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Form Approved

OMB No.: 0920-0621

Expiration Date: 05/31/2018

National Youth

Tobacco Survey (NYTS)

2018 Questionnaire

Thank You Very Much For Your Help.

This survey is about tobacco. We would like to know about you and things you do 

that may affect your health. Your answers will be used for programs for young people like 

yourself.

DO NOT write your name on this survey. The answers you give will be kept private. 

NO one will know what you write. Answer the questions based on what you really 

do and know. 

Completing the survey is voluntary. Whether or not you answer the questions will 

not affect your grade in this class. Try to answer all the questions. If you do not want to 

answer a question, just leave it blank. There are no wrong answers. 

The questions that ask about your background will only be used to describe the 

types of students completing this survey. The information will not be used to find out 

your name. No names will ever be reported. 

Please read every question. Try to answer all the questions. Fill in the circles in 

the booklet completely. When you are finished, follow the instructions of the person 

giving you the survey.

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time 

for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to 

a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden 

estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC

Reports Clearance Officer, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0621).

PRINT ONLY
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The first five questions ask some 

background information about you.

1. How old are you? 

A. 9 years old 

B. 10 years old 

C. 11 years old 

D. 12 years old 

E. 13 years old 

F. 14 years old 

G. 15 years old 

H. 16 years old 

I. 17 years old 

J. 18 years old 

K. 19 years old or older 

2. What is your sex? 

A. Male

B. Female 

3. What grade are you in? 

A. 6th

B. 7th

C. 8th

D. 9th

E. 10th

F. 11th

G. 12th

H. Ungraded or other grade 

4. Are you Hispanic, Latino, Latina, or of 

Spanish origin? (Select one or more)

A. No, not of Hispanic, Latino, 

Latina, or Spanish origin

B. Yes, Mexican, Mexican 

American, Chicano, or Chicana

C. Yes, Puerto Rican

D. Yes, Cuban

E. Yes, Another Hispanic, Latino, 

Latina, or Spanish origin

5. What race or races do you consider 

yourself to be? (Select one or more)

A. American Indian or Alaska 

Native

B. Asian

C. Black or African American

D. Native Hawaiian or Other Pacific 

Islander

E. White

The next six sections of questions ask about 

your use of particular kinds of tobacco 

products, such as cigarettes, cigars, 

smokeless tobacco, electronic cigarettes, 

hookahs, pipes, snus, dissolvable tobacco, 

and bidis.

The first 12 questions are about smoking 

conventional cigarettes (ones that have to 

be lit and burned).

6. Have you ever been curious about 

smoking a cigarette? 

A. Definitely yes 

B. Probably yes

C. Probably not

D. Definitely not

7. Have you ever tried cigarette smoking, 

even one or two puffs? 

A. Yes 

B. No 

8. How old were you when you first tried

cigarette smoking, even one or two 

puffs?

A. I have never smoked cigarettes, 

not even one or two puffs

B. 8 years old or younger 

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old

H. 14 years old

I. 15 years old

J. 16 years old

K. 17 years old

L. 18 years old 

M. 19 years old or older
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9. About how many cigarettes have you 

smoked in your entire life?

A. I have never smoked cigarettes, 

not even one or two puffs

B. 1 or more puffs but never a 

whole cigarette

C. 1 cigarette

D. 2 to 5 cigarettes

E. 6 to 15 cigarettes (about 1/2 a 

pack total)

F. 16 to 25 cigarettes (about 1 pack 

total)

G. 26 to 99 cigarettes (more than 1 

pack, but less than 5 packs)

H. 100 or more cigarettes (5 or 

more packs)

10. When was the last time you smoked a 

cigarette, even one or two puffs? 

(Please choose the first answer that 

fits)

A. I have never smoked cigarettes, 

not even one or two puffs

B. Earlier today 

C. Not today but sometime during 

the past 7 days

D. Not during the past 7 days but 

sometime during the past 30 

days

E. Not during the past 30 days but 

sometime during the past 6 

months 

F. Not during the past 6 months but 

sometime during the past year 

G. 1 to 4 years ago 

H. 5 or more years ago 

11. During the past 30 days, on how many 

days did you smoke cigarettes? 

A. 0 days

B. 1 or 2 days 

C. 3 to 5 days 

D. 6 to 9 days 

E. 10 to 19 days 

F. 20 to 29 days 

G. All 30 days

12. During the past 30 days, on the days 

you smoked, about how many 

cigarettes did you smoke per day? 

A. I did not smoke cigarettes during 

the past 30 days

B. Less than 1 cigarette per day

C. 1 cigarette per day

D. 2 to 5 cigarettes per day

E. 6 to 10 cigarettes per day

F. 11 to 20 cigarettes per day

G. More than 20 cigarettes per day

13. During the past 30 days, what brand of 

cigarettes did you usually smoke? 

(Choose only one answer)

A. I did not smoke cigarettes during 

the past 30 days

B. I did not smoke a usual brand

C. American Spirit

D. Camel

E. GPC, Basic, or Doral

F. Kool

G. Lucky Strike

H. Marlboro

I. Newport

J. Parliament

K. Virginia Slims

L. Some other brand not listed here

M. Not sure

14. Menthol cigarettes are cigarettes that 

taste like mint. During the past 30 days, 

were the cigarettes that you usually 

smoked menthol?

A. I did not smoke cigarettes during 

the past 30 days

B. Yes

C. No

D. Not sure

15. Do you think that you will try a cigarette 

soon? 

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not
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16. Do you think you will smoke a cigarette 

in the next year?

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not 

17. If one of your best friends were to offer 

you a cigarette, would you smoke it? 

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not

The next five questions are about the use of 

cigars, cigarillos, or little cigars such as 

Black and Mild, Swisher Sweets, Dutch 

Masters, White Owl, or Phillies Blunts.

18. Have you ever been curious about 

smoking a cigar, cigarillo, or little cigar?

A. Definitely yes

B. Probably yes

C. Probably not

D. Definitely not

19. Have you ever tried smoking cigars, 

cigarillos, or little cigars, such as Black 

and Milds, Swisher Sweets, Dutch 

Masters, White Owl, or Phillies Blunts, 

even one or two puffs? 

A. Yes 

B. No 

20. How old were you when you first tried

smoking a cigar, cigarillo, or little cigar, 

even one or two puffs? 

A. I have never smoked cigars, 

cigarillos, or little cigars, not 

even one or two puffs 

B. 8 years old or younger 

C. 9 years old 

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old

H. 14 years old

I. 15 years old

J. 16 years old

K. 17 years old

L. 18 years old

M. 19 years old or older

21. During the past 30 days, on how many 

days did you smoke cigars, cigarillos, or 

little cigars? 

A. 0 days 

B. 1 or 2 days 

C. 3 to 5 days 

D. 6 to 9 days 

E. 10 to 19 days 

F. 20 to 29 days 

G. All 30 days 

22. During the past 30 days, on the days 

that you smoked, about how many 

cigars, cigarillos, or little cigars did you 

smoke per day? 

A. I did not smoke cigars, cigarillos, 

or little cigars during the past 30 

days

B. Less than 1 cigar, cigarillo, or 

little cigar per day

C. 1 per day

D. 2 to 5 per day

E. 6 to 10 per day

F. 11 to 20 per day

G. More than 20 per day
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The next four questions are about the use of 

chewing tobacco, snuff, or dip. Do not think

about snus or dissolvable tobacco products 

when you answer these questions. 

23. Have you ever been curious about using 

chewing tobacco, snuff, or dip?

A. Definitely yes

B. Probably yes

C. Probably not

D. Definitely not

24. Have you ever used chewing tobacco, 

snuff, or dip, such as Redman, Levi 

Garrett, Beechnut, Skoal, Skoal Bandits, 

or Copenhagen, even just a small 

amount? 

A. Yes 

B. No 

25. How old were you when you used 

chewing tobacco, snuff, or dip for the 

first time? 

A. I have never used chewing 

tobacco, snuff, or dip

B. 8 years old or younger 

C. 9 years old 

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old

H. 14 years old

I. 15 years old

J. 16 years old

K. 17 years old

L. 18 years old

M. 19 years old or older

26. During the past 30 days, on how many 

days did you use chewing tobacco, 

snuff, or dip? 

A. 0 days 

B. 1 or 2 days 

C. 3 to 5 days 

D. 6 to 9 days 

E. 10 to 19 days 

F. 20 to 29 days 

G. All 30 days 

The next 11 questions are about electronic 

cigarettes or e-cigarettes. E-cigarettes are 

battery powered devices that usually 

contain a nicotine-based liquid that is 

vaporized and inhaled. You may also know 

them as e-cigs, vape-pens, hookah-pens, ehookahs, e-cigars, e-pipes, personal 

vaporizers, or mods. Some brand examples 

include NJOY, Blu, Vuse, MarkTen, Logic, 

Vapin Plus, eGo, and Halo. 

27. Have you ever been curious about using 

an e-cigarette? 

A. Definitely yes 

B. Probably yes

C. Probably not

D. Definitely not

28. Have you ever used an e-cigarette, 

even once or twice? 

A. Yes 

B. No 

29. How old were you when you first tried

using an e-cigarette, even once or 

twice? 

A. I have never used e-cigarettes

B. 8 years old or younger 

C. 9 years old 

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old

H. 14 years old

I. 15 years old

J. 16 years old

K. 17 years old

L. 18 years old

M. 19 years old or older

30. In total, on how many days have you 

used e-cigarettes in your entire life?

A. 0 days

B. 1 day

C. 2 to 10 days

D. 11 to 20 days

E. 21 to 50 days

F. 51 to 100 days

G. Over 100 days
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31. During the past 30 days, on how many 

days did you use e-cigarettes?

A. 0 days 

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

32. During the past 30 days, where did you 

get or buy the e-cigarettes that you have 

used? (Select one or more)

A. I have never tried an e-cigarette 

in the past 30 days

B. A gas station or convenience 

store

C. A grocery store

D. A drugstore

E. A mall or shopping center 

kiosk/stand

F. On the Internet

G. A vape shop or other store that 

only sells e-cigarettes

H. Some other place not listed here

I. From a family member

J. From a friend

L. From some other person that is 

not a family member or a friend

33. What are the reasons you have used ecigarettes? (Select one or more)

A. I have never tried an e-cigarette

B. Friend or family member used 

them

C. To try to quit using other tobacco 

products, such as cigarettes

D. They cost less than other 

tobacco products, such as 

cigarettes

E. They are easier to get than other 

tobacco products, such as 

cigarettes

F. Famous people on TV or in 

movies use them

G. They are less harmful than other 

forms of tobacco, such as 

cigarettes

H. They are available in flavors, 

such as mint, candy, fruit, or 

chocolate

I. They can be used in areas 

where other tobacco products, 

such as cigarettes, are not 

allowed

J. I used them for some other 

reason

34. Have you ever used marijuana, 

marijuana concentrates, marijuana 

waxes, THC, or hash oils in an ecigarette? 

A. I have never used an electronic 

product

B. Yes

C. No

35. Do you think that you will try an ecigarette soon? 

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not
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36. Do you think you will use an e-cigarette 

in the next year?

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not 

37. If one of your best friends were to offer 

you an e-cigarette, would you use it? 

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not

The next eight questions are about smoking 

tobacco in a hookah, which is a type of 

waterpipe. Shisha (or hookah tobacco) is 

smoked in a hookah. 

38. Have you ever been curious about 

smoking tobacco in a hookah or 

waterpipe?

A. Definitely yes 

B. Probably yes

C. Probably not

D. Definitely not

39. Have you ever tried smoking tobacco in 

a hookah or waterpipe, even one or two 

puffs?

A. Yes 

B. No 

40. How old were you when you first tried

smoking tobacco in a hookah or 

waterpipe, even one or two puffs?

A. I have never smoked tobacco 

from a hookah or waterpipe

B. 8 years old or younger 

C. 9 years old 

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old

H. 14 years old

I. 15 years old

J. 16 years old

K. 17 years old

L. 18 years old

M. 19 years old or older

41. During the past 30 days, on how many 

days did you smoke tobacco in a 

hookah or waterpipe?

A. 0 days 

B. 1 or 2 days 

C. 3 to 5 days 

D. 6 to 9 days 

E. 10 to 19 days 

F. 20 to 29 days 

G. All 30 days 

42. During the past 30 days, where did you 

smoke tobacco in a hookah or 

waterpipe? (Select one or more) 

A. I did not smoke tobacco in a 

hookah or waterpipe during the 

past 30 days

B. At my house

C. At a friend’s house

D. At a family member’s house, 

other than my house

E. At a hookah bar

F. At a café or restaurant

G. Some other place not listed here

43. Do you think that you will try smoking 

tobacco in a hookah or waterpipe soon?

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not 

44. Do you think you will smoke tobacco in 

a hookah or waterpipe in the next year?

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not

45. If one of your best friends were to offer 

you a hookah or waterpipe with tobacco, 

would you try it?

A. Definitely yes 

B. Probably yes 

C. Probably not 

D. Definitely not
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The next two questions are about the use of 

other tobacco products, not described in the 

previous sections.

46. Which of the following tobacco products 

have you ever tried, even just one 

time? (Select one or more) 

A. Roll-your-own cigarettes

B. Pipes filled with tobacco (not 

waterpipe)

C. Snus, such as Camel, Marlboro, 

or General Snus

D. Dissolvable tobacco products 

such as Ariva, Stonewall, Camel 

orbs, Camel sticks, Marlboro 

sticks, or Camel strips

E. Bidis (small brown cigarettes 

wrapped in a leaf)

F. I have never tried any of the 

products listed above

47. In the past 30 days, which of the 

following products have you used on at 

least one day? (Select one or more) 

A. Roll-your-own cigarettes 

B. Pipes filled with tobacco (not 

waterpipe)

C. Snus, such as Camel, Marlboro, 

or General Snus

D. Dissolvable tobacco products 

such as Ariva, Stonewall, Camel 

orbs, Camel sticks, Marlboro 

sticks, or Camel strips

E. Bidis (small brown cigarettes 

wrapped in a leaf)

F. I have not used any of the 

products listed above in the past 

30 days 

Now thinking about your responses to 

questions from the last six sections about 

past 30 day use of cigarettes, cigars,

smokeless tobacco, e-cigarettes, hookahs, 

pipes, snus, dissolvable tobacco, and bidis.

48. During the past 30 days, on how many 

days did you use any tobacco 

product(s)? 

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

The next two questions ask about flavors in 

tobacco products.

49. Which of the following tobacco products 

that you used in the past 30 days were 

flavored to taste like menthol (mint), 

alcohol (wine, cognac), candy, fruit, 

chocolate or any other flavors? (Select 

one or more)

A. Cigars, cigarillos, or little cigars

B. Chewing tobacco, snuff, or dip

C. E-cigarettes

D. Tobacco in a hookah or 

waterpipe

E. Pipe filled with tobacco (not 

waterpipe)

F. Snus

G. Dissolvable tobacco products

H. Bidis (small brown cigarettes 

wrapped in a leaf)

I. I did not use any of the flavored 

tobacco products listed above in 

the past 30 days 
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50. What flavors of tobacco products have 

you used in the past 30 days? (Select 

one or more) 

A. Menthol or mint

B. Clove or spice

C. Fruit

D. Chocolate

E. Alcoholic drink (such as wine, 

cognac, margarita or other 

cocktails)

F. Candy, desserts or other sweets

G. Some other flavor not listed here

The next two questions are about issues 

related to urges or needs to use tobacco 

products.

51. During the past 30 days, have you had a 

strong craving or felt like you really 

needed to use a tobacco product of any 

kind?

A. Yes

B. No

52. How soon after you wake up do you 

want to use a tobacco product?

A. I do not want to use tobacco

B. Within 5 minutes

C. From 6 to 30 minutes

D. From more than 30 minutes to 1 

hour

E. After more than 1 hour but less 

than 24 hours

F. I rarely want to use tobacco

The next four questions are about quitting 

tobacco products.

53. Are you seriously thinking about quitting 

the use of all tobacco products? 

(Please choose the first answer that 

fits)

A. I do not use tobacco products] 

B. Yes, during the next 30 days

C. Yes, during the next 6 months

D. Yes, during the next 12 months

E. Yes, but not during the next 12 

months

F. No, I am not thinking about 

quitting the use of all tobacco 

products 

54. During the past 12 months, how many 

times have you stopped using all 

tobacco products for one day or 

longer because you were trying to quit 

all tobacco products for good?

A. I did not use tobacco products 

during the past 12 months 

B. I did not try to quit all tobacco 

products during the past 12 

months 

C. 1 time

D. 2 times

E. 3 to 5 times

F. 6 to 9 times

G. 10 or more times

55. Are you seriously thinking about quitting 

cigarettes? (Please choose the first 

answer that fits)

A. I do not smoke cigarettes 

B. Yes, during the next 30 days

C. Yes, during the next 6 months

D. Yes, during the next 12 months

E. Yes, but not during the next 12 

months

F. No, I am not thinking about 

quitting cigarettes
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56. During the past 12 months, how many 

times have you stopped smoking 

cigarettes for one day or longer

because you were trying to quit smoking 

cigarettes for good?

A. I did not smoke cigarettes during 

the past 12 months

B. I did not try to quit during the 

past 12 months

C. 1 time

D. 2 times

E. 3 to 5 times

F. 6 to 9 times

G. 10 or more times

The next four questions are about getting 

tobacco products.

57. During the past 30 days, how did you 

get your own tobacco products? (Select 

one or more) 

A. I did not get any tobacco 

products during the past 30 days 

B. I bought them myself

C. I had someone else buy them for 

me

D. I asked someone to give me 

some

E. Someone offered them to me

F. I bought them from another 

person

G. I took them from a store or 

another person

H. I got them some other way 

58. During the past 30 days, where did you 

buy your own tobacco products? (Select 

one or more) 

A. I did not buy tobacco products 

during the past 30 days

B. A gas station or convenience 

store

C. A grocery store

D. A drugstore

E. A vending machine

F. On the Internet

G. Through the mail

H. Some other place not listed here 

59. During the past 30 days, did anyone 

refuse to sell you any tobacco products 

because of your age? 

A. I did not try to buy any tobacco 

products during the past 30 days

B. Yes

C. No

60. How easy do you think it is for kids your 

age to buy tobacco products in a store?

A. Easy

B. Somewhat easy

C. Not easy at all

The next four questions are about different 

issues related to tobacco. 

A warning label tells you if a product is 

harmful to you and can be either a picture or 

words.

61. During the past 30 days, how often did 

you see a warning label on a cigar, 

cigarillo, or little cigar package?

A. I did not see a cigar, cigarillo, or 

little cigar package during the 

past 30 days

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always

62. During the past 30 days, how often did 

you see a warning label on an ecigarette package?

A. I did not see an e-cigarette 

package during the past 30 days

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always
Page 11 of 14

63. During the past 30 days, how often did 

you see a warning label on a package of 

hookah tobacco?

A. I did not see a package of 

hookah tobacco during the past 

30 days

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always

64. In the past 12 months, have you seen or 

heard The Real Cost, on television, the 

internet, social media, or radio as part of 

ads about tobacco?

A. Yes

B. No

C. Not sure

The next nine questions ask about your 

thoughts on tobacco products.

65. How much do you think people harm 

themselves when they smoke 

cigarettes some days but not every 

day?

A. No harm

B. Little harm

C. Some harm

D. A lot of harm

66. How much do you think people harm 

themselves when they use chewing 

tobacco, snuff, dip, or snus, some 

days but not every day? 

A. No harm

B. Little harm

C. Some harm

D. A lot of harm 

67. Do you believe that chewing tobacco, 

snuff, dip, or snus is (LESS 

ADDICTIVE, EQUALLY ADDICTIVE, or 

MORE ADDICTIVE) than cigarettes?

A. Less addictive

B. Equally addictive

C. More addictive

D. I have never heard of chewing 

tobacco, snuff, dip, or snus

E. I don’t know enough about these 

products

68. How much do you think people harm 

themselves when they use e-cigarettes

some days but not every day?

A. No harm

B. Little harm

C. Some harm

D. A lot of harm

69. Do you believe that e-cigarettes are 

(LESS ADDICTIVE, EQUALLY 

ADDICTIVE, or MORE ADDICTIVE) 

than cigarettes?

A. Less addictive

B. Equally addictive

C. More addictive

D. I have never heard of ecigarettes

E. I don’t know enough about these 

products

70. How much do you think people harm 

themselves when they smoke tobacco 

in a hookah or waterpipe some days 

but not every day?

A. No harm

B. Little harm

C. Some harm

D. A lot of harm
Page 12 of 14

71. Do you believe that smoking tobacco 

in a hookah or waterpipe is (LESS 

ADDICTIVE, EQUALLY ADDICTIVE, or 

MORE ADDICTIVE) than cigarettes?

A. Less addictive

B. Equally addictive

C. More addictive

D. I have never heard of smoking 

tobacco in a hookah or 

waterpipe

E. I don’t know enough about these 

products

72. How strongly do you agree with the 

statement ‘All tobacco products are 

dangerous’?

A. Strongly agree

B. Agree

C. Disagree

D. Strongly disagree

73. Not including the vapor from ecigarettes, do you think that breathing 

smoke from other people’s cigarettes or 

other tobacco products causes...

A. No harm

B. Little harm

C. Some harm

D. A lot of harm

The next four questions ask about issues 

related to tobacco advertisement. Do not 

think of electronic cigarettes.

74. When you are using the Internet, how 

often do you see ads or promotions for 

cigarettes or other tobacco products?

A. I do not use the Internet

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

75. When you read newspapers or 

magazines, how often do you see ads or 

promotions for cigarettes or other 

tobacco products?

A. I do not read newspapers or 

magazines

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

76. When you go to a convenience store, 

supermarket, or gas station, how often 

do you see ads or promotions for 

cigarettes or other tobacco products?

A. I never go to a convenience 

store, supermarket, or gas 

station

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

77. When you watch TV or go to the 

movies, how often do you see ads or 

promotions for cigarettes or other 

tobacco products?

A. I do not watch TV or go to the 

movies

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 
Page 13 of 14

The next four questions ask about issues 

related to e-cigarette advertisement. Do not 

think about cigarettes or other tobacco 

products.

78. When you are using the Internet, how 

often do you see ads or promotions for 

e-cigarettes?

A. I do not use the Internet

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

79. When you read newspapers or 

magazines, how often do you see ads or 

promotions for e-cigarettes?

A. I do not read newspapers or 

magazines

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

80. When you go to a convenience store, 

supermarket, or gas station, how often 

do you see ads or promotions for ecigarettes?

A. I never go to a convenience 

store, supermarket, or gas 

station

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always 

81. When you watch TV, how often do you 

see ads or promotions for e-cigarettes?

A. I do not watch TV

B. Never

C. Rarely

D. Sometimes

E. Most of the time

F. Always

The next three questions ask about you 

being around other people’s tobacco 

smoke. Do not include exposure to vapor 

from e-cigarettes.

82. During the past 7 days, on how many 

days did someone smoke tobacco 

products in your home while you were 

there?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days

83. During the past 7 days, on how many 

days did you ride in a vehicle when 

someone was smoking a tobacco 

product?

A. 0 days

B. 1 day

C. 2 days

D. 3 days

E. 4 days

F. 5 days

G. 6 days

H. 7 days 

84. During the past 30 days, on how many 

days did you breathe the smoke from 

someone who was smoking tobacco 

products in an indoor or outdoor public 

place? Examples of indoor public places 

are school buildings, stores, restaurants, 

and sports arenas. Examples of outdoor 

public places are school grounds, 

parking lots, stadiums, and parks.

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days
Page 14 of 14

The next question asks about being around 

other people’s e-cigarette vapor. Do not 

include exposure to smoke from other 

tobacco products.

85. During the past 30 days, on how many

days did you breathe the vapor from

someone who was using an e-cigarette

in an indoor or outdoor public place?

Examples of indoor public places are

school buildings, stores, restaurants,

and sports arenas. Examples of outdoor

public places are school grounds,

parking lots, stadiums, and parks.

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

The last three questions ask about your 

experiences at home and at school.

86. Does anyone who lives with you now...?

(Select one or more)

A. Smoke cigarettes

B. Smoke cigars, cigarillos, or little

cigars

C. Use chewing tobacco, snuff, or

dip

D. Use e-cigarettes

E. Smoke tobacco in a hookah or

waterpipe

F. Smoke pipes filled with tobacco

(not waterpipes)

G. Use snus

H. Use dissolvable tobacco

products

I. Smoke bidis (small brown

cigarettes wrapped in a leaf)

J. No one who lives with me now

uses any form of tobacco

87. Do you speak a language other than

English at home?

A. Yes

B. No

88. Because of a physical, mental, or

emotional condition, do you have

serious difficulty concentrating,

remembering, or making decisions?

A. Yes

B. No

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