Word-Import - 1

2. Are you aware of the health risks brought about by smoking?

	3. If yes, how were you informed?


FORMCHECKBOX By the media
FORMCHECKBOX By friends
FORMCHECKBOX By the school
FORMCHECKBOX By the smoking awareness program
FORMCHECKBOX Others _______________________
FORMCHECKBOX By parents
FORMCHECKBOX By health professionals

4. Is smoking a need of the body?

5. Does prohibition and signs of no smoking matter to you?

6. Do you think smoking is the root of poverty?

7. Do you know any anti-smoking organizations?

8. Do you smoke?

	9.If yes, why did you start smoking?


FORMCHECKBOX Peer pressure
FORMCHECKBOX Convinced by cigarette advertisements
FORMCHECKBOX Parental influence
FORMCHECKBOX Out of curiosity
FORMCHECKBOX To relieve stress
FORMCHECKBOX To look cool
FORMCHECKBOX To lose weight
FORMCHECKBOX To fit in
FORMCHECKBOX Media influences

10. If no, do you have any plans to start smoking?

	11. What do you think is the good effect of smoking?


FORMCHECKBOX Boosts performance
FORMCHECKBOX Improves socialization skills
FORMCHECKBOX Feeling of contentment
FORMCHECKBOX Pantawid-gutom
FORMCHECKBOX Allows mind to think clearly FORMCHECKBOX Others _______________________

	12. What do you think is the bad effect of smoking?


FORMCHECKBOX Causes respiratory diseases
FORMCHECKBOX Allocates budget
FORMCHECKBOX Causes global warming
FORMCHECKBOX Waste of natural resources
FORMCHECKBOX Others _______________________

	13. What are the diseases that you know is associated with smoking?


FORMCHECKBOX Lung Cancer
FORMCHECKBOX Bronchitis
FORMCHECKBOX Emphysema
FORMCHECKBOX Chronic Obstructive Pulmonary Disease
FORMCHECKBOX Asthma
FORMCHECKBOX Addiction problems
FORMCHECKBOX Oral cancer
FORMCHECKBOX Impotence
FORMCHECKBOX Heart disease

	14.If you are a smoker, would you like to quit smoking?


FORMCHECKBOX Yes, I am starting step by step
FORMCHECKBOX Yes, but I don’t know how
FORMCHECKBOX No, I like smoking so much I can’t live without i
FORMCHECKBOX No, because I don’t want to go through the
withdrawal symptoms