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* 1. Tobacco use by adults should not be allowed on school grounds or at any school events. Do you…

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* 2. Tobacco use should not be allowed on college or university campuses or at any college-sponsored events. Do you…

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* 3. Smoking should not be allowed in multi-unit housing residences or any living quarters where secondhand smoke infiltration may occur. Do you…

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* 4. Smoking should not be allowed in outdoor public spaces.  Do you...

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* 5. Tobacco use of any kind should not be allowed in outdoor public spaces. Do you…

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* 6. E-cigarettes and other electronic vaping products should be treated the same as regular cigarettes in terms of tobacco laws and policies. Do you…

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* 7. E-cigarettes should not be allowed in places that prohibit smoking. Do you…

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* 8. Tobacco companies should not be allowed to advertise any tobacco products. Do you…

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* 9. Tobacco companies should not be allowed to advertise any tobacco products towards youth. Do you…

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* 10. E-cigarette companies should be prohibited from marketing and advertising their products on the radio, television or other means like cigarette companies are? Do you…

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* 11. It is important that adolescents and young adults never experiment with tobacco. Do you…

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* 12. The age to buy tobacco products, including e-cigarettes, should be raised to 21.  Do you

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* 13. Tobacco companies should reduce the amount of nicotine in cigarettes so that kids who experiment with smoking do not become addicted. Do you…

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* 14. Candy and fruit flavorings, including menthol, should be prohibited in e-cigarettes and other tobacco products. Do you…

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* 15. During the past SEVEN DAYS, in which of the following places have you smelled secondhand tobacco smoke? (Select all that apply) In your home

Demographic Questions - the next set of questions will be used to determine whether the sample of responses that were collected were representative of Chillicothe.  No identifiable information will be collected so please feel free to answer honestly, but you may omit questions you don't want to answer.

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* 16. Age

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* 17. Gender

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* 18. Ethnicity (select all that apply)

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* 19. Do you identify as a member of the LGBTQ+ community?

The next six questions ask about having a disability or long-term health problem (6 months or longer). A disability or long-term health problem can cause physical, emotional, learning, hearing, communication, speech, vision, or attention difficulty.

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* 20. Are you deaf, or do you have serious difficulty hearing?

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* 21. Are you blind, or do you have serious difficulty seeing, even when wearing glasses?

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* 22. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

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* 23. Do you have serious difficulty walking or climbing stairs?

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* 24. Do you have difficulty dressing or bathing?

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* 25. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?

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* 26. Education

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* 27. Household Income

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