ASSIGNMENT 2: Survey

Adult
 
Have you ever urged or tried to support a person to quit smoking, chewing, or using? Pick the answer closest to your situation. 

• No, I do not want to get involved or I worry about their reaction
• Yes, but with no success
• Yes, and they attempted to quit
• Yes, and they successfully quit
• No, I believe it is their choice and/or do not want to get involved

Would you call yourself a smoker?

• Yes
• No

If you are a smoker, at what age did you regularly start smoking?

I am not a smoker

• Age 12 or under
• Between age 13-15
• Between age 16-18
• Over age 18
• Over age 25
• Over age 35
• Over age 50

If you are a smoker, have you ever tried to quit? (Please answer even if you are not a smoker)

I am not a smoker

• I am currently trying to quit.
• Yes, I have tried to quit 1-2 times.
• Yes, I have tried to quit 3-5 times
• Yes I have tried to quit 5 times or more.
• Yes, I am a smoker but I have not tried to quit
• I am a former smoker, and successfully quit

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How many times in the last 6 months have you smoked a cigar?

• I have never smoked a cigar
• I have not smoked a cigar in the past six months but have smoked an occasional cigar before that.
• Less than once a month in the past six months
• More than once a month in the past six months
• 1-2 times per week
• Daily 

Additional Question

• How adult smoking affects behavior in children?
• Why is it so dangerous to smoke during pregnancy?
• How will smoking affect the baby?