Youth Leadership Academy Community Tobacco Survey for Smoke-free Parks Question Title * 1. What is your zip code? Question Title * 2. How often does someone in your family visit a local park? Once per week or more 1-3 times per month A few times per year Never Question Title * 3. Click the number on the scale that best describes how you feel about whether the following places should be tobacco-free: Strongly Disagree 1 2 3 4 Strongly Agree 5 Parks Parks Strongly Disagree 1 Parks 2 Parks 3 Parks 4 Parks Strongly Agree 5 Playgrounds Playgrounds Strongly Disagree 1 Playgrounds 2 Playgrounds 3 Playgrounds 4 Playgrounds Strongly Agree 5 Outdoor sports fields Outdoor sports fields Strongly Disagree 1 Outdoor sports fields 2 Outdoor sports fields 3 Outdoor sports fields 4 Outdoor sports fields Strongly Agree 5 Skateboard/bike parks Skateboard/bike parks Strongly Disagree 1 Skateboard/bike parks 2 Skateboard/bike parks 3 Skateboard/bike parks 4 Skateboard/bike parks Strongly Agree 5 Hiking/biking trails Hiking/biking trails Strongly Disagree 1 Hiking/biking trails 2 Hiking/biking trails 3 Hiking/biking trails 4 Hiking/biking trails Strongly Agree 5 Nature Preserves Nature Preserves Strongly Disagree 1 Nature Preserves 2 Nature Preserves 3 Nature Preserves 4 Nature Preserves Strongly Agree 5 Golf courses Golf courses Strongly Disagree 1 Golf courses 2 Golf courses 3 Golf courses 4 Golf courses Strongly Agree 5 Swimming Pools Swimming Pools Strongly Disagree 1 Swimming Pools 2 Swimming Pools 3 Swimming Pools 4 Swimming Pools Strongly Agree 5 Outdoor festivals Outdoor festivals Strongly Disagree 1 Outdoor festivals 2 Outdoor festivals 3 Outdoor festivals 4 Outdoor festivals Strongly Agree 5 Question Title * 4. Do you think litter from tobacco products is a problem in these places? Yes No Question Title * 5. Have you been bothered by tobacco smoke at any of the above places? Yes No Question Title * 6. Do you think outdoor tobacco smoke is harmful? Yes No Question Title * 7. What is your age? under 10 11-17 18-24 25-39 40-50 51+ Question Title * 8. Please check all the boxes that apply to you. I am a... Sports team/league participant Sports coach, leader or official Golfer Parent Grandparent Non-smoker Smoker Ex-smoker Question Title * 9. Has tobacco use at any of the above places affected you? Yes No Question Title * 10. If yes, how? Question Title * 11. Is there anything else you would like to share? Done