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Section ID Section Name
HH HH1
HH HH2
HH HH3
HH HH4b
HH HH4c
HH HH4cYear
HH HH4d
HH HH4e
HH EditRosterIntro
IQ Consent1
IQ Consent3
VariableName
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
HouseholdQuestionnaire
IndividualQuestionnaire
IndividualQuestionnaire
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IQ Consent4
IQ Consent6
IQ IntLang
A A01
A A01a
A A02a
A A02b
A A03
A A03a
A A04
IndividualQuestionnaire
IndividualQuestionnaire
IndividualQuestionnaire
BackgroundCharacteristics
BackgroundCharacteristics
Background
Characteristics
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
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A A05
A A06a
A A06b
A A06c
A A06d
A A06e
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
BackgroundCharacteristics
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A A06f
A A06g
A A06h
A A06i
A A06j
B Tobacco Smoking B01
B Tobacco Smoking B02
B Tobacco Smoking B03
BackgroundCharacteristics
BackgroundCharacteristics
Background
Characteristics
BackgroundCharacteristics
BackgroundCharacteristics
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B Tobacco Smoking B04
B Tobacco Smoking B05
B Tobacco Smoking B06a
B Tobacco Smoking B06a1
B Tobacco Smoking B06b
B Tobacco Smoking B06b1
B Tobacco Smoking B06c
B Tobacco Smoking B06c1
B Tobacco Smoking B06d
B Tobacco Smoking B06d1
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B Tobacco Smoking B06e
B Tobacco Smoking B06e1
B Tobacco Smoking B06f
B Tobacco Smoking B06f1
B Tobacco Smoking B06g
B Tobacco Smoking B06g1
B Tobacco Smoking B06g2
B Tobacco Smoking B07
B Tobacco Smoking B08
B Tobacco Smoking B09
B Tobacco Smoking B10a
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B Tobacco Smoking B10b
B Tobacco Smoking B10c
B Tobacco Smoking B10d
B Tobacco Smoking B10e
B Tobacco Smoking B10f
B Tobacco Smoking B10g
B Tobacco Smoking B10g1
B Tobacco Smoking B11
B Tobacco Smoking B12
B Tobacco Smoking B13a
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B Tobacco Smoking B13b
B Tobacco Smoking B14
B Tobacco Smoking B15
B Tobacco Smoking B16
B Tobacco Smoking B17
B Tobacco Smoking B18a
B Tobacco Smoking B18b
B Tobacco Smoking B18c
B Tobacco Smoking B18d
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B Tobacco Smoking B18e
B Tobacco Smoking B18f
B Tobacco Smoking B18g
B Tobacco Smoking B18g1
C Smokeless Tobacco C01
C Smokeless Tobacco C02
C Smokeless Tobacco C03
C Smokeless Tobacco C04
C Smokeless Tobacco C05
C Smokeless Tobacco C06a
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C Smokeless Tobacco C06a1
C Smokeless Tobacco C06b
C Smokeless Tobacco C06b1
C Smokeless Tobacco C06c
C Smokeless Tobacco C06c1
C Smokeless Tobacco C06d
C Smokeless Tobacco C06d1
C Smokeless Tobacco C06e
C Smokeless Tobacco C06e1
C Smokeless Tobacco C06e2
C Smokeless Tobacco C07
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C Smokeless Tobacco C08
C Smokeless Tobacco C09
C Smokeless Tobacco C10a
C Smokeless Tobacco C10b
C Smokeless Tobacco C10c
C Smokeless Tobacco C10d
C Smokeless Tobacco C10e
C Smokeless Tobacco C11
C Smokeless Tobacco C12
C Smokeless Tobacco C13a
C Smokeless Tobacco C13b
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C Smokeless Tobacco C14
C Smokeless Tobacco C15
C Smokeless Tobacco C16
C Smokeless Tobacco C17
C Smokeless Tobacco C18a
C Smokeless Tobacco C18b
C Smokeless Tobacco C18c
C Smokeless Tobacco C18d
C Smokeless Tobacco C18e
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C Smokeless Tobacco C18g
D1 D01
D1 D02a
D1 D02b
D1 D03a
D1 D03b
D1 D03c
D1 D03d
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-Tobacco
Smoking
Cessation-TobaccoSmoking
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D1 D03e
D1 D03f
D1 D03g
D1 D04
D1 D05
D1 D06
D1 D07
D1 D08
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
Cessation-Tobacco
Smoking
Cessation-TobaccoSmoking
Cessation-TobaccoSmoking
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D2 D09
D2 D10a
D2 D10b
D2 D11a
D2 D11b
D2 D11c
D2 D11d
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-Smokeless
Tobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
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D2 D11e
D2 D11g
D2 D12
D2 D13
D2 D14
D2 D15
D2 D16
E Secondhand Smoke E01
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-SmokelessTobacco
Cessation-Smokeless
Tobacco
Cessation-SmokelessTobacco
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E Secondhand Smoke E02
E Secondhand Smoke E03
E Secondhand Smoke E04
E Secondhand Smoke E05
E Secondhand Smoke E06
E Secondhand Smoke E07
E Secondhand Smoke E08
E Secondhand Smoke E09
E Secondhand Smoke E10
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E Secondhand Smoke E11
E Secondhand Smoke E12
E Secondhand Smoke E13
E Secondhand Smoke E14
E Secondhand Smoke E15
E Secondhand Smoke E16
E Secondhand Smoke E17
F F01a
F F01b
Economics-ManufacturedCigarettes
Economics-ManufacturedCigarettes
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F F01c
F F01d
F F02
F F03
F F04
G1 G01a
G1 G01b
G1 G01c
Economics-ManufacturedCigarettes
Economics-ManufacturedCigarettes
Economics-ManufacturedCigarettes
Economics-ManufacturedCigarettes
Economics-Manufactured
Cigarettes
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,
cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
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G1 G01d
G1 G01e
G1 G01e1
G1 G02
G1 G03
G1 G04a
G1 G04b
Media structure #1-Asking about only
one product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-
Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
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G1 G04c
G1 G04d
G1 G04e
G1 G04f
G1 G04g
G1 G04h
G1 G04i
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about only
one product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
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G1 G04j
G1 G04k
G1 G04k1
G1 G05
G1 G06a
G1 G06b
G1 G06c
G1 G06d
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-
Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
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G1 G06e
G1 G06f
G2 G01a1
G2 G01a2
G2 G01b1
G2 G01b2
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #1-Asking about onlyone product (e.g.,cigarettes)
Media structure #2-
Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,
smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G01c1
G2 G01c2
G2 G01d1
G2 G01d2
G2 G01e1
G2 G01e1a
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,
cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G01e2
G2 G01e2a
G2 G02
G2 G03
G2 G02a
G2 G03a
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,
cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G04a1
G2 G04a2
G2 G04b1
G2 G04b2
G2 G04c1
G2 G04c2
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,
cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G04d1
G2 G04d2
G2 G04e1
G2 G04e2
G2 G04f1
G2 G04f2
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,
cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G04g1
G2 G04g2
G2 G04h1
G2 G04h2
G2 G04i1
G2 G04i2
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,
cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G04j1
G2 G04j2
G2 G04k1
G2 G04k1a
G2 G04k2
G2 G04k2a
G2 G05
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,
smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two or
more products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G05a
G2 G06a1
G2 G06a2
G2 G06b1
G2 G06b2
Media structure #2-Asking about two or
more products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two or
more products (e.g.,cigarettes,smokeless tobacco)
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G2 G06c1
G2 G06c2
G2 G06d1
G2 G06d2
G2 G06e1
G2 G06e2
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two or
more products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
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G2 G06f1
G2 G06f2
H H01
H H02a
H H02b
H H02c
Media structure #2-Asking about two or
more products (e.g.,cigarettes,smokeless tobacco)
Media structure #2-Asking about two ormore products (e.g.,cigarettes,smokeless tobacco)
Knowledge, Attitudes& Perceptions
Knowledge, Attitudes& Perceptions
Knowledge, Attitudes& Perceptions
Knowledge, Attitudes& Perceptions
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H H03Knowledge, Attitudes& Perceptions
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Variable Description Type RangeLo
Numeric 0
Numeric 0
Numeric 0
What is this persons age? Numeric 0
What is the month of this persons date of birth? Numeric
What is the year of this persons date of birth? Numeric 1900
[RECORD GENDER (FOR VERIFICATION IF NECESSARY)] Numeric
Does this person currently smoke tobacco? Numeric
[DO YOU NEED TO REVIEW OR EDIT THE ROSTER?] Numeric
Numeric
Numeric
First, Id like to ask you a few questions about your household. Intotal, how many persons live in this household?
How many of these household members are 15 years of age orolder?
How many male/female household members are 15 years of age orolder?
[CHECK AGE OF SELECTED RESPONDENT FROM THE HOUSEHOLD
QUESTIONNAIRE CASE DETAILS, AND SELECT THE APPROPRIATECATEGORY BELOW:]
[ASK PARENT/GUARDIAN:] Do you agree with [NAME OFRESPONDENT]'s participation?
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[WAS THE SELECTED MINOR RESPONDENT PRESENT?] Numeric
[ASK SELECTED RESPONDENT:] Do you agree to participate? Numeric
[INTERVIEW LANGUAGE] Numeric
[RECORD GENDER FROM OBSERVATION. ASK IF NECESSARY.] Numeric
[IS THE RESPONDENT A {FILL A01= MALE/FEMALE}?] Numeric
What is the month of your date of birth? Numeric
What is the year of your date of birth? Numeric 1900
How old are you? Numeric 15
[WAS RESPONSE ESTIMATED?] Numeric
What is the highest level of education you have completed? Numeric
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Which of the following best describes your *main* work status overthe past 12 months? Government employee, non-government
employee, self-employed, student, homemaker, retired,unemployed-able to work, or unemployed-unable to work?
Please tell me whether this household or any person who lives in
the household has the following items:
Electricity?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Flush toilet?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Fixed telephone?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Cell telephone?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Television?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Have you smoked tobacco daily in the past? Numeric
Numeric
(Please tell me whether this household or any person who lives inthe household has the following item:)
Radio?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Refrigerator?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Car?
(Please tell me whether this household or any person who lives inthe household has the following item:)
Moped/scooter/motorcycle?
(Please tell me whether this household or any person who lives in
the household has the following item:)
Washing machine?
Do you *currently* smoke tobacco on a daily basis, less than daily,or not at all?
In the *past*, have you smoked tobacco on a daily basis, less thandaily, or not at all?
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How old were you when you first started smoking tobacco *daily*? Numeric 0
How many years ago did you first start smoking tobacco *daily*? Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.
Manufactured cigarettes?
On average, how many manufactured cigarettes do you currentlysmoke each week?
(On average, how many of the following products do you currently
smoke each day? Also, let me know if you smoke the product, butnot every day.)
Hand-rolled cigarettes?
On average, how many hand-rolled cigarettes do you currentlysmoke each week?
(On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.)
Kreteks?
On average, how many kreteks do you currently smoke eachweek?
(On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.)
Pipes full of tobacco?
On average, how many pipes full of tobacco do you currentlysmoke each week?
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Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Please specify the other type you currently smoke each day. Text
Numeric 0
Numeric
How old were you when you first started smoking tobacco *daily*? Numeric 0
How many years ago did you first start smoking tobacco *daily*? Numeric 0
Numeric 0
(On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.)_
Cigars, cheroots, or cigarillos?
On average, how many cigars, cheroots, or cigarillos do youcurrently smoke each week?
(On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.)
Number of water pipe sessions per day?
On average, how many water pipe sessions do you currently
participate in each week?
(On average, how many of the following products do you currentlysmoke each day? Also, let me know if you smoke the product, butnot every day.)
Any others?
On average, how many {B06g1} do you currently smoke eachweek?
How soon after you wake up do you usually have your first smoke?Would you say within 5 minutes, 6 to 30 minutes, 31 to 60minutes, or more than 60 minutes?
How many of the following do you currently smoke during a usualweek?
Manufactured cigarettes?
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Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Text
How old were you when you first started smoking tobacco *daily*? Numeric 0
How many years ago did you first start smoking tobacco *daily*? Numeric 0
Numeric
(How many of the following do you currently smoke during a usualweek?)
Hand-rolled cigarettes?
(How many of the following do you currently smoke during a usualweek?)
Kreteks?
(How many of the following do you currently smoke during a usualweek?)
Pipes full of tobacco?
(How many of the following do you currently smoke during a usualweek?)
Cigars, cheroots, or cigarillos?
(How many of the following do you currently smoke during a usualweek?)
Number of water pipe sessions per week?
(How many of the following do you currently smoke during a usualweek?)
Any others?
Please specify the other type you currently smoke during a usualweek.
How long has it been since you stopped smoking?
[ENTER UNIT]
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Numeric 1
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
(How long has it been since you stopped smoking?)
[ENTER NUMBER OF {FILL B13a: YEARS/MONTHS/WEEKS/DAYS}]
Have you visited a doctor or other health care provider in the past12 months?
How many times did you visit a doctor or health care provider inthe past 12 months? Would you say 1 or 2 times, 3 to 5 times, or 6or more times?
During any visit to a doctor or health care provider in the past 12months, were you asked if you smoke tobacco?
During any visit to a doctor or health care provider in the past 12months, were you advised to quit smoking tobacco?
During the past 12 months, did you use any of the following to tryto stop smoking tobacco?
Counseling, including at a smoking cessation clinic?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Nicotine replacement therapy, such as the patch or gum?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Other prescription medications, for example (FILL EXAMPLESRELEVANT TO THE COUNTRY)?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Traditional medicines, for example [FILL EXAMPLES RELEVANT TOTHE COUNTRY)?
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Numeric
Numeric
Numeric
Please specify what you used to try to stop smoking. Text
Numeric
Have you used smokeless tobacco daily in the past? Numeric
Numeric
Numeric 0
Numeric 0
Numeric 0
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
A quit line or a smoking telephone support line?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Switching to smokeless tobacco?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Anything else?
Do you *currently* use smokeless tobacco on a daily basis, lessthan daily, or not at all?
In the *past*, have you used smokeless tobacco on a daily basis,less than daily, or not at all?
How old were you when you first started using smokeless tobacco*daily*?
How many years ago did you first start using smokeless tobacco*daily*?
On average, how many times a day do you use the followingproducts? Also, let me know if you use the product, but not everyday.
Snuff, by mouth?
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Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Please specify the other type you currently use each day. Text
Numeric 0
Numeric
On average, how many times a week do you currently use snuff, bymouth?
(On average, how many times a day do you use the followingproducts? Also, let me know if you use the product, but not everyday)
Snuff, by nose?
On average, how many times a week do you currently use snuff, bynose?
(On average, how many times a day do you use the followingproducts? Also, let me know if you use the product, but not everyday.)
Chewing tobacco?
On average, how many times a week do you currently use chewingtobacco?
(On average, how many times a day do you use the followingproducts? Also, let me know if you use the product, but not everyday.)
Betel quid with tobacco?
On average, how many times a week do you currently use betelquid with tobacco?
(On average, how many times a day do you use the followingproducts? Also, let me know if you use the product, but not everyday.)
Any others?
On average, how many times a week do you currently use{C06e1}?
How soon after you wake up do you usually use smokeless tobaccofor the first time? Would you say within 5 minutes, 6 to 30minutes, 31 to 60 minutes, or more than 60 minutes?
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Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric 0
Numeric
Numeric 1
How old were you when you first started using smokeless tobacco*daily*?
How many years ago did you first start using smokeless tobacco*daily*?
How many times a week do you usually use the following?
Snuff, by mouth?
(How many times a week do you usually use the following?)
Snuff, by nose?
(How many times a week do you usually use the following?)
Chewing tobacco?
(How many times a week do you usually use the following?)
Betel quid with tobacco?
(How many times a week do you usually use the following?)
Any others?
How old were you when you first started using smokeless tobacco*daily*?
How many years ago did you first start using smokeless tobacco*daily*?
How long has it been since you stopped using smokeless tobacco?
[ENTER UNIT]
tobacco?)
[ENTER NUMBER OF {FILL C13a: YEARS/MONTHS/WEEKS/DAYS}]
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Have you visited a doctor or other health care provider in the past12 months?
How many times did you visit a doctor or health care provider inthe past 12 months? Would you say 1 or 2 times, 3 to 5 times, or 6
or more times?
During any visit to a doctor or health care provider in the past 12months, were you asked if you use smokeless tobacco?
During any visit to a doctor or health care provider in the past 12months, were you advised to stop using smokeless tobacco?
During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?
Counseling, including at a cessation clinic?
(During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?)
Nicotine replacement therapy, such as the patch or gum?
(During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?)
Other prescription medications, for example (FILL EXAMPLESRELEVANT TO THE COUNTRY)?
(During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?)
Traditional medicines, for example (FILL EXAMPLES RELEVANT TOTHE COUNTRY)?
(During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?)
A quit line or a telephone support line?
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Numeric
Numeric
Numeric
Numeric 1
Numeric
Numeric
Numeric
Numeric
(During the past 12 months, did you use any of the following to tryto stop using smokeless tobacco?)
Anything else?
The next questions ask about any attempts to stop smoking thatyou might have made during the past 12 months. Please thinkabout tobacco smoking.
During the past 12 months, have you tried to stop smoking?
Thinking about the last time you tried to quit, how long did youstop smoking?
[ENTER UNIT]
(Thinking about the last time you tried to quit, how long did youstop smoking?)
[ENTER NUMBER OF {FILL D02a: MONTHS/WEEKS/DAYS}]
During the past 12 months, did you use any of the following to tryto stop smoking tobacco?
Counseling, including at a smoking cessation clinic?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Nicotine replacement therapy, such as the patch or gum?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Other prescription medications, for example (FILL EXAMPLES
RELEVANT TO THE COUNTRY)?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Traditional medicines, for example (FILL EXAMPLES RELEVANT TOTHE COUNTRY)?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
A quit line or a smoking telephone support line?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Switching to smokeless tobacco?
(During the past 12 months, did you use any of the following to tryto stop smoking tobacco?)
Anything else?
Have you visited a doctor or other health care provider in the past12 months?
How many times did you visit a doctor or health care provider inthe past 12 months? Would you say 1 or 2 times, 3 to 5 times, or 6or more times?
During any visit to a doctor or health care provider in the past 12
months, were you asked if you smoke tobacco?
During any visit to a doctor or health care provider in the past 12months, were you advised to quit smoking tobacco?
Which of the following best describes your thinking about quittingsmoking? I am planning to quit within the next month, I amthinking about quitting within the next 12 months, I will quitsomeday but not within the next 12 months, or I am not interestedin quitting?
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Numeric
Numeric
Numeric 1
Numeric
Numeric
Numeric
Numeric
The next questions ask about any attempts to stop usingsmokeless tobacco that you might have made during the past 12months. Please think about your use of smokeless tobacco.
During the past 12 months, have you tried to stop using smokelesstobacco?
Thinking about the last time you tried to quit, how long did youstop using smokeless tobacco?
[ENTER UNIT]
(Thinking about the last time you tried to quit, how long did you
stop using smokeless tobacco?)
[ENTER NUMBER OF {FILL D10a: MONTHS/WEEKS/DAYS}]
During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?
Counseling, including at a cessation clinic?
(During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?)
Nicotine replacement therapy, such as the patch or gum?
(During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?)
Other prescription medications, for example (FILL EXAMPLESRELEVANT TO THE COUNTRY)?
(During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?)
Traditional medicines, for example (FILL EXAMPLES RELEVANT TOTHE COUNTRY)?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
(During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?)
A quit line or a telephone support line?
(During the past 12 months, have you used any of the following totry to stop using smokeless tobacco?)
Anything else?
Have you visited a doctor or other health care provider in the past12 months?
How many times did you visit a doctor or health care provider in
the past 12 months? Would you say 1 or 2 times, 3 to 5 times, or 6or more times?
During any visit to a doctor or health care provider in the past 12months, were you asked if you use smokeless tobacco?
During any visit to a doctor or health care provider in the past 12
months, were you advised to stop using smokeless tobacco?
Which of the following best describes your thinking about quittingsmokeless tobacco? I am planning to quit within the next month, Iam thinking about quitting within the next 12 months, I will quitsomeday but not within the next 12 months, or I am not interestedin quitting?
Which of the following best describes the rules about smokinginside of your home: Smoking is allowed inside of your home,smoking is generally not allowed inside of your home but there areexceptions, smoking is never allowed inside of your home, or thereare no rules about smoking in your home?
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Inside your home, is smoking allowed in every room? Numeric
Numeric
Do you currently work outside of your home? Numeric
Do you usually work indoors or outdoors? Numeric
Are there any indoor areas at your work place? Numeric
Numeric
Numeric
Numeric
Numeric
How often does *anyone* smoke inside your home? Would you saydaily, weekly, monthly, less than monthly, or never?
Which of the following best describes the indoor smoking policy
where you work: Smoking is allowed anywhere, smoking isallowed only in some indoor areas, smoking is not allowed in anyindoor areas, or there is no policy?
During the past 30 days, did anyone smoke in indoor areas whereyou work?
During the past 30 days, did you visit any government buildings orgovernment offices?
Did anyone smoke inside of any government buildings orgovernment offices that you visited in the past 30 days?
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During the past 30 days, did you visit any health care facilities? Numeric
Numeric
During the past 30 days, did you visit any restaurants? Numeric
Numeric
During the past 30 days, did you use any public transportation? Numeric
Numeric
Numeric
Numeric
Numeric 1
Did anyone smoke inside of any health care facilities that youvisited in the past 30 days?
Did anyone smoke inside of any restaurants that you visited in the
past 30 days?
Did anyone smoke inside of any public transportation that youused in the past 30 days?
Based on what you know or believe, does breathing other peoplessmoke cause serious illness in non-smokers?
The last time you bought cigarettes for yourself, how manycigarettes did you buy?
[ENTER UNIT]
(The last time you bought cigarettes for yourself, how manycigarettes did you buy?)
[ENTER NUMBER OF {FILL F01a:CIGARETTES/PACKS/CARTONS/OTHER}]
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[SPECIFY THE UNIT] Text
Numeric 0
In total, how much money did you pay for this purchase? Numeric 0
Numeric
Numeric
Numeric
Numeric
Numeric
How many cigarettes were in each {FILL F01a/c: PACK/CARTON/{F01c}}?
What brand did you buy the last time you purchased cigarettes foryourself?
The last time you purchased cigarettes for yourself, where did you
buy them?
In the last 30 days, have you noticed *information* about thedangers of smoking cigarettes or that encourages quitting in any ofthe following places?
In newspapers or in magazines?
(In the last 30 days, have you seen any *information* about thedangers of smoking cigarettes or that encourages quitting in any ofthe following places?)
On television?
(In the last 30 days, have you heard any *information* about thedangers of smoking cigarettes or that encourages quitting in any ofthe following places?)
On the radio?
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Numeric
Numeric
Please specify where. Text
Numeric
Numeric
Numeric
Numeric
(In the last 30 days, have you noticed *information* about thedangers of smoking cigarettes or that encourages quitting in any ofthe following places?)
On billboards?
(In the last 30 days, have you noticed *information* about thedangers of smoking cigarettes or that encourages quitting in any ofthe following places?)
Somewhere else?
In the last 30 days, did you notice any health warnings on cigarettepackages?
In the last 30 days, have warning labels on cigarette packages ledyou to think about quitting?
In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?
In stores where cigarettes are sold?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On television?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On the radio?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On billboards?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On posters?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
In newspapers or magazines?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
In cinemas?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On the internet?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On public transportation vehicles or stations?
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Numeric
Numeric
Please specify where. Text
Numeric
Numeric
Numeric
Numeric
Numeric
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
On public walls?
(In the last 30 days, have you noticed any *advertisements or signspromoting* cigarettes in the following places?)
Anywhere else?
In the last 30 days, have you noticed any sport or sporting eventthat is associated with cigarette brands or cigarette companies?
In the last 30 days, have you noticed any of the following types ofcigarette promotions?
Free samples of cigarettes?
(In the last 30 days, have you noticed any of the following types ofcigarette promotions?)
Cigarettes at sale prices?
(In the last 30 days, have you noticed any of the following types ofcigarette promotions?)
Coupons for cigarettes?
(In the last 30 days, have you noticed any of the following types ofcigarette promotions?)
Free gifts or special discount offers on other products when buyingcigarettes?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
(In the last 30 days, have you noticed any of the following types ofcigarette promotions?)
Clothing or other items with a cigarette brand name or logo?
(In the last 30 days, have you noticed any of the following types ofcigarette promotions?)
Cigarette promotions in the mail?
In the last 30 days, have you noticed any information in
*newspapers or in magazines* about the dangers of use or thatencourages quitting of the following tobacco products?
Cigarettes?
(In the last 30 days, have you noticed any information in*newspapers or in magazines* about the dangers of use or thatencourages quitting of the following tobacco products?)
Smokeless tobacco?
(In the last 30 days, have you seen any information on *television*about the dangers of use or that encourages quitting of thefollowing tobacco products?)
Cigarettes?
(In the last 30 days, have you seen any information on *television*about the dangers of use or that encourages quitting of thefollowing tobacco products?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Numeric
Numeric
Please specify where. Text
(In the last 30 days, have you heard any information on the *radio*about the dangers of use or that encourages quitting of thefollowing tobacco products?)
Cigarettes?
(In the last 30 days, have you heard any information on the *radio*about the dangers of use or that encourages quitting of thefollowing tobacco products?)
Smokeless tobacco?
(In the last 30 days, have you noticed any information on*billboards* about the dangers of use or that encourages quittingof the following tobacco products?)
Cigarettes?
(In the last 30 days, have you noticed any information on*billboards* about the dangers of use or that encourages quittingof the following tobacco products?)
Smokeless tobacco?
(In the last 30 days, have you noticed any information on*somewhere else* about the dangers of use or that encouragesquitting of the following tobacco products?)
Cigarettes?
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Numeric
Please specify where. Text
Numeric
Numeric
Numeric
Numeric
(In the last 30 days, have you noticed any information on*somewhere else* about the dangers of use or that encouragesquitting of the following tobacco products?)
Smokeless tobacco?
In the last 30 days, did you notice any health warnings on cigarettepackages?
In the last 30 days, have warning labels on cigarette packages ledyou to think about quitting?
In the last 30 days, did you notice any health warnings onsmokeless tobacco products?
In the last 30 days, have warning labels on smokeless tobaccoproducts led you to think about quitting?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *stores where theproducts are sold*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *stores where theproducts are sold*?)
Smokeless tobacco?
In the last 30 days, have you seen any advertisements or signspromoting the following tobacco products on *television*?
Cigarettes?
(In the last 30 days, have you seen any advertisements or signspromoting the following tobacco products on *television*?)
Smokeless tobacco?
In the last 30 days, have you heard any advertisements promotingthe following tobacco products on the *radio*?
Cigarettes?
(In the last 30 days, have you heard any advertisements promotingthe following tobacco products on the *radio*?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any advertisementspromoting the following tobacco products on *billboards*?
Cigarettes?
(In the last 30 days, have you noticed any advertisementspromoting the following tobacco products on *billboards*?)
Smokeless tobacco?
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *posters*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *posters*?)
Smokeless tobacco?
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *newspapers ormagazines*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *newspapers ormagazines*?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *cinemas*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products in *cinemas*?)
Smokeless tobacco?
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on the *internet*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on the *internet*?)
Smokeless tobacco?
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *public transportationvehicles or stations*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *public transportationvehicles or stations*?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Please specify where. Text
Numeric
Please specify where. Text
Numeric
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *public walls*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products on *public walls*?)
Smokeless tobacco?
In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products *any where else*?
Cigarettes?
(In the last 30 days, have you noticed any advertisements or signspromoting the following tobacco products *any where else*?)
Smokeless tobacco?
In the last 30 days, have you noticed any sport or sporting eventthat is associated with cigarette brands or cigarette companies?
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Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any sport or sporting eventthat is associated with smokeless tobacco brands or smokelesstobacco companies?
In the last 30 days, have you noticed any free distribution ofsamples of the following tobacco products?
Cigarettes?
(In the last 30 days, have you noticed any free distribution ofsamples of the following tobacco products?)
Smokeless tobacco?
In the last 30 days, have you noticed any of the following tobaccoproducts sold at sale prices?
Cigarettes?
(In the last 30 days, have you noticed any of the following tobacco
products sold at sale prices?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any distribution of couponsfor the following tobacco products?
Cigarettes?
(In the last 30 days, have you noticed any distribution of couponsfor the following tobacco products?)
Smokeless tobacco?
In the last 30 days, have you noticed any free gifts or specialdiscount offers on other products when buying any of the followingtobacco products?
Cigarettes?
(In the last 30 days, have you noticed any free gifts or specialdiscount offers on other products when buying any of the following
tobacco products?)
Smokeless tobacco?
In the last 30 days, have you noticed any clothing or other itemswith a brand name or logo of the following tobacco products?
Cigarettes?
(In the last 30 days, have you noticed any clothing or other itemswith a brand name or logo of the following tobacco products?)
Smokeless tobacco?
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Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
In the last 30 days, have you noticed any promotions in the mail
for the following tobacco products?
Cigarettes?
(In the last 30 days, have you noticed any promotions in the mailfor the following tobacco products?)
Smokeless tobacco?
The next question is asking about *smoking* tobacco.
Based on what you know or believe, does smoking tobacco causeserious illness?
Based on what you know or believe, does smoking tobacco causethe following...
Stroke (blood clots in the brain that may cause paralysis)?
(Based on what you know or believe, does smoking tobacco causethe following...)
Heart attack?
(Based on what you know or believe, does smoking tobacco causethe following...)
Lung cancer?
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NumericBased on what you know or believe, does using *smokelesstobacco* cause serious illness?
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RangeHi Option Label
50
50
20
125
1 012 02
3 034 04
5 056 067 078 08
9 0910 1011 11
12 1277 DON'T KNOW99 REFUSED
19937777 DON'T KNOW
9999 REFUSED
1 MALE
2 FEMALE
1 YES2 NO7 DON'T KNOW9 REFUSED
1 YES
2 NO
1 15-172 18 OR OLDER
3 EMANCIPATED MINOR (15-17)
1 YES2 NO
OptionValue
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1 PRESENT2 NOT PRESENT
1 YES2 NO
1 ENGLISH2 [SPECIFY]
3 [SPECIFY]4 [SPECIFY]
1 MALE2 FEMALE
1 YES
2 NO
1 012 023 03
4 045 056 06
7 078 089 09
10 1011 1112 12
77 DON'T KNOW99 REFUSED
20007777 DON'T KNOW9999 REFUSED
125999 REFUSED
1 YES
2 NO7 DON'T KNOW
1 NO FORMAL SCHOOLING2 LESS THAN PRIMARY SCHOOL COMPLETED3 PRIMARY SCHOOL COMPLETED
4 LESS THAN SECONDARY SCHOOL COMPLETED5 SECONDARY SCHOOL COMPLETED6 HIGH SCHOOL COMPLETED
7 COLLEGE/UNIVERSITY COMPLETED
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8 POST GRADUATE DEGREE COMPLETED77 DONT KNOW
99 REFUSED
1 GOVERNMENT EMPLOYEE
2 NON-GOVERNMENT EMPLOYEE3 SELF-EMPLOYED4 STUDENT5 HOMEMAKER
6 RETIRED7 UNEMPLOYED, ABLE TO WORK
8 UNEMPLOYED, UNABLE TO WORK 77 DONT KNOW
99 REFUSED
1 YES
2 NO7 DON'T KNOW
9 REFUSED
1 YES2 NO7 DON'T KNOW
9 REFUSED
1 YES2 NO7 DON'T KNOW
9 REFUSED
1 YES
2 NO7 DON'T KNOW9 REFUSED
1 YES
2 NO7 DON'T KNOW
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9 REFUSED
1 YES2 NO
7 DON'T KNOW9 REFUSED
1 YES2 NO
7 DON'T KNOW9 REFUSED
1 YES2 NO7 DON'T KNOW
9 REFUSED
1 YES2 NO
7 DON'T KNOW9 REFUSED
1 YES2 NO
7 DON'T KNOW9 REFUSED
1 DAILY2 LESS THAN DAILY
3 NOT AT ALL7 DON'T KNOW
9 REFUSED
1 YES2 NO7 DON'T KNOW
9 REFUSED
1 DAILY2 LESS THAN DAILY3 NOT AT ALL7 DON'T KNOW
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9 REFUSED
9899 REFUSED
98
99 REFUSED
200888 R SMOKES PRODUCT BUT NOT EVERY DAY
999 REFUSED
200
999 REFUSED
200
888 R SMOKES PRODUCT BUT NOT EVERY DAY999 REFUSED
200999 REFUSED
200888 R SMOKES PRODUCT BUT NOT EVERY DAY999 REFUSED
200999 REFUSED
200
888 R SMOKES PRODUCT BUT NOT EVERY DAY999 REFUSED
200
999 REFUSED
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200
888 R SMOKES PRODUCT BUT NOT EVERY DAY
999 REFUSED
200999 REFUSED
200888 R SMOKES PRODUCT BUT NOT EVERY DAY999 REFUSED
200999 REFUSED
200888 R SMOKES PRODUCT BUT NOT EVERY DAY
999 REFUSED
200
999 REFUSED
1 WITHIN 5 MINUTES
2 6 TO 30 MINUTES3 31 TO 60 MINUTES4 MORE THAN 60 MINUTES
9 REFUSED
9899 REFUSED
98 99 REFUSED
200
888 R SMOKES PRODUCT BUT < 1 PER WEEK 999 REFUSED
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200888 R SMOKES PRODUCT BUT < 1 PER WEEK 999 REFUSED
200
888 R SMOKES PRODUCT BUT < 1 PER WEEK 999 REFUSED
200888 R SMOKES PRODUCT BUT < 1 PER WEEK
999 REFUSED
200888 R SMOKES PRODUCT BUT < 1 PER WEEK 999 REFUSED
200888 R SMOKES PRODUCT BUT < 1 PER WEEK
999 REFUSED
200888 R SMOKES PRODUCT BUT < 1 PER WEEK 999 REFUSED
9899 REFUSED
98 99 REFUSED
1 YEARS2 MONTHS
3 WEEKS4 DAYS
5 LESS THAN 1 DAY
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7 DON'T KNOW9 REFUSED
999
1 YES
2 NO9 REFUSED
1 1 OR 2
2 3 TO 53 6 OR MORE9 REFUSED
1 YES
2 NO9 REFUSED
1 YES2 NO
9 REFUSED
1 YES2 NO9 REFUSED
1 YES
2 NO9 REFUSED
1 YES
2 NO9 REFUSED
1 YES
2 NO
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