Smoking Survey

Name (optional): 


  1. Have you ever tried smoking cigarettes?
    Yes
    No


  1. Do you smoke regularly now?
    Yes
    No


  1. How old were you when you first started smoking cigarettes?
    12-14
    15-17
    18-21
    22-30
    Above 30


  1. What brand of cigarettes do you smoke?


  1. About how many cigarettes do you smoke per day?
    0
    1-5
    6-10
    11-20
    more than a pack


  1. How much money do you spend on cigarettes in a week?
    $0
    $1.00-$4.00
    $4.01-$8.00
    $8.01-$14.00
    $14.01-$28.00
    More than $28.00


  1. Do you have a desire to quit smoking?
    Yes
    No


  1. What grade are you in?
    9th
    10th
    11th
    12th
    Faculty