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Have you ever smoked tobacco?
 
Yes
 
No
 
 
 
If yes, how old were you when you first started smoking?
 
8-13
 
14-17
 
18-20
 
21-24
 
25 or older
 
I’ve never smoked
 
 
 
Why did you start smoking? Please explain.
   
 
 
 
When was the last time you smoked?
 
Today
 
1-6 days ago
 
More than a week ago
 
More than a month ago
 
Less than a year ago
 
More than a year ago
 
 
 
What is your preferred way of smoking?
 
Cigarettes
 
Pipes
 
Cigars
 
Hookah
 
Other
 
 
 
If cigarettes, how many do you smoke per day?
 
1-2
 
3-5
 
6-10
 
11-16
 
17-20
 
More than 20
 
 
 
How much money do you spend buying tobacco per month?
 
None
 
Less than $5.00
 
$5.01 - $7.00
 
$7.01 - $10.00
 
$10.01 - $20.00
 
$20.01 - $40.00
 
More than $40.00
 
 
 
What brand of cigarette do you smoke?
 
Any
 
None
 
Marlboro
 
Camel
 
Newports
 
Virginia Slims
 
American Spirit
 
Pall Mall
 
Other
 
 
 
Have you ever tried to quit?
 
Yes
 
No
 
I never started
 
 
 
If yes, how many times?
 
None
 
One to two
 
Three to four
 
Five or more
 
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