Tobacco/E-Cigarette Prevention Campaign Survey Question Title * 1. Age: 25 or less 26 – 39 40 – 54 55 – 64 65 or over I prefer not to answer Question Title * 2. Sex: Male Female Other/I prefer not to answer Question Title * 3. What best describes your racial/ethnic background? (Choose all that apply) African-American/Black Asian Hispanic/Latino Caucasian/White American Indian or Alaska Native Native Hawaiian or Pacific Islander I prefer not to answer Question Title * 4. How often do you use tobacco, e-cigarettes, or other tobacco-related products? Every day Weekends/occasionally Not at all Question Title * 5. How do you suspect students access tobacco products? Purchase from store Purchased from/provided by peers Purchased from/provided by an adult Provided or sold by a peer Online/Social Media (Snap Chat, etc.) Other (please specify) Question Title * 6. Have you ever seen adults within the Chantilly community using tobacco, e-cigarettes, or other tobacco-related products? Yes No Not sure/don't know Question Title * 7. What kind of tobacco do you think is being used the most in our community? (Choose one) Pipe, hookah/narghile (water pipe) Chewing tobacco Cigar/cigarillo Electronic cigarettes (eCigs) Vape pipes Cigarettes Other (please specify) Question Title * 8. What do you perceive as the most common barrier to tobacco cessation within our school community? Lack of stress-relieving outlets Lack of material or social/emotional support Use is acceptable or encouraged by peers Cultural or social norms Too easy to obtain Other (please specify) Question Title * 9. In your opinion, do students within our school district receive adequate education on tobacco prevention? Yes No I don't know Question Title * 10. In your opinion, what is the best way to provide tobacco and e-cigarette prevention education to our community? Social media platforms Monthly “tobacco prevention” newsletter In person/virtual education sessions Tobacco prevention handouts Classroom instruction/activities Other (please specify) Question Title * 11. Do you think vaping/tobacco use is a problem in the student population at Chantilly High School or another Chantilly Pyramid school? Yes No I don't know Done