#whyichoose Campaign Survey
Thank you for spending the time to complete our survey!
1.
What is your age?
15
16
17
18
19
20
21
22
23
24
25
2.
What is your postcode?
3.
Are you an Aboriginal or Torres Strait Islander?
Aboriginal
Torres Strait Islander
No
Prefer not to say
4.
Are you a:
non-smoker
ex-smoker
occasional smoker
light smoker
heavy smoker
5.
In the last 12 months how many cigarettes have you smoked?
6.
In the last month how many cigarettes have you smoked?
7.
In the last 7 days how many cigarettes have you smoked?
8.
Which of these products do you currently smoke?
I don't currently smoke
Tailor made cigarettes (that is manufactured cigarettes in a packet)
Roll your owns, using loose tobacco
Pipes
Cigars
E-cigarettes
Not sure
Other (please specify)
9.
How often are you exposed to second hand tobacco smoke?
Always
Usually
Sometimes
Rarely
Never
10.
If you smoke, rate your motivation to cut back or quit:
Not motivated at all
1 star
Somewhat motivated
2 stars
Highly motivated
3 stars
N/A
For more information and support for people quitting or wanting to quit, head on over to the
#whyichoose website
or contact Youth Solutions on 02 4628 2319
Current Progress,
0 of 10 answered
