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:
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
Thank you for participating!
Smoking Questionnaire. Please Participate :) Watch
- Thread Starter
- 07-04-2013 18:26
- 07-04-2013 20:24
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!