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    1. Gender: Female Male



    2. Age: 18-30 31-45 46-60



    3. Do you smoke or used to smoke? Yes No (please jump to question 12)



    4. Why did you stop smoking? (for those who used to smoke only) _______________


    5. Why do you smoke?

    • stress reliever
    • recreational purpose
    • others, please specify: _______________



    6. Are you aware of smoking’s negative impact to your health? Yes No


    7. Do you suffer from:
    Asthma
    Bronchitis
    Shortness of breath
    Others, please specify: _______________


    8. Are you aware that passive smoking (secondhand smoking) is more dangerous than actual smoking itself? Yes No



    9. Do try to minimize passive smoking? Yes No



    • Have you attempted to stop smoking? Yes No



    10. If yes, why do you think you failed to stop? _______________


    11. Do you plan to do another attempt to quit smoking? Yes No



    (questions 12-14 is for those who do not smoke only)


    12. Have you tried to smoke? Yes No



    13. If yes, why did you not like it? _______________



    14. Are you aware that secondhand smoke’s harm and avoid it? Yes No





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    1. Female 2. 18-30 3. No. 12. Yes 13. I just did not like it, but I don't hate it either. 14. Yes.

    Could you also do mine? http://www.sojump.com/jq/2214993.aspx Thanks!
 
 
 
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