Smoking survey
Dear Respondent,
Please take a moment and fill in this short smoking related survey. The results of the questionnaire will be utilized by us so to understand the prevailing views on usage of nicotine products.
1) Please state your highest reached education
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No formal education
Elementary school
High school
Bachelor's degree
Master's degree
Ph.D. degree and higher
2) To which age category do you belong?
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Less than 15
16-20
21-25
26-30
31-40
41-50
51-60
61-70
71 and above
3) What are your opinions on the following smoking related statements?
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
Smoking is harmful
Passive smoking is harmful
Smoking is worse than alcohol
Smoking is highly addictive
Smoking is expensive
E-cigarettes are harmless
4) Would you ask a stranger at an adjacent table in a restaurant to stop smoking?
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Yes
No
I am not sure
5) Do you think that smoking habits do change with changing technologies like e-cigarettes and nicotine pouches?
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Yes
No
I am not sure
6) Are you/were you an active smoker?
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Yes
No
7) How long do/did you smoke for (in years)?
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8) If you are an active smoker, do you consider to quit?
Yes
No
9) If you tried to quit, were you successful? (at least 5 years without smoking)
Yes
No
10) How many cigarettes per day do you smoke?
*
11) How much do you spend on nicotine products during a typical month?
*
0 USD
Less than 20 USD
21 to 50 USD
51 to 100 USD
101 to 200 USD
More than 200 USD
12) Do you smoke at home?
Yes
No
13) If you have children, do they smoke?
Yes
No
14) If you smoke what are the reasons why you do so?
Please select at least 1 choice.
Like the taste of tobacco
Like the smell of tobacco
To kill the time
For social acceptance
It calms me down
15) How often do you use following nicotine products?
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Regularly
Sometimes
Never
Cigarettes
E-cigarettes
Nicotine pouches
Pipe
Tobacco
Vaporizer
*
Answer required
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