“1. My age:
My race:
2. Are you a smoker? If yes, go to next question. If no, skip to question 12.
__ cigarettes
__ cigars
__ I chew tobacco
Smokers
3. If so, how old were you when you started smoking?
4. How much do you smoke?
5. Where do you get your cigarettes?
__ grocery store
__ vending machines
__ convenience stores
__ parents
__ friends
6. Do your parents smoke?
7. Why do you smoke?
__ my friends smoke
__ I enjoy smoking
__ Smoking helps me relax
__ I tried to quit, but I can’t
8. Who introduced you to smoking?
__ parent
__ sister, brother or other relative
__ friends
9. Do you have to hide your smoking from your parents? If so, how?
__ I only smoke away from home
__ I smoke outside
__ I smoke when they’re not home
10. Do you think smoking is harmful?
11. Do you think tobacco is addictive?
Non-Smokers
12. What do you think of smokers?
13. Do cigarettes bother you?
14. Have you ever told someone to put out a cigarette?
15. Have you ever tried it?
Marijuana Smoking
16. Do you think it’s okay for teens to smoke marijuana?
17. Do you think marijuana smoking is harmful to your health?
18. Do you think marijuana smoking is less harmful than tobacco?
19. If you smoke marijuana, why do you smoke it?
__ my friends smoke marijuana
__ I enjoy smoking marijuana
__ Smoking marijuana helps me relax
__ I tried to quit, but I can’t
20. Do you think marijuana is addictive?
21. Have you ever smoked marijuana?
Send your survey to:
Smoking Survey
LA Youth office
6030 Wilshire Blvd. Ste. 201
L.A. CA 90036
If you are selected as a winner, we need your name and address to send you $25 cash and an LA Youth T-shirt:
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