QUESTIONNAIRE

1. Gender:
a) Male b) Female
2. Are you a cigarette smoker?
a) Yes b) No
3. How often do you smoke?
a) Occasionally b)Everyday c)Dont smoke
4. When you see women smoking, what do you think of them?
a) Stupid b) loser c) Spoiled d) Good
5. If your best friend offers you a cigarette, would you accept it?
a) Yes b) No
6. Has anyone in your family discussed the harmful effects of
smoking?
a) Yes b) No
7. At any time in the next 12 months would you like to smoke?
a) Yes b) No
8. Once someone has started smoking, do you think he/she would
be able to quit?
a) Yes b) No
9. Do you think, cigarette smokers have a good and satisfied life?
a) Yes b) No
10. You think smoking makes girls/boys attractive?
a) Yes b) No
11. You think smoking makes you gain or lose weight?
a) Gain b) Lose c) No change
12. You think smoking is harmful for your future?
a) Yes b) No
13. Do you know any regular smoker?
a) Yes b) No
14. You think that the no. of female smokers is more than
that of male smokers?
a) Yes b) No