Questions on Adult Tobacco Use
KNOWLEDGE (8 questions)
How many of your friends and family members smoke or use tobacco? Would it be none, a few, less
than half, about half, more than have, or most or all?
1 None
2 A few
3 Less than half
4 About half
5 More than half
6 Most or all
7 Don’t know / Not sure
9 Refused
(Source: SSS; needed for Brion Fox’s study)
SOURCE: Wisconsin Tobacco Survey, CTRI, 2001
Does your spouse or partner currently smoke or use tobacco?
1 Yes
2 No
3 Not applicable (no current spouse or partner)
7 Don’t know / Not sure
9 Refused
(Source: Brion Fox/Ellen Gritz)
SOURCE: Wisconsin Tobacco Survey, CTRI, 2001
Of your closest friends and relatives, about how many smoke cigarettes? Would you say...
1 All
2 Almost all
3 Some
4 Very few
5 None
77 Don't Know
99 Refused
SOURCE: Adult BRFSS
Smoking is addictive.
SOURCE: Adult BRFSS
Nicotine is physically addictive.
SOURCE: Adult BRFSS
Has your smoking affected your health?
If so, which of these health concerns have been affected? (check all that apply)
_____ Heart trouble/problem
_____ High blood pressure
_____ Cancer
_____ Emphysema
_____ Cough
_____ Shortness of breath
_____ Cold/flu/virus
_____ Other respiratory problem
_____ Sore throat
_____ Pregnancy
_____ Other: _________________________________________________
DK
Source:1987 NHIS
Do you think there is a strong, moderate, or slight relationship between cigarette smoking and:
|
|
1. Strong |
2.Moderate |
3. Slight |
77 DK |
99 (Refused) |
||
|
Emphysema |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Gallstones |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Lung cancer |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Chronic bronchitis |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Diabetes |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Cancer of the mouth or throat |
_______ |
_______ |
_______ |
_______ |
_______ |
||
|
Heart disease |
_______ |
_______ |
_______ |
_______ |
_______ |
||
Source:1987 NHIS