Proposed County Smoke Free Public Places-Community

The 2010 NC Smoke Free Restaurants and Bars Law (N.C Gen. Stat. 130A-498) allows local government to adopt and enforce smoke free ordinances that are broader than State law in local government buildings, on local government grounds, in local government vehicles, or in public places.

As a part of its strategic plan, Region 7 of the North Carolina Community Transformation Grant Project staff and networks are reviewing existing county smoke free policies and considering a new rule that would expand jurisdiction to be more comprehensive of public places.

Your feedback on this issue is important. Please complete this survey so that we can gather opinions from community members who live and/or work in this county.

*Confidentiality Note-This information is being collected for assessment purposes only. Your responses will remain confidential. Responses will not be publicized by name, but reported in a collective manner.

Please complete this survey by November 2013

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* 1. We are only asking county residents and/or people who live or work in this county and its municipalities (towns) to complete this survey.

City/Town:

ZIP:

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* 2. Do you currently smoke or use tobacco? (Note-This includes smoking in social settings)

Yes

I am a Former Smoker or Tobacco User

Prefer Not to Answer

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* 3. How important is it to you that the following places be smoke-free? (Smoke-free includes prohibiting the use if lighted cigarettes, lighted cigars, lighted pipes, or any other lighted tobacco products.)

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* 4. In general, do you support the idea of having smoke-free public places (that is, any enclosed area to which the public is invited or where the public is permitted) (like recently passed in Orange and Durham counties)?

Yes

Unsure

Other (please specify)

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* 5. What do you believe are the greatest benefits of a smoke-free public places rule?

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* 6. What do you believe are the biggest drawbacks of a smoke-free public places rule?

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* 7. What would make you supportive of a smoke-free public places rule in this county and its municipalities (towns)?

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* 8. Please mark whether you agree or disagree with this statement: Secondhand smoke is harmful to adults and children. (Secondhand smoke is environmental tobacco smoke which is either from the lighted end of a cigarette, cigar, or pipe, or the smoke exhaled by a smoker.)

Agree

Disagree

Unsure

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* 9. Are there any additional comments you would like to share?

Please complete the following demographic questions.

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* 10. Are you a parent or care giver?

Yes

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* 11. What is your age?

Under 18

18-25

26-55

56 and older

Prefer Not to Answer

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* 12. Please describe your race/ethnicity.

White

African American

Hispanic/Latino

Native American/American Indian

Asian/Pacific Islander

Prefer Not to Answer

Other (please specify)

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* 13. What is your highest level of education completed?

Less Than High School

High School Diploma or GED

Some College

College Degree or higher

Prefer Not to Answer

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* 14. What is the range of your total household income?

Less than $20,000

$20,000 - $39,999

$40,000 - $59,999

$60,000 - $79,999

Over $80,000

Prefer Not to Answer

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* 15. What county do you currently reside or work in?

Franklin

Granville

Halifax

Johnston

Nash

Vance

Warren

Wilson

Other (please specify)

	Very Important	Somewhat Important	Not Important
Government vehicles (County or town vehicles, buses)	Government vehicles (County or town vehicles, buses) Very Important	Government vehicles (County or town vehicles, buses) Somewhat Important	Government vehicles (County or town vehicles, buses) Not Important
Government Grounds (ex.land,parking lots of county or town buildings)	Government Grounds (ex.land,parking lots of county or town buildings) Very Important	Government Grounds (ex.land,parking lots of county or town buildings) Somewhat Important	Government Grounds (ex.land,parking lots of county or town buildings) Not Important
Parks, recreational facilities, trails, playgrounds	Parks, recreational facilities, trails, playgrounds Very Important	Parks, recreational facilities, trails, playgrounds Somewhat Important	Parks, recreational facilities, trails, playgrounds Not Important
Bus Stops	Bus Stops Very Important	Bus Stops Somewhat Important	Bus Stops Not Important
Sidewalks	Sidewalks Very Important	Sidewalks Somewhat Important	Sidewalks Not Important
Polling Places	Polling Places Very Important	Polling Places Somewhat Important	Polling Places Not Important
Child Care Facilities	Child Care Facilities Very Important	Child Care Facilities Somewhat Important	Child Care Facilities Not Important
Public Restrooms	Public Restrooms Very Important	Public Restrooms Somewhat Important	Public Restrooms Not Important
Retail stores, shopping malls, and convenience stores	Retail stores, shopping malls, and convenience stores Very Important	Retail stores, shopping malls, and convenience stores Somewhat Important	Retail stores, shopping malls, and convenience stores Not Important
Gaming facilities(ex.internet sweepstakes, video poker)	Gaming facilities(ex.internet sweepstakes, video poker) Very Important	Gaming facilities(ex.internet sweepstakes, video poker) Somewhat Important	Gaming facilities(ex.internet sweepstakes, video poker) Not Important
Lobbies, and other common areas of residential facilities, nursing homes, and apartments	Lobbies, and other common areas of residential facilities, nursing homes, and apartments Very Important	Lobbies, and other common areas of residential facilities, nursing homes, and apartments Somewhat Important	Lobbies, and other common areas of residential facilities, nursing homes, and apartments Not Important
Entertainment and sports arenas	Entertainment and sports arenas Very Important	Entertainment and sports arenas Somewhat Important	Entertainment and sports arenas Not Important
Galleries, libraries, and museums	Galleries, libraries, and museums Very Important	Galleries, libraries, and museums Somewhat Important	Galleries, libraries, and museums Not Important
Office, and commercial space where the public is invited	Office, and commercial space where the public is invited Very Important	Office, and commercial space where the public is invited Somewhat Important	Office, and commercial space where the public is invited Not Important