ID k 

QUESTloNNMm A 

DIETmY SUPPLEMENT STUDY 

Hello, my name is from QGek Test. As mentioned earlier, we are conducting a study 

today about advefiising. I m going lo give you a booklet sf advefiising materials that people 

mi&t receive in the mail. Please read the booklet caehlly and let me know when you axe 

finished. I wi11 ask you some questions after you have had a chance to read the booklet. There 

are no right or wrong mswers to these questions. If you don't tow an answer, that% ok., just 

say ""Idon't how." 

I. Would you please tell me the color of the cover gage of the booklet you just read. 

2 GWEN 

3 YELLOW 

4 BLUE 

5 ORANGE 

6 WHITE 

2. What was the mame of the product that was adve~ised? 

1 VITAMN O/ 0 (GO TO Q3) 

2 OTHER (CONTINUE) 

9 DON'T KNOW, DOWT MMEMBER OW NOT s (eccs~rr~er~) 

2a. Which of the following was the name of the product that was radvefiisedWas it: 

QRE;AD LIST) 

I Nut~tion Plus, (%EMINATE) 

2 Vitain 8, (CONTINUE) 

3 Minerals Matter, or (TERR/IIIVATE) 

4 Something Else-(TEjRR/ILNATE) 

9 DON'T TOW, DON'T EMEMBER OR NOT SUE (DO NOT MAD) 

(TEMINATE) 
3. %%at is the main idea the booklet co unicated to you? (DO NOT PROBE) 

3a. mat other ideas, if any, does the booklet co unicate to you? 

(PROBE UNTIL RODUGTIVE WITH: Anything else?) 
4. Now, I'm going to read you a list of statements, All, some, or none of these statements 

may have been made in or lqlied by the booklet you just read. After 1 read each 

statement, please tell me whether: 

Yes, this statement was made in or i~llplled by the booklet you read, or 

No, this statement was not made in or implied by the booklet you read, or 

You don't know or ase not sure. 

43. Vitmin 8 reduces breathing problems 

1 YES - STATEMENT WAS MAYaE IN OR LMPLIED BY BBOmET 

2 NO - STATEMENT WAS NOT MADE OR MPLED BY BOOKLET 

9 DON'T KNOW OR NOT S 

4b. Vltarnln O reduces thyroid pro"oems 

1 YES - STATEMENT WAS MADE LN OR IIVIPLIED BY BOOKLET 

2 NO - STATEMENT WAS NOT MmE IhT OR MPLIED BY BOOmET 

9 DON'T mOW OR MOT SURE 

46. Vitmin 0 increases energy levels 

1 YES - STATEMENT WAS MlaDE IN OR MPLIED BY BOOKLET 

2 NO - STATEMEm WAS NOT MADE IN OR MPLlED BY BOOmET 

9 DON'T mOW OR NOT SURE 

Lad- Vitamin O reduces hair loss 

H YES - STATEMENT WAS -MADE BN OR IAMPLIED BY BOOUET 

2 NO - STATEMENT WAS NOT Ib42i.DE FN OR MPLIED BY BOOKLET 

9 DON'T KATOW OR NOT SURE 

4e. Vilmin 0 relieves ehonie or persistent pain 

I YES - STATEMENT WAS MPS)E IN OR MPLIED BY BOOKLET 

2 lu'8 - STATEMENT WAS NOT MAT)E IN' OR MPLIED BY BOBmET 

9 DON'T WOW OR NOT S 

4f. Vitmin O reduces dry skin problems 

Z YES - STATEMENT WAS MADE IN OR IMPLIED BY BOOKLET 

2 NO - STATEMENT WAS NOT MAI)E 06;: MPLIED BY BOOKLET 

9 DON'T TOW OR NOT SLRE 

and 4c OW THIS PAGE, CIRCLE 5a AND 5c OW THE NEXT PAGE. ASK ONLY 
Se. 

Now T7d like you to think about all the people who might try Vitamin 0. 

Based on what the booklet said or suggested, wiII Vitmin 0 reduce breathing problems 

for all, almost all, most, about half, some, very few, or none of the people who try it? 

1 ALL 4 ABOUT HALF 7 NONE 

2 ALMOSTALL 5 SOME 9 DON'T m&>JY OR NOT S 

3 MOST 6 VERUFEW 

Based on what the booklet said or suggested, will Vitain O reduce thyolid 

problems for all, almost all, most, about half, some, very few, or none of the people who 

try it? 

1 ALL 4 ABOUTHALF 7 NOm 

2 AEMOSTALL 5 SOME 9 DON'T m8Mi OR NOT S 

3 MOST 5 VERY FEW 

Based on what the booklet said or suggested, wlPI Vitamin O Increase energy levels for 

all, almost all, most, about half, some, very few, or none ofthe people who try 153 

I ALL 4 BOUTHALF 7 WOm 

2 ALMOSTALL 5 SOME 9 DON'T mOW OR NOT S 

3 MOST 6 VERY FEW 

Based on what the booklet said or suggested, will Vitamin 0 reduce hair loss for all, 

almost all, most, about haif, some, very few, or none ofthe people ivho try it? 

I ALL 4 .ABOUT HALF 7 NONE 

2 ALMOST ALL 5 SOME 9 DON'T KNOW OR NOT S 

3 MOST 6 VERY FEW 

Based on what the booklet said or suggested, will Vitain O relieve chronic or 

persistent pain fix all, almost all, most, about half, some, very few, or none of the people 

who try it? 

1 ALL 4 BOUT HALF 7 NONE 

2 ALMQSTAEL 5 SOME 9 DON'T KNOW OR NOT S 

3 MOST 5 VERY FEW 

Based on what the booklet said or suggested, will Vitamin O reduce dry skin problems 

for all, almost all, most, about half, some, very few, or none ofthe people who try it? 

I ALL 4 ~LBOUT HALF 7 NONE 

2 ALMOST ALL 5 SOME 9 DON'TKNOW ORNOT S 

3 MOST 6 VERY FEW 
6. Was there a disclaimer or a notice that appeared in a box at the bottom of the gages of the 

booklet that you just read? 

1 YES (CONTINUE) 

2 NO ("60 TO EAST PAGE) 

9 DON'T KNOW OR NOT S (GO TO EAST PAGE) 

6,. What did the disclaimer or notice say or suggest? 

(PROBE bXTIL RCPDUGTWE WITH: Armflking else?) 

6 my do you think the disclaimer or notice was IncludedVQPROBE UNTIL, 

RODUCTTVE WITH: hy other reason?) 
Thank you very much. Would you please sign this certifi eation page so I can prove to my 

supervisor that I interviewed youWou may be contacted later to verify that the interview 

occurred, but infomation you provide will be kept confidential and will not be used to sell you 

anything. 

mSPONDEN'F CERTIFICATION 

% cefiify that H was shown a promotional booklet, asked some questions about it, and paid $2.00 

for my paicipation, 

INTERVIEmR CERTIFICATION 

1 hereby cefiify that all of the above infomation was obtaJned by me from the respondent nmed 

above, who is not personally hown to me. I agree to provide this affidavit under oath, 

ediately upon request. 

IICdTERVTEWER NAME (PRLPJT): 

DATE 

IF mSPONDENT WFUSES NAME OR PHONE NUMBIEIB, PLEASE HAVE 

SUPERVISOR SIGN BELOW AS OM-SITE VUIDATED, 

SWERVISOR SIGNATer-WE DATE 

INTERVIEWER -- CIRCLE BOBUET USED FOR THIS TNTEWIEW: 

PUmEE GEEN YELLOW 

BLUE OMNGE: WHITE