Global Youth Tobacco Survey (GYTS): Questionnaire Adaptation

Overview GYTS Core Questionnaire, Optional Modules, and Optional Questions Guidelines for Adapting, Translating, and Finalizing the GYTS Questionnaire

Documents Referenced GYTS Implementation Instructions manual Questionnaire Adaptation Instructions, pages 7 to11

GYTS Core Questionnaire with Optional Questions

GYTS Questionnaire and School Policy Questionnaire Standard core questionnaire and optional modules and questions of the GYTS Questionnaire permit adaptation to meet the data needs of the country Completed by students aged 13 to 15 years old GYTS School Policy Questionnaire provides information on tobacco-free policies and enforcement in schools Completed by School Principal or Administrator One School Policy Questionnaire for each school

GYTS Questionnaire A total of 153 questions available Three main sections Core Questionnaire Optional Modules Optional Questions Lettering scheme designates a question’s section Core Questionnaire (prefix C) Optional Modules (prefix EL, B, S, SL) Optional Questions (prefix O)

Core Questionnaire 43 total questions (prefix C) All 43 questions must be included in a country’s adapted questionnaire and questions should not be changed Some Core questions require that the Research Coordinator enter country-specific examples and answer choices (Ex. C3, C4, C26, C28, C29, etc.) The maximum number of answer choices is eight (8)

Core Questionnaire Introduction Background Characteristics Key Tobacco-Control Indicators Tobacco Use Cessation Secondhand Smoke Economics Pro-/Anti-Tobacco Media and Advertising Knowledge and Attitudes about Tobacco

Core Questionnaire – Introduction Explains and provides examples of different types of tobacco products Defines and groups tobacco use Smoking Tobacco Cigarettes Other types Shisha Pipes Cigars Smokeless Tobacco Chewing tobacco Snuff Dip

Examples: Smoking Tobacco Water pipe Shisha Narguile Pipes Manufactured cigarettes Hand-rolled cigarettes Cigar Kreteks cigarettes Bidis

Examples: Smokeless Tobacco Snus Chewing tobacco Snuff Gutka Dip

Core Questionnaire – Background Characteristics Four questions on background characteristics Age Gender School grade level Spending money (economics) Section includes questions that require Research Coordinator to provide country-specific answers

Core Questionnaire – Tobacco Use Cigarettes Ever use and current use Age of initiation Frequency of use (# of days smoked, # of cigarettes) Other smoked tobacco Smokeless tobacco Smoking tobacco dependence

Core Questionnaire – Cessation Desire to quit smoking Attempts to quit smoking during past 12 months Opinions on being able to quit smoking Receive help/advice to help quit smoking

Core Questionnaire – Secondhand Smoke Exposure to smoking in the past 7 days at home, indoor public places, and outdoor public places Noticing others smoking at school Knowledge of harmfulness of secondhand smoke Opinion on banning smoking Indoor public places Outdoor public places

Core Questionnaire – Economics Obtaining Cigarettes Where cigarettes were purchased Inability to buy cigarettes because of age Package type Individual sticks, packs, cartons, roll your own Average cost of a pack of 20 cigarettes

Core Questionnaire – Media: Anti-Tobacco Advertising messages against tobacco Media (Television, radio, internet, billboards, posters, newspapers, magazines, movies) Sports and social events (sports games, fairs, concerts, community events, social gatherings) Attention to health warning labels on cigarette packages School lessons about the dangers of tobacco use

Core Questionnaire – Media: Pro-Tobacco Tobacco promotion and use on television shows, videos, and movies Tobacco advertising/ promotions at points of sale Items with tobacco brand logo: ownership, willingness (i.e., Marketing receptivity) Tobacco company representative offering a free tobacco product

Core Questionnaire – Knowledge & Attitudes Susceptibility to tobacco use Using tobacco if offered by friends Future tobacco use in the next 12 months Ability to quit smoking Smoking tobacco to feel comfortable Curiosity (“I think I might enjoy smoking a cigarette.”)

Optional Modules Four Optional Modules provide additional questions to capture further data on tobacco types and use 48 questions total Electronic Cigarettes (3 questions, prefix EL) Shisha (14 questions, prefix S) Bidis (14 questions, prefix B) Smokeless Tobacco (17 questions, prefix SL) All or some questions of an Optional Module can be included

Optional Questions 62 Optional Questions for review (prefix O) Incorporates Core and Optional Questions from previous GYTS questionnaires New questions based on emerging topics about tobacco use Optional Questions are broken out by key tobacco- control topics

Country-Created Questions Research coordinators can revise or amend optional modules or optional questions They can also create and include their own questions (i.e., country-created questions) A justification or rationale for the inclusion of country- created questions must be provided for review

School Policy Questionnaire Seven (7) questions on tobacco-free policies and enforcement for students, teachers, and other school personnel Country-specific answer choices for position/role of person completing the questionnaire

Questionnaire Adaptation & Finalization

Questionnaire Adaptation Research Coordinator has primary responsibility for adapting the GYTS Questionnaire Works in collaboration with the country’s Ministry of Health or Education and technical experts Use core questions, optional modules, and/or optional questions

Steps for Questionnaire Adaptation Start with editable GYTS Core questionnaire Fill in country-specific examples and answer choices for specific questions (Ex. C3, C4, C26, C28, C29) Add questions from Optional Modules (if appropriate) Add questions from the list of Optional Questions (if appropriate) Add other questions (“country-created”) if needed to address important country-specific issues

Adding Questions Optional Modules can be inserted at the end of the Core Questionnaire Individual optional/country-created questions should be added at the end of the related key topic category Questions may be reordered during the questionnaire review and finalization process to improve flow The suggested maximum number of questions included in the final questionnaire should not exceed 75 The Research Coordinator is not required to add questions from the Optional Modules or the Optional Questions section; a GYTS Questionnaire can include only the Core Questionnaire

Submitting to WHO/CDC for Review Submit the Microsoft Word version (English) of the country-adapted GYTS Questionnaire for WHO and CDC review GYTS standard question lettering schemes (e.g., C1-C43 for Core, S1- S14 for Shisha Module) should be maintained until the Questionnaire is finalized WHO/CDC will Review the Questionnaire and provide comments or edits Return the Questionnaire for final adaptations

Questionnaire Translation Remove lettering prefixes and revise questionnaire to consecutive numbering (e.g., 1 to 75) Translate adapted GYTS Questionnaire and School Policy Questionnaire into local country language Back-translate into English for review Translations and back-translations should be done independently by language experts Content and survey experts should review for consistency

Questionnaire Testing Questionnaire testing in group setting with a facilitator 6 to 8 participants (13-15 year old students) Student debriefing session Evaluate the following: Wording translation Comprehension of any new country-specific questions Overall flow Submit any revisions to WHO and CDC for approval; any approved revisions must be translated and back-translated to English

Finalizing the Questionnaire Once finalized The order of questions should not be changed The numbering should be changed to remove the letter prefixes and to number the questions consecutively (e.g., 1-75) RC sends the finalized questionnaire (English and translated versions) to WHO and CDC for documentation

GYTS Questionnaire Adaptation Process RC, MoH/MoE, and technical experts Translation and back-translation (reviewed by WHO/CDC) Questionnaire testing and modification RC sends questionnaire (in English) to WHO/CDC for review Final questionnaire sent to all for documentation WHO/CDC works with RC to review/analyze questionnaire for finalization

THANK YOU! This concludes this presentation on the GYTS Questionnaire Adaptation process.