Sr.No_____

Introduction

We are from CASE University and we are conducting a survey on smoking habits of people. Can you give us (5-10) minutes, we will be very thankful to you for this act of kindness.

NAME________________________

OCCUPATION__________________

EMAIL________________________

CONTACT NO__________________

AGE__________________________

Illiterate

Less than Primary

School 5-9years Matric Intermediate Graduate

Post Graduate

Unskilled worker E-2 E-2 E-1 E-1 D D C

Petty traders E-2 E-2 E-1 E-1 D C C

Skilled workers E-2 E-2 E-1 D D C C

Non-executive staff E-2 E-2 D D D C C

Supervisory level D D C C B B B

Small shopkeeper/ Businessmen D D C C B B A-2

Lower/ Middle: Executive, Officer D C C C B B A-2

Self employed/ Employed/ Professionals B B A-2 A-2 A-2 A-1 A-1

Medium Businessmen B A-2 A-2 A-2 A-2 A-1 A-1

Senior Executive/ Officer B A-2 A-2 A-2 A-1 A-1 A-1

Large Businessmen/ Factory owner A-2 A-2 A-2 A-1 A-1 A-1 A-1

Education of chief earner

Occupation of chief earner

Who is the Chief wage earner of your household who contributes the most to the budget of the household and bears the greatest proportion of the overall house expense?

Name_______________________

Relation_____________________

Please tell me what is the occupation of your chief wage Earner?Occupation________________

Grade____________________

Nature of Work____________

SURVEY

1. When I say cigarette which brand come to your mind.

Brand TOM UNAIDED AIDEDMarlboro 1 1 1Benson & Hedges 2 2 2Gold Leaf 3 3 3Dunhill 4 4 4Gold Flake 5 5 5Morven 6 6 6Embassy 7 7 7K-2 8 8 8Red & White 9 9 9Captain Black 10 10 10Pine 11 11 11Capstan 12 12 12

2. (a)Mark the brand in the table you are currently smoking (B)Which brand of cigarette you have ever smoked?(c)Which brand your majority of friends smoke?

Brand Currently smoking

Ever smoked Friends smoke

Marlboro 1 2 3Benson & Hedges 1 2 3Gold Leaf 1 2 3Dunhill 1 2 3Gold Flake 1 2 3Morven 1 2 3Embassy 1 2 3K-2 1 2 3Red & White 1 2 3Captain Black 1 2 3Pine 1 2 3Capstan 1 2 3

3. Please tell us after looking at the following grid that why have you selected the brand you are currently smoking?

Price 1Taste 2Quality 3Brand image 4Filter 5To create the impression 6My friend smoke it 7

Any other___________

4. Why you have switched from the brand you selected in the ever smoked part ?

Price 1Taste 2Quality 3Brand Image 4Filter 5To Make Better Impression 6My friend switch to other brand 7

Any other______________

5. Which of the following best describes your smoking habits?

I have tried a few cigarettes when I was younger but I currently do not smoke any cigarettes

1

I smoke occasionally (such as when I am socializing)

2

I smoke less than half pack 3I smoke between half a pack and 1 pack per day

4

I smoke more than a pack a day 5

I am a former smoker and no longer smoke cigarettes

6

6. Please mark the below that best describes your current situation regarding cigarette smoking and the approximately number of years you have smoked.

I currently smoke (less than 1 year) 1I currently smoke (1-3 years) 2I currently smoke (4-8 years) 3I currently smoke (9-15 years) 4I currently smoke (16-25 years) 5I used to smoke (more than 25 years) 6I used to smoke (less than 5 years) 7I used to smoke (6-15 years) 8;’[I used to smoke (16-25 years) 9

7. Do you want to stop smoking?

Yes, as soon as possible. 1Yes, but I am not ready. 2No, but I plan to eventually. 3No, and I plan on smoking rest of my life. 4Not sure. 5I already did. 6

8. Which of the following best describes your smoking habits?

I have tried a few cigarettes when I was younger but I currently do not smoke any cigarettes

1

I smoke occasionally (such as when I am socializing)

2

I smoke less than half pack 3I smoke between half a pack and 1 pack per day

4

I smoke more than a pack a day 5

9. How do you usually get your own cigarettes?

I have not smoked cigarette for the past 1 month.

1

I bought them in a store such as convenience store, supermarket, discount store, or gas station

2

I gave someone else money to buy them for me.

3

I borrowed them from someone else 4I got them from a family member 5

10.Please indicate the level of importance that you believe each scenario had in your decision to smoke your first cigarette.

Extremely Important

Somewhat Important

Slightly Important

Not Important at all

Not applicable

Your parents smoke/smoked

5 4 3 2 1

Your relatives encouraged you to try

5 4 3 2 1

Many of your friends smoke/smoked

5 4 3 2 1

Television/Movie advertisement

5 4 3 2 1

You believe smoking is a sign of maturity

5 4 3 2 1

You have/had many problems in your life, and at the time you started smoking, you didn't care if it might hurt or kill you.

5 4 3 2 1

You started as a dare or on a bet from a friend

5 4 3 2 1

You liked the smell of cigarettes and thought the taste would be a pleasant experience.

5 4 3 2 1

You were able to buy or obtain cigarettes easily as a minor.

5 4 3 2 1

I think buying cigarettes is a waste of money

5 4 3 2 1

11.Do you believe that the warning statements and picture on cigarette packs are major factor in quitting smoking?

Strongly agree 1Somewhat agree 2Somewhat disagree 3Strongly disagree 4

12.Do you think you will be smoking cigarettes 5 year from now?

I definitely will 1I probably will 2I probably will not 3I definitely will not 4

13.In the past 12 months, how often your parents or guardian discussed the dangers of tobacco use with you?

Never 1Rarely 2Sometimes 3Often 4Very often 5

THANK YOU VERY MUCH FOR GIVING YOUR PRECIOUS TIME