Community Tobacco Survey

1. Are you in support of having tobacco-free parks in your community?

Are you in support of having tobacco-free parks in your community? Yes

Neutral

Comments:

2. I would support a tobacco-free zone in the following places:
(For each place, check the box that best describes how you feel)

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Stongly Agree
Parks	*I would support a tobacco-free zone in the following places: (For each place, check the box that best describes how you feel) Parks Strongly disagree	Parks Disagree	Parks Neither agree nor disagree	Parks Agree	Parks Stongly Agree
Playgrounds	Playgrounds Strongly disagree	Playgrounds Disagree	Playgrounds Neither agree nor disagree	Playgrounds Agree	Playgrounds Stongly Agree
Outdoor sports facilities	Outdoor sports facilities Strongly disagree	Outdoor sports facilities Disagree	Outdoor sports facilities Neither agree nor disagree	Outdoor sports facilities Agree	Outdoor sports facilities Stongly Agree
Skateboard/bike parks	Skateboard/bike parks Strongly disagree	Skateboard/bike parks Disagree	Skateboard/bike parks Neither agree nor disagree	Skateboard/bike parks Agree	Skateboard/bike parks Stongly Agree
Hiking/biking paths	Hiking/biking paths Strongly disagree	Hiking/biking paths Disagree	Hiking/biking paths Neither agree nor disagree	Hiking/biking paths Agree	Hiking/biking paths Stongly Agree
Picnic grounds	Picnic grounds Strongly disagree	Picnic grounds Disagree	Picnic grounds Neither agree nor disagree	Picnic grounds Agree	Picnic grounds Stongly Agree
Outdoor concert areas	Outdoor concert areas Strongly disagree	Outdoor concert areas Disagree	Outdoor concert areas Neither agree nor disagree	Outdoor concert areas Agree	Outdoor concert areas Stongly Agree

Comments:

3. Are you ever bothered by secondhand smoke when you attend community events, such as sporting events, fun runs, or concerts?

Are you ever bothered by secondhand smoke when you attend community events, such as sporting events, fun runs, or concerts? Yes

Sometimes

Comments:

4. How likely would you be to attend an event (i.e., fun run, concert, sporting event, etc.) at a tobacco-free park?

How likely would you be to attend an event (i.e., fun run, concert, sporting event, etc.) at a tobacco-free park? More likely

Less likely

Neutral

Comments:

5. Please enter your city and state:

Please enter your city and state:

6. Please check all that apply to you.
I am a:

Please check all that apply to you. I am a: Parent

Grandparent

Elementary Student

Jr. High Student

High School Student

College Student

Youth leader/coach

Sports participant

Other (please specify)

7. (Optional) Gender:

(Optional) Gender: Male

Female

8. (Optional) Are you:

(Optional) Are you: a smoker

a non-smoker

a former smoker

9. Please add any additional comments:

Please add any additional comments:

Community Tobacco Survey
Exit this survey

1. Tobacco-Free Parks

1. Are you in support of having tobacco-free parks in your community?

2. I would support a tobacco-free zone in the following places:
(For each place, check the box that best describes how you feel)

3. Are you ever bothered by secondhand smoke when you attend community events, such as sporting events, fun runs, or concerts?

4. How likely would you be to attend an event (i.e., fun run, concert, sporting event, etc.) at a tobacco-free park?

5. Please enter your city and state:

6. Please check all that apply to you.
I am a:

7. (Optional) Gender:

8. (Optional) Are you:

9. Please add any additional comments:

Community Tobacco SurveyExit this survey

1. Tobacco-Free Parks

1. Are you in support of having tobacco-free parks in your community?

2. I would support a tobacco-free zone in the following places: (For each place, check the box that best describes how you feel)

3. Are you ever bothered by secondhand smoke when you attend community events, such as sporting events, fun runs, or concerts?

4. How likely would you be to attend an event (i.e., fun run, concert, sporting event, etc.) at a tobacco-free park?

5. Please enter your city and state:

6. Please check all that apply to you. I am a:

7. (Optional) Gender:

8. (Optional) Are you:

9. Please add any additional comments:

Community Tobacco Survey
Exit this survey

2. I would support a tobacco-free zone in the following places:
(For each place, check the box that best describes how you feel)

6. Please check all that apply to you.
I am a: