Second Hand Smoke Exposure Opinion Survey
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1.

1. How long have you lived in this unit?

How long have you lived in this unit? a. Less than a year

b. 1 to 3 years

c. 3 to 5 years

d. More than 5 years

2. How harmful do you think it is to breathe secondhand smoke (smoke from someone else’s cigarette, pipe or cigar?)

How harmful do you think it is to breathe secondhand smoke (smoke from someone else’s cigarette, pipe or cigar?) a. Very harmful

b. Somewhat harmful

c. Not at all harmful

3. Would the smell of someone else’s tobacco smoke within your building bother you?

Would the smell of someone else’s tobacco smoke within your building bother you? a. Not at all

b. A little

c. A lot

4. Have you ever complained to the management about tobacco smoke drifting into your unit?

Have you ever complained to the management about tobacco smoke drifting into your unit? a. Yes

b. No

5. In your building or complex, where do people smoke?

In your building or complex, where do people smoke? a. Inside their units

b. Inside the hallways, laundry room, lobby, etc.

c. Outside only

d. Inside and Outside

e. Smoking is not allowed at our building

f. Don’t know

6. Do you have children, teens, or older people living in your apartment?

	Yes	No
Children 0-12 Years old?	*Do you have children, teens, or older people living in your apartment? Children 0-12 Years old? Yes	Children 0-12 Years old? No
Youth 13-19 Years old?	Youth 13-19 Years old? Yes	Youth 13-19 Years old? No
Eldery over 65?	Eldery over 65? Yes	Eldery over 65? No

7. Do you or does someone who lives with you live with a chronic disease such as heart disease, diabetes, arthritis, asthma or cancer?

Do you or does someone who lives with you live with a chronic disease such as heart disease, diabetes, arthritis, asthma or cancer? a. Yes

b. No

8. Does anyone who lives in your home currently smoke cigarettes or use tobacco products?

Does anyone who lives in your home currently smoke cigarettes or use tobacco products? a. Yes

b. No

c. Prefer not to answer

9. Do you allow smoking in your apartment unit?

Do you allow smoking in your apartment unit? a. Yes

b. No

10. Would you support any of the following measures to limit smoking in your building?

	Yes	No	Not Sure
a. Making common areas such as hallways, rec. rooms, laundry room, and elevators non-smoking?	*Would you support any of the following measures to limit smoking in your building? a. Making common areas such as hallways, rec. rooms, laundry room, and elevators non-smoking? Yes	a. Making common areas such as hallways, rec. rooms, laundry room, and elevators non-smoking? No	a. Making common areas such as hallways, rec. rooms, laundry room, and elevators non-smoking? Not Sure
b. Making outside areas like balconies, patios, playgrounds, or a swimming pool non-smoking?	b. Making outside areas like balconies, patios, playgrounds, or a swimming pool non-smoking? Yes	b. Making outside areas like balconies, patios, playgrounds, or a swimming pool non-smoking? No	b. Making outside areas like balconies, patios, playgrounds, or a swimming pool non-smoking? Not Sure
c. Creating smoking and non-smoking apartment sections of the building?	c. Creating smoking and non-smoking apartment sections of the building? Yes	c. Creating smoking and non-smoking apartment sections of the building? No	c. Creating smoking and non-smoking apartment sections of the building? Not Sure
d. Making the entire building non-smoking?	d. Making the entire building non-smoking? Yes	d. Making the entire building non-smoking? No	d. Making the entire building non-smoking? Not Sure

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