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Appendix 1.

Potential Health Premium for Smoking and Obese Individuals

Hello, my name is Gaby Paniccia. As a student enrolled in a grade twelve Challenge and Change course, I am conducting a research experiment for my final project. The purpose of my study is to examine the effects of obesity and smoking on the growing costs (in dollars) of Canadian Health Care and to evaluate the benefits of raising the health insurance costs and extra medical service costs of the individuals who practice these habits (obese and smoking individuals). This study aims to collect data from a sample population consisting of students in grades nine through twelve who attend Nelson High School. Once all of the surveys have been collected, the students responses will be divided up into the following categories: smoke, do not smoke, are obese, are not obese, to examine whether or not ones health status has an effect on their opinion towards the addition of a healthcare premium for smoking and obese individuals. I can assure you that all of the information collected from your survey is and will remain confidential. Thank you in advance for your cooperation. Once you have completed this survey, please hand it back to me. 1. Do you smoke on a regular basis? Circle the response that applies to you. a) Yes b) No 2. What is your weight? Write you answer below. pounds 3. What is your height? Write you answer below. feet inches 4. On a scale of one to four, how you would rate your current health status? (Circle one number): Poor Fair Good Excellent

5. On a scale of one to five, how strongly you agree or disagree with the following statement (Circle one number): The government should provide free healthcare to Canadians. Strongly Disagree Disagree Neutral Agree Strongly Agree

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6. a) b) c) d) e) 7. a) b) c) d) e)

In your opinion, what is the main reason why people are obese? Circle one reason. It is in their genetic makeup By choice Neither a) or b) Other (please specify): No opinion In your opinion, what is the main reason why people smoke? (Circle one). It is in their genetic makeup By choice Neither a) or b) Other (please specify): No opinion

8. In 2006, 23% of the Canadian population was obese. (Statistics Canada, 2006) What is your opinion on the percentage of obesity based on this statistic? (Circle one option) a) It is too high b) It is too low c) It is normal d) No opinion

9. a) b) c) d)

In your opinion, the percentage in the statistic in question #10 needs to: (Circle one option) Increase Decrease Stay the same No opinion

10. In 2005, 20% of the Ontario population smoked. (Statistics Canada, 2005). What is your opinion on the percentage of people who smoke, based on this statistic? (Circle one option) a) It is too high b) It is too low c) It is normal d) No opinion 11. a) b) c) d) In your opinion, the percentage in the statistic in question #12 needs to: (Circle one option) Increase Decrease Stay the same No opinion

12. In your opinion, how do obese individuals affect Canadian health care insurance costs and extra medical service costs? (Circle one). a) Cause them to increase b) Cause them to decrease c) No effect d) No opinion 13. In your opinion, how do individuals who smoke affect Canadian health care insurance costs and extra medical service costs? (Circle one). a) Cause them to increase b) Cause them to decrease c) No effect d) No opinion Please show how strongly you agree or disagree with the following statements. (Mark one circle for each line). Strongly Disagree 14. Obese individuals should pay a health care premium. 15. Smoking individuals should pay a health care premium. 16. An extra health care premium for obese individuals would be effective in changing their lifestyle choices. 17. An extra health care premium for smoking individuals would be effective in changing their lifestyle choices. 18. A healthier Canadian population would result from an extra healthcare premium taxed on obese individuals. 19. A healthier Canadian population would result from an extra healthcare premium taxed on individuals who smoke. Thank you for completing this survey. Your participation is greatly appreciated. Disagree Neutral Agree Strongly Agree