Hey All-I am long time lurker on this list, and I was hoping that you guys
could help me out. I am taking a Stat class and have to do a project. All I
need you to do is fill out the survey below and send it back to me. To
answer the questions you can either put an X under the answer that applies,
or just delete the answers that don't apply. After you have filled out the
survey just send it back to me at this address: [EMAIL PROTECTED]
Thank you for your help. Aaron Stoker
Smoking Survey
Age: Sex: Male Female
Circle the category that best describes your current smoking status:
Smoker Former Smoker Non-Smoker
If you answered smoker or former smoker, please answer questions in section
B. If you answered Non-smoker, please answer questions in section C.
Section B:(For Smokers and Former Smokers)
At what age did you start smoking?
At the time that you started smoking, please circle the category that best
describes the smoking status of your primary care givers.
Father or Father figure: Smoker Former Smoker Non-Smoker
Not Applicable
Mother or Mother figure: Smoker Former Smoker Non-Smoker
Not Applicable
Did your parents discourage or encourage you to smoke? Encourage
Discourage
Were you allowed to smoke in the house? Yes No
Were you punished if you were caught smoking? Yes
No
Did your parents give you cigarettes? Yes
No
Did your parents give you money for cigarettes? Yes
No
Section C:(For Non-Smokers Only)
Please circle the category that best describes the current smoking status of
your primary care givers.
Father or Father figure: Smoker Former Smoker Non-Smoker
Not Applicable
Mother or Mother figure: Smoker Former Smoker Non-Smoker Not
Applicable
Did your parents discourage or encourage you to smoke?
Encourage Discourage
If either of your primary care givers are former smokers, please list the
age you were when they quit smoking.
Father or Father figure: Mother or Mother figure:
