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The Champaign-Urbana Public Health District is collecting community opinions about menthol tobacco product use and its impact. Community responses and comments will remain confidential. They will be compiled to assist with policy creation efforts. Thank you for taking the time to complete this survey.
Part 1: General Information

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1. Age

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2. Zip Code

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3. Gender

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4. Race (Please select one)

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5. Ethnicity (Please select one)

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6. Household Income

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7. What is the highest level of education you have completed?

If you do not smoke cigarettes or tobacco products, please continue to Part 3: Question 15.
Part 2: Tobacco Use

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8. Have you smoked 100 cigarettes (approximately 5 packs) in your lifetime?

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9. Do you usually smoke menthol or non-menthol cigarettes?

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10. How long have you smoked menthol cigarettes?

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11. In the past 12 months, were you smoking every day, some days, or not at all? 

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12. In the past 3 months, were you smoking every day, some days, or not at all?

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13. In the past, have you attempted to quit smoking?

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14. If so, how many times have you attempted to quit smoking?

Part 3: Sales Restriction Attitude and Impact

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15. Menthol makes it easier for young people to start smoking and/or using tobacco products.

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16. Menthol makes it harder to quit smoking.

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17. In your opinion, how harmful are menthol cigarettes compared to non-menthol cigarettes?  

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18. There should be more local policies to restrict the sale of menthol cigarettes and menthol flavored tobacco products.

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19. Would a sales restriction on menthol tobacco products impact your life? 

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20. How likely would it be that a sales restriction would lead to an attempt to quit menthol cigarettes? 

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21. How likely would it be that a sales restriction would lead to you to seek out smoking cessation resources? 

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Additional comments:

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23. Interested in staying up to date with menthol policy news and other updates? If so, please include your email address below to be added to the Tobacco Coalition mailing list.

0 of 23 answered
 

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