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.

  1. Strongly Agree
  2. Agree
  3. Disagree
  4. Strongly Disagree
  1. Don’t Know
  1. Refused

SOURCE: Adult BRFSS


Nicotine is physically addictive. 

  1. Strongly Agree
  2. Agree
  3. Disagree
  4. Strongly Disagree
  1. Don’t Know
  1. Refused

SOURCE: Adult BRFSS


Has your smoking affected your health?

 

  1. Yes
  2. No
  1. Don’t Know
  1. Refused


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