#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

#whyichoose Campaign Survey

Thank you for spending the time to complete our survey!

Question Title

* 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?

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* 4. Are you a:

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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?

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

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* 10. If you smoke, rate your motivation to cut back or quit:

Question Title

1. What is your age?

2. What is your postcode?

3. Are you an Aboriginal or Torres Strait Islander?

4. Are you a:

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

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

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

8. Which of these products do you currently smoke?

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

10. If you smoke, rate your motivation to cut back or quit: