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Protocol - Use of Tobacco Products

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Description

This protocol includes questions from the Wave 1 Adult Population Assessment of Tobacco and Health (PATH) Survey instrument and the PATH Wave 1 Individual Screener. These specific questions are used to measure a respondent’s use and regularity of use of the following tobacco products: cigarettes, e-cigarettes, cigars, pipe tobacco, hookah and shisha tobacco, smokeless tobacco, and dissolvable tobacco. An analysis of the results allow respondents to be categorized as: ever user, current user, everyday user, some day user, 30-day user, experimental current user, experimental former user, former user, former user 12 month, former user 12 month plus.

Specific Instructions

The working group recommends that when investigators are asking questions about e-cigarettes or electronic smoking devices, they consider providing study participants with specific examples of devices of interest and clarify which attributes. For instance, do they care about all types of electronic smoking devices or just some of them (e.g., tank systems, vapor pens, vapes, e-hookah, e-cigars)? Do they care whether they are disposable or rechargeable devices, and whether they contain nicotine, do not contain nicotine, or either? As new products emerge, investigators should consider their inclusion as well.

The table included in the protocol text not only relates to user group definitions for cigarettes, but applies to all the tobacco product types listed within the protocol (cigarettes, e-cigarettes, cigars, pipe tobacco, hookah and shisha, smokeless tobacco and dissolvables.

In order for the investigator to determine which user group(s) the respondent belongs to, the working group has included the item numbers for each tobacco product type in the table below.

User group

Ever user

Cigarettes

If Q1 = 1 THEN EVER USER = 1 (YES)

If Q1 = 2 OR DK/R THEN EVER USER = 2 (NO)

E-Cigarettes

If Q7 = 1 THEN EVER USER = 1 (YES)

If Q7 = 2 OR DK/R THEN EVER USER = 2 (NO)

Cigars

If Q15 or Q16 = 1 THEN EVER USER = 1 (YES)

If Q15 or Q16 = 2 OR DK/R THEN EVER USER = 2 (NO)

Pipe Tobacco

If Q27 = 1 THEN EVER USER = 1 (YES)

If Q27 = 2 OR DK/R THEN EVER USER = 2 (NO)

Hookah and Shisha

If Q34 = 1 THEN EVER USER = 1 (YES)

If Q34 = 2 OR DK/R THEN EVER USER = 2 (NO)

Smokeless Tobacco

If Q44 = 1 THEN EVER USER = 1 (YES)

If Q44 = 2 OR DK/R THEN EVER USER = 2 (NO)

Dissolvable

If Q52 = 1 THEN EVER USER = 1 (YES)

If Q52 = 2 OR DK/R THEN EVER USER = 2 (NO)

Current user

Cigarettes

IF Q1 = 1 AND Q4 = 5 AND Q2 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q1 = 2, DK/R OR Q4 =1,2,3,4, DK/R OR Q2 = 3, DK/R, THEN CURRENT USER = 2 (No)

E-Cigarettes

IF Q7 = 1 AND Q10 = 5 AND Q8 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q7 = 2, DK/R OR Q10 =1,2,3,4, DK/R OR Q8 = 3, DK/R, THEN CURRENT USER = 2 (No)

Cigars

IF Q15 or Q16 = 1 AND Q23 = 5 AND Q21 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q15 or Q16 = 2, DK/R OR Q23 =1,2,3,4, DK/R OR Q21 = 3, DK/R, THEN CURRENT USER = 2 (No)

Pipe Tobacco

IF Q27 = 1 AND Q30 = 5 AND Q28 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q27 = 2, DK/R OR Q30 =1,2,3,4, DK/R OR Q28 = 3, DK/R, THEN CURRENT USER = 2 (No)

Hookah and Shisha

IF Q34 = 1 AND Q36 = 5 AND Q35 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q34 = 2, DK/R OR Q36 =1,2,3,4, DK/R OR Q35 = 3, DK/R, THEN CURRENT USER = 2 (No)

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 5 AND Q45 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q44 = 2, DK/R OR Q47 =1,2,3,4, DK/R OR Q45 = 3, DK/R, THEN CURRENT USER = 2 (No)

Dissolvable

IF Q52 = 1 AND Q56 = 5 AND Q53 = 1 OR 2, THEN CURRENT USER = 1 (YES)

IF Q52 = 2, DK/R OR Q56 =1,2,3,4, DK/R OR Q53 = 3, DK/R, THEN CURRENT USER = 2 (No)

Everyday user

Cigarettes

IF Q1=1 AND Q4=5 AND Q2 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q1=2, DK/R OR Q4=1, 2, 3, 4, DK/R OR Q2 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

E-Cigarettes

IF Q7=1 AND Q10=5 AND Q8 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q7=2, DK/R OR Q10=1, 2, 3, 4, DK/R OR Q8 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Cigars

IF Q15 or Q16=1 AND Q23=5 AND Q21 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q15 or Q16=2, DK/R OR Q230=1, 2, 3, 4, DK/R OR Q21 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Pipe Tobacco

IF Q27=1 AND Q30=5 AND Q28 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q27=2, DK/R OR Q30=1, 2, 3, 4, DK/R OR Q28 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Hookah and Shisha

IF Q34=1 AND Q36=5 AND Q35 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q34=2, DK/R OR Q36=1, 2, 3, 4, DK/R OR Q35 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Smokeless Tobacco

IF Q44=1 AND Q47=5 AND Q45 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q44=2, DK/R OR Q47=1, 2, 3, 4, DK/R OR Q45 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Dissovable

IF Q52=1 AND Q56=5 AND Q53 = 1 THEN EVERYDAY USER = 1 (YES).

IF Q52=2, DK/R OR Q56=1, 2, 3, 4, DK/R OR Q53 = 2, 3, DK/R THEN EVERYDAY USER =2 (NO).

Some day user

Cigarettes

IF Q1 = 1 AND Q4=5 AND Q2 = 2 THEN SOME DAY USER = 1 (YES).

IF Q1 = 2, DK/R OR Q4 =1, 2, 3, 4, DK/R OR Q2 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

E-Cigarettes

IF Q7 = 1 AND Q10=5 AND Q8 = 2 THEN SOME DAY USER = 1 (YES).

IF Q7 = 2, DK/R OR Q10 =1, 2, 3, 4, DK/R OR Q8 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

Cigars

IF Q15 or Q16 = 1 AND Q23=5 AND Q21 = 2 THEN SOME DAY USER = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 =1, 2, 3, 4, DK/R OR Q21 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30=5 AND Q28 = 2 THEN SOME DAY USER = 1 (YES).

IF Q27 = 2, DK/R OR Q30 =1, 2, 3, 4, DK/R OR Q28 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

Hookah and Shisha

IF Q34 = 1 AND Q36=5 AND Q35 = 2 THEN SOME DAY USER = 1 (YES).

IF Q34 = 2, DK/R OR Q36 =1, 2, 3, 4, DK/R OR Q35 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47=5 AND Q45 = 2 THEN SOME DAY USER = 1 (YES).

IF Q44 = 2, DK/R OR Q47 =1, 2, 3, 4, DK/R OR Q45 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

Dissovable

IF Q52 = 1 AND Q56=5 AND Q53 = 2 THEN SOME DAY USER = 1 (YES).

IF Q52 = 2, DK/R OR Q56 =1, 2, 3, 4, DK/R OR Q53 = 1, 3, DK/R THEN SOME DAY USER = 2 (NO).

30-day user

Cigarettes

Not used in any skip patterns, not defined.

E-Cigarettes

Not used in any skip patterns, not defined.

Cigars

Not used in any skip patterns, not defined.

Pipe Tobacco

Not used in any skip patterns, not defined.

Hookah and Shisha

Not used in any skip patterns, not defined.

Smokeless Tobacco

Not used in any skip patterns, not defined.

Dissolvable

Not used in any skip patterns, not defined.

Experimental current user

Cigarettes

IF Q1 = 1 AND Q4 = 1, 2, 3, 4 AND Q2 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q1 = 2, DK/R OR Q4 = 5, DK/R OR Q2 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

E-Cigarettes

IF Q7 = 1 AND Q10 = 1, 2, 3, 4 AND Q8 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q7 = 2, DK/R OR Q10 = 5, DK/R OR Q8 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

Cigars

IF Q15 or Q16 = 1 AND Q23 = 1, 2, 3, 4 AND Q21 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 = 5, DK/R OR Q21 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30 = 1, 2, 3, 4 AND Q28 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q27 = 2, DK/R OR Q30 = 5, DK/R OR Q28 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

Hookah and Shisha

IF Q34 = 1 AND Q36 = 1, 2, 3, 4 AND Q35 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q34 = 2, DK/R OR Q36 = 5, DK/R OR Q35 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 1, 2, 3, 4 AND Q45 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q44 = 2, DK/R OR Q47 = 5, DK/R OR Q45 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

Dissolvable

IF Q52 = 1 AND Q56 = 1, 2, 3, 4 AND Q53 = 1 or 2 THEN EXPERIMENTAL CURRENT USER = 1

(YES).

IF Q52 = 2, DK/R OR Q56 = 5, DK/R OR Q53 = 3, DK/R THEN EXPERIMENTAL CURRENT USER = 2

(NO).

Experimental former user

Cigarettes

IF Q1 = 1 AND Q4 = 1, 2, 3, 4 AND Q2 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q1 = 2, DK/R OR Q4 = 5, DK/R OR Q2 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

E-Cigarettes

IF Q7 = 1 AND Q10 = 1, 2, 3, 4 AND Q8 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q7 = 2, DK/R OR Q10 = 5, DK/R OR Q8 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Cigars

IF Q15 or Q16 = 1 AND Q23 = 1, 2, 3, 4 AND Q21 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 = 5, DK/R OR Q21 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30 = 1, 2, 3, 4 AND Q28 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q27 = 2, DK/R OR Q30 = 5, DK/R OR Q28 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Hookah and Shisha

IF Q34 = 1 AND Q36 = 1, 2, 3, 4 AND Q35 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q34 = 2, DK/R OR Q36 = 5, DK/R OR Q35 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 1, 2, 3, 4 AND Q45 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q44 = 2, DK/R OR Q47 = 5, DK/R OR Q45 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Dissolvable

IF Q52 = 1 AND Q56 = 1, 2, 3, 4 AND Q53 = 3 THEN EXPERIMENTAL FORMER USER = 1 (YES).

IF Q52 = 2, DK/R OR Q56 = 5, DK/R OR Q53 = 1, 2, DK/R THEN EXPERIMENTAL FORMER USER = 2 (NO).

Former user

Cigarettes

IF Q1 = 1 AND Q4 = 5 AND Q2 = 3 THEN FORMER USER = 1 (YES).

IF Q1 = 2, DK/R OR Q4 = 1, 2, 3, 4, DK/R OR Q2 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

E-Cigarettes

IF Q7 = 1 AND Q10 = 5 AND Q8 = 3 THEN FORMER USER = 1 (YES).

IF Q7 = 2, DK/R OR Q10 = 1, 2, 3, 4, DK/R OR Q8 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Cigars

IF Q15 or Q16 = 1 AND Q23 = 5 AND Q21 = 3 THEN FORMER USER = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 = 1, 2, 3, 4, DK/R OR Q21 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30 = 5 AND Q28 = 3 THEN FORMER USER = 1 (YES).

IF Q27 = 2, DK/R OR Q30 = 1, 2, 3, 4, DK/R OR Q28 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Hookah and Shisha

IF Q34 = 1 AND Q36 = 5 AND Q35 = 3 THEN FORMER USER = 1 (YES).

IF Q1 = 2, DK/R OR Q4 = 1, 2, 3, 4, DK/R OR Q2 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 5 AND Q45 = 3 THEN FORMER USER = 1 (YES).

IF Q44 = 2, DK/R OR Q47 = 1, 2, 3, 4, DK/R OR Q45 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Dissolvable

IF Q52 = 1 AND Q56 = 5 AND Q53 = 3 THEN FORMER USER = 1 (YES).

IF Q52 = 2, DK/R OR Q56 = 1, 2, 3, 4, DK/R OR Q53 = 1, 2, DK/R THEN FORMER USER = 2 (NO).

Former user 12 month

Cigarettes

IF Q1 = 1 AND Q4 = 5 AND Q2 = 3 AND Q5 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q1 = 2, DK/R OR Q4 = 1, 2, 3, 4, DK/R OR Q2 = 1, 2, DK/R OR Q5 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

E-Cigarettes

IF Q7 = 1 AND Q10 = 5 AND Q8 = 3 AND Q11 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q7 = 2, DK/R OR Q10 = 1, 2, 3, 4, DK/R OR Q8 = 1, 2, DK/R OR Q11 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Cigars

IF Q15 or Q16 = 1 AND Q23 = 5 AND Q21 = 3 AND Q24 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 = 1, 2, 3, 4, DK/R OR Q21 = 1, 2, DK/R OR Q24 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30 = 5 AND Q28 = 3 AND Q32 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q27 = 2, DK/R OR Q30 = 1, 2, 3, 4, DK/R OR Q28 = 1, 2, DK/R OR Q32 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Hookah and Shisha

IF Q34 = 1 AND Q36 = 5 AND Q35 = 3 AND Q38<= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q34 = 2, DK/R OR Q36 = 1, 2, 3, 4, DK/R OR Q35 = 1, 2, DK/R OR Q38 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 5 AND Q45 = 3 AND Q49 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q44 = 2, DK/R OR Q47 = 1, 2, 3, 4, DK/R OR Q45 = 1, 2, DK/R OR Q49 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Dissolvable

IF Q52 = 1 AND Q56 = 5 AND Q53 = 3 AND Q57 <= 12 MONTHS AGO THEN FORMER USER 12 MONTH = 1 (YES).

IF Q52 = 2, DK/R OR Q56 = 1, 2, 3, 4, DK/R OR Q53 = 1, 2, DK/R OR Q57 > 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS = 2 (NO).

Former user 12 month plus

Cigarettes

IF Q1 = 1 AND Q4 = 5 AND Q2=3 AND Q5 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q1 = 2, DK/R OR Q4 = 1, 2, 3, 4, DK/R OR Q2 = 1, 2, DK/R OR Q5 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

E-Cigarettes

IF Q7 = 1 AND Q10 = 5 AND Q8=3 AND Q11 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q7 = 2, DK/R OR Q10 = 1, 2, 3, 4, DK/R OR Q8 = 1, 2, DK/R OR Q11 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

Cigars

IF Q15 or Q16 = 1 AND Q23 = 5 AND Q21 = 3 AND Q24 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q15 or Q16 = 2, DK/R OR Q23 = 1, 2, 3, 4, DK/R OR Q21 = 1, 2, DK/R OR Q24 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

Pipe Tobacco

IF Q27 = 1 AND Q30 = 5 AND Q28=3 AND Q32 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q27 = 2, DK/R OR Q30 = 1, 2, 3, 4, DK/R OR Q28 = 1, 2, DK/R OR Q32 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

Hookah and Shisha

IF Q34 = 1 AND Q36 = 5 AND Q35=3 AND Q38 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q34 = 2, DK/R OR Q36 = 1, 2, 3, 4, DK/R OR Q35 = 1, 2, DK/R OR Q38 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

Smokeless Tobacco

IF Q44 = 1 AND Q47 = 5 AND Q45=3 AND Q49 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q44 = 2, DK/R OR Q47 = 1, 2, 3, 4, DK/R OR Q45 = 1, 2, DK/R OR Q49 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

Dissolvable

IF Q52 = 1 AND Q56 = 5 AND Q53=3 AND Q57 > 12 MONTHS AGO THEN FORMER USER 12 MONTH PLUS = 1 (YES).

IF Q52 = 2, DK/R OR Q56 = 1, 2, 3, 4, DK/R OR Q53 = 1, 2, DK/R OR Q57 <= 12 MONTHS AGO, DK/R THEN FORMER USER 12 MONTHS PLUS = 2 (NO).

[CIGARFILL] = traditional cigars, cigarillos, and filtered cigars.

[SMKLSSFILL] = smokeless tobacco; snus

Availability

Available

Protocol

Cigarettes

1. Have you ever smoked a cigarette, even one or two puffs?

1[ ] Yes

2[ ] No [GO TO Q6]

-8[ ] DON’T KNOW [GO TO Q6]

-7[ ] REFUSED [GO TO Q6]

ASK: All respondents

2. Do you now smoke cigarettes…

1[ ] Every day

2[ ] Some days

3[ ] Not at all [GO TO Q3]

-8[ ] DON’T KNOW [GO TO Q3]

-7[ ] REFUSED [GO TO Q3]

ASK: Respondents who have ever smoked a cigarette (Q1 = 1)

3. In the past 30 days, have you smoked a cigarette, even one or two puffs?

1[ ] Yes

2[ ] No

-8[ ] REFUSED

-7[ ] DON’T KNOW

ASK: Respondents who do not currently smoke every day or some days (Q2 = 3)

4. How many cigarettes have you smoked in your entire life? A pack usually has 20 cigarettes in it.

1[ ] 1 or more puffs but never a whole cigarette

2[ ] 1 to 10 cigarettes (about ½ pack total)

3[ ] 11 to 20 cigarettes (about ½ pack to 1 pack)

4[ ] 21 to 50 cigarettes (more than 1 pack but less than 3 packs)

5[ ] 51 to 99 (more than 2 ½ packs but less than 5 packs)

6[ ] 100 or more cigarettes (5 packs or more)

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have ever smoked a cigarette (Q1 =1)

5. About how long has it been since you completely quit smoking cigarettes?

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Former users (IF Q1 = 1 AND Q4 = 5 AND Q2 = 3) and Experimental Former users (IF Q1 = 1 AND Q4 = 1, 2, 3, 4 AND Q2 = 3). Else go to next section (Q6).

Electronic Cigarettes (E-Cigarettes)

The next questions are about electronic cigarettes, often called e-cigarettes. E-cigarettes look like regular cigarettes, but are battery-powered and produce vapor instead of smoke. There are many types of e-cigarettes. Some common brands include NJOY®, Blu™, and Smoking Everywhere.

SHOW GENERIC IMAGE OF E-CIGARETTES

6. Have you ever seen or heard of an electronic cigarette or e-cigarette before this study?

1[ ] Yes

2[ ] No [GO TO Q13]

-8[ ] DON’T KNOW [GO TO Q13]

-7[ ] REFUSED [GO TO Q13]

ASK: All respondents

SHOW GENERIC IMAGE OF E-CIGARETTES

7. Have you ever used an e-cigarette, such as NJOY®, Blu™, or Smoking Everywhere, even one or two times?

1[ ] Yes

2[ ] No [GO TO Q13]

-8[ ] DON’T KNOW [GO TO Q13]

-7[ ] REFUSED [GO TO Q13]

ASK: Respondents who have seen or heard of e-cigarettes (Q6 = 1)

SHOW GENERIC IMAGE OF E-CIGARETTES

8. Do you now use e-cigarettes…

1[ ] Every day

2[ ] Some days

3[ ] Not at all

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used an e-cigarette (Q7 = 1)

9. In the past 30 days, have you used an e-cigarette, even one or two times?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used an e-cigarette (Q7 = 1) AND do not currently use e-cigarettes every day or some days (Q8 = 3).

10. How many disposable e-cigarettes or e-cigarette cartridges have you used in your entire life?

1[ ] 1 or more puffs but never a whole one

2[ ] 1 to 10

3[ ] 11 to 20

4[ ] 21 to 50

5[ ] 51 to 99

6[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used an e-cigarette (Q7 = 1).

11. About how long has it been since you last took a puff from an e-cigarette? (If it was earlier today, enter 1 day).

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used e-cigarettes (Q7 = 1) AND do not use every day (Q8 <> 1)

GO TO: If Q8 = 3, go to Q12. Else go to Q13.

12. Have you completely quit using e-cigarettes?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used e-cigarettes (Q7 = 1) AND currently use not at all (Q8 = 3).

Cigars

The next questions are about traditional cigars, cigarillos, and filtered cigars. These products go by lots of different names, so please use these descriptions and photos to understand what they are.

Traditional cigars contain tightly rolled tobacco that is wrapped in a tobacco leaf. Some common brands of cigars include Macanudo®, Romeo y Julieta®, and Arturo Fuente®, but there are many others.

Cigarillos and filtered cigars are smaller than traditional cigars. They are usually brown. Some are the same size as cigarettes, and some come with plastic or wood tips. Some common brands are Black & Mild®, Swisher Sweets®, Dutch Masters®, Phillies Blunts®, Prime Time®, and Winchester®.

13. Have you ever seen or heard of a cigar, cigarillo, or filtered cigar before this study?

1[ ] Yes

2[ ] No [GO TO Q26]

-8[ ] DON’T KNOW [GO TO Q26]

-7[ ] REFUSED [GO TO Q26]

ASK: All respondents

SHOW GENERIC IMAGE OF TRADITIONAL CIGARS, CIGARILLOS, AND FILTERED CIGARS

14. Which type of cigar have you heard of before this study?

1[ ] Traditional cigars like Macanudo®, Romeo y Julieta®, Arturo Fuente®, or others [GO TO Q15]

2[ ] Cigarillos or filtered cigars like Black & Mild®, Swisher Sweets®, Dutch Masters®, Phillies Blunts®, Prime Time®, Winchester®, or others [GO TO Q15]

-8[ ] DON’T KNOW [GO TO Q26]

-7[ ] REFUSED [GO TO Q26]

ASK: Respondents who have seen or heard of a cigar, cigarillo, or filtered cigar (Q13 = 1)

GO TO: If R has not heard of either type of cigar (Q14 NOT IN (1, 2)), go to Q26.

15. Have you ever smoked a traditional cigar, even one or two puffs?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have heard of a traditional cigar (Q14 IN TRADITIONAL CIGAR)

SHOW GENERIC IMAGE OF TRADITIONAL CIGARS

16. Have you ever smoked a cigarillo or filtered cigar, even one or two puffs?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have heard of a cigarillo/FC (Q14 IN "CIGARILLO OR FILTERED CIGAR")

SHOW GENERIC IMAGE OF CIGARILLOS AND FILTERED CIGARS

17. Sometimes people take tobacco out of a cigar, cigarillo or filtered cigar and replace it with marijuana. This is sometimes called a "blunt." Have you ever smoked part or all of a cigar, cigarillo or filtered cigar with marijuana in it?

1[ ] Yes

2[ ] No [GO TO Q20]

-8[ ] DON’T KNOW [GO TO Q20]

-7[ ] REFUSED [GO TO Q20]

ASK: Respondents who have seen or heard of a cigar, cigarillo or filtered cigar (Q13 = 1 AND Q14 IN (1 or 2) AND Q16 NE -8 or -7).

18. In the past 12 months, have you smoked part or all of a cigar, cigarillo or filtered cigar with marijuana in it?

1[ ] Yes

2[ ] No [GO TO Q20]

-8[ ] DON’T KNOW [GO TO Q20]

-7[ ] REFUSED [GO TO Q20]

ASK: Respondents who have smoked cigars with marijuana (Q17 = 1).

19. In the past 12 months, when you smoked a cigar, cigarillo or filtered cigar, how often has tobacco been replaced with any marijuana?

1[ ] Every time

2[ ] Most of the time

3[ ] Sometimes

4[ ] Rarely

5[ ] Never

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked cigars with marijuana in the past 12 months (Q18 = 1).

20. Which of the following kinds of cigarillos or filtered cigars have you smoked [as blunts]? Choose all that apply. The kind…

1[ ] With a plastic or wooden tip

2[ ] With a filter (like a cigarette filter)

3[ ] Without a tip or filter

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked a cigarillo/FC (Q16 = 1) OR are blunt-only cigar smokers

(Q16 = 2 AND Q18 = 1).

PROGRAM: Display "as blunts" if Q16 = 2 AND Q18 = 1.

SHOW GENERIC IMAGE OF CIGARILLOS WITH TIPS, FILTERED CIGARS, AND CIGARILLOS WITHOUT TIPS

21. Do you now smoke [ [CIGARFILL]s/cigarillos as blunts/filtered cigars as blunts ]…

1[ ] Every day

2[ ] Some days

3[ ] Not at all [GO TO Q22]

-8[ ] DON’T KNOW [GO TO Q22]

-7[ ] REFUSED [GO TO Q22]

ASK: Respondents who have smoked at least one type of cigar (regular cigar (Q15 = 1) and/or cigarillo

(Q20 = 1 OR 3) and/or FC (Q20 = 2)) OR are blunt-only cigar smokers (Q16 = 2 AND Q18 = 1).

PROGRAM: If Q16 = 2 AND Q18 = 1 AND Q20 = 1 OR 3, display "cigarillos as blunts." If Q16 = 2

AND Q18 = 1 AND Q20 = 2, display ‘filtered cigars as blunts’. Else, display [CIGARFILL]s as specified.

22. In the past 30 days, have you smoked a [ [CIGARFILL]/ cigarillos as a blunt/ filtered cigar as a blunt ], even one or two puffs?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked at least one type of cigar (regular cigar (Q15=1) and/or cigarillo

(Q20 = 1 OR 3) and/or FC (Q20 = 2)) OR are blunt-only cigar smokers (Q16 = 2 AND Q18 = 1) and do not currently smoke every day or some days (Q21 = 3).

PROGRAM: If Q16 = 2 AND Q18 = 1 AND Q20 = 1 OR 3, display "cigarillo as a blunt." If Q16 = 2

AND Q18 = 1 AND Q20 = 2, display "filtered cigar as a blunt." Else, display [CIGARFILL] as specified.

23. How many [CIGARFILL]s have you smoked in your entire life?

1[ ] 1 or more puffs but never a whole one

2[ ] 1 to 10

3[ ] 11 to 20

4[ ] 21 to 50

5[ ] 51 to 99

6[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked at least one type of cigar where traditional cigar (Q15 = 1) and/or cigarillo (Q20 = 1 OR 3) and/or LFC (Like a filtered cigar) (Q20 = 2).

24. About how long has it been since you last smoked [CIGARFILL]s? (If it was earlier today, enter 1 day)

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked [CIGARFILL]s and do not smoke every day (Q21 <> 1)

GO TO: If Q21 = 3, go to Q25. Else go to next section.

25. Have you completely quit smoking [CIGARFILL]s?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked [CIGARFILL]s and currently smoke not at all (Q21 = 3).

Pipe Tobacco

The next questions are about smoking tobacco in pipes. We first ask about smoking tobacco in a regular pipe. There are many different types of regular pipes. They all have a bowl that holds the tobacco and a stem.

Regular Pipe

26. Have you ever seen or heard of a pipe before this study?

1[ ] Yes

2[ ] No [GO TO Q33]

-8[ ] DON’T KNOW [GO TO Q33]

-7[ ] REFUSED [GO TO Q33]

ASK: All respondents

DISPLAY GENERIC IMAGES OF PIPES

27. Have you ever smoked a pipe filled with tobacco, even one or two puffs?

1[ ] Yes

2[ ] No [GO TO Q33]

-8[ ] DON’T KNOW [GO TO Q33]

-7[ ] REFUSED [GO TO Q33]

ASK: Respondents who have seen or heard of pipes (Q26 = 1).

DISPLAY GENERIC IMAGES OF PIPES

28. Do you now smoke a pipe filled with tobacco…

1[ ] Every day [GO TO Q30]

2[ ] Some days [GO TO Q30]

3[ ] Not at all [GO TO Q29]

-8[ ] DON’T KNOW [GO TO Q29]

-7[ ] REFUSED [GO TO Q29]

ASK: Respondents who have a smoked pipe filled with tobacco (Q27 = 1)

29. In the past 30 days, have you smoked a regular pipe filled with tobacco, even one or two puffs?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked a pipe filled with tobacco (Q27 = 1) AND do not currently smoke pipes every day or Some Days (Q28 = 3).

[SHOW IMAGES OF PIPES AND PIPE TOBACCO - BOTH LOOSE AND IN TINS]

30. How many bowls filled with pipe tobacco have you smoked in your entire life?

1[ ] 1 or more puffs but never a whole one

2[ ] 1 to 10

3[ ] 11 to 20

4[ ] 21 to 50

5[ ] 51 to 99

6[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked a pipe (Q27 = 1).

31. When did you last smoke a pipe filled with tobacco?

1[ ] In the past hour

2[ ] Sometime today

3[ ] Yesterday

4[ ] Day before yesterday

5[ ] Three or more days ago

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who smoke a pipe everyday or some days (Q28 = 1, 2, -8, or -7)

32. About how long has it been since you last smoked a pipe filled with tobacco? (If it was earlier today, enter 1 day)

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have smoked a pipe (Q27 = 1) and do not smoke every day (Q28 <> 1)

PROGRAM: EXCLUDE Some day smokers (Q28 = 2) who previously reported they last smoked in the past hour, sometime today, yesterday, or the day before yesterday (Q31 = 1 or 2 or 3 or 4).

Hookah and Shisha

We next ask about smoking tobacco in a hookah, which is a type of water pipe. It is sometimes also called a "narghile" pipe. From now on, we will use "hookah" to refer to a water pipe or narghile pipe that is often used to smoke tobacco. There are many types of hookahs. People often smoke tobacco in hookahs in groups at cafes or in hookah bars.

[DISPLAY GENERIC IMAGE OF HOOKAH]

33. Have you ever seen or heard of a hookah before this study?

1[ ] Yes

2[ ] No [GO TO Q43]

-8[ ] DON’T KNOW [GO TO Q43]

-7[ ] REFUSED [GO TO Q43]

ASK: All respondents

[DISPLAY GENERIC IMAGE OF HOOKAH]

34. Have you ever smoked tobacco in a hookah, even one or two puffs?

1[ ] Yes

2[ ] No [GO TO Q43]

-8[ ] DON’T KNOW [GO TO Q43]

-7[ ] REFUSED [GO TO Q43]

ASK: Respondents who have seen or heard of a hookah (Q33 = 1)

[DISPLAY GENERIC IMAGE OF HOOKAH]

35. Do you now smoke hookah…

1[ ] Every day

2[ ] Some days

3[ ] Not at all [GO TO Q43]

-8[ ] DON’T KNOW [GO TO Q43]

-7[ ] REFUSED [GO TO Q43]

ASK: Respondents who have smoked hookah (Q34 = 1)

36. How many times have you smoked hookah in your entire life? Count each sitting or session where you smoked tobacco in a hookah, whether alone or with others.

1[ ] 1 to 10

2[ ] 11 to 20

3[ ] 21 to 50

4[ ] 51 to 99

5[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have ever smoked hookah (Q34 = 1).

37. When did you last smoke hookah?

1[ ] In the past hour

2[ ] Sometime today

3[ ] Yesterday

4[ ] Day before yesterday

5[ ] Three or more days ago

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who smoke hookah everyday or some days (Q35 = 1, 2, -8, or -7).

38. About how long has it been since you last smoked hookah? (If it was earlier today, enter 1 day)

1[ ] I___I___I DAYS [GO TO Q42]

2[ ] I___I___I MONTHS [GO TO Q42]

3[ ] I___I___I YEARS [GO TO Q42]

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have ever smoked hookah (Q34 = 1) and do not smoke every day (Q35 <> 1)

PROGRAM: EXCLUDE Some day smokers (Q35 = 2) who previously reported they last smoked in the past hour, sometime today, yesterday, or the day before yesterday (Q37=1 or 2 or 3 or 4).

39. Have you smoked hookah at least once in the past 30 days?

1 Yes [GO TO Q42]

2 No

-8 DON’T KNOW

-7 REFUSED

ASK: Respondents who did not provide the amount of time that has passed since they had last smoked hookah (Q38 IN (DK,R))

40. Have you smoked hookah at least once in the past three months?

1 Yes [GO TO Q42]

2 No

-8 DON’T KNOW

-7 REFUSED

ASK: Respondents who did not provide the amount of time that has passed since they had last smoked hookah AND have not smoked hookah at least once in the past 30 days (Q38 IN (DK,R) AND Q39 IN (2, DK, R)).

41. Have you smoked hookah at least once in the past twelve months?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who did not provide the amount of time that has passed since they had last smoked

hookah AND have not smoked hookah at least once in the past 3 months (Q38 IN (DK,R) AND Q39 IN (2, DK, R) AND Q40 IN (2, DK, R)).

If Q40 <> 1 OR Q38 > 90 DAYS or 3 MONTHS, go to Q42.

42. Have you completely quit smoking hookah?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have not smoked hookah in the last three months (Q40 <> 1 OR Q38 > 90 DAYS or 3 MONTHS)

Smokeless Tobacco

The next questions ask about smokeless tobacco which you put in your mouth. Frequently you chew, suck or spit while using smokeless tobacco, although there is no need to do so for some types. Snus, for instance, is a type of smokeless tobacco that comes in a small pouch that you put inside your lip.

There are many kinds of smokeless tobacco, such as snus pouches, loose snus, moist snuff, dip, spit, and chewing tobacco. Common brands include Redman®, Levi Garrett®, Beechnut®, Skoal®, Grizzly®, Nordic Ice®, and Copenhagen®.

[SHOW GENERIC IMAGES OF SMOKELESS TOBACCO]

43. Have you ever seen or heard of smokeless tobacco, such as snus pouches, loose snus, moist snuff, dip, spit, or chewing tobacco, before this study?

1[ ] Yes

2[ ] No [GO TO Q51]

-8[ ] DON’T KNOW [GO TO Q51]

-7[ ] REFUSED [GO TO Q51]

ASK: All respondents

[SHOW GENERIC IMAGES OF SMOKELESS TOBACCO]

44. Have you ever used any of the following smokeless tobacco products, even one or two times? Choose all that apply.

1[ ] Snus pouches

2[ ] Loose snus, moist snuff, dip, spit, or chewing tobacco

3[ ] I have never used a smokeless tobacco product [GO TO Q51]

-8[ ] DON’T KNOW [GO TO Q51]

-7[ ] REFUSED [GO TO Q51]

ASK: Respondents who have seen or heard of smokeless tobacco (Q43 = 1).

GO TO: If respondent has NOT used any type of smokeless tobacco including snus pouches AND loose snus, moist snuff, dip, spit or chewing tobacco ((Q44(3) = 1 OR Q44 = -8, -7)), go to Q51

[SHOW GENERIC IMAGES OF SMOKELESS TOBACCO]

45. Do you now use [SMKLSSFILL]…

1[ ] Every day

2[ ] Some days

3[ ] Not at all [GO TO Q46]

-8[ ] DON’T KNOW [GO TO Q46]

-7[ ] REFUSED [GO TO Q46]

ASK: Respondents who have used smokeless tobacco (Q44 = 1).

PROGRAM: If SMKLSSTYPE[1] = 1, display "smokeless tobacco"; if SMKLSSTYPE[2] = 2, display "snus pouches."

46. In the past 30 days have you used [SMKLSSFILL], even one or two times?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used smokeless tobacco (Q44 = 1) AND do not currently use smokeless tobacco every day or some days (Q45 = 3).

PROGRAM: If SMKLSSTYPE[1] = 1, display "smokeless tobacco"; if SMKLSSTYPE[2] = 2, display "snus pouches."

47. How many [times/ snus pouches] have you used [smokeless tobacco] in your entire life?

1[ ] 1 to 10

2[ ] 11 to 20

3[ ] 21 to 50

4[ ] 51 to 99

5[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used [SMKLSSFILL] (Q45 = 1 or 2).

PROGRAM: If SMKLSSTYPE[1] = 1, display "times" and "smokeless tobacco"; if SMKLSSTYPE[2] = 2, display "snus pouches."

48. When did you last use [SMKLSSFILL]?

1[ ] In the past hour

2[ ] Sometime today

3[ ] Yesterday

4[ ] Day before yesterday

5[ ] Three or more days ago

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who use [SMKLSSFILL] everyday or some days (Q45 = 1, 2, -8, or -7)

49. About how long has it been since you last used [SMKLSSFILL]? (If it was earlier today, enter 1 day)

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used [SMKLSSFILL] and do not use every day (Q45 <> 1).

PROGRAM: EXCLUDE Some day users (Q45 = 2) who previously reported they last used in the past

hour, sometime today, yesterday, or the day before yesterday (Q48 = 1 or 2 or 3 or 4).

GO TO: If Q45 = 3, go to Q50

50. Have you completely quit using [SMKLSSFILL]?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have use [SMKLSSFILL] and currently use not at all (Q45 = 3)

Dissolvable Tobacco

The next questions ask about another type of tobacco called dissolvable tobacco. You don’t smoke dissolvable tobacco products-they are made of finely ground flavored tobacco that dissolves in your mouth.

Dissolvable tobacco products come in a variety of shapes, including small round pellets, thin sticks and flat strips. Some common brands are Ariva®, Stonewall™, and Camel Orbs, Sticks, or Strips.

[SHOW GENERIC IMAGES OF DISSOLVABLES]

51. Have you ever seen or heard of dissolvable tobacco before this study?

1[ ] Yes

2[ ] No [END QUESTIONS]

-8[ ] DON’T KNOW [END QUESTIONS]

-7[ ] REFUSED [END QUESTIONS]

ASK: All respondents

[SHOW GENERIC IMAGES OF DISSOLVABLES]

52. Have you ever used dissolvable tobacco products, such as Ariva®, Stonewall™, or Camel Orbs, Sticks, or Strips, even one or two times?

1[ ] Yes

2[ ] No [END QUESTIONS]

-8[ ] DON’T KNOW [END QUESTIONS]

-7[ ] REFUSED [END QUESTIONS]

ASK: Respondents who have seen or heard of dissolvable tobacco (Q51 = 1).

[SHOW GENERIC IMAGES OF DISSOLVABLES]

53. Do you now use dissolvable tobacco…

1[ ] Every day

2[ ] Some days

3[ ] Not at all [GO TO Q54]

-8[ ] DON’T KNOW [GO TO Q54]

-7[ ] REFUSED [GO TO Q54]

ASK: Respondents who have used dissolvable tobacco (Q52 = 1).

54. In the past 30 days, have you used dissolvable tobacco, even one or two times?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used dissolvable tobacco AND do not currently use dissolvable tobacco every day or some days (Q53 = 3, DK, RF).

55. When did you last use dissolvable tobacco?

1[ ] In the past hour

2[ ] Sometime today

3[ ] Yesterday

4[ ] Day before yesterday

5[ ] Three or more days ago

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who use dissolvable tobacco every day or some days (Q53 = 1, 2, -8, or -7).

56. How many pieces of dissolvable tobacco have you used in your entire life?

1[ ] 1 to 10

2[ ] 11 to 20

3[ ] 21 to 50

4[ ] 51 to 99

5[ ] 100 or more

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used dissolvable tobacco (Q52 = 1).

57. About how long has it been since you last used dissolvable tobacco? (If it was earlier today, enter 1 day)

1[ ] I___I___I DAYS

2[ ] I___I___I MONTHS

3[ ] I___I___I YEARS

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have used dissolvable tobacco (Q52 = 1) and do not use every day

(Q53 <> 1).

PROGRAM: EXCLUDE Some day users (Q53 = 2) who previously reported they last used in the past hour, sometime today, yesterday, or the day before yesterday (Q55 = 1 or 2 or 3 or 4).

GO TO: If Q53 = 3, go to Q58. Else, End Questionnaire.

58. Have you completely quit using dissolvable tobacco?

1[ ] Yes

2[ ] No

-8[ ] DON’T KNOW

-7[ ] REFUSED

ASK: Respondents who have use dissolvable tobacco (Q52 = 1) and currently use not at all (Q53 = 3)

Personnel and Training Required

None.

Equipment Needs

None.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Lifestage

Adult

Participants

Adult (18+ years of age)

Selection Rationale

The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, in-person longitudinal cohort study of nonusers and users of tobacco products and those at risk for tobacco use across the United States. Respondents 12 years old or older are asked questions on tobacco use, attitudes, and health, and biospecimens (buccal cell, urine, and blood) are collected from adults. The PATH Study was implemented to provide an evidence base for assessing and monitoring the Food and Drug Administration’s regulatory actions in meeting its mandate under the Family Smoking Prevention and Tobacco Control Act. Regulatory domains include product standards, new and modified risk products, health warnings, and health education campaigns.

Language

English, Other languages available at source

Standards
StandardNameIDSource
caDSR Form PhenX PX741401 - Use Of Tobacco Products 6247181 caDSR Form
Derived Variables

None.

Process and Review

Not applicable.

Protocol Name from Source

Population Assessment of Tobacco and Health (PATH) Study, Wave 1 Adult Extended Interview 7.5 and Individual Screener 7.5

Source

National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA), Population Assessment of Tobacco and Health (PATH) Study, PATH Wave 1 Adult Extended Interview 7.5, 2013, Items AC1005, AC1009, AE1005, AE1009, AE1010, AG1005, AG1009, AG1010, AP1005, AP1009, AH1005, AH1009, AH9001, AH9002, AH9010, AH1010, AS1005, AS1009, AS1010, AD1005, AD1009, and AD1010.

National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA), Population Assessment of Tobacco and Health (PATH) Study, PATH Wave 1 Individual Screener 7.5, 2013, Items AC1002, AC1003, AC1004, AE1001, AE1002, AE1003, AE1004, AG1001, AG9002, AG9003, AG9004, AG9105, AG9107, AG9106, AG9009, AG1003, AG1004, AP1001, AP1002, AP1003, AP1004, AP0100, AH1001, AH1002, AH1003, AH0100, AS1001, AS1002, AS1003, AS1004, AS0100, AD1001, AD1002, AD1003, AD1004, and AD0100.

General References

National Institutes of Health, U.S. Food and Drug Administration. (2013). Population Assessment of Tobacco and Health (PATH) Study: Final Adult Baseline (Wave 1) Questionnaire. Bethesda, MD: National Institutes of Health.

Protocol ID

741401

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX741401_Useof_Tobacco_Cigarillo_Blunts
PX741401210000 Do you now smoke [[CIGARFILL]s/cigarillos as more
blunts/filtered cigars as blunts]... show less
N/A
PX741401_Useof_Tobacco_Cigarillo_Bluntsthirty
PX741401220000 In the past 30 days, have you smoked a more
[[CIGARFILL]/ cigarillos as a blunt/ filtered cigar as a blunt], even one or two puffs? show less
N/A
PX741401_Useof_Tobacco_Cigarillo_History
PX741401160000 Have you ever smoked a cigarillo or filtered more
cigar, even one or two puffs? show less
N/A
PX741401_Useof_Tobacco_Cigarillo_Kinds
PX741401200000 Which of the following kinds of cigarillos more
or filtered cigars have you smoked [as blunts]? Choose all that apply. The kind... show less
N/A
PX741401_Useof_Tobacco_Cigarpaper_Marijuana
PX741401170000 Sometimes people take tobacco out of a more
cigar, cigarillo or filtered cigar and replace it with marijuana. This is sometimes called a "blunt." Have you ever smoked part or all of a cigar, cigarillo or filtered cigar with marijuana in it? show less
N/A
PX741401_Useof_Tobacco_Cigarpaper_Marijuanayear
PX741401180000 In the past 12 months, have you smoked part more
or all of a cigar, cigarillo or filtered cigar with marijuana in it? show less
N/A
PX741401_Useof_Tobacco_Cigarpaper_Replacedyear
PX741401190000 In the past 12 months, when you smoked a more
cigar, cigarillo or filtered cigar, how often has tobacco been replaced with any marijuana? show less
N/A
PX741401_Useof_Tobacco_Cigartype_Familiarity
PX741401140000 Which type of cigar have you heard of before more
this study? show less
N/A
PX741401_Useof_Tobacco_Cigar_Familiarity
PX741401130000 Have you ever seen or heard of a cigar, more
cigarillo, or filtered cigar before this study? show less
N/A
PX741401_Useof_Tobacco_Cigar_History
PX741401150000 Have you ever smoked a traditional cigar, more
even one or two puffs? show less
N/A
PX741401_Useof_Tobacco_Cigar_Quit
PX741401250000 Have you completely quit smoking [CIGARFILL]s? N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthdays
PX741401240101 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthdays_Encoded
PX741401240102 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthmonths
PX741401240201 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthmonths_Encoded
PX741401240202 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthyears
PX741401240301 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlengthyears_Encoded
PX741401240302 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Quitlength_Coded
PX741401240400 About how long has it been since you last more
smoked [CIGARFILL]s? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Cigar_Total
PX741401230000 How many [CIGARFILL]s have you smoked in more
your entire life? show less
N/A
PX741401_Useof_Tobacco_Current_Use
PX741401020000 Do you now smoke cigarettes... Variable Mapping
PX741401_Useof_Tobacco_Dissolvable_Currentuse
PX741401530000 Do you now use dissolvable tobacco... N/A
PX741401_Useof_Tobacco_Dissolvable_Familiarity
PX741401510000 Have you ever seen or heard of dissolvable more
tobacco before this study? show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Lasttime
PX741401550000 When did you last use dissolvable tobacco? N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthdays
PX741401570101 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthdays_Encoded
PX741401570102 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthmonths
PX741401570201 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthmonths_Encoded
PX741401570202 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthyears
PX741401570301 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlengthyears_Encoded
PX741401570302 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Quitlength_Coded
PX741401570400 About how long has it been since you last more
used dissolvable tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Thirtydays
PX741401540000 In the past 30 days, have you used more
dissolvable tobacco, even one or two times? show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Total
PX741401560000 How many pieces of dissolvable tobacco have more
you used in your entire life? show less
N/A
PX741401_Useof_Tobacco_Dissolvable_Type
PX741401520000 Have you ever used dissolvable tobacco more
products, such as Ariva®, Stonewall™, or Camel Orbs, Sticks, or Strips, even one or two times? show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Familiarity
PX741401060000 Have you ever seen or heard of an electronic more
cigarette or e-cigarette before this study? show less
N/A
PX741401_Useof_Tobacco_Ecigarette_History
PX741401070000 Have you ever used an e-cigarette, such as more
NJOY®, Blu™, or Smoking Everywhere, even one or two times? show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quit
PX741401120000 Have you completely quit using e-cigarettes? N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthdays
PX741401110101 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthdays_Encoded
PX741401110102 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthmonths
PX741401110201 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthmonths_Encoded
PX741401110202 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthyears
PX741401110301 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlengthyears_Encoded
PX741401110302 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Quitlength_Coded
PX741401110400 About how long has it been since you last more
took a puff from an e-cigarette? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Thirtydays
PX741401090000 In the past 30 days, have you used an more
e-cigarette, even one or two times? show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Total
PX741401100000 How many disposable e-cigarettes or more
e-cigarette cartridges have you used in your entire life? show less
N/A
PX741401_Useof_Tobacco_Ecigarette_Use
PX741401080000 Do you now use e-cigarettes... N/A
PX741401_Useof_Tobacco_History
PX741401010000 Have you ever smoked a cigarette, even one more
or two puffs? show less
Variable Mapping
PX741401_Useof_Tobacco_History_Thirtydays
PX741401030000 In the past 30 days, have you smoked a more
cigarette, even one or two puffs? show less
Variable Mapping
PX741401_Useof_Tobacco_Hookah_Currentuse
PX741401350000 Do you now smoke hookah... N/A
PX741401_Useof_Tobacco_Hookah_Familiarity
PX741401330000 Have you ever seen or heard of a hookah more
before this study? show less
N/A
PX741401_Useof_Tobacco_Hookah_History
PX741401340000 Have you ever smoked tobacco in a hookah, more
even one or two puffs? show less
N/A
PX741401_Useof_Tobacco_Hookah_Lasttime
PX741401370000 When did you last smoke hookah? N/A
PX741401_Useof_Tobacco_Hookah_Quit
PX741401420000 Have you completely quit smoking hookah? N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthdays
PX741401380101 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthdays_Encoded
PX741401380102 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthmonths
PX741401380201 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthmonths_Encoded
PX741401380202 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthyears
PX741401380301 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlengthyears_Encoded
PX741401380302 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Quitlength_Coded
PX741401380400 About how long has it been since you last more
smoked hookah? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Hookah_Thirtydays
PX741401390000 Have you smoked hookah at least once in the more
past 30 days? show less
N/A
PX741401_Useof_Tobacco_Hookah_Threemonths
PX741401400000 Have you smoked hookah at least once in the more
past three months? show less
N/A
PX741401_Useof_Tobacco_Hookah_Total
PX741401360000 How many times have you smoked hookah in more
your entire life? Count each sitting or session where you smoked tobacco in a hookah, whether alone or with others. show less
N/A
PX741401_Useof_Tobacco_Hookah_Twelvemonths
PX741401410000 Have you smoked hookah at least once in the more
past twelve months? show less
N/A
PX741401_Useof_Tobacco_Pipe_Currentuse
PX741401280000 Do you now smoke a pipe filled with tobacco... Variable Mapping
PX741401_Useof_Tobacco_Pipe_Familiarity
PX741401260000 Have you ever seen or heard of a pipe before more
this study? show less
N/A
PX741401_Useof_Tobacco_Pipe_History
PX741401270000 Have you ever smoked a pipe filled with more
tobacco, even one or two puffs? show less
Variable Mapping
PX741401_Useof_Tobacco_Pipe_Lasttime
PX741401310000 When did you last smoke a pipe filled with more
tobacco? show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthdays
PX741401320101 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthdays_Encoded
PX741401320102 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthmonths
PX741401320201 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthmonths_Encoded
PX741401320202 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthyears
PX741401320301 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlengthyears_Encoded
PX741401320302 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Quitlength_Coded
PX741401320400 About how long has it been since you last more
smoked a pipe filled with tobacco? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Pipe_Thirtydays
PX741401290000 In the past 30 days, have you smoked a more
regular pipe filled with tobacco, even one or two puffs? show less
Variable Mapping
PX741401_Useof_Tobacco_Pipe_Total
PX741401300000 How many bowls filled with pipe tobacco have more
you smoked in your entire life? show less
N/A
PX741401_Useof_Tobacco_Quitlength_Coded
PX741401050400 About how long has it been since you more
completely quit smoking cigarettes? show less
N/A
PX741401_Useof_Tobacco_Quitlength_Days
PX741401050101 About how long has it been since you more
completely quit smoking cigarettes? show less
Variable Mapping
PX741401_Useof_Tobacco_Quitlength_Days_Encoded
PX741401050102 About how long has it been since you more
completely quit smoking cigarettes? show less
N/A
PX741401_Useof_Tobacco_Quitlength_Months
PX741401050201 About how long has it been since you more
completely quit smoking cigarettes? show less
Variable Mapping
PX741401_Useof_Tobacco_Quitlength_Months_Encoded
PX741401050202 About how long has it been since you more
completely quit smoking cigarettes? show less
N/A
PX741401_Useof_Tobacco_Quitlength_Years
PX741401050301 About how long has it been since you more
completely quit smoking cigarettes? show less
Variable Mapping
PX741401_Useof_Tobacco_Quitlength_Years_Encoded
PX741401050302 About how long has it been since you more
completely quit smoking cigarettes? show less
N/A
PX741401_Useof_Tobacco_Smokeless_Currentuse
PX741401450000 Do you now use [SMKLSSFILL]... N/A
PX741401_Useof_Tobacco_Smokeless_Familiarity
PX741401430000 Have you ever seen or heard of smokeless more
tobacco, such as snus pouches, loose snus, moist snuff, dip, spit, or chewing tobacco, before this study? show less
N/A
PX741401_Useof_Tobacco_Smokeless_Lasttime
PX741401480000 When did you last use [SMKLSSFILL]? N/A
PX741401_Useof_Tobacco_Smokeless_Quit
PX741401500000 Have you completely quit using [SMKLSSFILL]? N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthdays
PX741401490101 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthdays_Encoded
PX741401490102 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthmonths
PX741401490201 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthmonths_Encoded
PX741401490202 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthyears
PX741401490301 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlengthyears_Encoded
PX741401490302 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Quitlength_Coded
PX741401490400 About how long has it been since you last more
used [SMKLSSFILL]? If it was earlier today, enter 1 day show less
N/A
PX741401_Useof_Tobacco_Smokeless_Thirtydays
PX741401460000 in the past 30 days have you used more
[SMKLSSFILL], even one or two times? show less
N/A
PX741401_Useof_Tobacco_Smokeless_Total
PX741401470000 How many [times/ snus pouches] have you used more
[smokeless tobacco] in your entire life? show less
N/A
PX741401_Useof_Tobacco_Smokeless_Type
PX741401440000 Have you ever used any of the following more
smokeless tobacco products, even one or two times? Choose all that apply. show less
N/A
PX741401_Useof_Tobacco_Total_Cigarettes
PX741401040000 How many cigarettes have you smoked in your more
entire life? A pack usually has 20 cigarettes in it. show less
Variable Mapping
Tobacco Regulatory Research: Vector
Measure Name

Use of Tobacco Products

Release Date

June 24, 2015

Definition

Instrument used to determine a respondent’s tobacco product use and regularity of use.

Purpose

The purpose of this measure is to assess a respondent’s use and regularity of use of the following tobacco products: cigarettes, e-cigarettes, cigars, pipe tobacco, hookah and shisha tobacco, smokeless tobacco, and dissolvable tobacco.

Keywords

Population Assessment of Tobacco and Health Study, PATH, cigarettes, e‑cigarettes, cigarillos, filtered cigars, traditional cigars, smokeless tobacco, snus, Redman®, Levi Garrett®, Beechnut®, Skoal®, Grizzly®, Nordic Ice®, Copenhagen®, dissolvables, hookah, shisha, pipe tobacco, blunt, marijuana, Ariva®, Stonewall™, Camel Orbs, snus pouches, loose snus, moist snuff, dip spit, Chewing Tobacco, pipe, smokeless tobacco, dissolvable tobacco

Measure Protocols
Protocol ID Protocol Name
741401 Use of Tobacco Products
Publications

Ross, J. C., et al. (2023) Perceived message effectiveness of cigar warning themes among adults in the United States. Preventive Medicine Reports. 2023 May; 32. doi: 10.1016/j.pmedr.2023.102236

Hensel, E. C. and R. J. Robinson (2022) A proposed cigarette emissions topography protocol reflecting smokers' natural environment use behavior. PLoS ONE. 2022 April; 17(4): 1-13. doi: 10.1371/journal.pone.0266230

Lv, N., et al. (2021) Problem-solving therapy–induced amygdala engagement mediates lifestyle behavior change in obesity with comorbid depression: a randomized proof-of-mechanism trial. American Journal of Clinical Nutrition. 2021 September; 114(6): 2060-2073. doi: 10.1093/ajcn/nqab280

Castner, J., et al. (2020) Prediction model development of women's daily asthma control using fitness tracker sleep disruption. Heart & Lung. 2020 September; 49(5): 548-555. doi: 10.1016/j.hrtlng.2020.01.013

Garcia-Cazarin, M.L., Mandal, R.J., Grana, R., Wanke, K.L., Meissner, H. (2020) Host-agent-vector-environment measures for electronic cigarette research used in NIH grants. Tobacco Control. 2020 January; 29(1). doi: 10.1136/tobaccocontrol-2017-054032

Hensel, E. C., et al. (2020) A Proposed Waterpipe Emissions Topography Protocol Reflecting Natural Environment User Behaviour. International Journal of Environmental Research and Public Health. 2020 January; 17(1): 11. doi: 10.3390/ijerph17010092