#whyichoose Campaign Survey

Thank you for spending the time to complete our survey!

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* 1. What is your age?

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* 2. What is your postcode?

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* 3. Are you an Aboriginal or Torres Strait Islander?

Aboriginal

Torres Strait Islander

Prefer not to say

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* 4. Are you a:

non-smoker

ex-smoker

occasional smoker

light smoker

heavy smoker

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* 5. In the last 12 months how many cigarettes have you smoked?

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* 6. In the last month how many cigarettes have you smoked?

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* 7. In the last 7 days how many cigarettes have you smoked?

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* 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)

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* 9. How often are you exposed to second hand tobacco smoke?

Always

Usually

Sometimes

Rarely

Never

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* 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

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