23/12/2019 Cigarette Smoking Behaviour

Cigarette Smoking Behaviour

* Required

1. Age *
Mark only one oval.

18-21
22-25
>25

2. Gender *
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Female
Male

Other:

3. State *
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North
South
East
West
Central

4. Do you Smoke? *
Mark only one oval.

Yes Skip to question 5.

No Skip to question 12.

Attitudes
5. Smoking Status *
Mark only one oval.

Daily Smoker
Occasional Smoker
Former Smoker

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23/12/2019 Cigarette Smoking Behaviour
6. Choose what is applicable *
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No Family member smokes

Father Smokes
Mother smokes
Sibling Smokes
More than one member smokes

7. What was the major reason to start smoking? *

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Friends
Work pressure and distress
Pleasure and Fun
Relaxation
Personal issues

Other:

8. What was the major reason to continue smoking? *

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Friends
Work pressure and distress
Pleasure and Fun
Relaxation
Personal issues

Other:

9. Number of cigarettes consumed per day *

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One to Two
Three to Four
Five to Six
More than Six

10. When did you start smoking? *

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School
Graduation
Work
Post Graduation

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23/12/2019 Cigarette Smoking Behaviour
11. Favorite Smoking Place *
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Outdoor
Room
Bathroom
Parties

Awareness
12. Are you aware of the smoking hazards? *
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Yes
No
Maybe

13. Do you believe all the hazards are true? *

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Yes
No
Maybe

14. Have you ever tried quitting? *

Mark only one oval.

Successfully Quitted
Tried but failed
Not tried
I have never smoked

15. What would be/was the reason to quit smoking? *

Mark only one oval.

Hazardous effects of smoking on health

Family pressure
Advertisements
Doctor's advice
Religious beliefs
Not Applicable

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