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  1. Surveys
  2. 2010
  3. November
  4. T
  5. Tobacco Prevention
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Hello:
You are invited to participate in our survey [TOBACCO PREVENTION]. In this survey, approximately [100] people will be asked to complete a survey that asks questions about [Teen tobacco use]. It will take approximately [3 minutes] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Brandon Jay] by email at the email address specified below. [email protected]

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
In your opionion, who has the greatest effect on teenage smoking/tobacco use?
 
friends/peers
 
parents
 
media/TV/movies
 
other
 
 
 
In your opinion, what percent of teenagers try smoking?
 
0-25%
 
25-50%
 
50-75%
 
75-100%
 
 
 
Do you live/work in an area with enviromental tobacco smoke (secondhand)?
 
yes
 
no
 
 
 
Do your parents/guardians smoke?
 
yes
 
no
 
 
 
Do your friends/peers smoke?
 
yes
 
no
 
 
 
Do you smoke? If yes, then what is the average amount of cigarettes do you smoke in a day?
 
1-10
 
10-20
 
1 pack
 
more than 1 pack
 
I do not smoke
 
 
 
Do you know of someone in your family that dips or chews?
 
yes
 
no
 
 
 
What experience have you had with tobacco related cancers?
 
family member has had lung cancer
 
family member has had oral cancer
 
friend with lung cancer
 
friend with oral cancer
 
no experience with tobacco related cancers
 
 
 
In your opionion, at what age do most teenagers engage in tobacco use?
 
8-10 yr olds (3rd-5th grade)
 
11-13 yr olds (6th-8th grade)
 
14-18 yr olds (9th-12th grade)
 
earlier than 8 yrs old
 
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