Diboll Community Tobacco Survey Questions (English) Question Title * 1. Indicate your residential zip code: Question Title * 2. Do you live in the city limits of Diboll? Yes No Question Title * 3. Do you know about the free confidential quit line to help people stop smoking? (1-877-YES-QUIT) Yes No Question Title * 4. Please indicate if you agree with the following statement: local governments have an obligation to protect public health. Strongly agree Agree Disagree Strongly disagree Question Title * 5. Please indicate if you agree with the following statement: all workers, regardless of the type of worksite, should be protected from exposures to secondhand smoke. Strongly agree Agree Disagree Strongly disagree Question Title * 6. Please indicate if you agree with the following statement: our community should have a strong municipal ordinance to protect children and adults from being exposed to secondhand smoke. Strongly agree Agree Disagree Strongly disagree Question Title * 7. Complete this statement: in general, exposure to secondhand smoke is _________. A serious health hazard A moderate health hazard A minor health hazard Not a health hazard Question Title * 8. If someone's cigarette use were offending you, would you ask the person to put out his/her cigarette? Yes No Question Title * 9. Please indicate if you would be in favor or oppose a city ordinance prohibiting smoking in the following places? Strongly favor a no smoking ordinance Favor a no smoking ordinance Oppose a no smoking ordinance Strongly oppose a no smoking ordinance Fast food restaurants: Fast food restaurants: Strongly favor a no smoking ordinance Fast food restaurants: Favor a no smoking ordinance Fast food restaurants: Oppose a no smoking ordinance Fast food restaurants: Strongly oppose a no smoking ordinance Dining areas of all restaurants: Dining areas of all restaurants: Strongly favor a no smoking ordinance Dining areas of all restaurants: Favor a no smoking ordinance Dining areas of all restaurants: Oppose a no smoking ordinance Dining areas of all restaurants: Strongly oppose a no smoking ordinance Bar areas of all restaurants: Bar areas of all restaurants: Strongly favor a no smoking ordinance Bar areas of all restaurants: Favor a no smoking ordinance Bar areas of all restaurants: Oppose a no smoking ordinance Bar areas of all restaurants: Strongly oppose a no smoking ordinance Bars: Bars: Strongly favor a no smoking ordinance Bars: Favor a no smoking ordinance Bars: Oppose a no smoking ordinance Bars: Strongly oppose a no smoking ordinance Hospitals: Hospitals: Strongly favor a no smoking ordinance Hospitals: Favor a no smoking ordinance Hospitals: Oppose a no smoking ordinance Hospitals: Strongly oppose a no smoking ordinance Nursing homes: Nursing homes: Strongly favor a no smoking ordinance Nursing homes: Favor a no smoking ordinance Nursing homes: Oppose a no smoking ordinance Nursing homes: Strongly oppose a no smoking ordinance Shopping malls: Shopping malls: Strongly favor a no smoking ordinance Shopping malls: Favor a no smoking ordinance Shopping malls: Oppose a no smoking ordinance Shopping malls: Strongly oppose a no smoking ordinance Bowling alleys: Bowling alleys: Strongly favor a no smoking ordinance Bowling alleys: Favor a no smoking ordinance Bowling alleys: Oppose a no smoking ordinance Bowling alleys: Strongly oppose a no smoking ordinance Bingo halls: Bingo halls: Strongly favor a no smoking ordinance Bingo halls: Favor a no smoking ordinance Bingo halls: Oppose a no smoking ordinance Bingo halls: Strongly oppose a no smoking ordinance Casinos: Casinos: Strongly favor a no smoking ordinance Casinos: Favor a no smoking ordinance Casinos: Oppose a no smoking ordinance Casinos: Strongly oppose a no smoking ordinance Sporting events: Sporting events: Strongly favor a no smoking ordinance Sporting events: Favor a no smoking ordinance Sporting events: Oppose a no smoking ordinance Sporting events: Strongly oppose a no smoking ordinance Outdoor parks: Outdoor parks: Strongly favor a no smoking ordinance Outdoor parks: Favor a no smoking ordinance Outdoor parks: Oppose a no smoking ordinance Outdoor parks: Strongly oppose a no smoking ordinance Question Title * 10. If you are currently active in your community, please check all that apply and name the group(s) or organization(s). City council: Member of a local governing body: Neighborhood organization: Political organization: Volunteer group: Fraternal organization: Business/professional organization: Sports organization: Other: Question Title * 11. Are you currently: A non-smoker A smoker A former smoker Question Title * 12. If you currently smoke, how many cigarettes do you smoke each week? Times: Question Title * 13. If you currently smoke, how many times have you tried to quit in past? Times: Done