lessthan l/2pack per day. . . . . . . . .

(0.0; (2.6; (7.6; (2.6; (0.0$ (0.0:

2=1/2–l pack per day, . . . . . . . . . . . . . . . .

(2.6:) (2.6; (13,1; (0.0; (2.6; (0.0;

3=1-1 -l/2 packs per day. . . . . . . . .

(0.0; (13.1; (22.:: (5.2; (0.00! (o.o~

4=1–1/2-2packs per day. . . . . . . . .

(0.00! (0.0; (0.0; (5.2: (5.2{ (2.63)

5=2-2–l/2packs perday. . . . . . . .

(0.0; (0.0; (0.0; (5.2; (0.00) (o.o~

6 = More than 2-1/2 packs per day . . . . .

(0,0; (0.0; (0.0; (0.0: (0.0; (2.63)

NOTE:The 19e2 questionnaire for one subject could not be located.

27
Table S. Number and percent of smoking levels reported in 1982 compared with 1989-90 among standard Interview respondents

[Percents appear in parentheses]

1989–90 reported level

1982 reported level 1 2 3 4 5 6

l= Less than l/2pack perday. . . . . . . . . . . .

(0.0;

2=1/2–l pack perday. .,...... . . . . . . . .

(0.0;

3=1-1 –l/2pack per day . . . . . . . . . . . . . . .

(0,0;

4=1–1/2-2packs perday. . . . . . . . . . . . . . .

(0.0;

5=2-2-l/2 packs perday. . . . . . . . . . . . .

(0.00!

More than 2–1/2 packs per day . . . . . . . . . . .

(0.0;

(5.41; (2.7; (0.0; (0.oj (0.00!

(5.4; (13.3; (0.0: (0.00:

1

(o.o~

(8.11)

(5.41;

(0.0;

(0.0;

(18.92)

(18.9;

(0.0;

(0.0;

(2.70)

(0.0:

(2.7;

(0.0;

(0.00)

(0.0:

3

(8.11)

1

(2.70)

(0.oflj

(0.0;

(5.4:

(0.0;

NOTE: The 1982 questionnaire for one subject could not be located.

Table T. Consistency between 1982 questionnaire and 1989-90 interview reports of cigarette features, by interview condition

Experimental interview Standard interview

Corrected Corrected

Percent Chance level level Percent Chance level level

Cigarette feature agreement of agreement of agreemerrP agreement of agreement of agreement

Brand . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.46 . . . 0.47

Length . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . .

0.61 0.25 0.48 0.49 0.25

Mentholated . . . . . . . . . . . . . . . . . . . . . . . .

0.32

0.79 0.50 0.58 0.89 0.50

“Lights’’ . . . . . . . . . . . . . . . . . . . . . . . . . .

0.78

0.74 0.50 0.48 0.76 0.50 0.52

acorrection for chance agreement on items with limited options. Corrected agreement= (99 A - Chance % A)/(l - Chance % A).

48 percent among the standard-interview respondents

(again, nonsignificant), These results are shown in

table U.

Although the trend toward greater consistency in the

responses to subjective items among the standardinterview group was not statistically significant, it suggests

the possibility that standard-interview respondents may

have had an advantage in terms of the similarity of the

Table U. Consistency in description of objective and subjective

aspects of social environment, by interview condition

[Standard errors appear in parentheses]

Experimental Starrdarc/

interview interview

Social environment n=38 n=3P

Objective social environment

Number poasiblec . . . . . . . . . . . . . .

Number of matches . . . . . . . . . . . . .

Percent matches . . . . . . . . . . . . . . .

Subjective social environmental

Number possible . . . . . . . . . . . . . . .

Number of matches . . . . . . . . . . . ,.

Percent matches . . . . . . . . . . . . . .

4.32

(;;;)

(:::)

(0:04)

2.55

(::)

(0:15)

0.40

(0.06)

4.38

(:.:)

(0:17)

0.66

(0.03)

2.54

(TJ

(0:14)

0.48

(0.05)

aOoes not include one subject whose 1982 queationnalre could not ba located.

bkmludes whether respondent tived alone, number of adults In household, number of smokers

In household, proporhon of friends who smoked, and proportion of coworkers who smoked,

‘Number possible varies depending upon whether the individual fived alone end was

employed at tha t!me the queetnonnaire was completed.

dhwludes rstmgs of degree of supporl raceived from housahold membars, friends, and

coworkers, each on a 4-point scale.

strategies used to answer the question on the two occasions. Either a standard interview or a written questionnaire is likely to elicit a rough estimate, “gut reaction,”

when a complex question such as “How supportive were

your friends when you tried to stop smoking?” is posed,

The slower paced, more detailed discussion elicited in the

experimental interview was designed to lead respondents

to actually recall specific people and how they responded

to the attempt to stop smoking. To the extent that respondents did so and actually tried to mentally average the

degree of support over various friends or family members,

they may have tended to arrive at a different answer than

the estimate provided in 1982 after more superficial consideration of the item on the questionnaire (51).

Reasons for quitting and restarting- In comparing the

congruence of the 1982 and 1989–90 responses to these

questions, it should be remembered that those in the

experimental interview responded to a large set of options

shown in table O after describing the reasons in their own

words for wanting to quit smoking (or for restarting),

Respondents in the standard interview merely responded

to the set of options.

Figure 5 shows some examples of the reasons

experimental-interview respondents provided in response

to the open-ended question about why they wanted to quit

and the options selected by the same respondents. Respondents in this condition clearly selected some options

that were quite different from anything they had talked

about in response to the open-ended query. Nevertheless,

the data shown in table W suggest that preceding the

28
Structured-Response Items

Si?i’:

s#12:

S#23:

S#29:

s#35:

S#48:

srY51:

Open-ended response

Mother had recently died of cancer . . i was smoking a lot and

not enjoying it.

We had recently moved from Oregon and were planning for

children . . We wanted to be nonsmokers .

1 wanted to get healthier . . . A guy I was dating didn ‘t smoke.

Also a friend was in this stop-smoking program . . .

Dad died and mother was concerned about people who smoke in

general . . It was really devotion to my mother .

/ had recently quit drugs and alcohol so I thought I should quit

smoking too.

The real motivator was my wife. She really wanted to quit and I

just sort of went along.

I was anticipating a divorce and wanted to take control of my

life . . .

v

.

—

—

—

—

—

—

—

—

—

.

—

—

v

—

v’

Figure 5. Comparison of responses to open-ended and structured-response items on reasons for stopping smoking
Table W. Consistency between 1982 questionnaire and 1989-90

interviewitems on reasons for quitting smoking in 1981-82 and

reasons for prior relapses, by condition

[Standarderrorsappear in parentheses]

the experimental group was 34 percent compared with

24 percent for the standard-interview group, a difference

that was not statistically significant,

Experimental Standard

interview interview

Interview items n=38 n=3F

Reasons for quitting smoking

Number possibleb . . . . . . . . . . . . . .

Hits . . . . . . . . . . . . . . . . . . . . . .

False alarms . . . . . . . . . . . . . . . . .

Percent hits . . . . . . . . . . . . . . . . .

(Hits-false alarms)/possible . . . . . . . .

Reasons for prior relapses

Number possibleb . . . . . . . . . . . . . .

Hits . . . . . . . . . . . . . . . . . . . . . .

False alarms............,,,..

Percent hits . . . . . . . . . . . . . . . . . .

(Hits-false alarms)/possible. . , . . . . .

7.66

(0.34)

4.71

(0,28)

0.92

(0.18)

0.64

(;:)

(004)

4.26

(:.3IJ

(0:23)

0.64

(::).)

(0.05)

0.06

(0.10)

7.05

(0.33)

4.64

(0.33)

1.20

(0.22)

0.64

(0.03)

0.44

(0!05)

3.76

(0.37)

2.14

(0.27)

1,30

(O&)

(0:06)

0.20

(0.08)

aDoesnot include onesubjecr whose 1982 questionnaire could nct relocated.

bN”mber possible vanes, depending upon number of items marked On 19a2 aUtVaY.

standard question with the open-ended item may have

made respondents more conservative in selecting options:

Experimental respondents were less likely than respondents in the standard-interview condition to select options

that they had not marked on the 1982 questionnaire

(mean of 0.92 versus 1.20 per respondent), When the

proportion of matches between the interview and the 1982

questionnaire responses was corrected for these intrusions, the experimental-interview group had a score of

48 percent compared with 44 percent for those in the

standard-interview condition, a difference that was not

statistically significant.

Methods used –Table Y shows the consistency between 1982 and 1989 questionnaire and interview items on

methods used to try to stop smoking by interview condition, As shown in the table, the corrected recall score for

Table Y. Consistency between 1982 questionnaire and 1989-90

interview items on methods used to try to stop smoking, by

condition

[Standard errors appear in parentheses]

Success of the smoking cessation

As previously described, the strongest effect of the

experimental-interview condition was found for the respondent’s ability to place his or her smoking cessation in

time, Another important factor in determining the accuracy with which the respondent could date the event was

whether this attempt to quit smoking was ultimately successful (that is, the respondent never smoked again), It is

quite reasonable to assume that the date of the final

cessation of smoking is more likely to be discussed or

otherwise mentally rehearsed than the date of an attempt

to quit smoking that was not sustained. This is clearly the

case: The mean absolute deviation between the remembered date and the actual date for the attempt to quit

smoking was 3.76 months if it was the “final” attempt and

11.75 months if it was not. A general linear model test,

with both condition and finality of the quit as factors,

found a significant effect for the interaction between these

two variables, F(1,52) = 5,87, p <0.05 (as well as significant

main effects, F(1,52) = 5.19, p <0.05 for condition and

F(1,52) = 10.16, p <0.01 for finality of the quit), Respondents in the experimental-interview group were good at

dating the event regardless of whether it was the final

attempt to quit (3.95-month and 5,90-month deviations for

final and nonfinal attempts, respectively). In contrast,

respondents in the standard-interview condition were

quite good at dating final attempts to quit (mean deviation

of 3.58 months) but very poor at dating the smoking

cessation if it was not ultimately successful (mean deviation of 17.91 months), Table Z displays these data, which

are illustrated in figure 6.

Table AA compares the respondents who quit for

good in 1981-82 with those who subsequently resumed

smoking in terms of corrected percent matches for reasons

for quitting in 1982, reasons for previous relapses, and

methods used prior to the 1981-82 smoking cessation

program. The finality of the quit in 1981-82 was not

related to consistency of responses for any of these

variables.

Experimental Standard

Interview !ntervie w

Method n=38 n=3P

Table Z. Deviations between recalled and actual date of stopping

smoking

Methods used before 1982 quit

Number possibleb . . . . . . . . . . . . . 1.79 1.92

(0.19) (0.18)

Hits . . . . . . . . . . . . . . . . . . . . . . 0.79 0.75

(0.10) (0.13)

False alarms . . . . . . . . . . . . . . . . . 0.25 0.26

(0.08) (0.11)

Percent hits . . . . . . . . . . . . . . . . . 0.53 0.40

(0.07)

(Hits-false alarms)/prxsib[e . . . . . . . .

(0.07)

0.34 0.24

(0.11) (0.13)

aDoes not include one subject whose 1982 questionnaire could not be located,

bNumber possible varies depending upon number of items marked on 1982 survey.

Mean absolute

deviation Standard

Interview condition N (in months) error

Total sample. . . . . . . . . . . . . . 56 7.47 1.50

Experimental interview. . . . . . . . 28 4.99 1.29

Never smoked again. . . . . . . . . 13 3.95 2.02

Smoked again . . . . . . . . . . . . . 15 5.90 1.68

Standard interview. . . . . . . . . . 28 10.74 2.66

Never smoked again. . . . . . . , . 14 3.58 1,17

Smoked again..........,,. 14 17.91 3.98

NOTE: A value equal to the total sample mean plus one standerd deviation was imputed for

two subjects who reported thet they had no idea when the event occurred,

30
‘“r m Experimental EZZ3Standard

Smoked egain Never smoked again

Flgurt! 6. Deviation between retailed and actual date of stopping

smoking

Table AA. Consistency between 1982 questionnaire and 1989-90

interview reports of reasons for quitting smoking, reasons for

relapses, and methods tried, by quit status

[Number of sub]ects appears in parentheses]

Find quit Resumed smoking

Corrected percent matches in 1981-82 after 1981-62 quit

Reasons for quitting . . . . . . . . . . . . 0.42 0.51

(38) (33)

Reasons for restarting after previous

quits, .,, . . . . . . . ! ! . . . . . . . . . 0.15 0.10

(37) (33)

Methods tried In previous quits . . . . . Q:26 0.32

(38) (31)

NOTE:The 1982 questlon!w.lre for one subject could not be located.

Current smoking status

Several studies of retrospective reporting suggest that

individuals whose behavior patterns change are less accurate in reports of past behaviors than are those who have

continued the same kind of activity (52–54). For this

remon, we had expected individuals who are current

smokers to have better memory for information related to

their smoking in 1982. Testing this hypothesis was severely

hampered by the fact that only 14 of the respondents in

our sample were still smokers at the time of the 1989–90

interview, Nevertheless, we compared these respondents

with the remaining respondents who either never resumed

smoking after 19S2 or resumed but subsequently quit.

Table BB displays these data.

Tabie BB. Consistency between 1982 questionnaire and 1989-90

interview reports of reasons for quitting smoking, reasons for

reiapses, and methods tried, by current smoking status

[Number of subjacts appears in parentheses]

Current Current

Behavior pattern nonsmokers smokers

Reasons for quitting . . . . . . . . . . . . 0.46 0.48

(58) (13)

Reasons for restarting after previous

quits. . . . . . . . . . . . . . . . . . . . . . 0.14 0.08

f:~ y~

Methods tried in previous quits . . . . .

(57) (;2)

NOTE The 1982 questionnaire for one subject could not be located.

Current smokers and nonsmokers appear similar in

terms of consistency between 1982 questionnaire and 1989

interview responses. The largest difference between

means was for reports of methods used to try to stop

smoking: Individuals who currently smoke reported the

same methods they had cited in 1982 in 53 percent of the

cases compared with 24 percent for those who are now

nonsmokers. This seems reasonable because these individuals may still be evaluating methods for quitting, and

hence their earlier methods are relevant to future

decisions. Nevertheless, despite the sizable difference in

means, the effect of smoking status was not statistically

significant with this small sample of current smokers.

Discussion

The experimental-interview technique used in this

study appeared effective in helping respondents recall an

accurate smoking history for the period surrounding a

smoking cessation that occurred 7 to 9 years earlier. Both

memory for the date when the smoking cessation occurred

and the report of smoking status a year afterward were

more accurate among experimental-interview

respondents.

At the same time, the data also indicate that another

factor that needs to be considered is the salience of the

information to be remembered. For respondents whose

attempt to quit smoking in 1982 or 1983 was successful

(who never resumed smoking), memory for the date of this

event was highly accurate regardless of the interviewing

technique. The date for such an event is likely to become

one of the “landmarks” in autobiographical memory— one

of the relatively few events for which an exact date is

stored —and thus a potential aid in reconstructing dates

for other personal events. The advantage of the experimental interviewing technique was found for less salient

events —attempts to quit that were not ultimately successful. Because the events queried in standardized interviews

are not necessarily of high salience for the respondents,

this finding is important. At the same time, it should be

acknowledged that the memory for smoking behaviors,

going back as many as 9 years, displayed by our respondents was almost certainly enhanced by the fact that they

had the unusual event of participating in the 1982-83 SRI

31
smoking relapse study as a cue for recalling other events in

their smoking histories.

Although the aspects of their smoking histories that

could be validated by project records were more accurate

for experimental respondents, there was no comparable

advantage for consistency between responses to more

subjective survey items administered on the two occasions

7 to 9 years apart. When interview responses were compared with responses on a questionnaire completed in

1982, none of the differences between experimental

groups was statistically significant. Likewise, those who

quit for good in 1981–82 were no more or less consistent in

their responses than those who later resumed smoking. In

part this may reflect the relatively small size of our sample,

but it also appears to reflect the instability of the type of

response requested by the questionnaire (for example,

responses to 12 feasible justifications for trying to stop

smoking),

Overall, the data suggest that, to the extent that the

survey designer seeks to get accurate retrospective reports

of specific medium-salience events, the techniques explored here have promise, especially when there is a

requirement for placing the events in time. At this stage in

our research, however, our data do not permit us to

pinpoint the locus of our experimental interview’s positive

effect. It could be the change in question order to one

more compatible with autobiographical memory. Alternatively, the change in the nature of the interaction to one in

which personal details are elicited, and the respondent is

encouraged to relate the target event to other things going

on in his or her life at that time, maybe the critical factor

(34). These two aspects of the intervention need to be

separately tested and evaluated as potential tools for

national surveys.

Before such techniques are considered for implementation on a wider scale, we would want to identify the

contribution of these individual factors to increases in

validity as well as their costs in terms of increased time to

complete the interview, Although a change in the question

order could be implemented in national surveys without

greatly increasing interview time, the more interactiveinterview technique and the request for respondents to

recall major life incidents that might serve as cues for

recalling the target information would be likely to have

major implications for time requirements and interviewer

training.

In our study, experimental interviews averaged three

times as long as control interviews (33 versus 11 minutes in

a sample of 10 respondent pairs matched on the remembered number of attempts to quit). This was probably an

extreme case because we compared respondents questioned about each incident separately (the experimental

group) with those who responded once for a whole class of

incidents (standard group). Comparing the two

approaches for survey items concerned with specific

events, rather than classes of events, would presumably

show smaller differences in the time required to conduct

the two types of interviews. Alternatively, there may be

more efficient ways of providing a meaningful context for

respondents’ attempts at recall, perhaps by providing a

piece of general or personal information that can serve as

a date marker and a retrieval cue (55).

Interviewer selection and training in our study were

more extensive than in many large-scale surveys but not as

costly as one might suppose. The training was conducted

in three four-spaced sessions of several hours each over a

period of 3 weeks, and included modeling and coaching in

the experimental techniques, using videotaped practice

interviews. The majority of interviews were conducted by

research assistants with bachelor’s degrees and interview

experience, but with no formal advanced training in social

science or research methodology. Certainly a much

broader research base is needed to support decisions

concerning whether the additional training and implementation time for cognitive interviewing techniques are warranted for various applications. Given such information,

individual survey designers can weigh increased costs

against the value they place on the estimated increment in

the validity of individual responses. To the extent that the

latter is a serious concern, we believe that alternative

interview methods designed to facilitate respondents’ recall and to clarify communication are worth investigating,

32
References

1.

7

‘-,

.,3

4,

.%.

(i

7.

L, Y

q>

10.

11.

12,

13,

14,

15,

U.S. Public Health Service. Smoking and health: A report of

the Surgeon General. Washington: U.S. Government Printing OfTice. 1979.

Pcchucek TF, Fox BH, Murray DM, Luepker RV. Review

of techniques for measurement of smoking behavior. In:

Matarazzo JD, Weiss SM, Herd JA, Miller NE, eds. Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley. 19S4.

Jmvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C,

%loojee Y. Comparison of tests used to distinguish smokers

from nonsmokers. Am J Public Health 77:1435-S. 1987.

Idle JR. Titrating exposure to tobacco smoke using cotinine – a minefield of misunderstandings. J Clin Epidemiol

43:317-333. 19s9.

Sillet RW, Wilson MB, Malcolm RE, Ball KP. Deception

omong smokers, Brit Med J 2:11S5–6. 197S,

Wilcox RG, Hughes J, Roland J. Verification of smoking

history in patients after infarction using urinary nicotine and

cotinine measurements. Brit Med J 2:1026-S. 1979.

Abrams DB, Follick MJ, Biener L, Carey KB, Hihi J. Saliva

cotinine as a measure of smoking status in field settings. Am

J Public Health 77:S46-S. 19S7.

Luepker RV, Pallonen UE, Murray DM, Pirie PL. Validity

of telephone surveys in assessing cigarette smokhg in young

adults. Am J Public Health 79:202-4. 19S9.

Wall MA, Johnson J, Jacob P, Benowitz NL. Cotinine in the

serum, saliva, and urine of nonsmokers, passive smokers,

and active smokers. Am J Public Health 7S(6):699-701. 1988.

Jarvis hfJ, Russell MAH, Feyerabend C, Eiser JR, Morgan

M, Gammage P, Gray ME. Passive exposure to tobacco

smoke: Saliva cotinine concentrations in a representative

population’s~mple of nonsmoking schoolchildren. Brit Med

J ~gl :9~7_9. 19s5.

Benowitz NL, Hall SM, Herning RI, Jacob P, Jones RT,

Osman A. Smokers of low-yield cigarettes do not consume

less nicotine. N Engl J Med 309:139-42. 19S3.

Haley NJ, Axelrod CM, Tilton HA. Validation of selfreported smoking behavio~ Biochemical analyses of cotinine and thiocyanate. Am J Public Health 73:1204–6. 19S3.

Hill P, H&y NJ, Wynder LL. Cigarette smoking: Carboxyhcmoglobin, plasma nicotine, cotinine, and thiocyanate versus self-reported smoking data and cardiovascular disease. J

Chronic Disease 36:439-49. 19S3.

Pierce JP, Dwyer T, DiGiusto E, Carpenter T, Hannam C,

Amin A, Yong C, Sarfaty G, Shaw J, Burke N. Cotinine

validation of self-reported smoking in a commercially run

community survey. J Chronic Disease 40:6S9-95. 19S7.

Cwey KB, Abrams DB. Properties of saliva cotinine in

young adult light smokers. Am J Public Health 7S:S42-3.

19ss!

16. O’Toole BI, Battistutta D, Long A, Crouch K. A comparison of costs and data quality of three health survey methods:

Mail, telephone, and personal home interview. Am J Epidemiol 124:317-2S. 19S6.

17. Vesey, CJ, Saboojee Y, Cole PV, Russell MAH. Blood

carboxyhemoglobin, plasma thiocyanate and cigarette consumption: Implications for epidemiological studies in smokers. Brit Med J 204:1516-1S. 19S2.

1S. Warner K. Possible increases in the under-reporting of

cigarette consumption. J Am Stat Assoc 73:314-1S. 197S.

19, Bradburn NM. Response effects. In: Rossi PH, Wright JD,

Anderson AS, eds. Handbook of survey research. New

York: Academic Press, 2S9-328. 19S3.

20. Krall EA, Valadian I, Dwyer JT, Gardner J. Accuracy of

recalled smoking data. Am J Public Health 79:200–02. 19S9.

21. Jobe JB, Mingay DJ. Cognition and survey measurement:

History and overview. Appl Cognitive Psych 5:175-92.1991.

22. Cannell CF, Miller PV, Oksenberg L. Research on interviewing techniques. In: Leinhardt S, ed. Sociological methodology 19S1. San Francisco: Jossey-Bass, 3S9-437. 19S1.

23. Lessler J, Salter W, Tourangeau R. Questionnaire design in

the cognitive research laboratory. National Center for

Health Statistics. Vital Health Stat 6(l). 19S9.

24. Willis GB, Royston PN, Bercini D. The use of verbal report

methods in the applied cognitive laboratory. Appl Cognitive

Psych 5:251-67.1991.

25. Tulving E. Elements of episodic memory. New York Oxford

University Press. 19S3.

26. Loftus EF, Smith KD, Johnson DA, Fiedler J. Remembering “when”: errors in the dating of autobiographical memories. In: Gruneberg MM, Morris PE, Sykes RN, eds.

Practical aspects of memory. Chichester, United Kingdom:

Wiley, 234-40. 19SS.

27. Anderson RC. Some reflections on the acquisition of knowledge. Educational Researcher 13:5–10. 19S4.

2S. Schank RC, Abelson RP. Scripts, plans, goals, and understanding. Hillsdale, New Jersey: Erlbaum. 1977.

29. Linton M. Ways of searching and the contents of memory.

In: Rubin DC, ed. Autobiographical memory. Cambridge:

Cambridge University Press, 50-67. 19S6.

30. Neisser U. Nested structure in autobiographical memory.

In: Rubin DC, ed. Autobiographical memory. Cambridge:

Cambridge University Press, 71-S1. 19S6.

31. Reiser BJ, Black JB, Kalamarides P, Strategic memory

search processes. In: Rubin DC, ed. Autobiographical memory. Cambridge: Cambridge University Press, 100–21. 1986.

32. Means B, Nigam A, Zarrow M, Loftus EF, Donaldson MS.

Autobiographical memory for health-related events. National Center for Health Statistics. Vital Health Stat 6(2).

19s9.

33
33. Blair E, Burton S. Processes used in the formulation of

behavioral frequency reports in surveys, Paper presented at

the annual meeting of the American Statistical Association.

1986,

34, Means B, Loftus EF, When personal history repeats itself:

Decomposing memory for recurring events. Appl Cognitive

Psych 5:297–318. 1991.

35. Tversky A, Kahneman D. Availability A heuristic for judging frequency and probability. In: Kahneman D, Slovic P,

Tversky A, eds. Judgment under uncertainty: Heuristics and

biases. Cambridge: Cambridge University Press, 163-78.

1982.

36, Bruce D, Read JD, The how and why of memory for

frequency. In: Gruneberg MM, Morris PE, Sykes RN, eds.

Practical aspects of memory. Chichester, United Kingdom:

Wiley, 317–22. 1988.

37. Bradburn NM, Rips LJ, Shevell SK. Answering autobiographical questions: The impact of memory and inference

on surveys. Science 198:157-61.1987.

38. Menon G, Sudman S. Increasing the accuracy of respondents’ estimates of behavioral frequencies: A cognitive psychology perspective. Paper presented at the meeting of the

American Association for Public Opinion Research, St.

Petersburg, Florida. 1990,

39. Tukey JW. Exploratory data analysis. Reading, Massachusetts: Addison-Wesley. 1977.

40. Schiffman S. Personal Communication. 1990.

41. Bradburn NM, Sudman S, and Associates. Improving interview method and questionnaire design. San Francisco:

Jossey-Bass, 168.1979.

42. Sudman S, Bradbum NM. Asking questions: A practical

guide to questionnaire design. San Francisco: Jossey-Bass.

1982.

43. Crespi I, Swinehart JW, Some effects of sequenced questions using different time intervals on behavioral selfreports, Paper presented at the American Association of

Public Opinion Research. 1982.

44. Public Health Service. The health consequences of smoking:

Cancer and chronic lung disease in the workplace. A report

of the Surgeon General. Washington: Public Health Service,

1985.

45. Swan GE, Denk CE. Dynamic models for the maintenance

of smoking cessation: Event history analysis of late relapse, J

Behav Med 10:527-54.1987.

46. Stoto MA. Estimating age-specific transition rates for population subgroups from successive surveys: Changes in adult

rates of cigarette smoking. Paper presented at 1986 annual

meeting of the Populations Association of America. 1987.

47. Marlatt GA. Relapse prevention: Theoretical rationale and

overview of the model. In: Marlatt GA, Gordon JR, eds,

Relapse prevention. New York: Guilford Press. 1985.

48. Wagenaar WA. My memory: A study of autobiographical

memory over six years, Cognitive Psych 18:225-52. 1986,

49. Stein NL, Nezworski T. The effects of organization and

instructional set on story memory. Discourse Processes

1:177–93. 1978,

50. Swan GE, Denk CE, Parker SD, Carmelli DC, Furze T,

Rosenman RH, Risk factors for late relapse in male and

female ex-smokers. Addictive Behaviors 13:253-66.1988.

51. Krosnick JA. Response strategies for coping with the cognitive demands of attitude measures in surveys. Appl Cognitive Psych 5:213-36.1991,

52. Collins LM, Graham JW, Hansen WB, Johnson CA. Agreement between retrospective accounts of substance use and

earlier reported substance use. Appl Psych Measurement

9:301-09.1985.

53. Markus GB. Stability and change in political attitudes:

observed, recalled, and “explained.” Political Behavior

8:21-44.1986,

54. Strube G, Neubauer S. Remember that exam? In: Gruneberg MM, Morris PE, Sykes RN, eds, Practical aspects of

memory. Chichester, United Kingdom: Wiley. 1988.

55. Loftus EF, Marburger WM. Since the eruption of Mt. St,

Helens has anyone beaten you up? Improving the accuracy

of retrospective reports with landmark events, Memo~ and

Cognition 11:114-20, 1983.

34
Appendixes

Contents

I. Study l: Recruiting and screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

11. Study l: Initial interview protocol.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

III. Study l: Second interview protocols, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

IV. Study 2: Interview protocols, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

V, Study 3: Respondents locating and recruitment procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

VI. Study 3: Interview protocols, by condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Appendix figure

L Recruitment and sampling of smokers from mid-Peninsula and South Bay regions of the San Francisco Bay

Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3’7

35
Appendix I

Recruiting and

screening

Sample selection

Recruiting of potential respondents

Respondents were recruited between February and

August 1990, from the surrounding communities of SRI

International, which included Menlo Park, Palo Alto,

Redwood City, Mountain View, Belmont, and Sunnyvale,

California. Posters soliciting smokers were posted in businesses (for example, business offices, retail establishments,

bars, restaurants, car dealerships), libraries, bus stops, and

train stations within a l-mile radius of SRI. Classified

advertisements were published in the daily newspapers of

these cities, as well as in four weekly papers covering

readership from San Jose to South San Francisco. The

advertisement read, “Smokers Wanted, earn $45 for one

week’s participation in an SRI International study on

smoking patterns. Call (415) 859–3456.” In addition, some

respondents were referred by word-of-mouth from previous participants.

Interested participants called and listened to a brief

recording on an answering machine, with a description of

initial screening criteria (items 2–5 listed below) and a

brief description of the procedure they would be asked to

follow to help investigate smoking patterns. Respondents

were never told that the study was investigating memory.

If candidates were still interested after listening to the

recording, they were instructed to leave their name and

phone number so someone could call them and set up an

appointment or answer additional questions. Once a message was received, candidates were phoned within a week

to screen for participation and to set up an interview

appointment. Before an interview could be scheduled, the

following items were screened over the phone with the

candidate (the acceptable response is indicated in parentheses):

1.

2,

3.

4.

5.

6.

7.

36

Have you already participated in this study? (No)

Do you only smoke cigarettes (for example, not a pipe

or other tobacco)? (Yes)

Are you between the ages of 18 and 65? (Yes)

Do you smoke an average of at least five cigarettes a

day? (Yes)

Are you trying to quit smoking? (No)

Are you on any medications that might affect your

memory? (No)

Do you have a permanent residence? (Yes)

8,

9.

10.

11

Are you able to understand English well enough to

learn how to use the hand-held computer? (Yes)

Would you be able to carry a small, hand-held computer with you 24 hours a day for 6 days? (Yes)

Would you be able to participate in a one-half hour

interview at SRI International, in Menlo Park on a

Friday between 8 a.m. and 6 p.m.? (Yes)

Would you be able to participate in a 30-minute to

l-hour long followup interview at SRI International,

in Menlo Park on the following Thursday between 8

a,m and 6 p.m.? (Yes)

Many of these criteria were checked simply through

the course of informal conversation rather than in a

structured interview format. In some cases, however, respondents were probed further because of something

unusual mentioned in the conversation. Because of the

relatively complex procedure for collecting the data and

the cost of the electronic diary, potential respondents

whose responses suggested a tendency towards unreliability were thanked for their interest but denied participation.

Respondents were called each Thursday to confirm

their appointment and time for the next day, to make sure

that they knew SRI’s location, and to tell them whom to

contact once they arrived.

Response rates

Figure I summarizes the response, screening, and

participation rates. Of the 246 candidates who left a

message indicating interest in the study, after speaking

with them on the phone, 70 (28 percent) were screened

out for ineligibility based on the screening criteria. Reasons for screening out respondents spanned the entire

range of items (1–11).

Of the 176 candidates (72 percent) who passed the

initial screening and were scheduled for an interview, 40

(23 percent) canceled or did not show up. Eight (4 percent) were dropped because they were unable to complete

the entire procedure (that is, two were unable to understand the electronic diary procedure, one lost the electronic diary, two experienced technical difficulties and

declined to participate another week, two declined to

participate after completing the initial interview, and one

returned several days late for the second interview), The

remaining 128 candidates (73 percent) completed all

phases of participation.
n

246

Responded

to advertisements

in the local area

r

----- 1

m28% (70)

Did not maet

selection criteria

&

72% (176)

Met selection

criteria

r

---- —-1

m p-l

73% (128)

Completed all

phases of

participation

Figure L Recruitment and sampling of smokers from the

mid-Peninsula and South Bay regions of the San Francisco Bay

Area

37
Appendix H

Study 1: Initial

interview protocol

Overview

There were three essential goals of the initial interview —completion of the interview record form, explanation of how to use the electronic diary (ED), and

encouragement to comply with the data collection

procedure.

Interview record form

After a brief overview of the purpose of the study,

respondents were asked a series of questions about the

type of cigarettes they smoke and how they usually smoke

them. This 5-minute protocol was used primarily to divert

the respondent’s attention away from the issue of frequency of cigarettes smoked. The items included in this

section of the interview are listed on the interview record

form at the end of this appendix.

Summary of electronic diary training

The interviewer set up the ED for training mode (in

which entries are not stored) so that all instructions could

be hands-on for the respondent. Respondents were told

that they would need to respond to the ED on two types of

occasions —just before smoking each cigarette and when

the ED prompts them by “beeping,” which could be up to

five times a day. At the end of the training section of the

interview, respondents were required to demonstrate their

ability to record a cigarette, respond to prompts, suspend

prompts, and set the wake-up alarm.

Data collection compliance

encouragement

Finally, throughout the training, respondents were

given several incentives to comply with the procedure.

Missed prompts would be recorded, too many suspends

were discouraged, and the sleep function was only to be

used when actually sleeping, Respondents received an

instruction card and an error card that fit into the carrying

case for the ED, as well as a number to call if problems

arose. They signed a pledge form promising to take good

care of the ED and to record all of their cigarettes and

were told that they could also receive a $5-bonus for

exempla~ compliance. Once the ED was taken out of

training mode and set up for regular data collection, the

cover was positioned so that onIy the top SLYkeys were

visible, and using a screw on the back of the unit, the

computer was sealed shut.

The interviewer’s protocol of the initial interview for

all conditions and the interview record form follow on the

remaining pages in this appendix.

38
INTERVIEWER’SPROTOCOL

INITIAL INTERVIEW:

ALLCONDITIONS

We’re trying to learn more about the variables that affect the nicotine

dosage a person receives from each cigarette smoked. Today, I’m going to ask

you questions about the type of cigarettes that you smoke and how you usually

smoke them. Then I’m going to explain our procedures for monitoring your

smoking and show you how to use an electronic diary to record the time of day

for every cigarette you smoke.

First, though, I need to give you this form that describes your rights

and the things that you’ll be asked to do during the study. Please read it

over carefully, ask any questions that you have, then sign the form,

indicating your consent to participate.

[After completing consent form.] OK, this copy is for you to keep.

Now we can get started. First, I need a description of the brand of

cigarettes you smoke most frequently. Can you show me a pack? I’m going to

record all the information here so that we can obtain tar and nicotine levels

for your cigarette type.

[Go through Interview Record Form items.]

OK. Good. Now, I need to explain the procedures we’re going to use to

get an accurate assessment of your smoking. From the time you leave this

interview until you come back next Thursday, you’ll record each cigarette you

smoke on this device. When you indicate that you are about to smoke a

cigarette, this Electronic Diary (ED) will automatically store the time of

day. This way, we’ll know exactly how long you go between cigarettes.

ELECTRONICDIARY(ED) TRAINING

The Electronic Diary (ED) [Show ED to subject] will record when you

smoke. In addition, the ED will beep you throughout the day to make sure

that you’recarryingit,withyou. So, it’sessentialthatyou carrythe ED

at all times. We’re not asking you to change your everyday smoking or

activity patterns, just to carry the ED and record each cigarette you do

smoke.

You’ll need to respond to the ED on two types of occasions:

(1) when you smoke

(2) when the ED “beeps” you

In addition, you’ll need to know how to put the ED to sleep and set the alarm

when you go to bed at night. I’m going to show you how to do each of these

things and also give you a sheet of directions to take with you.

[Turn ED on and start training program. Training prompt wi17 go off in 1

minute.]

39
Key Pad Orientation

[Show key pad to subject ]

ON used to initiate any interaction

MODE - used to record responses or make choices

LEFT/RIGHT - used to see choices

So ON is how you start an interaction and MODE is what you use to enter

your response onto the ED.

Responding to a Prompt

Up to 5 times a day the ED will prompt you by sounding a beep randomly.

When the prompt sounds the ED display looks like this [Mait for ED to begin

prompting. Let subject hear both alarms.] The ED will beep for a period of

2 minutes. If for some reason you do not hear the first beep, the ED changes

its “beep” to a siren-like sound after 1 minute. If you do not respond to the

second alarm, it will turn off and record that you have missed the prompt. We

will keep track of how many prompts you miss, so you want to keep the number

of missed prompts to a minimum.

To respond to a beep, simply press the ON during the alarm.

We want you to avoid missing prompts. To help do this you can:

(1) Place the ED on a hard surface (1ike a desk or a table) as much as

possible since this increases the volume of the alarm.

(2) Keep the ED as close to you as possible so that the alarm will be

audible at all times.

Recording a Cigarette

Just before smoking, press the ON key [Have subject turned-on.].

The screen will look like this [point to screen disp7ay of ED.] The left

and right arrows are used to move back and forth between different menu

choices [show on computer]. Since the menu will show CIGARETTE after you

press ON, all you have to do is press MODE to select the cigarette option.

The M in the upper right-hand corner is a reminder to press MODE to register

your choice. Press MODE and see what the ED displays:

Entry Complete

Recording...

This message indicates that your entry has been recorded and the ED is

turning off. You should see this message at the end of every interaction you

start with the ED. Ifyoudon’t see it, you haven’t finished.

40
Review basic steps - ON (initiation)

make choice

- hit MODE

It’s essential that you record ALL of your cigarettes just before you

smoke. If you forget and start smoking, please record the cigarette as

soon as you remember. If you remember within 5 minutes of actually smoking

it, use the ED as I’ve just shown you. If more than 5 minutes has gone by,

use this Error Card. The card has a place for the date and the time of day

which you fill in and then just note “smoked cigarette.” We have you use

this instead of the ED because if you entered a forgotten cigarette an hour

later, the ED record would show the wrong time.

Suspend

We recognize that it may sometimes be severely inconvenient to be

“beeped” -- in situations like ceremonies or very important business

meetings. So we’ve made it possible for you to suspend all prompts for up

to 2 hours.

Putting the ED into Suspend mode stops the prompts but allows you to

record cigarettes. So, ifyou’re in a situation where you absolutely can’t

be beeped, set the ED on Suspend mode. Please, use this Wwhen being

prompted would be very disruptive.

To use the Suspend function [/favesubject use ED]:

(1) Press ON to get Entry menu.

(2) Use the Right arrow key twice to select “Suspend.”

(3) Press MODE to enter this Choice.

(4) The ED now displays “Time to Suspend.” You have a choice of eight

intervals ranging from 15 minutes to 2 hours. Using the LEFT/RIGHT

arrow keys, select the desired Suspend interval. Press MODE to enter

choice. The ED will remind you to “Record each Cigarette.”

(5) Press MODE once and the ED reminds you to “Record each Cigarette.”

(6) Press MODE a second time and the ED is in the Suspend mode.

At the end of the Suspend interval, the ED will sound the alarm in the same

manner as a prompt. This signals the end of the Suspend mode and is a

regular prompt. After responding to this prompt, the ED returns to normal

functioning.

It’s essential that you record your cigarettes even when you’ve

suspended all prompts. The procedure for this is identical to recording a

cigarette normally. [Review cigarette entry. ]

41
Please use the suspend function as little as possible. When you do use

Suspend, you want to make sure that you set it for long enough that the

end-of-Suspend alarm doesn’t go off in the middle of the very event you

didn’t want interrupted. When you use Suspend, it’s a good idea to set it

for more time than you think you’ll need. Then, it’s possible to get out of

the Suspend mode when your circumstances change and prompting would no

longer be a problem. We ask that you do interrupt the Suspend interval if

you can respond to prompts before it’s over.

To do this: [/favesubject use ED. ]

(1) Press ON. The ED will display the Choice menu.

(2) Use the Right arrow key to get to the “Resume” choice.

(3) Press MODE to enter this selection. The ED now

displays the heading “Resuming normal operation.”

(4) Press MODE and the ED is back to normal.

Sleep Timer

When you’re ready to go to bed at night, you must put the ED “to sleep”

also. Do this ONLY when you’re going to sleep. You can set an alarm to

wake you up in the morning, just like a clock radio.

[Go through steps on Instruction Card, having subject follow with

ED. Have subject set alarm for2 minutes from current time on ED. Do not

forget to mention:]

- ED uses 24-hour time

use left/right keys to switch from hours to min.

use up/down keys to change time

- ED will not let you set a wake-up time of less than 30 minutes or

more than 12 hours from the current time.

In the morning the ED will sound an alarm for a period of 2 minutes.

Press the ON key and the ED will display a good morning message that looks

1ike this. [wait for El)to being sounding the a7arm.]

If you do not want to get up immediately when the alarm sounds, you can

sleep a little longer by using the ED’s “Snooze” option. [Have subject

fo770w the steps on the Instruction Card.] When the ED sounds the alarm,

just press ON to get the Wake Up menu and then use the right arrow key to

get to the Snooze option on the menu. The ED then displays “Minutes to

Delay” and gives you a choice of 5, 10, 15, or 20 minutes to snooze. Use

the LEFT/RIGHT arrow keys to select the snooze interval you want and press

MODE to enter your selection.

When the snooze interval is over, you get the same beep as with the

wake-up alarm and after pressing ON, you will see the regular Wake Up menu.

42
If you miss the alarm the first time, it will continue to “beep” you

every 15 minutes until you respond to it. At any time during this period

you can press ON, then MODE, and the ED will be ready to go.

Breaking Sleep Mode

If you wake up in the middle of the night to smoke, you need to wake up

the ED so that you can record the cigarette. [Have subject put ED to

sleep according to a morning wake-up time.] To wake the ED up early,

press ON, then MODE. The ED is now awake. Record your cigarette as usual.

Do not forget to put the ED back to sleep before you return to bed.

Oops! Function

I If you press ON to record a cigarette or initiate a suspend and then

change your mind, you can get out of the interaction by pressing the right

arrow key until you see the OOPS! display. Press MODE and the ED will turn

off without recording anything. The OOPS! function only works if you use it

before pressing MODE. You cannot change an entry once you have hit MODE.

If you do make a mistake and enter wrong information on the ED or

forget to enter a cigarette, you have a backup in the 3 X 5 card. Keep this

card with you all the time. We hope that you will not make any mistakes in

using the ED, but if you do, write the date and time on this card and

indicate whatever happened. For example, you might have recorded a

cigarette but then been interrupted and ended up not smoking it. Just write

the time and date and note “Recorded cigarette but didn’t smoke it.” Or you

might have awakened early and forgotten to wake up the ED. If this happens,

write “Actual wake up time at ....” and then indicate the date and time to

the best of your knowledge. It is important that you use this card to make

any necessary corrections to the ED record. Be sure and record the date and

time as well as the correction because we will be computing things such as

time between cigarettes.

Summary

Although we have covered a fair amount, there are really just two basic

things you need to know:

(1) - how to enter a cigarette and

(2) - how to respond to a prompt.

The two other ED functions we covered are:

- sleep timer

- suspend.

Now I’d like for you to show me that you know how to do each of these

things. First, showme how you would record a cigarette...[Check off

ski77s on Interview Record Form.]

43
PIedge

Do you have any questions about this? I’m going to ask you to sign

this pledge saying that you will record each cigarette you smoke from the

time you leave this office until you return for your interview next Thursday

and that you will take good care of the ED.

As you can see, I’m sealing up the unit. Please only use the six

exposed buttons on the top row. We are asking that you please do not open

up the case. It would be very easy to accidentally wipe out our research

data. Also, please do not:

--- lend the ED to others

--- let others use your ED

--- leave the ED anywhere.

Your second interview is scheduled for XXXXXXX. Is that still OK for

you? You’ll come back here and bring the ED with you. Your appointment

time is written on the back of your Error Card. Please call us if you need

to reschedule. Also on the back of your Error Card is a phone number and

the name of someone you may call if any you have any questions or problems

before returning next Thursday. Please call us immediately should any

problems or questions arise.

At your second interview, we’ll get the physiological measure of the

nicotine dosage you experienced over the past few days.

After we’ve had a chance to check the data recorded on the electronic

diary, we’ll send you a check in compensation for your participation.

You’ll receive $45 for participating in all phases of the study and using

the ED conscientiously every day. We’re also giving a $5 bonus to subjects

who are in the top 25% in terms of responding to all the beeps and

minimizing the number of suspends. In addition, we’ll prepare a record of

your smoking for you so that you’ll be able to see how long you go between

cigarettes and the times of day when you smoke the most. Once the entire

study is finished and the data are analyzed, we’ll send you a record of your

results and the study’s findings.
INTERVIEWRECORD FORN

Subject ID

1. Cigarette Brand

Length is Regular/ King Size

100 mm

— 120mm

Softpack? — yes Mentholated? Yes

No — NO

“Lights”? Yes Filtered? Yes

— NO No

2. HOW much ,ofeach cigarette usually smoke? Less than 1/4

Between 1/4 and 1/2

Over 1/2

Most all of it

3. How often leave on ashtray? Less than 1/4 time

Between 1/4 and 1/2

1/2 or more of time

Almost every time

4. How much time between cigarettes?

5. How deeply inhale? Just puff, don’t really inhale at all

Inhale into the chest, but not too deeply

Inhale into the chest deeply

6. Are there restrictions on smoking at your place of work?

— yes Describe them

— NO

45
Initial Int Record 2

7. How often do you buy cigarettes?

times per Day Week Month

[circle one]

8. Do you usually buy them by the carton or by the pack?

Carton Pack

9. Do you use any tobacco other than cigarettes?

Substance Use Inhale?

Cigars/cigarillos — yes — NO

Pipe — yes — NO

Chewing tobacco NA

Nicorette gum NA

10. Are you frequently exposed to passive smoking?

[circ7e one]

Yes

No [Go to Q1O]

Weekly Freauencv

cigars

bowlS

can(s)

sticks

— y= Describe

— NO

11. Saturday/Sunday smoking compared to weekdays

More on Saturday/Sunday

Less on Saturday/Sunday

About the same

12. Body Frame — small

Medium

Large

13. Height Weight 100-125 lbs.

126-150

151-175

176-200

201-225

226-250

251-275

276-300

Over 300

14. Second interview date/time

46
CHECK-OFF FOR ED USE SKILLS

1. Record a cigarette

2. Respond to a prompt

3. Set sleep timer

4. Set Suspend

47
Appendix Ill

Study 1: Second

interview protocols, by

condition
~. INTERVIEW RECORD FORM

2-2-90

Condition: Study 1 Free Strategy Date:

Time:

s#: Interviewer:

I’m going to start by asking you some general questions about your

background, just so that we’ll be able to describe our participants.

[Estab7ish pacing typica7 of national surveys with these initia7 items.]

Your current age:

Occupation:

Highest year of education completed:

Were you born in U.S.? What state?

Age at which you started smoking?

Are you married?

[If yes] Does your spouse smoke?

SMOKING FREQUENCY

Q1. How many cigarettes did

Do you think that’s the

ADJUSTED TOTAL _

you smoke yesterday?

correct number or would you change it?

STRATEGY REPORT

Q2. Now I’d like to ask you to think about ~you answered the question

about how many cigarettes you smoked. Can you describe what you were

thinking from the time I asked the question until you gave your final answer

of X cigarettes?

49
Free p. 2

Q3. [Show strategy card.] Here Is a list of different methods people

use to answer questions about how many cigarettes they smoke. Which of these

is closest to what you did?

—1 =

—2 =

—3 =

—4 =

—5 =

—6=

—7 =

Think of each individual event for the entire day and add up

the total number.

Divide the day up into parts (such as during work and after

work); recall each individual event within each part; and

then add up the total.

Divide the day up into parts (such as during work and after

work); rely on knowledge about how often I usually smoke

during each part; and then add up the numbers to get a total.

Give the first number that comes to mind, a gut reaction or

guess.

Rely on knowledge about my usual daily total for smoking.

Make an inference from a fact I remembered (e.g., opening a

new pack).

A combination of the above. (Specify which ones and how they

were combined.)

—8= None of the above. (Describe how you did arrive at a

number.)

CONFIDENCE ESTIMATE

Q4. How confidentare you that the numberof cigarettesyou gave is correct?

1 = I think I could be off by more than 10 cigarettes.

2 = I think the number is off by 5-10 cigarettes.

3 = I think the number is off by no more than 4 or 5 cigarettes.

4 = I think the number is off by no more than 2 or 3 cigarettes.

5 = I think the number is off by no more than 1 cigarette.

MONDAY SMOKING

NOW, I’d like you to try to remember your smoking on a different day.

How many cigarettes did you smoke on Monday?

Q5. Number Cigarettes =

Do you think that’s the correct number for Monday or would you change it?

ADJUSTED TOTAL

50
Free p. 3

Q5a. How confident are you that the number of cigarettes you gave is

correct?

= I think I could be off by more than 10 cigarettes.

—i = I think the number is off by 5-10 cigarettes.

—3 = I think the number is off by no more-than 4

4 = I think the number is off by no more than 2

5 = I think the number is off by no more than 1

SATURDAY SMOKING

Now, I’d like you to try to remember your smoking once

cigarettes did you smoke on Saturday?

Q6. Number Cigarettes =

or 5 cigarettes.

or 3 cigarettes.

cigarette.

more. How many

Doyou think that’s the correct number for Saturday or would you change it?

ADJUSTED TOTAL

Q6a. How confident are you that the number of cigarettes you gave is

correct?

= I think I could be off by more than 10 cigarettes.

—i= I think the number is off by 5-10 cigarettes.

3 = I think the number is off by nomore4 = I think the number is off by no more

—5 = I think the number is off by no more

COLLECTION OF SALIVA

Turn off tape recorder. Have subject hold cotton in

Invite him/her to read own material or 7ab materia7.

afterward.

than 4 or 5 cigarettes.

than 2 or 3 ci~arettes.

than 1 cigarette.

mouth for 5 minutes.

Offer drink of water

[Turn tape recorder on. ] OK. Now I’d like to ask you a few questions

about your experiences recording your cigarettes on the ED.

Q7. Was it diffiCU1t to remember to record your cigarettes?

— yes

No [Go to09]

Q8. Whatmade it difficult?
Q9. Were there some occasions

on the ED or the Error Card?

— yes

No [Go tO Qll]

Q1O. Please describe each one

Free p. 4

when you had a cigarette and did not record it

and tell me what day it happened.

Total not recorded per week Total not recorded on target days:

Wed Mon Sat

Q1l. Do you think that you changed the number of cigarettes you were smoking

because you were in this study?

— y=

No [Go to Q13]

Q12. tiOWSO?

Cut down by cigarettes a day

Increased smoking by cigarettes a day

— Other

Q13. Whi1e you were recording your cigarettes on the ED, did you think that

you might be asked to remember how many cigarettes you smoked on a particular

day?

— yes

— NO

~Inform subject that after data are uploaded from the hand-held computer

and checked for completeness, you’ll send a check for participation and a

printout ofhis/her smoking record. Remind subject that you’ll also be

sending a description of results after the whole study is completed.]

Do you have any comments or questions for us?

Are there any changes in procedure you would suggest to make recording

cigarettes easier or more efficient?

52
INTERVIEW RECORD FORM

2-2-90

Condition: Study 1 Availability Date:

s#: 21- Time:

Age: Interviewer:

STRATEGY PRACTICE

[Turn on tape recorder.] I‘m going to ask you to try to answer some

questions about how often you did certain things yesterday and I want you to

try to give me as accurate an answer as you can. I also want you to arrive

at your answer in a particular way.

When I ask you how often you did something...say getting into a car on a

certain day...I want you to just give me your gut reaction, the first number

that comes to you without trying to think of all the instances.

How many times did you get into a car yesterday?

Now, how many times did you make a phone call to someone?

Got into a Car Made a Phone Call

SMOKING FREQUENCY

Now, I’d like you to try out this method once more. This time, tell me your

gut reaction, how many cigarettes did you smoke yesterday?

Q1. Number Cigarettes =

Do you think that’s the correct number for yesterday or would you change it?

ADJUSTED TOTAL

STRATEGY REPORT

Q2. NowI’d 1ike to ask you to think about ~ you answered the question

about how many cigarettes you smoked. Can you describe what you were

thinking from the time I asked the question until you gave the final answer

of X cigarettes?

53
Avail p. 2

Q3. [Show sttwtegy card.] Here is a list of different methods people

use to answer questions about how many cigarettes they smoke. Which of these

is closest to what you did?

—1 =

—2 =

—3 =

—4=

—5 =

—6=

—7 =

Think of each individual event for the entire day and add up

the total number.

Divide the day up into parts (such as during work and after

work); recall each individual event within each part; and

then add up the total.

Divide the day up into parts (suchas duringwork and after

work); rely on knowledge about how often I usually smoke

during each part; and then add up the numbers to get a total.

Give the first number that comes to mind, a gut reaction or

guess.

Rely on knowledge

Make an inference

new pack).

about my usual daily total for smoking

from a fact I remembered (e.g., opening a

A combination of the above. (Specify which ones and how they

were combined.)

—~ = li:ie:f)the above. (Describe how you did arrive at a

.

CONFIDENCE ESTIMATE

Q4. How confident are you that this number is correct? [Show card.]

= I think I could be off by more than 10 cigarettes.

—i= I think the number is off by 5-10 cigarettes.

3 = I thinkthe numberis off by no more than 4 or 5 cigarettes.

4 = I think the number is off by no more than 2 or 3 cigarettes.

5 = I think the number is off by no more than 1 cigarette.

MONDAY SMOKING

Now, I’d like you to try to remember your smoking again, using the same

method, this time for Monday. Again, tell me your gut reaction, how many

cigarettes did you smoke on Monday?

Q5. Number Cigarettes =

Do you think that’s the correct number

ADJUSTED TOTAL

for Monday or would you change it?

54
Avail p. 3

Q5a. How confident are you that this number is correct? [Show card.]

1 = I think I could be off by more than 10 cigarettes.

—2 = I think the number is off by 5-10 cigarettes.

—3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

5 = I think the number is off by no more than 1 cigarette.

SATURDAY SMOKING

Now, I’d like you to try to remember your smoking one more time. Again,

tell me your gut reaction, how many cigarettes did you smoke on Saturday?

Q6. Number Cigarettes =

Do you think that’s the correct number for Saturday or would you change it?

ADJUSTED TOTAL

Q6a. How confident are you that this number is correct? [ShcIw card.]

= I think I could be off by more than 10 cigarettes.

—i= I think the number is off by 5-10 cigarettes

—3 = I think the number is off by no more than 4 or 5 cigarettes

—4 = I think the number is off by no more than 2 or 3 cigarettes

—5 = I think the number is off by no more than 1 cigarette.

COLLECTION OF SALIVA

Turn off tape recorder. Have subject hold cotton in mouth for 5 minutes.

Invite him/her to read ownmateria7 or Iab material. Offer drink of water

afterward.

[Turn tape recorder on. ] OK. Now I’d like to ask you a few questions

about your experiences recording your cigarettes on the ED.

Q7. Was it difficult to remember to record your cigarettes on the ED?

— yes

No [Go toQ9]

Q8. What made it difficult?

Q9. Were there some occasions when you had a cigarette and did not record it

on the computer or the ED?

— yes

No [Go to Qll]

55
Avail p. 4

Q1O. Please describe each one and tell me what day it happened.

Total not recorded per week Total not recorded on target days

Wednesday Monday Saturday _,

Q1l. Do you think that you changed the number of cigarettes you were smoking

because you were in this study?

— yes

No [(ioto Q13]

Q12. tiOWSO?

Cut down by._

Increased smoking

— Other

cigarettes a day

by — cigarettes a day

Q13. While you were recording your cigarettes on the ED, did you think that

you might be asked to remember how many cigarettes you smoked on a particular

day?

— yes

— NO

[Inform subject that after data are uploaded from the hand-held computer

and checked for completeness, you’77 send a check and a prfntout of his/her

smoking record. Remind subject that you’77 a7so be sending a description of

resu7ts after the who7e study is competed.]

Do you have any comments or questions for us?

Are there any changes in procedure you would suggest to make recording

cigarettes easier or more efficient?

56
2/2/90

Condition: Study 1 Additive

s#: 21-

Age:

STRATEGY PRACTICE

Turn on tape recorder.]

INTERVIEW RECORD

Decomposition

FORM

Date:

Time:

Interviewer:

I’m going to ask you to try to answer some

questions about-how often you did ~ertain things yesterday and I want you to

try to give me as accurate an answer as you can. I also want you to arrive

at your answer in a particular way.

When I ask you how often you did something...say getting into a car on a

specific day...I want you to first think about your typical day and divide

your day up into parts. Then I’d like you to think about how often you

usually do whatever it is we’re talking about during each of those portions

of your typical day. Finally, you should add up all the pieces to get a

total for the day.

First, we have to figure out how to divide up your typical weekday.

OK, let’s use these divisions to figure out how many times you got into

a car yesterday. Typically, how often do you get into a car ...[Using

divisions subject selected]. So that would be X times. Is that a good

estimate for yesterday or would you change it? [Allow subject to adjust

esttn)ateif desired.]

Now I want you to figure out how many times you make a phone call to

someone in a typical day, using the same method. So that makes Y times that

you place a call to someone. Is that a good estimate for yesterday or would

you change it?

Dav Divisions

1.

2*

3*

4.

5.

6.

7.

8.

Got into a Car Made a Call

TOTAL

57
Add Decomp p. 2

SMOKINGFREQUENCY

Now I’d like you to use this method once more. This time,

about how many cigarettes you smoke in a typical day. How many

you typically smoke...[Use first division, etc.]

Dav Divisions

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Q1. TOTAL (Sum of 1-10)

let’s talk

cigarettes do

OK, so that equals X cigarettes on a tvDical day. Do you think that’s

the right number foryesterd;y or would you”~hange it? -

ADJUSTED TOTAL

STRATEGY REPORT

Q2. Now I’d like to ask you to think about ~you answered the smoking

question about how many cigarettes you smoked. Can you describe what you

were thinking from the time I asked the question until you gave your final

answer of X cigarettes?

58
Add Decomp

Q3. [Show strategy card. ] Here is a 1ist of different methods people

use to answer questions about how many cigarettes they smoke. Which of

is closest to what you did?

p. 3

these

—1=

—2 =

—3’

—4 =

—5=

—6 =

—7=

Think of each individual event for the entire day and add up

the total number.

Divide the day up into parts (such as during work and after

work); recall each individual event within each part; and

then add up the total.

Divide the day up into parts (such as during work and after

work); rely on knowledge about how often I usually smoke

during each part; and then add up the numbers to get a total.

Give the first number that comes to mind, a gut reaction or

guess.

Rely on knowledge about my usual daily total for smoking

Make an inference from a fact I remembered (e.g., opening a

new pack).

A combination of the above. (Specify which ones and how they

were combined.)

8= None of the above. (Describe how you did arrive at a

number.)

CONFIDENCE ESTIMATE

Q4 . How confident are

correct? [Show card. ]

1 = I think

—2 = I think

3 = I think

4 = I think

5= I think

MONDAY SMOKING

Now, I’d like .YOU

you that the number of cigarettes you gave is

I could be off by more than 10 cigarettes.

the number is off by 5-10 cigarettes.

the number is off by no more than 4 or 5 cigarettes.

the number is off by no more than 2 or 3 cigarettes.

the number is off by no more than 1 cigarette.

to try to remember your smoking on a different day,

again using the sama method,-this time for-Monday. Was Monday a typical day

for you? [If yes] Well, on a typical day you said that you [recap

subtota7s] for a total of’X cigarettes. Do you think that’s the correct

number for Monday? [If Monday atypica7, get new divisions and go through

additive decomp procedure as for Wed.]

Q5. ADJUSTED MON TOTAL =

59
Add Decomp. 4

Q5a. How confident are you that the number of cigarettes you gave is

correct? [Show card.]

= I think I could be off by more than 10 cigarettes.

—i= I think the number is off by 5-10 cigarettes.

—3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

—5 = I think the number is off by no more than 1 cigarette.

SATURDAY SMOKING

Now, I’d like you to try to remember your smoking once more. Again,

think about how much you smoke in each part of your day, but this time I want

to know about Saturday, so you may need to divide your day differently.

[Get new divisions and go though additive decomp]

Q6. Number Cigarettes =

Do you think that’s the correct number for Saturday or would you change it?

ADJUSTED SAT TOTAL

Q6a. How confident are you that the number of cigarettes you gave is

correct? [Show card.]

= I think I could be off by more than 10 cigarettes.

—i= I think the number is off by 5-10 cigarettes.

3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

—5 = I think the number is off by no more than 1 cigarette.

COLLECTIONOF SALIVA

Turn off tape recorder. tlavesubject hold cotton in mouth for5 minutes.

Invite him/her to read own material or lab material. Offer drink of water

afterward.

[Turn tape recorder on.] OK. Now I’d like to ask you a few questions

about your experiences recording your cigarettes on the ED.

Q7. Was it difficult to remember to record your cigarettes?

— yes

No [Go

Q8. What made it

to Q9]

difficult?

60
Add Decomp p. 5

Q9. Were there some occasions when you had a cigarette and did not record it

on the ED or on the Error Card?

Q1O. Please describe each one and tell me what day it happened.

Total not saved per week Total not saved on each target

day (Wed) (Men) (Sat)

Q1l. Do you think that you changed the number of cigarettes you were smoking

because you were in this study?

— yes

No [Go to Q13]

Q12. How SO?

Cut down by cigarettes a day

Increased smoking by cigarettes a day

Other

Q13. While you were recording your cigarettes on the ED, did you think that

you might be asked to remember how many cigarettes you smoked on a particular

day?

— Yes

— NO

[Inform subject that after data are uploaded from the hand-held computer

and checked for completeness, you’ll send a check and a printout of his/her

smoking pattern. Remind subject that you’ll also be sending a description of

resu7ts when the whole study is completed.]

Do you have any comments or questions for us?

Are there any changes in procedure you would suggest to make recording

cigarettes easier or more efficient?

61
2-2-90

INTERVIEW RECORD FORM

Condition: Study 1 Episodic Date:

s#: 21- Time:

Age: Interviewer:

STRATEGY PRACTICE

[Turn on tape recorder.] I’m going to ask you to try to answer some

questions about how often you did certain things yesterday and I want you to

try to give me as accurate an answer as you can. I also want you to arrive

at your answer in a particular way.

When I ask you how often you did something...say getting into a car...I

want you to think through the day from beginning to end and try to remember

each instance...every time you got into a car on that day. After you’ve

recalled all the instances, we can add them up to figure out how many there

were. OK. Are you ready to try it?

Think about the times you got into a car on Saturday. Tell me about

each time you can remember. [Pause forS reca77.] So that was X times

in all.

Now, let’s try the method again. This time, think about the times you

made a phone call to someone yesterday. Tell me about each one starting at

the beginning of the day. [Pause] So that makes Y times in all.

Got into a Car Made a Call

Incidents

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

TOTAL

62
SMOKING FREQUENCY

Now I’d like

.YOUto fiwre out

Episodic

you to try out this method once more. This time,

how many cigarettes you smoked yesterday. Again,

~hrough tie day from the beginning and-tell me about each cigarette

smoked.

Instance

Q1. So that makes....

Would you say that

smoked yesterday or wouADJUSTED TOTAL

STRATEGY REPORT

I want

go

you

TOTAL

X is the right number for how many cigarettes you

d you change it?

Q2. Now I’d like to ask you to think about ~you answered the question

about how many cigarettes you smoked. Can you describe what you were

thinking from the time I asked the question until you gave your final answer

X cigarettes?

63
Episodic p. 3

Q3. [Show strategy card.] Here is a list of different methods people

use to answer questions about how many cigarettes they smoke. Which of these

is closest to what you did?

—1 =

—2 =

—3 =

—4 =

—5 =

—6=

—7 =

Think of each individual event for the entire day

the total number.

Divide the day up into parts (such as during work

and add up

and after

work); recall-each individual‘event within ~ach part; and

then add up the total.

Divide the day up into parts (such as during work and after

work); rely on knowledge about how often I usually smoke

during each part; and then add up the numbers to get a total.

Give the first number that comes to mind, a gut reaction or

guess.

Rely on knowledge about my usual daily total for smoking.

Make an inference from a fact I remembered (e.g., opening a

new pack).

A combination of the above. (Specify which ones and how they

were combined.)

8= !hieff)the above. (Describe how you did arrive at a

.

CONFIDENCE ESTIMATE

Q4. How confident are you that the number of cigarettes you gave is correct?

—1 = I think I could be off by more than 10 cigarettes.

—2 = I think the number is off by 5-10 cigarettes.

—3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

—5 = I think the number is off by no more than 1 cigarette.

64
Episodic 4

MONDAY SMOKING

Now, I’d like you to try to remember your smoking again, using the same

method, this time for Monday. Can YOU remember Monday? Something particular

that happened that day? Again, I want you to go through the day from

beginning to end, remembering each time you smoked.

Instance

Q5. So that makes .... MONTOTAL

Do you think that’s the correct number for Monday or would you change it?

ADJUSTED MONTOTAL

Q5a. How confident are you that the number of cigarettes you gave is

correct?

—1 = I think I could be off by more than 10 cigarettes.

2 = I think the number is off by 5-10 cigarettes.

—3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

5 = I think the number is off by no more than 1 cigarette.

65
Episodic 5

SATURDAYSMOKING

Now, I’d like you to try to remember your smoking one more time. Again,

I want you to go through the day from beginning to end, remembering each time

you smoked. How many cigarettes did you smoke on Saturday?

Instance

Q6. So that makes.... SATTOTAL

Do you think that’s the correct number for Saturday or would you change it?

ADJUSTEDSATTOTAL

Q6a. Howconfident are you that the number of cigarettes you gave is

correct?

1 = I think I could be off by more than 10 cigarettes.

2 = I think the number is off by 5-10 cigarettes.

3 = I think the number is off by no more than 4 or 5 cigarettes.

—4 = I think the number is off by no more than 2 or 3 cigarettes.

5 = I think the number is off by no more than 1 cigarette.

COLLECTIONOF SALIVA

Turn off tape recorder. Have subject hold cotton in mouth for5 minutes.

Invite him/her to read ownmateria7 or Iab material. Offer drink of water

afterward.
Episodic 6

[Turn tape recorder on.] OK. Now I’d like to ask you a few questions

about your experiences recording your cigarettes on the ED.

Q7. Was it difficult to remember to record your cigarettes on the ED?

— yes

No [Go to(N]

Q8. What

Q9. Were

on the ED

made it difficult?

there some occasions when You had a cigarette and did not record it

or on the Error Card? -

— yes

No [Go tO Qll]

Q1O. Please describe each one and tell me what day it happened.

Total not recorded per week Total not recorded on target

Wednesday — Monday Saturday

days

Q1l. Do you think that you changed the number of cigarettes you were smoking

because you were in this study?

— yes

No [Go to Q13]

Q12. tioW SO?

Cut down by cigarettes a day

Increased smoking by cigarettes a day

— Other

Q13. While you were recording your cigarettes on the ED, did you think that

you might be asked to remember how many cigarettes you smoked on a particular

day?

— yes

— NO

[Inform subject that after data are up70aded from the hand-held computer

and checked for completeness, you’ll send a check and a printout of his/her

smoking record. Remind subject that you’ll also be sending a description of

resu7ts after the whole study is competed.]

67
Episodic 7

Do you have any comments or questions for us?

Are there any changes in procedure you would suggest to make recording

cigarettes easier or more efficient?

68
Appendix IV

Study 2: Interview

protocols, by condition

69
INTERVIEWRECORD FORM

Condition: Study 2 Neutral Date:

s#: Interviewer:

Sex: Site:

Age:

Marital Status:

Highest Year of Education:

Born in U.S.?

Father born in U.S.?

Mother born in U.S.?

SMOKING FREQUENCY

1. Do you smoke?

[If yes] The NCHS

cigarettes people smoke.

Yes

No

is seeking detailed knowledge of how many

I’m aoina to ask you about the number of cigarettes

you smoked yesterday.

answer as you can.

2. [For smokers] How

I’d lik; yo~ to think about it and give me as exact an

many cigarettes did you smoke yesterday?

HEALTHACTIVITIES

I’m going to

health. I’d like

you usually do as

3. Activities

show you a list of some practices that contribute to good

You to look at the list and tell me which of these thinqs

much or more than most people.

Eat fresh fruit and vegetables

Take vitamin & mineral supplements

Drink plenty of water

Get exercise

Not drink in excess or not at all
Neutral p. 2

Avoid fatty foods

Keep a regular schedule of going to bed & getting up

Have a period of relaxation at least 1 X per day

Avoid staying out in the sun a long time without sunscreen or lotion

Include whole grains & fibre in your diet

4. Currently, are you living alone?

Yes [Go to Q7]

— NO

5. How many people age 18 or older are living with you?

6. Of these people, how many smoke?

7. How many of your friends smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

8. Are you employed or going to school?

9. In your present job (or at your school), are there restrictions on

smoking?

No, smoking is allowed anywhere and at any time

Yes [Mark all that apply, below.]

Smoking is allowed only at certain times

Smoking is allowed only in certain places

Smoking is not allowed at all

71
Neutral p. 3

10. In your present job (or at your school), how many of your co-workers (or

fellow students) smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

11. [For smokers] What do you usually do when you are in a public place

that has no rules about smoking?

Light up a cigarette if I want to

Look around to see if others are smoking and then light up

if I want to

Ask others if they would mind if I smoke

Just not smoke

Something else [describe]

12. As part of our study, we are examining the saliva of people who smoke

and people who don’t smoke to compare it for cotinine, a nicotine byproduct.

Would you be willing to give us a sample? This card explains what’s

involved. [Show cmfexp7ainingpr ocedures]

Sample Requested

Sample Supplied

Sample Refused
INTERVIEWRECORD FORM

Condition: Study 2 Stress Date:

s# : Interviewer:

Sex: Site:

Age:

Marital Status:

Highest Year of Education:

Born in U.S.?

Father born in U.S.?

Mother born in U.S.?

SMOKING FREQUENCY

When we interview people about their health habits, we find that many

people’s habits are shaped by stress. When they encounter tension on the job

or at home, they respond by taking a drinking, smoking a cigarette, or eating

something fattening.

Do you find that there are times when stress triggers such behaviors for

you?

Yes

No

1. Do you ever smoke cigarettes because of stress?

[If rIO] Do YOU

[If yes] The NCHS

cigarettes people smoke.

you smoked yesterday. I

answer as you can.

Yes

No

ever smoke cigarettes at all?

Yes

No

is seeking detailed knowledge of how many

I’m going to ask you about the number of cigarettes

‘d like you to think about it and give me as exact an

2. [For smokers]How many cigarettes did you smoke yesterday?

73
Stress p. 2

HEALTHACTIVITIES

I’m going to show you a list of some practices that contribute to good

health. [Show response card] I’d like you to look at the list and tell

me which of these things you usually do as much or more than most DeoDle.

3. Activities

Eat fresh fruit & vegetables

Take vitamin &mineral supplements

Drink plenty of water

Get exercise

Not drink in excess or not at all

Avoid fatty foods

Keep a regular schedule of going to bed and getting up

Have a period of relaxation at least 1X per day

Avoid staying out in the sun a long time without sunscreen or lotion

Include whole grains & fibre in your diet

4. Currently, are you living alone?

Yes [Go to Q7]

— NO

5. How many people age 18 or older are living with You?

6. Of thesepeople,how many smoke?

7. How many of your friends smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

74 ‘
Stress p. 3

8. Are you employed or going to school?

— yes

No [Go to Q12]

9. In your present job (or at your school), are there restrictions on

smoking?

No, smoking is allowed anywhere and at any time

Yes [Mark all that apply, below.]

Smoking is allowed only at certain times

Smoking is allowed only in certain places

Smoking is not allowed at all

10. In your present job (or at your school), how many of your co-workers (or

fellow students) smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

11. [For mokers] What do you usually do when you are in a public place

that has no rules about smoking?

Light up a cigarette if I wanted to

Look around to see if others were smoking and then light up

if I wanted to

Ask others if they would mind if I smoked

Just not smoke

Something else [describe]
Stress p. 4

12. As part of our study, we are examining the saliva of people who smoke

and people who don’t smoke to compare it for cotinine, a nicotine byproduct.

Would you be willing to give us a sample? This card explains what’s

involved. [Show card explaining procedures]

Sample Requested

Sample Supplied

Sample Refused

76
INTERVIEWRECORD FORM

Condition: Study 2 Health Date:

s#: Interviewer:

Sex: Site:

Age:

Marital Status:

Highest Year of Education:

Born in U.S.?

Father born in U.S.?

Mother born in U.S.?

HEALTH ACTIVITIES

I’m going to show you a list of some practices that contribute to good

health. [Show interview card] I’d like you to look at the list and tell

me which of these things you usually do as much or more than most DeoDle.

1. Activities

Benefit? How?

Eat fresh fruit & vegetables

Take vitamin &mineral supplements _

Drink plenty of water

Get exercise

Not drink in excess of not at all _

Avoid fatty foods

Keep.a regular schedule of going to bed &

Have period of relaxation at least 1

Avoid staying out in the sun a

long time-wi~hout sunscreen or lotion

getting up

X per day

Include whole grains & fibre

in your diet

77
Health p. 2

SMOKING FREQUENCY

2. Do you smoke?

Yes

No

[If yes] The NCHS is seeking detailed knowledge of how many

cigarettes people smoke. I’m going to ask you about the number of cigarettes

you smoked yesterday. I’d like you to think about it and give me as exact an

answer as you can.

3. How many cigarettes did you smoke yesterday?

SMOKING ENVIRONMENT

4.

5.

6.

7.

8.

9.

Currently, are you living alone?

Yes [Go

— NO

How many people

to Q7]

age 18 or older are living with you?

Of these people, how many smoke?

How

Are

many of your friends smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

you employed or going to school?

— ~=

No [Go to Qll]

In your present job (or at your school), are there restrictions on

smoking?

No, smoking is

Yes [Mark all

Smoking

Smoking

Smoking

allowed anywhere and at any time

that apply, below.]

is allowed only at certain times

is allowed only in certain places

is not allowed at all

78
Health p. 3

10. In your present job (or at your school), how many of your co-workers (or

fellow students) smoke?

None of them

A few of them

About 1/2 of them

Most of them

All or nearly all of them

11. [For smokers] What do you usually do when you are in a public place

that has no rules about smoking and you want to smoke?

Light up a cigarette if I wanted to

Look around to see if others were smoking and then light up

if I wanted to

Ask others if they would mind if I smoked

Just not smoke

Something else [describe]

12. As part of our study, we are examining the saliva of people who smoke

and people who don’t smoke to compare it for cotinine, a nicotine byproduct.

Would you be willing to give us a sample? This card explains what’s

involved. [Show ctircfexp7ainfng procedures]

Sample Requested

Sample Supplied

Sample Refused

79
Appendix V

Study 3: Subject

locating and

recruitment procedures

Recruitment of subjects

Initially, a list of possible respondents was made from

the 1982 SRI Smoking Study of approximately 2,000

respondent-record files. Since the current study would

attempt to ask respondents to remember past events from

8 to 14 years prior, eligibility was based upon respondents

having indicated at least one or more si~ifcant attempts

to quit smoking during the 5 years prior to participating in

the 1982 study. (“Significant” was at first defined as at

least one 6-month period of smoking cessation. Later, to

recruit a sufficient number of respondents, “significant”

was redefined to be any cessation attempt no longer than 5

years prior.) Of the previous participants, 131 were determined eligible to participate in the new study.

Respondents were recruited from August 1989 to

October 1990, Because the last known address and phone

numbers of the former study were an average of 8 years

old, there was some difficulty in reaching potential participants.

The first step in locating potential respondents was’to

try reaching them by phone at home or at work. About

two-thirds of the 76 respondents were reached at an old

phone number, with an average of about 4 attempts per

respondent, Although all phone numbers on file were

tried, directory assistance was used to confirm the number,

or to list a possible alternate number if the one on file was

found to be incorrect or disconnected. About one-third of

those located for interview were found either through

directory assistance under their name or possible relatives’

names, or from information obtained from former coworkers at an old place of employment. Approximately 10 to 12

phone calls per respondent were needed to finally reach

this group.

If a potential respondent was unreachable by phone,

an attempt was made to contact the person by mail,

However, this method proved to be unsuccessful. Aside

from the initial phone attempt and the letter, an attempt

was made to locate respondents through the local voters’

registrar from three counties, One respondent was located

as a result of this effort,

When the respondent was reached, the research assistant introduced herself and briefly explained that he or

she was being contacted because of his or her participation in a previous study done at SRI a number of years

ago. The assistant would not mention the year of the

previous study but explained that the current study was

related but not a followup. However, recruitment of respondents for the pilot study did mention their year of

participation in the 1982 SRI Smoking Study, Respondents were asked to participate in a one-time interview to

discuss their smoking behavior prior to their participation

in the previous study. They were told that the interview

could be scheduled at a time and place convenient for

them and that it would take no more than 45 minutes, The

SRI’s research assistant explained interest in seeing how

much people can remember about their smoking over a

long period and what cues trigger recall. The respondents

were instructed not to look at any records or to do any

checking on their past smoking history prior to the interview,

‘i.

Results of recruitment

Of the 131 possible respondents, 3 were deceased, 3

had moved out of the area, and 2 refused to participate,

(It is worth noting that the two refusals came from current

smokers.) Another 45 respondents were determined lost

because they could not be reached by phone, mail, or the

voters’ registrar. One respondent was in poor health and

unable to participate, and one was willing to participate

but was never scheduled, During the pilot study in

1988–89, 20 respondents were interviewed, and 56 respondents were scheduled during the main period of data

collection in 1989-90.

80
Appendix VI

Study 3: Interview

protocols, by condition
INTERVIEWER RECORD FORM

7/27/89

Condition: Study 3 Experimental Date:

s#: Interviewer:

Sex:

DOB :

INTRODUCTION

As you answer these questions, I want you to think aloud. Tell me everything

that comes into your mind. I’mjust as interested in Myou remember things

as I am in what you remember. OK, first off...

1982 SMOKING CESSATION

I’d like to ask you about your smoking in the past. Do you remember taking

part in a stop smoking program and becoming a subject in SRI’s Smoking

Research Project? You participated in several interviews held by SRI...

1. I want you to think backto the period in your life when you joined the

quit smoking program just before participating in the SRI study. How

well do you remember that period? [pause] Do you remember where

you were living and what you were doing at the time? [Prompt to think

aloud]

When you took part in the program, what was happening in your life that

made you want to stop smoking? [Probe for a specific event.]

2. These are some reasons people typically give for trying to stop smoking.

[Give STOP card to read.] Which of these reasons apply to your attempt

to stop smoking when you joined the_ program? [Mark a77 that app7y]

a. Experienced some problems related to

smoking (cough, shortness of breath, etc.)

b. Felt I’d get benefit from a more active life,

which smoking hinders

c.

d.

e.

&

f.

Concerned about the possibility of lung cancer

My physician advised me to quit

Realized need for changing my lifestyle

quitting smoking was part of that

Some of my friends convinced me of the

value of quitting

82
Exptl p. 2

9. Was experiencing some tension with friends

and/or relatives & thought quitting

smoking might lessen it

h. Concerned about the possibility of heart disease

i. Wanted to be a good example to those

important to me by not smoking

j. Thought cigarette smoking was too much a dirty habit

k. Wanted to quit smoking to show that I have power

& control over my actions

1. Someone important to me wanted me to quit smoking

3. Can you remember the stop-smokinq--- Droqram YOU were in before startinq the

SRI4. When

study? What kind was it (who offered it)?

KS ALA

you started the

SmokEnders Other

stop smoking program, were you living alone?

Yes

No How many people age 18 or older were living

with you?

Who was this?

Did he/she/any of them smoke cigarettes?

No. adult smokers

5. Did the people you were living with make it easier or harder to give UP

smoking? [Get-description in subject’s words; probe as needed. ] - ‘

[Show DIFFICULTY Card after getting verbatim response for Qs 5, 9, & 11. ]

These are some standard categories for describing how others affected your

attempt to stop smoking. Which of these statements best describes the people

you were living with when you joined the

They made it

They made it

They made it

They made it

stop smoking program? - “

much more difficult

somewhat more difficult

somewhat easier

much easier

83
6. How much

stop-smoking

Exptl p. 3

were you smoking in the month prior to participation in the

program? [Get open response then use scale be70w]

Less than 1/2 pack per day

1/2 to 1 pack per day

1 to 1-1/2 pack per day

1-1/2 to 2 packs per day

2 to 2-1/2 packs per day

More than 2-1/2 packs per day

7. What kind of cigarettes were you smoking?

(brand)

Length Regular

(circle one) King

100 mm

120 mm

Mentholated? Yes “Lights”? Yes

No No

[If aSmokEnders part~cipant, get brand before & during program.]

8. Thinking back to the people who were your friends at the time, did they

tend to be smokers or nonsmokers? [Possib7e probe: Do you remember

particular friends smoking or nonsmoking?]

So how many of your friends would you say smoked at that time? [Read

& show PROPORTION card.]

None of them

A few of them

Most of them

All or nearly all of them

9. Did your friends make it easier or harder to give up smoking?

[Possib7e probes: How did they react when you smoked? How did you

fee7 seeing them smoke whi7e you were trying to stop?]

Which of these categories best describes the effect your friends had on

your efforts to stop smoking? [Read & show DIFFICULTY card.]

They made it much more difficult

They made it somewhat more difficult

They made it somewhat easier

They made it much easier
Exptl p. 4

10. At that time, were you working?

— yes

How about your co-workers? Did they tend to be smokers? [Possib7e

probe: Who were the smokers among your co-workers]

So how many of your co-workers would you say smoked? [Read & show

PROPORTION card.]

None of them

A few of them

Most of them

All or nearly all of them

11. Did your co-workers make it easier or harder to give up smoking?

, [Get open response & then use DIFFICULTY card. ]

They made it much more difficult

They made it somewhat more difficult

They made it somewhat easier

They made it much easier

12. Earlier you said that you joined the stop smoking program because

[Mention reason and any specific events cited in Q2] Looking at

this calendar [show calendar], can you show me the month and year

when you stopped smoking as part of the program?

(mo./yr. stopped)

13. After participating in the program, did you ever smoke again?

Yes No

13b. [If “yes”] What made you start smoking again?

13C. [If applicable] In what month did you start smoking again?

(me. restarted)

85
Exptl P. 5

OTHER SMOKING CESSATION ATTEMPTS

Now I want to have you think about your smoking during a longer period.

Specifically, I’m going to ask about all your other attempts to stop smoking

when stayed off cigarettes for a week or more during the period from 1977

until 198_ [year of program or year after if didn’t stop for good then]

As you answer these questions, I want you to continue to think aloud,

telling me everything that comes into your head. First, can you remember

what you were doing in 1977 . . . where you were living and what you were

doing at work or at home? [pause until subject reports]

OK, so I want you to think about your life between when [whatever said

doing in 1977] until 198_ when you were [whatever told you earlier was

doing when entered stop smoking program].

Think about an attempt to stop smoking (other than the one in 198X that

you’ve already described) when you stayed off cigarettes for a week or more.

[pause] Do you have a particular attempt in mind?

14. Tell me, at that time WHY did you try to stop smoking? [Complete (Js

14-18 for Time 1, then recycle for Time2, etc.]

Time 1 Time 2 Time 3

Verbatim Reason Stopped

15. What did you do to try to stop smoking? [Record verbatim response]

Time 1 Time 2

Verbatim method

Time 3

16. These are some methods for quitting that we ask everyone about. Which

of these statements describe techniques you used to try to stop smoking

that time? [Show flETHC)f)card. More than one may be marked.]

a. Drugstore remedy (Nicoban,

One-Step-at-a-Time, Bantron)

b. Health Association Program

(Five-Day P1an, American Heart

Assoc., Amer. Cancer Society)

c. Commercial program (Schick,

SmokEnders)

d. Individual counseling/

private therapy

86
Exptl p. 6

e. Group therapy

f. Hypnosis

9. Quit on own

17. [(.h7ess final quit] After this period of not smoking, what made you

start smoking again?

Time 1 Time 2 Time 3

Verbatim reason restarted

These are some reasons people start smoking after quitting. Which of

these reasons describe why you started smoking again? [Show RESTART

card. #lore than one maybe marked.]

Restart Reason Checklist

a. Problems in personal life

b. Pressure from family/friends

to start again

c. Pressure on job

d. Withdrawal symptoms

e. Desire for cigarettes

remained high

f. Learned that your health

was not affected by smoking

9“ Gaining weight

h. Smoked without remembering

resolution to quit

i. Quitting smoking was

disrupting life

j. Found enjoyed smoking too

much and nothing else

was a good substitute’

k. Boredom

1. Other

Time 1 Time 2 Time 3

87
Exptl p. 7

18. [Show calendar] Now I’d 1ike you to try to recall WHEN this period

of not smoking took place. When did you stop smoking? How long did you

stay off cigarettes? When did you start again?

Dates of Not Smoking Time 1 Time 2 Time 3

a. Stopped (mo/yr)

b. Time off cigarettes (mos.)

c. Restarted (mo/yr)

19. Were there any other attempts to stop smoking you haven’t told me about,

between 1977 and 198X? [If subject says yes, repeat items 14 - 18

using next co7umn. Go to Supplement if necessary.]

RECAP

Sometimes people realize they’ve recalled something incorrectly after

recalling more details, so lets check the smoking history we have for you

between 1977 and 198_. In 1977 you were smoking and you smoked until ...

[Recap reported periods of smoking and nonsmoking, including events causing

a change in smoking status, in chronological order]. Would you make any

changes in this history?

CURRENT SMOKING

20. [Choose appropriate version] C)oyou now smoke cigarettes? or

And you told me you quit for good so you do not now smoke cigarettes.

Yes [If current smoker] How many cigarettes do you smoke in a

typical day?

cigarettes per day

No [Pick appropriate question format]

When did you give up cigarettes for good?

So you quit fo;rgood in . . .

mo/yr stopped for good

88
EXPERIMENTAL INTERVIEW SUPPLEMENT s-1

14. Tell me, at that time WHY did you try to stop smoking? [Complete Qs

14-18 for Time 4, then recycle for Time5, etc.]

Time 4 Time 5 Time 6

Verbatim Reason Stopped

15. What did you do to try to stop smoking? [Record verbatim response]

Time 4 Time 5 Time 6

Verbatim method

16. Which of these statements match the method you used to try to stop

smoking that time? [Show METHOD card. More than one may be marked.]

a. Drugstore remedy (Nicoban,

One-Step-at-a-Time, Bantron)

b. Health Association Program

(Five-Day Plan, American Heart

Assoc., Amer. Cancer Society)

c. Commercial program (Schick,

SmokEnders)

d. Individual counseling/

private therapy

e. Group therapy

f. Hypnosis

g. Quit on own

17. [Unless fina7 quit] After quitting this time, what made you start

smoking again? - -

Time 4

Verbatim reason restarted

Time 5 Time 6

89
EXPERIMENTAL INTERVIEW SUPPLEMENT s-2

Which of these reasons describe why you started smoking again? [Show

restart list. More than one maybe marked.]

Time 4 Time 5

a. Problems in personal life

b. Pressure from family/friends

to start again

c. Pressure on job

d. Withdrawal symptoms

e. Desire for cigarettes

remained high

f. Learned that your health

was not affected by smoking

9“ Gaining weight

h. Smoked without remembering

resolution to quit

i. Quitting smoking was

disrupting life

j. Found enjoyed smoking too

much and nothing else

was a good substitute

k. Boredom

1. Other

Time 6

18. [Show calendar] Now I’d like you totryto recall WHEN this period

of not smoking took place. When did you stop smoking? How long were you off

cigarettes? When did you start again?

Dates of Not Smoking Time 4 Time 5 Time 6

a. Stopped (mo/yr)

b. Time off cigarettes (mos.)

c. Restarted (mo/yr)

Were there any other times you haven’t told me about, between 1977 and

198_, when you tried to stop smoking and stayed off cigarettes for more than

one week? [If subject says yes, repeat items 14 - 18 using next column.]

90
INTERVIEWERRECORDFORM

8/1/89

Condition: Study 3 Control

s# :

Sex:

DOB:

Date:

Interviewer:

SMOKING CESSATION ATTEMPTS

I’m going to ask you about all the times you tried to stop smoking and stayed

off cigarettes for a week or more during the period from 1977 until 198_

[year after participation in the stop smoking program].

1. How many times between 1977 and 198_did you try to stop smoking and stay

off cigarettes for a week or more?

2. When was your last attempt to stop during this period? [Show

ca7endar]

What month and year did you stop? [mo/yr]

Did you start smoking again? — yes When? [mo/yr]

No [Go toQ4]

How long were you off cigarettes? [in mos.]

3. Was that the longest you ever stayed off cigarettes between 1977 and 19_?

Yes [Go to 04~ — NO

What was the longest you ever stopped smoking between 1977 and 198_?

months weeks [Circle unit of time]

When did that cessation period start? [mo/yr]

When did you start smoking again? [mo/yr]

4. What were the dates of the other times between 1977 and 198_ when you

tried to stop smoking and stayed off cigarettes for a week or more?

a. What month and year did you stop? b. How long were you off

cigarettes? c. When did you start smoking again? [Repeat #4 unti7 S

says there weren’t any more times. Use Supplement if necessary.]

Time 1 Time 2 Time 3

a. Stopped smoking [mo/yr]

b. Time off [inmos.]

c. Started smoking again [mo/yr]

91
1982 SMOKINGCESSATION

Now I’d like to ask you more questions about the period

smoking cessation program and became a subject in SRI’s

Project.

Control p. 2

when you were in the

Smoking Research

5. As part of that program, you quit smoking when? [Shouldbe one of dates

given above, if not see whether to add to set above.]

/ mo/yr

5b. After participating in the program, how long did you stay off

cigarettes?

[If restarted] Date restarted / mo/yr

6. Can you remember what kind of stop smoking program it was (who offered

it)?

ACS

7. How much were

program?

ALA SmokEnders Other

you smoking in the month prior to participation in the

Less than 1/2 pack per day

1/2 to 1 pack per day

1 to 1-1/2 pack per day

1-1/2 to 2 packs per day

2 to 2-1/2 packs per day

More than 2-1/2 packs per day

8. What kind of cigarettes were you smoking?

(brand)

Length Regular

(circle one) King

100 mm

120 mm

Mentholated? Yes “Lights”? Yes

No No

[If a SmokEnders participant, get brand before& during program.]
Control p. 3

9. Which of these reasons describe why you tried to stop smoking that time

in 198X? [Read STOP card. Mark all that app7y]

a. Experienced some problems related to

smoking (cough, shortness of breath, etc.)

b. Felt I’d get benefit from a more active life,

which smoking hinders

c.

d.

e.

&

f.

Concerned about the possibility of lung cancer

My physician advised me to quit

Realized need for changing my lifestyle

quitting smoking was part of that

Some ofmy friends convinced me of the

value of quitting

9* Was experiencing some tension with friends

and/or relatives & thought quitting

smoking might lessen it

h. Concerned about the possibility of heart disease

i. Wanted to be a good example to those

important to me by not smoking

j. Thought cigarette smoking

k. Wanted to quit smoking to

& control

1. Someone

10. In 198X,

alone?

was too much a dirty habit

show that I have power

over my actions

important to me wanted me to quit smoking

when you started the stop smoking program, were you living

Yes

No

How many people age 18 or older were living

with you?

Of these, how many smoked cigarettes?

93
Ctl P. 4

11. Did the people you were living with make it easier or harder to give up

smoking? [Show DIFFICULTY card for f?s 11, 13 & 15.]

They made it much more difficult

They made it somewhat more difficult

They made it somewhat easier

They made it much easier

12. At that time, how many of your friends smoked? [~how~~~~~~T~~~

card] -

13. Did your friends

DIFFICULTYcard]

None of them

A few of them

Most of them

All or nearly all of them

make it easier or harder to give up smoking? [Show

They made it much more difficult

They made it somewhat more difficult

They made it somewhat easier

They made it much easier

14. At that time, were you working?

— yes No [Skip tO (/16]

How many of your co-workers smoked? [Show PMWORTIOflcard]

None of them

A few of them

Most of them

All or nearly all of them

94
Ctl P. 5

15. Did your co-workers make it easier or harder to give up smoking?

[Show DIFFICULTY card]

They made it much more difficult

They made it somewhat more difficult

They made it somewhat easier

They made it much easier

METHODS & REASONS

16. Now I’m going to read a list of methods that people use to stop

smoking. In any of your attempts to quit between 1977 and 198_, m

including the stop smoking program in 198_, did you ever-use a ...

[Read METHOD card]

a. Drugstore remedy (Nicoban, One-Step-at-a-Time, Bantron)

b. Health Association Program (Five-Day Plan,

American Heart Assoc., Amer. Cancer Society)

c. Commercial program (Schick, SmokEnders)

d. Individual counseling/private therapy

e. Group therapy

f. Hypnosis

g. Quit on own

17. Now I’m going to read a list of reasons why people start smoking again

after trying to stop. In any of your attempts to quit smoking between

1977 and 198_ did you ever restart because of [Read RESTART card]

a. Problems in personal life

b. Pressure from family/friends to start again

c. Pressure on job

d. Withdrawal symptoms

e. Desire for cigarettes remained high

f. L’earnedthat your health was not affected

by smoking

95
9*

h.

i.

j.

k.

1.

Ctl P. 6

Gaining weight

Smoked without remembering resolution to quit

Quitting smoking was disrupting life

Found enjoyed smoking too much and nothing

else was a good substitute

Boredom

Other [Describe]

CURRENT SMOKING

18. Do you now smoke cigarettes?

Yes [If yes] How many cigarettes do you smoke in a typical day?

cigarettes per day

No [Choose appropriate follow up question]

When did you give up cigarettes for good?

So you gave up ciga%tes for good on. . .

L— mo/yr

96
CONTROL CONDITION SUPPLEMENTAL PAGE c-1

4. Were there other times between 1977 and 198_ when you tried to stop ~

smoking? [IfS says yes] a. Uhat month did you stop? b. How

long were you off cigarettes? c. When did you start smoking again?

[Repeat #4 unt~l S says there weren’t any more times.]

Time 4 Time 5 Time 6

a. Stopped smoking [mo/yr]

b. Time off [inmos.]

c. Started smoking again [mo/yr]

* U.S. GOVERNMENT PRINTING OFFICE: 1$)92 -3 12 -0 82 , 6 0 0 12

97
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3,

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10,

SERIES 11.

SERIES 2.

SERIES 13.

Programs and Collection Procedures–These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the

methods used to collect and process the data, definitions,

and other material necessary for understanding the data,

Data Evaluation and Methods Resesrch –These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new suiwey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies–These reports

present anal~ical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports In the other series,

Documants and Committee Reports–These are final

reports of major committees concerned w[th vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death ceflificates.

International Vital and Health Statistics Reporta –These

reports are analytical or descriptive reports that compare US,

vital and health statistics with those of other countries or

present other International data of relevance to the health

statistics system of the United States.

Cognition and Survey Maasurement– These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cogn[tlve science to design, evaluate, and test survey

instruments,

Data From the National Health Interview Survay – These

reports contain statistics on illness; unintentional Injuries;

dlsabllity; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey,

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination

Survay– Data from direct examination, testing, and

measurement on representatwe samples of the civillan

noninstitutional zed population prowde the basle for (1)

medically defined total prevalence of specific diseases or

conditions m the United States and the dletrtbuttons of the

population with respect to physical, physiological, and

psychological characterlst{cs, and (2) analyses of trends and

relationships among various measurements and between

survey periods.

Data From the Institutionalized Population

Surveys – Discontinued in 1975. Repofls from these surveys

are included in Series 13,

Data From the National Health Care Survey– These

reports contain statistics on health resources and the Public’s

use of health care resources including ambulatory, hospital,

and long-term care sewices based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15,

SERIES 16.

SERIES 20.

SERIES 21,

SERIES 22,

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and

Facilities– Discontinued in 1990. Reports on the numbers,

geographic distribution, and characteristics of health

resources are now included in Series 13,

Data From Special Surveys–These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics,

Compilations of Advance Data F om Vital and Health

Statistics – Advance Data Reports $ rovide early release of

information from the Nalional Center for Health Statistics’

health and demographic suweys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in series 10–13.

Data on Mortality–These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports, Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, and Divorce–These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports, Special

analyses by health and demographic variables and

geographic and trend analyses are included,

Data From the National Mortality and Natality

Surveys– Discontinued in 1975. Reports from these sample

surveys, based on vital records, are now published in series

20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriage; adoption; use of medical care for

family planning and infertility; and related maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compila!lons of Data on Natality, Mortality, Marriage,-.

Divorce, and Induced Terminations of Pregnancy –These

include advance reports of births, deaths, marriages, and

divorces based on final data from the National Vital Statistics

System that were published as supplements to the Month/y

Vita/ Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

publlshed in Vita/ Statistics of the United States, Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Scientific and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

6525 Beicrest Road, Room 1064

Hyattsville, MD 20782

(301 ) 436-8500
DEPARTMENTOF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

ISBN 0-16 -038120-7

II I II

90000

9 780160381201

BULK RATE

POSTAGE & FEES PAID

Pi-lS/NCHS

PERMIT NO. G-281

For sale by the U.S. Gotfemment Printing Oftice

Superintendent of Documents, Mail Stop SSOP, Washington, DC 20402-932S

ISBN 0-16-038120-7

DHHS Publication No. (PHS) 92-1080, Series 6, No. 5