DCR-4 Chapter 15 “Designing Questionnaires, Interviews, and Online Surveys” Appendix 15: An Example of a Questionnaire about Smoking

This appendix in the textbook provides an example of paper survey questions about smoking. Here are the same questions in an online survey.  Online surveys are generally clearer and easier for the respondents because they incorporate skip logic.  A non-smoker will not reach questions about the age at which he started or the average number of cigarettes smoked per day.

Have you smoked at least 100 cigarettes in your entire life?
Yes
No

About how old were you when you smoked your first cigarette?
(years old)
On the average over the entire time since you started smoking, about how many cigarettes did you smoke per day?
(cigarettes per day)
Have you smoked any cigarettes in the past week?
Yes
No

About how many cigarettes per day did you smoke in the past week?
  (cigarettes per day)

How old were you when you stopped smoking?
 (years old)

Have you ever lived for at least a year in the same household with someone who
smoked cigarettes regularly?
Yes
No

For about how many years, in total have you lived with someone
who smoked cigarettes regularly at the time?
 (years)
On the average over the entire time you lived with people who smoked, about how many cigarettes a day were smoked while you were at home?
 (cigarettes per day)

Do you now live in the same household with someone who smokes cigarettes regularly?
Yes
No