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QUESTIONNAIRE
1. Are You?
Please select
Female
Male
2. How old are you?
Please select
Under 10
10-14
15-18
18+
3. Do you live in Rotherham?
Please select
Yes
No
4. How many cigarettes do you smoke per day?
Please select
1-5
6-10
10-15
15+
5. How many cigarettes do you smoke per week?
Please select
10
11-20
21-30
30+
6. How do you get your cigarettes?
Please select
Friends
Shop
Mum
Dad
Sister
Brother
Other
7. Would you describe yourself as a regular smoker?
Please select
Yes
No
Not Sure
8. Who do you smoke with?
Please select
Friends
Mum
Dad
Sister
Brother
Other
9. Do you enjoy smoking?
Please select
Yes
No
10. Have you ever thought about and/or tried to stop smoking?
Please select
Yes
No
Not Sure
11. If you have tried to stop smoking, how successful were you?
Please select
I don’t smoke
I stopped for 6 months
I didn’t stop for less than 6 months
I couldn’t stop
12. Why is it hard for you to stop smoking?
Please select
Cravings
Friends smoke
Parents smoke
Easy to buy cigarettes
Cigarettes are cheap
I get bored with out cigarettes
13. Have you ever felt under pressure from anybody to try a cigarette?
Please select
Friends
Shop
Mum
Dad
Sister
Brother
Other
14. Why did you choose not to try a cigarette?
Please select
Health problems
Smell
Too expensive
Taste bad
Family pressure not to smoke
Other
15. Do you think you will smoke in the future?
Please select
Yes
No
Not Sure
16. Do the majority of people you know – mum, dad, friends, brother or sister, smoke?
Please select
Yes
No
Not Sure
17. What do you think about friends and/or families who smoke?
Please select
It’s cool
Not bothered
I don’t like the smell
It gets my asthma going
It makes my eyes go soar
I have difficulty breathing
Other
