Survey on Smoking

We are a group of student from Temasek polytechnic currently doing a short survey for Health Promotion Board (HPB) under the “Quitline” services. This survey helps us understand more about your view point and preference on teenage smoking.

This survey will take up about 7minutes of your time.

(Survey will be kept confidential)

* Gender

Female

Male

* Age

* Occupation

* is there anyone in your family that smokes?

None

1-3 members

4-6 members

7 or more

* DId smoking affect your mental health

Yes

No

* Did smoking affect your physical health?

Yes

No

What caused you to start smoking? (you may tick more than 1 box)

Are you aware of the health issues you may impose on others when you smoke around them?

Yes

No

* What are your top 3 cigarette brands? ( rank them accordingly) (eg: 1: XXX 2: YYY 3:ZZZ)