Awareness on the Negative Health Effects of Cigare

Name (Optional):

Age:

Year Level:

I. Please select a corresponding answer to each statement.

I have been smoking before I enrolled in UP Manila.

Yes

No

If No, please indicate your age and the year level you were in when you started smoking.

In a week, I smoke for (number of days):

1

2-4

5-7

In a day, I smoke (number of cigarette sticks):

1-3

4-6

More than 6

I usually buy cigarettes from:

Sari-sari store

Street vendor

Mall/Supermarket

Other

PART TWO. Please select all the items that apply to you.

1. I began smoking because:

I was curiuous about it.

I sought it as a diversion from my problems.

People at home smoke and it seemed okay for me to do so.

My friends asked me to try it.

I saw it in advertisements and thought that it will be nice if I try it.

Other

2. I like to smoke because: