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Student Smoking Influence Survey

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elleneuvaxia
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16 views2 pages

Student Smoking Influence Survey

Uploaded by

elleneuvaxia
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Dear Students,

Good day! We are conducting a research study as part of our academic requirements,
and we kindly request your participation as one of our respondents. Your honest responses
will be highly valuable in achieving the objectives of this study. Please be assured that all
information gathered will be treated with the utmost confidentiality and used solely for
academic purposes. Thank you for your time and cooperation.

Direction: Put a check mark on the space that corresponds to your answer.
Sex: Age:
_____ Male ______ 15 years old
_____ Female ______ 16 years old
______ 17 years old
______ 18 years old and above
Who influenced you to smoke?
_____ Peer Influence
_____ Family Influence
_____ Stress

5 4 3 2 1
Questions (SA) (A) (N) (D) (S
D)
1. I find smoking relaxing and comforting.

2. I believe smoking helps me concentrate or focus better.

3. I feel that smoking has become a regular part of my


daily routine.

4. I have developed a pattern of smoking after meals or


during breaks.

5. I smoke more frequently when I am alone than when I’m


with others.
6. I find myself reaching for a cigarette without consciously
thinking about it.

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