Brief Survey: Honor the Air - Smoke-Free Native Homes Program

Evaluation Survey

Welcome and thank you for being interested in HONOR THE AIR, a program of the Tribal Youth Ambassadors for Tobacco Control Project of the California Indian Museum and Cultural Center.

We are here to help you have a smoke-free home from commercial tobacco and marijuana smoke using education materials created by the Native community for Native families in Sonoma, Lake, and Mendocino Counties.

Learn how you can protect your family and stay healthy using Native traditions by visiting our webpages at https://cimcc.org/tpp/

Thank you for your participation in today's event. Please answer the following questions so we can learn about your first experience and determine what type of resources would best support your journey in creating a smoke-free home.

If you have any questions or concerns, feel free to contact us. Christina Inong, ASW, Health Education Specialist, (707) 579-3004, christinacimcc@gmail.com, will contact you.

Yahwi!

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* 1. Contact Information:

Name *

Tribal Affiliation *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

FEEDBACK ON SESSION

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* 3. Congratulations on participating in your first education session. How helpful was the education you received at the event?

Extremely helpful

Very helpful

Somewhat helpful

Not so helpful

Not at all helpful

Other (please specify)

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* 4. What was your favorite part of the session?

STARTING QUESTIONS

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* 5. Are you and your family ready to have a smoke-free home? Using the slider below to tell us how ready you are. 0 means you're uncertain, 1 means you're not ready, and 5 means you're really ready!

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 6. Do you and your family know about how Native traditions can help you create a smoke-free home? Use the slider below to tell us how much you know. 0 means uncertain, 1 means very little, and 5 means a lot.

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. Are you and your family aware of the harms caused by smoking or vaping commercial tobacco in a home? Use the slider below to tell us how aware you are. 0 means uncertain, 1 means a little, and 5 means a lot.

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 8. Are you and your family aware of the harms caused by smoking or vaping marijuana in a home? Use the slider below to tell us how aware you are. 0 means uncertain, 1 means a little, and 5 means a lot.

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. Please tell us what kind of help you need to have a smoke-free home.

I want resources on traditional tobacco and its uses.

I want resources to create a smoke-free home.

I want resources to help a family member create a smoke-free home.

I want to learn about the harms of secondhand and thirdhand smoke.

I want a follow-up check-in zoom call to receive more guidance on how to create a smoke-free home.

Other (please specify)

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* 10. Would you like us to contact you with more information regarding the next steps in the HONOR THE AIR program?

Yes

I don't know

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* 11. How did you hear about the Honor the Air Program?

Thank you for completing this survey. For more information on this Project, go to https://cimcc.org/tpp/. For any questions, please get in touch with Christina Inong, ASW, Health Education Specialist, at christinacimcc@gmail.com; projectdirectortya4tc@gmail.com, 1-866-904-3091.