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  1. Surveys
  2. 2013
  3. December
  4. P
  5. Preceived Discrimination and Smoking
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Exit Survey
 
 
Hello:
You are invited to participate in our survey that would examine if perceived discrimination among African Americans adults has a correlation with smoking. The completion of the survey should take approximately 15 minutes. Your participation in this study is completely voluntary. If you feel uncomfortable answering any questions, you can withdraw from the survey at any point.



 
 
 
Have you ever smoke?
 
Yes
 
No
 
 
 
Do you now smoke?
 
Yes
 
No
 
 
 
Do you now smoke daily?
 
Yes
 
No
 
 
 
How do you characterize your daily smoke ritual?
 
Do not smoke
 
Rarely (0-1 cigarettes)
 
Occasionally (2-4 cigarettes)
 
Frequently (5 or more cigarettes)
 
 
 
Do you want to quit smoking?
 
Yes
 
No
 
Other
 
 
 
 
Have you ever try to quit smoking?
 
Yes
 
No
 
Other
 
 
 
 
How often are you watched more closely than others?
 
Once a week or more
 
A few times a month
 
A few times a year
 
Less than once a year
 
Never
 
 
 
How often do you feel treated unfairly?
 
Once a week or more
 
A few times a month
 
A few times a year
 
Less than once a year
 
Never
 
 
 
How often do you feel that you have to work twice as hard as others work?
 
Once a week or more
 
A few times a month
 
A few times a year
 
Less than once a year
 
Never