Vaping Survey for Parents Question Title * 1. What is your gender? Female Male Transgender Non-binary I do not wish to answer Question Title * 2. What is your race/ethnicity? American Indian or Alaskan Native Asian or Asian American Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White or Caucasian Other More than one race/ethnicity I do not wish to answer Question Title * 3. Do you live in the same home as your child (or any of your children)? Yes, I live in the same home as my child No, I do not live in the same home as my child Question Title * 4. What percent of e-cigarettes or vaping products contain nicotine? 0-20% 20-40% 40-60% 60-80% 80-90% 90-100% Question Title * 5. Do you think you would be able to recognize the smell of an e-cigarette or nicotine vaping product (ex. Juul, Mod, Puff Bar, Blu, etc.) if your child (or any of your children) was using one of these products in your home? Yes, I would be able to recognize the smell of an e-cigarette or nicotine vaping product if it were being used in my home No, I would not be able to recognize the smell of an e-cigarette or nicotine vaping product if it were being used in my home I do not know if I would be able to recognize the smell of an e-cigarette or nicotine vaping product if it were being used in my home Question Title * 6. To your knowledge, does your child (or any of your children) use e-cigarettes or nicotine vaping products? Yes, my child uses e-cigarettes or nicotine vaping products No, my child does not use e-cigarettes or nicotine vaping products I do not know if my child uses e-cigarettes or nicotine vaping products Question Title * 7. How frequently has your child (or any of your children) used e-cigarettes or nicotine vaping products in the past 30 days? My child does not use e-cigarettes or nicotine vaping products 1-3 times Once a week Multiple times per week Once a day Multiple times per day Question Title * 8. How frequently have you used e-cigarettes or nicotine vaping products in the past 30 days? I do not use e-cigarettes or nicotine vaping products 1-3 times Once a week Multiple times per week Once a day Multiple times per day Question Title * 9. Does your child (or any of your children) use e-cigarettes or nicotine vaping products inside your home? Yes, my child uses e-cigarettes or nicotine vaping products inside my home No, my child does not use e-cigarettes or nicotine-vaping products inside my home I do not know Question Title * 10. Have you ever disciplined your child (or any of your children) for using e-cigarettes or nicotine vaping products? Yes, I have disciplined my child for using e-cigarettes or nicotine vaping products No, I have no disciplined my child for using e-cigarettes or nicotine vaping products Question Title * 11. Have you ever assisted your child (or any of your children) in purchasing e-cigarettes or nicotine vaping products? Yes, I have assisted my child in purchasing e-cigarettes or nicotine vaping products No, I have never assisted my child in purchasing e-cigarettes or nicotine vaping products Question Title * 12. What is your attitude towards your child (or any of your children) using e-cigarettes or nicotine vaping products? I strongly disapprove of my child using e-cigarettes or nicotine vaping products I disapprove of my child using e-cigarettes or nicotine vaping products I neither approve or disapprove of my child using e-cigarettes or nicotine vaping products I approve of my child using e-cigarettes or nicotine vaping products I strongly approve of my child using e-cigarettes or nicotine vaping products Question Title * 13. Has your child (or any of your children) ever been formally disciplined by the school or the police for using e-cigarettes or nicotine vaping products? Yes, my child has been formally disciplined by the school or the police for using e-cigarettes or nicotine vaping products No, my child has not been formally disciplined by the school or the police for using e-cigarettes or nicotine vaping products I do not know Question Title * 14. What do you believe influences your child (or any of your children) to use e-cigarettes or nicotine vaping products? My child does not use e-cigarettes or nicotine vaping products The flavors Friends New types of e-cigarettes or nicotine vaping products Reliance on nicotine Other Question Title * 15. Do you believe that the government (both state and local levels) is doing enough to prevent and discourage minors from using e-cigarettes and nicotine vaping products? Yes, I believe that the government is doing enough to prevent and discourage minors from using e-cigarettes and nicotine vaping products No, I do not believe that the government is doing enough to prevent and discourage minors from using e-cigarettes and nicotine vaping products I do not know Question Title * 16. Please provide your contact info for a chance to win a membership to Lakeville Studio Done
