Tobacco Survey

This survey is a reality check. The questions are to help you, your teacher, and your class engage in an honest discussion about tobacco. Select or type in your responses to the questions in Parts One and Two. Try to answer all of the questions. If you do not want to answer a question, skip it. Answers will be submitted anonymously to your teacher.

Part I

Part II

If you need to print this page, click "Print" before you click "Submit." Then, close the print window and click "Submit" to send your anonymous responses and see a final question.

1	Have you ever tried cigarette smoking, even one or two puffs?	Yes	No
2	During the last 30 days, on how many days did you smoke cigarettes?	0 days 3 to 5 days 10 to 19 days all 30 days	1 or 2 days 6 to 9 days 20 to 29 days
3	Have you ever used chewing tobacco snuff or dip?	Yes	No
4	During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?	0 days 3 to 5 days 10 to 19 days all 30 days	1 or 2 days 6 to 9 days 20 to 29 days
5	How many of your four closest friends smoke cigarettes?	None Two Four	One Three Not Sure
6	How many of your four closest friends use chewing tobacco, snuff, or dip?	None Two Four	One Three Not Sure
7	If one of your best friends offered you a cigarette, would you smoke it?	Definitely Yes Probably Not	Probably Yes Definitely Not
8	Do you think it is safe to smoke for only a year or two, as long as you quit after that?	Definitely Yes Probably Not	Probably Yes Definitely Not

1	Do you think most middle school students smoke?	Yes No
2	Do you think most high schoolers smoke?	Yes No
3	Do you think most young males use smokeless tobacco?	Yes No
4	Why do you think young people smoke cigarettes or use smokeless tobacco?
5	Why do you think young people who do not use tobacco choose to be tobacco free?
6	Have you ever felt pressured to use tobacco? If so, what did you do?	Yes No
7	Have you learned ways to say "no" to offers of tobacco? If so, explain how you would refuse the offers.	Yes No
8	Do you think there are health consequences from using tobacco? If so, what do you think they are?	Yes No
9	Do you think it is easy or difficult to quit using tobacco? Explain your answer.	Easy Difficult
10	Do you think most young people like or dislike being around smokers?	Like being around smokers. Dislike being around smokers.
	Type in your teacher's email address and submit your anonymous survey answers!