#whyichoose Campaign Survey Thank you for spending the time to complete our survey! Question Title * 1. What is your age? 15 16 17 18 19 20 21 22 23 24 25 OK Question Title * 2. What is your postcode? OK Question Title * 3. Are you an Aboriginal or Torres Strait Islander? Aboriginal Torres Strait Islander No Prefer not to say OK Question Title * 4. Are you a: non-smoker ex-smoker occasional smoker light smoker heavy smoker OK Question Title * 5. In the last 12 months how many cigarettes have you smoked? OK Question Title * 6. In the last month how many cigarettes have you smoked? OK Question Title * 7. In the last 7 days how many cigarettes have you smoked? OK Question Title * 8. Which of these products do you currently smoke? I don't currently smoke Tailor made cigarettes (that is manufactured cigarettes in a packet) Roll your owns, using loose tobacco Pipes Cigars E-cigarettes Not sure Other (please specify) OK Question Title * 9. How often are you exposed to second hand tobacco smoke? Always Usually Sometimes Rarely Never OK Question Title * 10. If you smoke, rate your motivation to cut back or quit: Not motivated at all Somewhat motivated Highly motivated N/A Not motivated at all Somewhat motivated Highly motivated N/A OK For more information and support for people quitting or wanting to quit, head on over to the #whyichoose website or contact Youth Solutions on 02 4628 2319 OK Question Title OK DONE
