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  1. Surveys
  2. 2011
  3. July
  4. S
  5. Smoking
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How many cigarettes do you smoke in a day?
 
Less than 4
 
5 - 10
 
11 - 15
 
16 - 20
 
21 - 25
 
26 - 30
 
More than 31
 
 
 
How many years have you smoked regularly for?
 
Less than 1 year
 
1 - 3 years
 
4 - 6 years
 
7 - 10 years
 
10 - 15 years
 
16 + years
 
 
 
Who in your life smokes as well(Select all that apply)?
 
Parents
 
Significant other
 
Siblings
 
Friends
 
Co-workers
 
Relative

 
 
 
What benefits do you receive from smoking (emotion and physical)?
   
 
 
 
Do any of these factors want encourage you to quit smoking(Select all that apply)?
 
Pressure from loved ones
 
Your health
 
The health of loved ones
 
Cost

 
 
 
How old were you when you started smoking?
   
 
 
If you were to try to stop smoking, how supportive do you think the following people would be?
Not at all A little Quite Very N/A
Spouse/Partner
Children
Parents
Other relative
Friends
Co-workers
 
 
 
Please rank (1 - 5) with 1 being the most important to 5 being the least the following in regards to difficulty in quitting smoking:
Enjoy smoking too much
Not enough willpower
Put on weight
Friends/Partner smokes
No desire to stop smoking
 
 
 
What health related issues related to smoking concern you if any?
 
Cancer
 
Cardiovascular disease
 
Chronic obstructive pulmonary disease (COPD)
 
Hypertension
 
Infertility
 
Macular degeneration
 
Cataracts
 
Periodontal disease
 
None

 
 
 
What would motivate you to stop smoking?
   
 
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