Knowledge of Notre 37

APPENDIX D

Survey Questionnaire





Knowledge of Notre Dame University Student on Second-hand Smoke and Its effects towards Health





Instruction: Please answer the following questions honestly and carefully. The confidentially of your
answer will be observed.


Part I. Participants Profile



Direction: Please provide the information needed.



a. Name (optional)
b. Age
c. Sex
d. Course
e. Economic status: specify the income of the family:
f. If participants smokes: Yes No


Part II. Knowledge on Second-hand Smoke



Direction: Encircle your chosen answer. Please avoid erasures. If you want to change your answer, put
an X mark on your previous answer then encircle you final answer.


1. Cigarette use among teens is largely attributed to which of the following:
a. Peer influence
b. Genetics
c. Aggressive marketing tactics by tobacco industry
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2. What law has provisions that will protect the youth from tobacco use and exposure to
second-hand smoke?
a. RA 1129
b. RA 9121
c. RA 9211

3. A substance in tobacco that is used to kill, preserve dead bodies, and manufacture other
chemicals.
a. Formalin
b. Arsenic
c. Tar

4. A poisonous gas from vehicular emissions, combustion of fossil fuel and industrial emission.
a. Carbon Monoxide
b. Sulfur Dioxide
c. Carbon Dioxide

5. A component of cigarette which leaves a brown residue that stains smokers teeth, fingers,
and lungs.
a. Benzene
b. Nicotine
c. Tar

6. In second-hand smoke, there is a combination of mainstream smoke and
a. Passive smoke
b. Sidestream smoke
c. Involuntary smoke

7. The most important influence in engaging to smoking is
a. Family
b. Friends
c. Both

8. Second-hand smoke contains how many substances
a. 2,000
b. 5,000
c. 4,000

9. A solvent when inhaled through second-hand smoke will lead to cancer
a. Methyl alcohol
b. Benzene
c. Xylene

10. The following is true about nicotine except: it
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a. Makes tobacco addictive
b. Causes cancer-causing substance
c. Enhances memory

11. The minimum age requirement for the sale, purchase, and use of cigarettes and other tobacco
products under the Tobacco Regulation Act of 2003
a. 25 years old
b. 15 years old
c. 18 years old

12. Which of the following is wrong about Carbon Monoxide?
a. Colorless gas with smell
b. Sticks to our RBC in place of oxygen
c. Increase effect of Formalin

13. All but one is the effect of Formalin.
a. Throat irritation
b. Cancer
c. Edema

14. A component of cigarette that causes lung diseases
a. Tar
b. Arsenic
c. Chromium

15. The effect of Nicotine in the body are the following except:
a. Stimulates and relaxes the brain
b. Decreases heart rate and blood pressure
c. Alters mood


Part III. Knowledge on the effects of Second-hand Smoke


1. All but one are the effects of second-hand smoke exposure to babies and children
a. Tetanus
b. Ear Infection
c. Asthma

2. Considered as the third leading hazardous form of indoor air pollution
a. Alcohol
b. Environmental Tobacco Smoke
c. Cigarette Smoke

3. A highly carcinogenic compound with higher quantity in Sidestream smoke than mainstream
smoke?
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a. N-nitrosamine
b. B-nitrosamine
c. M-nitrosamine

4. What type of test do non-smokers perform poorly when exposed in second-hand smoke?
a. Essay
b. Logic
c. Memory

5. The medical conditions that worse due to second-hand smoke are the following except:
a. Emphysema
b. Liver Cirrhosis
c. Anemia

6. An immediate adverse effects of smoking in adolescence:
a. Pneumonia
b. Depression
c. Sleep Problem

7. Cigarettes are considers as
a. Illegal
b. Gateway drug
c. Glamorous drug

8. A smoker who identify himself as a safe levels is
a. Chain smoker
b. Second-hand smoker
c. Social smoker

9. How many cigarettes per day triple the risk of death due to heart disease?
a. One to four
b. Five to eight
c. Eight to ten

10. Which of the following is responsible to the harmful substances associated to second-hand
smoke exposure?
a. Mainstream smoke
b. Sidestream smoke
c. Third-hand smoke







Knowledge of Notre 41

Effects of Tar in Smoking
Last Updated: Jul 29, 2010 | By Sydney Hornby, M.D.

When cigarette smoke is passed through a filter, it leaves a black, sticky substance known as tar. The exact
composition of the tar that smokers inhale is uncertain. Any sort of plant material is a veritable witch's brew of
complex chemical compounds. Burning transforms these compounds in the tobacco leaves in an unpredictable
manner, and the final composition of the inhaled smoke depends on exactly how a cigarette is smoked. While it's
hard to determine exactly what's in tar, it's clear that it causes most of the deleterious health effects of tobacco.