Smoking Survey
Answers marked with a * are required.
This is NOT a cigarette survey
  Please only take this if you currently (or have in the past) smoke "things". Remember that the information you give is for RESEARCH purposes only. Depending on how many responses I get (hopefully in the thousands eventually) I plan to forward the results to politicians.
 
Where do you currently live? (If in the U.S. please specify the state [no abbreviations], otherwise specify the country)
 
 
 
What is your age? *
      
 
 
 
What is your sex? *
      
 
 
 
What is your ethnicity? *
      
 
 
 
How often do you smoke? *
      
 
 
 
What reason(s) do you smoke for? (Check only ones that apply towards multiple usages, not just a single instance) *
       		 
 
 
Have you ever been arrested because of it? *
      
 
 
 
What other substances have you tried? *
       		 
 
 
If "Other", please specify what and how often / when you last used. . ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- If you picked an option and don't currently use anymore please point that out . ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Otherwise, skip this question
 
 
 
What are some positive side-effects you have noticed when smoking? (Optional)
 
 
 
What are some negative side-effects you have noticed when smoking? (Optional)
 
 
 
How would you say smoking has effected you in your...? *
  Greatly Improved Improved Slightly Improved Had no effect Slightly Hindered Hindered Greatly Hindered
Social life
Sex life
Family life
Career
Schooling (grades)
 
 
 
Compared to when you're not smoking, when you are smoking how would you rate your abilities to...? *
  Much Better Better About the same Worse Much Worse
Walk
Eat
Sleep
Set long-term goals
Focus
Drive
Set short-term goals
 
 
 
Did you graduate from High School? *
 
 
 
Do you plan to graduate from High School? (If you ALREADY GRADUATED please skip)
 
 
 
Did you graduate from College? *
 
 
 
Do you plan to graduate from College? (If you already graduated from College please skip)
 
 
 
What is your (current / most recent) GPA? (Optional)
 
 
 
What is your current job title? Please be basic (Ex. Teacher, Student, Engineer, Artist, Cashier, Manager, Musician, Cook, etc.) [Optional]
 
 
 
What is your current yearly salary? (If you don't wish to disclose or plan to be dishonest, please skip this question. Thanks!) [Optional]
      
 
 
 
How would you rate this survey? *
 
 
 
Please give your reason for your rating what you did on this survey and feel free to give any recommendations. (Optional)
 
 
 
 
 

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