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BUILD YOUR OWN SURVEY

This page provides links to an inventory of survey questions compiled from a variety of tested behavioral risk survey instruments used nationwide. Types of questions (general questions and questions about knowledge, attitude and behavior) are listed across the top of the table. Topics the questions address are listed in the left-hand row. To access a list of questions that have been tested and appear on other survey questionnaires, click the number corresponding with the target audience (adult vs. youth), the topic you would like to address with the question, and the type of question you would like to ask (knowledge, attitude, behavior or general). The number in the table represents the number of questions we have so far provided.


To use these questions in constructing your own questionnaire, highlight the text of the question, copy the text as it appears on the screen, and paste it into your word processing document. You may need to reformat the text to meet your needs.

 

 TOPIC
covered by question

Adult

Youth

Knowledge

Attitude

Behavior

General

Knowledge

Attitude

Behavior

General

Demographics

 

 

 

11

 

 

 

7

Special Populations

4

 

7

 

4

 

7

 

Tobacco Use

8

9

13

 

9

17 (Includes some questions re: behavioral intent)

19

 

Policy/General

1

6

1

 

 

5

 

 

Policy/Restaurant

 

 

 

 

 

 

 

 

Policy/Worksite

 

 

 

 

 

 

 

 

Policy/Municipal Bldg.

 

 

 

 

 

 

 

 

ETS/General

8

4

11

 

9

ETS/Restaurant

 

 

 

 

 

 

 

 

ETS/Worksite

 

1

1

 

 

 

 

 

ETS/Municipal Bldg.

 

 

 

 

 

 

 

 

Cessation

Patient report of provider behavior (2)

10

11

Behavioral intent (6)

2

15

5

Behavioral intent (4)

Household "policy"

1

2

8

 

1

2

7

 

Media Interventions and Industry Influence

2

7

 

 

2

7

 

 

Other

 

 

 

 

 

 

 

 

Return to Surveys for Evaluation Methods