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Smoking Survey - 10 questions

1. Page 1 of 2

50% of survey complete.

Questions 1-5

Question Title

* 1. Please check the box below that best describes your current situation regarding cigarette smoking and the approximately number of years you have smoked or did smoke before quitting.

I currently smoke (less than 1 year).

I currently smoke (1-3 years).

I currently smoke (4-8 years).

I currently smoke (9-15 years).

I currently smoke (16-25 years).

I currently smoke (more than 25 years).

I used to smoke (less than 5 years).

I used to smoke (6-15 years).

I used to smoke (16-25 years).

I used to smoke (over 25 years).

I have only smoked a handful of times or less.

I smoke very sporadically and/or on rare occasions.

I have never smoked a single cigarette.

If you used to smoke, please indicate in the box below how many years ago since you quit, and the method you used to quit (laser therapy, patches, prescription drugs, etc.). Feel free to add any additional comments.

Question Title

* 2. How old were you when you smoked your first cigarette?

Less than 11 years old.

Between 11 and 15 years old.

Between 16 and 19 years old.

Between 20 and 25 years old.

Over 26 years old.

I have never smoked a cigarette.

Please indicate your current age and M/F (male/female)

Question Title

* 3. What was the first drug you tried or experimented with? If it's not on the list, please list it in the comment box. Feel free to make any additional comments.

Alcohol.

Cigarettes.

Cigars.

Marijuana.

Methamphetamine.

Cocaine.

LSD/acid.

Glue or other inhalants.

Prescription drugs (in an illegal or abusive manner).

Other (please specify)

Question Title

* 4. If you smoke, please check all that apply regarding your behavior when smoking and secondhand smoke. If you don't smoke, we'd still like your opinion on several of the statements below.

I always consider others around me when smoking and don't smoke in front of children or non-smokers, unless they say it's okay.

I abide by the law of the land, if it's legal to smoke, I do. If it's illegal to smoke, I don't.

It's my right to smoke most anywhere I want, if others don't like it, they have the right to leave.

If a non-smoker gets on my nerves, I will intentionally blow smoke toward them.

I have kids, although they know I smoke, I don't smoke in front of them.

I have kids, and sometimes smoke in front of them.

I have kids and they don't know that I smoke.

I am conscious not to let some people know that I smoke (i.e. parents, teachers, boss, spouse, doctor, etc.).

I do not hide the fact that I smoke from anyone.

I do not believe secondhand smoke hurts anyone in any way.

I have voted in elections regarding smoking ban issues, and have voted FOR them.

I have voted AGAINST smoking bans.

I have placed smoking limits on myself (i.e. don't smoke in my car, home, workplace, etc.)

I believe that businesses should decide if they want to allow smoking, and it's strictly up to each indivdual business.

Other (please specify)

Question Title

* 5. Please indicate the level of importance that you believe each scenario had in your decision to smoke your first cigarette. Skip this question if you have never smoked a single cigarette.

	Extremely important	Somewhat important	Slightly important	Not important at all	Not applicable
Your parents smoke/smoked.	Your parents smoke/smoked. Extremely important	Your parents smoke/smoked. Somewhat important	Your parents smoke/smoked. Slightly important	Your parents smoke/smoked. Not important at all	Your parents smoke/smoked. Not applicable
Your parents or other close relatives encouraged you to try it.	Your parents or other close relatives encouraged you to try it. Extremely important	Your parents or other close relatives encouraged you to try it. Somewhat important	Your parents or other close relatives encouraged you to try it. Slightly important	Your parents or other close relatives encouraged you to try it. Not important at all	Your parents or other close relatives encouraged you to try it. Not applicable
Many of your friends smoke/smoked.	Many of your friends smoke/smoked. Extremely important	Many of your friends smoke/smoked. Somewhat important	Many of your friends smoke/smoked. Slightly important	Many of your friends smoke/smoked. Not important at all	Many of your friends smoke/smoked. Not applicable
Many of your friends encouraged you to try it.	Many of your friends encouraged you to try it. Extremely important	Many of your friends encouraged you to try it. Somewhat important	Many of your friends encouraged you to try it. Slightly important	Many of your friends encouraged you to try it. Not important at all	Many of your friends encouraged you to try it. Not applicable
You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.).	You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.). Extremely important	You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.). Somewhat important	You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.). Slightly important	You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.). Not important at all	You knew someone that smoked that you looked up to and respected (i.e. teacher, sports star, neighbor, someone at church, etc.). Not applicable
Television/Movie advertising.	Television/Movie advertising. Extremely important	Television/Movie advertising. Somewhat important	Television/Movie advertising. Slightly important	Television/Movie advertising. Not important at all	Television/Movie advertising. Not applicable
Advertising in stores, windows, sidewalk signs, etc.	Advertising in stores, windows, sidewalk signs, etc. Extremely important	Advertising in stores, windows, sidewalk signs, etc. Somewhat important	Advertising in stores, windows, sidewalk signs, etc. Slightly important	Advertising in stores, windows, sidewalk signs, etc. Not important at all	Advertising in stores, windows, sidewalk signs, etc. Not applicable
The rebellious side of you.	The rebellious side of you. Extremely important	The rebellious side of you. Somewhat important	The rebellious side of you. Slightly important	The rebellious side of you. Not important at all	The rebellious side of you. Not applicable
You believe smoking is a sign of maturity.	You believe smoking is a sign of maturity. Extremely important	You believe smoking is a sign of maturity. Somewhat important	You believe smoking is a sign of maturity. Slightly important	You believe smoking is a sign of maturity. Not important at all	You believe smoking is a sign of maturity. Not applicable
You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you.	You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you. Extremely important	You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you. Somewhat important	You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you. Slightly important	You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you. Not important at all	You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you. Not applicable
You started as a dare or on a bet from a friend or acquaintance.	You started as a dare or on a bet from a friend or acquaintance. Extremely important	You started as a dare or on a bet from a friend or acquaintance. Somewhat important	You started as a dare or on a bet from a friend or acquaintance. Slightly important	You started as a dare or on a bet from a friend or acquaintance. Not important at all	You started as a dare or on a bet from a friend or acquaintance. Not applicable
You liked the smell of cigarettes and thought the taste would be a pleasant experience.	You liked the smell of cigarettes and thought the taste would be a pleasant experience. Extremely important	You liked the smell of cigarettes and thought the taste would be a pleasant experience. Somewhat important	You liked the smell of cigarettes and thought the taste would be a pleasant experience. Slightly important	You liked the smell of cigarettes and thought the taste would be a pleasant experience. Not important at all	You liked the smell of cigarettes and thought the taste would be a pleasant experience. Not applicable
You were able to buy or obtain cigarettes easily as a minor.	You were able to buy or obtain cigarettes easily as a minor. Extremely important	You were able to buy or obtain cigarettes easily as a minor. Somewhat important	You were able to buy or obtain cigarettes easily as a minor. Slightly important	You were able to buy or obtain cigarettes easily as a minor. Not important at all	You were able to buy or obtain cigarettes easily as a minor. Not applicable

Feel free to make comments if you wish.