Debriefing Survey

When you think about air pollution, do you consider any of the following
air pollution?

pollen from plants

yes

no

don’t know

smoke from a wood fire

yes

no

don’t know

dust from a construction site or other open area

YES

NO

don’t know

smoke from factories

Yes

No

Don’t know

exhaust from cars and trucks

yes

no

don’t know

In this survey, when we say air pollution we are not talking about
pollen.

Overall, how would you rate the level of air quality in [name of metro
area]?  Would you say it is excellent, good, fair, poor or very poor?

excellent [skip to Q5]

good

fair

poor

very poor

Please rate the level of air quality in [insert name of metro area]
during each season. [if all excellent, skip to Q5]

	Excellent	good	fair	poor	Very poor

Winter





	Spring





	Summer





	Fall





	

In some cities, air quality may be different in different parts of the
city. Do you think the air quality in the neighborhood where you live is
better, worse or about the same as the rest of the [name of city]?

Better

Worse

About the same

Don’t know

Have you ever lived somewhere else that had episodes of high air
pollution? 

yes

no

don’t know

In your opinion, can air pollution have an impact on a person’s life
or the quality of their life? 

Air pollution can have a big impact

Air pollution can have a moderate impact

Air pollution can have a small impact

Air pollution has no impact

Don’t Know

Ask Q7 only if they think air quality in their city is good or less in
Q2 and 3 or lived somewhere that had air pollution (Q6)

What about your life -- would you say air pollution currently has a big
impact, a moderate impact, a small impact or no impact on your life and
the quality of your life? 

Air pollution has a big impact

Air pollution has a moderate impact

Air pollution has a small impact

Air pollution does not affect the quality of my day-to-day life at all

Don’t Know

Ask everyone

Do you think people can experience symptoms or other health problems due
to air pollution? The health problems could be short term or long term.
Remember we are talking about air pollution, not pollen. 

Yes

No Don’t Know 

Has a doctor, nurse, or other health professional ever told you to
reduce your outdoor activity level when the air quality is bad? 

Yes

No[skip to Q13]

Don’t know

Ask Q10-12 only if think air pollution can impact health

Have you ever experienced any symptoms or developed any health problems
that you think were related to air pollution? Please think about all the
places you have lived when you answer this question.

Yes

No [skip to Q12]

Don’t know

Some people are more likely to experience health problems related to air
pollution than others.  Do you consider yourself to be more likely than
the average person your age to experience health problems related to air
pollution? 

Yes

No

Don’t know

Thinking about the other people in your household, is there anyone in
your household who is more likely than the average person their age to
experience health problems related to air pollution? 

Yes

No

Don’t know 

Ask Q13 to 16 only if they think air quality in their city is good or
less in Q2 and 3 or lived somewhere that had air pollution (Q6) and
think air pollution has some impact on day to day life (Q7)

Sometimes people make big changes in their life because of air
pollution.  Has air pollution ever been an important factor in your
decision about what city to live in?

Yes

No

I don’t know

Has air pollution ever been an important factor in your decision about
which neighborhood within the city to live in? 

Yes

No

I don’t know

Has air pollution ever been an important factor in your decision about
what job to take? 

Yes

No

I don’t know

Has air pollution ever been an important factor in your decisions about
your daily schedule or things you do during the day?  Examples might be
the time of day you exercise, how long you exercise, how you commute,
when you commute, or what activities to participate in. 

Yes

No

I don’t know

Ask everyone

Do you think there are actions that people can take to protect
themselves from exposure to air pollution? 

Yes

No [skip to Q19]

Don’t know

What actions can people take to avoid being exposed to air pollution or
to reduce the effects of being exposed?   Please list up to 3 actions.

________________________________________________

________________________________________________

________________________________________________

Here is a list of strategies that have been suggested if people want to
avoid being exposed to air pollution. In your opinion, how effective
would the strategy be in reducing someone’s exposure to air pollution
or reducing the impact air pollution had on the individual?

	Very Effective	Somewhat Effective	Not at all effective	No opinion

Spend less time outdoors





Use the air conditioner







Close the windows







Engage in less strenuous activities outdoors







Take medication







Wear a face mask









Now we would like you to think about the things a person can do to
reduce air pollution.  Do you think there are actions that people can
take to reduce their contribution to air pollution? 

Yes

No [skip to Q22]

Don’t know

 What actions can people take to reduce air pollution? Please list up to
3 actions. 

________________________________________________

________________________________________________

________________________________________________

Here is a list of strategies that have been suggested if people want to
reduce the amount of pollution in their city. In your opinion, how
effective would the strategy be in reducing the amount of air pollution?

	Very Effective	Somewhat Effective	Not at all effective	No opinion

Drive less, carpool or postpone errands







Use  public transportation







Don’t burn wood in the fireplace or wood stove







Don’t burn trash or brush







Drive a hybrid car or a car that gets good gas mileage







Postpone refueling their cars until after sundown







Postpone using gas-powered machines or tools until after sundown







Reduce electricity use







Get you car’s emissions tested regularly









Ask Q23 and 24 only if they think air quality in their city is good or
less in Q2 and 3 or lived somewhere that had air pollution (Q6) 

Now let’s go back to actions people can take to avoid exposing
themselves to air pollution and talk about things that you, personally,
might have done.  We recognize that people have very demanding schedules
and lifestyles.  Making changes to avoid air pollution can be difficult
or impossible.  For these next few questions, please give us your honest
opinions.

On days when you think air pollution is high, do you [only include
somewhat or very effective actions from Q19]

	Always	Sometimes	Rarely	Never

Spend less time outdoors





Use the air conditioner







Close the windows







Engage in less strenuous activities outdoors







Take medication







Wear a face mask









 [if never] There are lots of reasons why people do or do not do things.
What would say is the main reason that you don’t [name of activity]? 

People don’t do things like that where I live.

Air pollution is not a big enough problem here

I can’t [insert activity].

I don’t take any medication

It costs too much

I never thought about doing this

I don’t know

Now let’s go back actions people can take to reduce air pollution, and
talk about things that you, personally, have done.  Again, we realize
that some of these actions may be difficult to take.  Please give us
your honest opinions.

On days when you think air pollution is high, do you [only include
somewhat or very effective actions from Q22]

	Always	Sometimes	Rarely	Never

Drive less, carpool or postpone errands







Use  public transportation







Don’t burn wood in the fireplace or wood stove







Don’t burn trash or brush







Drive a hybrid car or a car that gets good gas mileage







Postpone refueling their cars until after sundown







Postpone using gas-powered machines or tools until after sundown







Reduce electricity use







Get you car’s emissions tested regularly









[if no] Again, there are lots of reasons why people do or do not do
things. What would say is the main reason that you don’t [name of
activity]? 

I am worried about air pollution, but I don’t think this will help
reduce air pollution levels.

Air pollution is not a big enough problem here

People don’t do things like that where I live

I can’t [insert activity].

I don’t drive

I don’t have any gas powered machines or tools

The reduction in air pollution would be so small it wouldn’t matter

It costs too much.

I never thought about doing this.

I don’t know

Ask everyone

During the past year, have you heard, read or seen any news stories,
articles or public service announcements about air pollution in your
city? We are interested in what you have heard about your city, not
national or international air pollution.

Yes

No [skip to Q27]

Don’t know [skip to Q27]

Where have you heard about or seen information about daily air pollution
or air pollution warnings  

on TV

on the radio

in a newspaper

on the Internet or a website

at your school or office

from a friend, family member, or colleague at work

I receive e-mail notifications when higher levels of air pollution are
forecast

Other, where _______________

Don’t know

In some cities, the government routinely collects information on air
quality that may be distributed by local radio, TV and newspapers to
help inform the public about air pollution levels.  Have you ever heard
or read about air pollution information or warning systems where you
live? Please do not include times when you may have heard or read about
high pollen counts. 

Yes

No [skip to Q29]

Don’t know [skip to Q29]

What is the name an air pollution warning system used in your city?
________________________________________ [skip to Q31]

These warnings might be called the Air Quality Index, Code Red or Orange
Days, Air Pollution Watch, Ozone Action Days, Smog Alert, Spare the Air
Day or something similar.   Have you ever heard or read about any of
these air pollution alerts where you live? Please do not include times
when you may have heard or read about high pollen counts. 

Yes 

No [skip to Q36]

Don’t Know

Which of the following do you think is the name of the air pollution
warning system in your city?

Air Quality Index

Code Red or Orange Days

Air Quality Action Day

Air Pollution Watch

Ozone Action Days

Smog Alert

Spare the Air Day

Enviroflash

Other, name ________________

Don’t know

Using a scale of 1 to 10, where 1 is least important to you and 10 is
vitally important to you, how important are air quality forecast alerts
to you and your family’s daily life? 

enter response _______

What is the name of the agency or organization that provides air
pollution information for your city?

The name is ______________

Don’t know

Do you think the information in the air quality forecast is 

Very reliable

Somewhat reliable

Not very reliable

Don’t know

In general, which of the following best describes how often you get
information about air pollution during the summer? 

I receive e-mail notifications when bad air quality conditions are
forecasted

  SEQ CHAPTER \h \r 1 I look for the air pollution forecast myself every
day or almost every day

  SEQ CHAPTER \h \r 1 I look for the air pollution forecast myself some
days

  SEQ CHAPTER \h \r 1 I do not check the forecast, if I see or hear that
air pollution is forecast to be high, I consider that information when I
make plans for the day

  SEQ CHAPTER \h \r 1 I rarely or never pay attention to air pollution
or air pollution warnings

Other, ____________________

Can you tell me what air quality color code was forecast for today [OR
Can you tell me if a smog alert/ozone action day/spare the air day was
forecast for today – tailor to city]?

Code Red

Code Orange

Code Yellow

Code Green

Other _________

Don’t know

Ask Q36 and Q37 only if they think there is air pollution in their city
or lived somewhere that had air pollution

Which of the following pollutants is biggest problem in your city in the
summer, if any? (randomize order)

My city does not have an air pollution problem in the summer

Ozone

Particle pollution

Carbon Dioxide

Nitrogen

Sulfur or acid rain

Other, ___________

Don’t know

Which of the following pollutants is biggest problem in your city in the
winter, if any? 

My city does not have an air quality problem in the winter

Ozone

Particle pollution

Carbon Dioxide

Nitrogen

Sulfur or acid rain

Other, ___________

Don’t know

The public reporting and recordkeeping burden for this collection of
information is estimated to average 20 minutes per response.  Send
comments on the Agency's need for this information, the accuracy of the
provided burden estimates, and any suggested methods for minimizing
respondent burden, including through the use of automated collection
techniques to the Director, Collection Strategies Division, U.S.
Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460.  Include the OMB control number in any
correspondence.  Do not send the completed survey to this address.

OMB Control Number 2060-XXXX

Approval Expires xx/xx/xxxx

