NMAAT Let’s Be Real Community Survey

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* 1. Do you drink water daily?

Always

Usually

Sometimes

Rarely

Never

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* 2. In a typical week, how many days do you exercise?

I don't regularly exercise

Once a week

2 to 4 days a week

5 to 7 days a week

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* 3. What is your 5-digit zipcode?

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* 4. Do you smoke or use vape devices?

Multiple times a day

Once a day

A few times a week

A few times a month

Less than once a month

Not at all

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* 5. Do you think commercial tobacco is harmful?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 6. Do you think vaping is harmful?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 7. What age did you start smoking/vaping?

13 or Younger

14-17

18-24

25-34

35-44

45-54

55-64

65+

None of the above

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* 8. What is your age?

13 or younger

14 to 17

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 9. How likely are you to smoke or vape menthol products?

Very likely

Likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Unlikely

Very unlikely

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* 10. How likely are you to smoke or vape a flavored product, other than menthol?

Very likely

Likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Unlikely

Very unlikely

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* 11. About how many cups of fruit do you eat each day? If you don’t know for certain, please provide an estimate.

None

Some, but less than 1 cup

1 to less than 1.5 cups

1.5 cups to less than 2 cups

2 or more cups

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* 12. About how many cups of vegetables do you eat each day? If you don’t know for certain, please provide an estimate.

None

Some, but less than 1 cup

1 to less than 1.5 cups

1.5 cups to less than 2 cups

2 or more cups

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* 13. How often do you think about your health?

A great deal

A lot

A moderate amount

A little

None at all

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* 14. Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 15. On average, over the last year, how often have you engaged in the following practices?

	Daily/Regularly	Weekly	Monthly	Not Nearly Enough	N/A
Engaging in a Hobby	Engaging in a Hobby Daily/Regularly	Engaging in a Hobby Weekly	Engaging in a Hobby Monthly	Engaging in a Hobby Not Nearly Enough	Engaging in a Hobby N/A
Partying, Hanging Out, Having Fun	Partying, Hanging Out, Having Fun Daily/Regularly	Partying, Hanging Out, Having Fun Weekly	Partying, Hanging Out, Having Fun Monthly	Partying, Hanging Out, Having Fun Not Nearly Enough	Partying, Hanging Out, Having Fun N/A
Religious, Spiritual, or Traditional Practices	Religious, Spiritual, or Traditional Practices Daily/Regularly	Religious, Spiritual, or Traditional Practices Weekly	Religious, Spiritual, or Traditional Practices Monthly	Religious, Spiritual, or Traditional Practices Not Nearly Enough	Religious, Spiritual, or Traditional Practices N/A
Spending Time in the Outdoors	Spending Time in the Outdoors Daily/Regularly	Spending Time in the Outdoors Weekly	Spending Time in the Outdoors Monthly	Spending Time in the Outdoors Not Nearly Enough	Spending Time in the Outdoors N/A
Community Service	Community Service Daily/Regularly	Community Service Weekly	Community Service Monthly	Community Service Not Nearly Enough	Community Service N/A
Using THC or CBD	Using THC or CBD Daily/Regularly	Using THC or CBD Weekly	Using THC or CBD Monthly	Using THC or CBD Not Nearly Enough	Using THC or CBD N/A
Prayer	Prayer Daily/Regularly	Prayer Weekly	Prayer Monthly	Prayer Not Nearly Enough	Prayer N/A
Using Alcohol	Using Alcohol Daily/Regularly	Using Alcohol Weekly	Using Alcohol Monthly	Using Alcohol Not Nearly Enough	Using Alcohol N/A
Attending to Loved Ones	Attending to Loved Ones Daily/Regularly	Attending to Loved Ones Weekly	Attending to Loved Ones Monthly	Attending to Loved Ones Not Nearly Enough	Attending to Loved Ones N/A
Meditation, Yoga, Mindfulness Practice	Meditation, Yoga, Mindfulness Practice Daily/Regularly	Meditation, Yoga, Mindfulness Practice Weekly	Meditation, Yoga, Mindfulness Practice Monthly	Meditation, Yoga, Mindfulness Practice Not Nearly Enough	Meditation, Yoga, Mindfulness Practice N/A
Spending Time with Friends	Spending Time with Friends Daily/Regularly	Spending Time with Friends Weekly	Spending Time with Friends Monthly	Spending Time with Friends Not Nearly Enough	Spending Time with Friends N/A

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* 16. Do you think marketing and advertising greatly impact your perspectives on smoking/vaping?

Yes

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* 17. Select the top 3 factors which you think makes smoking & vaping so popular? Only select 3 choices, please.

	Top Reason Why	Definitely a Factor	This Counts Too
Friends/Relatives who engage in the behavior	Friends/Relatives who engage in the behavior Top Reason Why	Friends/Relatives who engage in the behavior Definitely a Factor	Friends/Relatives who engage in the behavior This Counts Too
They are affordable	They are affordable Top Reason Why	They are affordable Definitely a Factor	They are affordable This Counts Too
It can be easily shared with others	It can be easily shared with others Top Reason Why	It can be easily shared with others Definitely a Factor	It can be easily shared with others This Counts Too
It looks cool	It looks cool Top Reason Why	It looks cool Definitely a Factor	It looks cool This Counts Too
They combine well with other drugs	They combine well with other drugs Top Reason Why	They combine well with other drugs Definitely a Factor	They combine well with other drugs This Counts Too
Nicotine is a habitual drug	Nicotine is a habitual drug Top Reason Why	Nicotine is a habitual drug Definitely a Factor	Nicotine is a habitual drug This Counts Too
It’s legal	It’s legal Top Reason Why	It’s legal Definitely a Factor	It’s legal This Counts Too
Stressful times	Stressful times Top Reason Why	Stressful times Definitely a Factor	Stressful times This Counts Too
They are easily available	They are easily available Top Reason Why	They are easily available Definitely a Factor	They are easily available This Counts Too

Other (please specify)

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* 18. Do you feel influenced to smoke or vape in your household?

Yes

Sometimes

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* 19. Would you ask someone close to you who smokes/vapes to quit if you thought it would improve their life?

Certainly because I am clear on what to say

Yes - if I was clear on what to share or say

Maybe

Maybe Not because of being uncertain of what to say or share

Not at all

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* 20. Do you think smoking cessation products work like they’re supposed to?

A great deal

A lot

A moderate amount

A little

None at all

Other (please specify)

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* 21. Do you think smoking cessation products should be available at no-cost?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 22. Would health reasons make you stop smoking nicotine products?

Definitely would

Probably would

Probably would not

Definitely would not

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* 23. Would you support an effort to remove nicotine products from the marketplace today?

Definitely would

Probably would

Probably would not

Definitely would not

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* 24. Thank you for participating in the NMAAT “Let’s Be Real Community Survey”. We expect the results to be ready by late June. If you’d like to review the results of this survey – please leave your contact information and we will keep in touch about the findings. For more information – go to our website at www.NMAATp.com

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Email Address

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