Smoking.

Do you smoke?

• Yes
• No
• Only socially

How often do you smoke?

• 1-3 days a week
• 4-7 days a week
• Only socially
• I dont smoke

Are you aware of the health concerns of smoking ?

• Yes
• No

Which health concerns do you know of ?

Please select all that apply.

• Lung Cancer
• Emphysema
• Liver Cancer
• Periodontitis
• Reproductive complications
• None of the above

How did you start smoking?

Please select all that apply.

• With friends - socially
• Bought my own pack
• Other
• I dont smoke

How were you influenced to smoke?

Please select all that apply.

• Parents/family who smoke
• Friends
• By yourself
• Peer pressure
• Other
• I dont smoke