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| Have you ever smoked tobacco? |
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| If yes, how old were you when you first smoked? |
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| Why did you start smoking? Please explain | | |
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| When was the last time you smoked? |
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| What is your preferred way of smoking? |
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| If cigarettes, how many do you smoke per day? |
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| How much money do you spend buying tobacco per month? |
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| What brand of cigarette do you smoke? (Check all that apply) |
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| Have you ever tried to quit? |
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| What was the longest time you have gone without smoking? |
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| Did you use any anti-smoking aids in order to help you quit? (patches, gum, etc.) |
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| If yes, what did you use? (Check all that apply) |
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| How helpful were these anti smoking aids? |
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| Are you familiar with any of the following anti-smoking campaigns? (Check all that apply) |
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| Did any television advertisements help convince you to quit? (If yes, please explain what happened in the advertisement.) |
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| Are you aware of the risks of smoking? |
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| Which of these risks are you MOST concerned about? |
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| Which of these risks are you LEAST concerned about? |
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| Are you currently enrolled at a university? |
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