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Gender:
   
 
 
Age:
   
 
 
 
How old are you when you started smoking?
 
Between 12-16
 
Between 16-18
 
18 and above
 
 
 
What brand of cigarettes did you first try?
 
Marlboro
 
Winston
 
Lucky Strike
 
Others (please specify):
 
 
 
 
What flavor do you buy?
 
Red
 
Lights
 
Menthol
 
Others (please specify):
 
 
 
 
How many sticks do you consume in a day?
 
5 and below
 
10 and below
 
More than 10
 
 
 
Are you aware about the hazards of smoking?
 
Yes
 
No
 
 
 
Do your parents smoke?
 
Yes
 
No
 
 
 
Where do you usually smoke?
 
Bar
 
Coffee Shop
 
Restaurants
 
Streets
 
 
 
Do you plan to stop smoking?
 
Yes
 
No, but I'm planning to
 
No
 
Not sure
 
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