ADULT TOBACCO SURVEY
2002-2003
1.

Data Results 1 		Would you say that in general your health is:
  1. Excellent
  2. Very good
  3. Good
  4. Fair
  5. Poor

   7. Don't know/Not sure
   9. Refused

Crosstabulation: Percentage of Adults with Fair or Poor Self-Perceived Health Status
2.

Data Results 2 		Have you smoked at least 100 cigarettes in your entire life?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

Crosstabulation: Percentage of Adults Who Have Smoked at Least 100 Cigarettes in Their Entire Life
3.
Data Results 3 		Do you now smoke cigarettes everyday, some days, or not at all?
  1. Everyday
  2. Some days
  3. Not at all

   7. Don't know/Not sure

   9. Refused
Crosstabulation: Percentage of Adults Who Currently Smoke Cigarettes
4.
Data Results 4

On the average, about how many cigarettes a day do you now smoke?

  Number of cigarettes _____

  77. Don't know/Not sure
  99. Refused

5.
Data Results 5 		During the past 30 days, on how many days did you smoke cigarettes?

  Number of Days _____

   88. None
   77. Don't know/Not sure
   99. Refused

6.
Data Results 6

On the average, on days when you smoked during the past 30 days, about how many cigarettes did you smoke a day?

  Number of cigarettes _____

  77. Don't know/Not sure
  99. Refused

7.
Data Results 7		 How soon after you wake up do you have your first cigarette?
  1. Within 5 minutes
  2. 6-30 minutes
  3. 31-60 minutes
  4. After 60 minutes

   7. Don't know/Not sure
   9. Refused

8.
Data Results 8 		About how long has it been since you last smoked cigarettes regularly?
  1. Within the past month (< 1 month ago)
  2. Within the past 3 months (1 month but less than 3 months ago)
  3. Within the past 6 months (3 months but less than 6 months ago)
  4. Within the past year (6 months but less than 1 year ago)
  5. Within the past 5 years (1 year but less than 5 years ago)
  6. Within the past 10 years (5 years but less than 10 years ago)
  7. 10 or more years ago

   77. Don't know/Not sure
   99. Refused

9.
Data Results 9 		During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

10.
Data Results 10 		[FORMER SMOKERS:] When you quit smoking...
[CURRENT SMOKERS:] The last time you tried to quit smoking,
did you use the nicotine patch, nicotine gum, or any other medication to help you quit?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

11.
Data Results 11 		[FORMER SMOKERS:] When you quit smoking...
[CURRENT SMOKERS:] The last time you tried to quit smoking,
did you use any other assistance such as classes or counseling?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

12.
Data Results 12

Are you seriously considering stopping smoking within the next six months?

  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

13.
Data Results 13 		Are you planning to stop smoking within the next 30 days?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

14.
Data Results 14 		In the past 12 months, have you seen a doctor or other health professional to get any kind of care for yourself?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

15.
Data Results 15 		During the past 12 months, did any doctor, nurse, or other health professional advise you to not smoke?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

16.
Data Results 16 		During the past 12 months, did any doctor, or other health professional ask if you smoke?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

17.
 		 In the past 12 months, when a doctor, or other health professional advised you to quit smoking, did they also do any of the following?

a.
Data Results 17a

...Prescribe or recommend a patch, nicotine gum, nasal spray, an inhaler or pills such as Zyban?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

...Suggest that you set a specific date to stop smoking?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

...Suggest that you use a smoking cessation class, program, quit line or counseling?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

...Provide you with booklets, videos, or other materials to help you quit smoking on your own?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

18.
Data Results 18 		Not including yourself, how many of the adults who live in your household smoke cigarettes, cigars or pipes?

   Number of adult _____

  88. None
  77. Don't know/Not sure
  99. Refused

19.
Data Results 19 		During the past 7 days, that is since [DATE FILL], how many days did anyone smoke cigarettes, cigars, or pipes anywhere inside your home?
  1. One day
  2. Two days
  3. Three days
  4. Four days
  5. Five days
  6. Six days
  7. Seven days

   88. Less than 1 day per week/rarely/none
   77. Don't know/Not sure
   99. Refused

20.
Data Results 20 		Which statement best describes the rules about smoking inside your home? Do not include decks, garages, or porches.
  1. Smoking is not allowed anywhere inside your home.
  2. Smoking is allowed in some places or at some times.
  3. Smoking is allowed anywhere inside the home.

   77. Don't know
   99. Refused

21.
Data Results 21		 Are you currently...
  1. Employed for wages
  2. Self-employed
  3. Out of work for more than 1 year
  4. Out of work for less than 1 year
  5. A homemaker
  6. A Student
  7. Retired
  8. Unable to work
  9. Both a student and employed for wages

   77. Don't know/Not sure
   99. Refused

22.
Data Results 22 		While working at your job, are you indoors most of the time?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

23.
Data Results 23 		As far as you know, in the past seven days, that is since [DATE FILL], has anyone smoked in your work area?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

24.
Data Results 24 		Which of the following best describes your place of work's official smoking policy for work areas?
  1. Not allowed in any work areas
  2. Allowed in some work areas
  3. Allowed in all work areas
  4. No official policy

   7. Don't know/Not sure
   9. Refused

25.
Data Results 25 		Which of the following best describes your place of work's official smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunchrooms?
  1. Not allowed in any public areas
  2. Allowed in some public areas
  3. Allowed in all public areas
  4. No official policy

   7. Don't know/Not sure
   9. Refused

26.
Data Results 26 		In indoor work areas, do you think smoking should be allowed in all areas, some areas or not at all?
  1. Allowed in all areas
  2. Allowed in some areas
  3. Not allowed at all

   7. No opinion/Not sure
   9. Refused

27.
Data Results 27 		In the past seven days, that is since [DATE FILL], have you been in a car with someone who was smoking?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

28.
Data Results 28 		In the indoor dinning area of restaurants, do you think that smoking should be allowed in all areas, some areas, or not allowed at all?
  1. Allowed in all areas
  2. Allowed in some areas
  3. Not allowed at all
  4. The decision should be up to the business/restaurant owner

   7. No opinion/Not sure
   9. Refused

29.
Data Results 29 		In indoor shopping malls, do you think that smoking should be allowed in all areas, some areas, or not allowed at all?
  1. Allowed in all areas
  2. Allowed in some areas
  3. Not allowed at all

   7. No opinion/Not sure
   9. Refused

30.
Data Results 30 		I am going to read a statement. I want you to tell me whether you strongly agree, agree, disagree, or strongly disagree with this statement.

If a person has smoked a pack of cigarettes a day for more than 20 years, there is little health benefit to quitting smoking.
  1. Strongly agree
  2. Agree
  3. Disagree
  4. Strongly disagree

   7. No opinion/Not sure
   9. Refused

31.
Data Results 31

Now I am going to ask about smoke from other people's cigarettes.

Do you think that breathing smoke from other people's cigarettes is:

  1. Very harmful to one's health
  2. Somewhat harmful to one's health
  3. Not very harmful to one's health
  4. Not harmful at all to one's health

   7. No opinion/Not sure
   9. Refused

32.
  		Would you say that breathing smoke from other people's cigarettes causes:
Lung cancer in adults?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

Heart disease in adults?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

Colon cancer?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

Respiratory problems in children?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

Sudden infant death syndrome?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

33.
Data Results 33 		What is your age?

   Code age in years _____

   7. Don't know/Not sure
   9. Refused

34. How many children live in your household who are:
(7=7 or more children)
 Younger than 5 years old? ____

   88. None
   99. Refused

 5 through 11 years old? ____

   88. None
   99. Refused

 12 to 17 years old? ____

   88. None
   99. Refused

35.
Data Results 35 		Are you Hispanic or Latino?
  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

36.
Data Results 36 		Which one or more of the following would you say is your race?
  1. White
  2. Black or African American
  3. Asian
  4. Native Hawaiian or Other Pacific Islander
  5. Alaska Native, American Indian
  6. Other [specifiy:] _______________

   7. Don't know/Not sure
   8. No additional choice
   9. Refused

37.
Data Results 37 		Which one of these groups would you say best represents your race?
  1. White
  2. Black or African American
  3. Asian
  4. Native Hawaiian or Other Pacific Islander
  5. Alaska Native, American Indian
  6. Other [specifiy:] _______________

   7. Don't know/Not sure
   9. Refused

38.
Data Results 38		 Are you:
  1. Married
  2. Divorced
  3. Widowed
  4. Separated
  5. Never married
  6. A member of an unmarried couple

   9. Refused

39.
Data Results 39 		What is the highest level of school you completed or the highest degree you received?
  1. Never attended school or only attended kindergarten
  2. Grades 1 through 8 (Elementary)
  3. Grades 9 through 11 (Some high school)
  4. Grade 12 (High school graduate)
  5. GED
  6. Some College, no degree
  7. AA, Technical/vocational
  8. AA, Academic
  9. BA, BS (college graduate)
  10. At least some graduate or professional school

   77. Don't know
   99. Refused

40.
Data Results 40 		Is your annual household income from all sources:
  1. Less than $10,000
  2. Less than $15,000 ($10,000 to less than $15,000)
  3. Less than $20,000 ($15,000 to less than $20,000)
  4. Less than $25,000 ($20,000 to less than $25,000)
  5. Less than $35,000 ($25,000 to less than $35,000)
  6. Less than $50,000 ($35,000 to less than $50,000)
  7. Less than $75,000 ($50,000 to less than $75,000)
  8. $75,000 or more

   77. Don't know/Not sure
   99. Refused

41. What county do you live in?

   ___ FIPS county code

   777. Don't know/Not sure
   999. Refused

42.
Data Results 42 		Indicate sex of respondent. Ask only if necessary.
  1. Male
  2. Female
43.
Data Results 43

Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine.

  1. Yes
  2. No

   7. Don't know/Not sure
   9. Refused

44.
Data Results 44 		How many of these are residential numbers?

   ___ Residential telephone numbers [6=6 or more]

   7. Don't know/Not sure
   9. Refused