304-344-8463 - firstname.lastname@example.org
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Day in the Life
Focus Group Registration
Focus Group Client Questionnaire - For Attorneys
Focus Group Sample Clip
Focus Group Confidentiality Agreement
January 28 Focus Group Screener
Tobacco Focus Group Screener
Teresa Evans, RMR, CRR, Owner
Tara Fisher Coughlin, Office Manager
Jessica Drake, National Scheduler and Focus Group Coordinator
TOBACCO DISCUSSION GROUP SCREENER
Indicates required field
City and State of Residence
In the past five years (including now), have you, a member of your immediate family or a close friend worked for any of the following types of businesses? Select all that apply.
a. An advertising or public relations firm
b. A marketing or marketing research firm or department
c. A marketing or market research consultant
d. Any kind of media company - like a TV station or radio station or newspaper
e. The federal government or a federal government agency
f. A manufacturer or representative of tobacco
g. None of these.
Have you ever received money or gift cards from a company for sharing your opinions about tobacco in a discussion group, interview, or survey?
Yes, within the past six months.
Yes, more than six months ago.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
How many of the last 30 days have you smoked cigarettes?
How may cigarettes per day do you smoke?
When is the last time you smoked a cigarette?
Have you EVER used an e-cigarette such as JUUL, Suorin, FIN, NJOY, blu, eGo, Logic or Vuse, even one time?
On how many of the PAST 30 DAYS did you use an e-cigarette such JUUL, Suorin, FIN, NJOY, blu, eGo, Logic or Vuse?
Have you EVER smoked tobacco from a hookah or waterpipe even one time?
On how many of the PAST 30 DAYS did you smoke tobacco from a hookah or waterpipe?
Have you EVER used smokeless tobacco products like chewing tobacco, snuff, dip or snus even one time?
On how many of the PAST 30 DAYS did you use smokeless tobacco products like chewing tobacco, snuff, dip, or snus?
Have you EVER smoked a regular cigar, cigarello, or little cigar such as Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts even one time? This does not include paper to smoke marijuana.
On how many of the PAST 30 DAYS did you smoke a regular cigar, cigarillo, or little cigar such as Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts
Have you EVER used any nicotine replacement therapy such as the patch, gum, lozenges, inhaler or nasal spray?
On how many of the PAST 30 DAYS have you used the following nicotine replacement therapy products? Which one(s) do you use?
What is your current gender identity?
c. Trans male/Trans man
d. Trans female/ Trans women
e. Genderqueer/ Gender non-conforming
What is your race? Check all that apply.
a. American Indian and Alaska Native
c. Black/ African American
d. Native Hawaiian
e. White/ Caucasian
f. Hispanic or Latino
Which of the following best represents how you think of yourself?
Queer, pansexual, trisexual, or omnisxual
Prefer not to say
What is the highest grade or year of school that you have finished or gotten credit for?
Less than high school
Some high school, no diploma
High school graduate
Some college or technical/trade school, but no degree
Diploma from technical/trade school
Which of the following best describes your current work status?
Unemployed, looking for work
Unemployed, not looking for work
Which of the following categories best describes your total household income in the past 12 months?
Less than $10,000
$10,000 to $14,999
$15,000 to $24,999
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 to $199,999
$200,000 or more
Are you interested in taking part in the discussion group? It will be held at 713 Lee Street East in Charleston.
We will be audio recording the discussion group. Would you be willing to be audio recorded during the discussion group? This is just to help the discussion group leader have a record for their analysis.
We'd like to live-stream the discussion group. This means that while the groups is taking place, members of our research team who could not be here in person would beable to watch the groups remotely. Groups will not be video recorded. Would you be willing to be live-streamed during the discussion group?
How did you hear about this?