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OMB No.: 0920-0621 

Expiration Date: 

12/31/2011

National Youth 

Tobacco Survey (NYTS) 

2009 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/ATSDR Reports Clearance Officer, 

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

 Use a #2 pencil only. 

 Make dark marks. 

 Fill in a response like this: 

 If you change your answer, erase your old answer 

completely. 

The first questions ask for 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 

l. 20 years old 

m. 21 years old 

2. What is your sex? 

a. Female 

b. Male 

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 or Latino? 

a. Yes 

b. No

5. What race or races do you consider yourself to be? 

(Please select one or more than one category) Would 

you say: 

a. American Indian or Alaska Native 

b. Asian 

c. Black or African American 

d. Native Hawaiian or Other Pacific Islander 

e. White 

6. During an average week, how much money do you get 

from a job and other sources (allowance, etc.)? 

a. None

b. Less than $1

c. $1 to $5

d. $6 to $10

e. $11 to $20

f. $21 to $50

g. $51 to $100

h. $101 to $150

i. $151 or more

7. During the past 30 days, how many days did you miss 

school for any reason, with or without permission? 

a. 0 days

b. 1 day

c. 2 to 5 days

d. 6 to 10 days

e. 11 or more days

The next questions ask about your use of tobacco. 

The first group of questions is about cigarette smoking. 

8. Have you ever tried cigarette smoking, even one or two 

puffs? 

a. Yes 

b. No

9. How old were you when you smoked a whole cigarette for 

the first time? 

a. I have never smoked a whole cigarette 

b. 8 years old or younger 

c. 9 

d. 10

e. 11

f. 12

g. 13

h. 14

i. 15

j. 16

k. 17 years old or older 

10. About how many cigarettes have you smoked in your 

entire life? 

a. None 

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) 
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11. Now think back 12 months ago. At this time last year, 

about how much were you smoking? 

a. I have never smoked cigarettes 

b. I have smoked in my life, but I wasn’t smoking at this 

time last year 

c. I smoked on some days at this time last year 

d. I smoked on most days at this time last year 

e. I smoked every day at this time last year 

12. Have you ever smoked cigarettes daily, that is, at least 

one cigarette every day for 30 days? 

a. Yes 

b. No

13. 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 

14. During the past 30 days, on the days you smoked, 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 

15. 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 do not have 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 

16. What type of cigarette did you usually smoke in the past 

30 days? 

a. I have never smoked 

b. I have smoked but not in the past 30 days

c. I do not have a usual type 

d. Regular/Full flavor 

e. Light

f. Ultra Light 

17. Are the cigarettes you usually smoke menthol cigarettes? 

a. I do not smoke cigarettes 

b. Yes 

c. No

18. When was the last time you smoked a cigarette, even one 

or two puffs? 

a. I have never smoked 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 

19. Where do you smoke cigarettes? 

(Choose one or more answers) 

a. I do not smoke now 

b. At home 

c. At school 

d. At work 

e. In the car 

f. At friends’ houses

g. At sports events, parties, dances, raves, or other 

social events 

h. In public buildings (restaurants, fast food places, 

shopping malls, or other hangouts)

i. Outdoors (sidewalks, parking lots, parks, or other 

places) 

20. Have you ever tried any of these tobacco products? 

(Choose one or more answers)

a. Eclipse cigarettes 

b. Omni 

c. Advance Lights 

d. Accord 

e. Ariva 

f. I have not tried any of these products 

21. During the past 30 days, how did you usually get your own 

cigarettes? (Choose only one answer)

a. I did not smoke cigarettes during the past 30 days 

b. I bought them in a store such as a convenience store, 

supermarket, or gas station 

c. I bought them from a vending machine 

d. I gave someone else money to buy them for me 

e. I borrowed them from someone else 

f. I stole them 

g. A person 18 years old or older gave them to me 

h. I got them some other way 
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22. During the past 30 days, where did you buy the last pack 

of cigarettes you bought? (Choose only one answer)

a. I did not buy a pack of cigarettes during the past 30 

days 

b. A gas station 

c. A convenience store 

d. A grocery store 

e. A drugstore 

f. A vending machine 

g. I bought them over the Internet 

h. Other 

23. When you bought or tried to buy cigarettes in a store 

during the past 30 days, were you ever asked to show 

proof of age? 

a. I did not try to buy cigarettes in a store during the past 

30 days 

b. Yes, I was asked to show proof of age 

c. No, I was not asked to show proof of age 

24. During the past 30 days, did anyone ever refuse to sell 

you cigarettes because of your age? 

a. I did not try to buy cigarettes in a store during the past 

30 days 

b. Yes, someone refused to sell me cigarettes because 

of my age 

c. No, no one refused to sell me cigarettes because of 

my age 

25. During the past 30 days, on how many days did you 

smoke cigarettes on school property? 

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 

26. Do you want to stop smoking cigarettes? 

a. I do not smoke now 

b. Yes 

c. No

27. Are you seriously thinking about quitting smoking? 

a. I have never smoked 

b. I do not smoke now 

c. Yes, within the next 30 days 

d. Yes, within the next 6 months 

e. Yes, but not within the next 6 months 

f. No, I am not thinking of quitting smoking 

g. Not sure 

28. How many times during the past 12 months have you 

stopped smoking for one day or longer because you were 

trying to quit smoking?

a. I have not smoked in the past 12 months 

b. I have not tried to quit 

c. 1 time 

d. 2 times 

e. 3 to 5 times 

f. 6 to 9 times 

g. 10 or more times 

29. When you last tried to quit, how long did you stay off 

cigarettes?

a. I have never smoked cigarettes 

b. I have never tried to quit 

c. Less than a day 

d. 1 to 2 days 

e. 3 to 7 days 

f. More than 7 days but less than 30 days 

g. 30 days or more but less than 6 months 

h. 6 months or more but less than a year 

i. 1 year or more 

30. During the past 12 months, did a medical doctor, dentist, 

or nurse ask you whether you smoke cigarettes?

a. Yes 

b. No

c. I don’t know/I can’t remember

 

31. During the past 12 months, did a medical doctor, dentist, 

or nurse tell you to stop smoking?

a. I have never smoked 

b. Yes 

c. No

d. I don’t know/I can’t remember

32. In the past 12 months, did you do any of the following to 

help you stop smoking? (Choose one or more answers)

a. I have never smoked 

b. I have not smoked in the past 12 months 

c. I did not try to quit in the past 12 months 

d. Attended a program in my school 

e. Attended a program in the community 

f. Called a help line or quit line 

g. Used nicotine gum 

h. Used nicotine patch 

i. Used any medicine to help quit 

j. Visited an internet quit site 

k. Got help from family or friends 

l. I tried to quit but did something else 

m. I tried to quit but did not do any of these things 

33. In the past 12 months, did you have to go to a stop 

smoking class because you were caught smoking? 

a. I have never smoked 

b. I have not smoked in the past 12 months 

c. Yes, I had to go to a stop smoking class 

d. No, I did not have to go to a stop smoking class 
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34. Do you think you would be able to quit smoking cigarettes 

now if you wanted to? 

a. I do not smoke now 

b. Yes 

c. No

35. How long can you go without smoking before you feel like 

you need a cigarette? 

a. I have never smoked cigarettes 

b. I do not smoke now 

c. Less than 1 hour

d. 1 to 3 hours 

e. More than 3 hours but less than a day 

f. A whole day 

g. Several days 

h. A week or more 

36. How true is this statement for you? After not smoking for a 

while, I feel restless and irritable. 

a. I have never smoked cigarettes 

b. I don’t smoke now

c. Not at all true 

d. Not very true 

e. Fairly true 

f. Very true 

37. How true is this statement for you? When I go without a 

smoke for a few hours, I experience craving. 

a. I have never smoked cigarettes 

b. I don’t smoke now

c. Not at all true 

d. Not very true 

e. Fairly true 

f. Very true 

The next questions are about smokeless tobacco—

chewing tobacco, snuff, or dip. 

38. Have you ever used chewing tobacco, snuff, or dip, such 

as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, 

or Copenhagen?

a. Yes

b. No

39. 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 

d. 10

e. 11

f. 12

g. 13

h. 14

i. 15

j. 16

k. 17 years old or older 

40. 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 

41. During the past 30 days, on how many days did you use 

chewing tobacco, snuff, or dip on school property? 

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 questions are about cigars and pipes. 

42. Have you ever tried smoking cigars, cigarillos, or little 

cigars, even one or two puffs? 

a. Yes 

b. No

43. How old were you when you smoked a cigar, cigarillo, or 

little cigar for the first time? 

a. I have never smoked a cigar, cigarillo or little cigar 

b. 8 years old or younger 

c. 9 

d. 10

e. 11

f. 12

g. 13

h. 14

i. 15

j. 16

k. 17 years old or older 

44. 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 

45. Have you ever tried smoking tobacco in a pipe, even one 

or two puffs? 

a. Yes 

b. No
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46. During the past 30 days, on how many days did you 

smoke tobacco in a pipe? 

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 questions are about bidies and kreteks. Bidis (or 

“beedies”) are small brown cigarettes from India made of 

tobacco wrapped in a leaf tied with a thread. They can 

taste like vanilla, chocolate, cherry or other flavors. 

Kreteks (or “clove cigarettes”) are cigarettes containing 

tobacco and clove extract. 

47. Have you ever tried smoking any of the following: 

a. Bidis 

b. Kreteks 

c. I have tried both bidis and kreteks 

d. I have never smoked bidis or kreteks 

48. During the past 30 days, on how many days did you 

smoke bidis? 

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 

49. During the past 30 days, on how many days did you 

smoke kreteks? 

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 questions ask about other people smoking and 

using tobacco around you. 

50. During the past 7 days, on how many days were you in the 

same room with someone who was smoking cigarettes? 

a. 0 days 

b. 1 or 2 days 

c. 3 or 4 days 

d. 5 or 6 days 

e. 7 days 

51. During the past 7 days, on how many days did you ride in 

a car with someone who was smoking cigarettes? 

a. 0 days 

b. 1 or 2 days 

c. 3 or 4 days 

d. 5 or 6 days 

e. 7 days 

52. Do you think the smoke from other people’s cigarettes is 

harmful to you?

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 

53. Does anyone who lives with you now smoke cigarettes? 

a. Yes 

b. No

54. Does anyone who lives with you now use chewing 

tobacco, snuff, or dip? 

a. Yes 

b. No

55. How many of your four closest friends smoke cigarettes? 

a. None 

b. One 

c. Two 

d. Three 

e. Four 

f. Not sure 

56. How many of your four closest friends use chewing 

tobacco, snuff, or dip? 

a. None 

b. One 

c. Two 

d. Three 

e. Four 

f. Not sure 

57. Which statement best describes the rules about smoking 

inside your home? 

a. Smoking is not allowed anywhere inside my home 

b. Smoking is allowed in some places or at some times 

c. Smoking is allowed anywhere in my home 

d. There are no rules about smoking in my home 

The next questions ask about your thoughts about 

tobacco. 

58. Do you think you will smoke a cigarette at anytime during 

the next year? 

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 
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59. Do you think you will be smoking cigarettes 5 years from 

now? 

a. I definitely will 

b. I probably will 

c. I probably will not 

d. I definitely will not 

60. If one of your best friends offered you a cigarette, would 

you smoke it? 

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 

61. Do you think that you will try a cigarette soon? 

a. I have already tried smoking cigarettes 

b. Yes 

c. No

62. During the past 12 months, has either of your parents (or 

guardians) told you not to smoke cigarettes?

a. Mother (female guardian) only 

b. Father (male guardian) only 

c. Both 

d. Neither 

63. In the past 12 months, how often have your parents or 

guardians discussed the dangers of tobacco use with you? 

a. Never 

b. Rarely 

c. Sometimes 

d. Often 

e. Very often 

64. Do you think it is safe to smoke for only a year or two, as 

long as you quit after that? 

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 

65. Do you think smoking cigarettes makes young people look 

cool or fit in? 

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 

Some tobacco companies make items like sports gear, tshirts, lighters, hats, jackets, and sunglasses that people 

can buy or receive free. 

66. During the past 12 months, did you buy or receive 

anything that has a tobacco company name or picture on 

it?

a. Yes 

b. No

67. Would you ever use or wear something that has a tobacco 

company name or picture on it such as a lighter, t-shirt, 

hat, or sunglasses?

a. Definitely yes 

b. Probably yes 

c. Probably not 

d. Definitely not 

The next questions ask about events you may have 

attended or what you have seen or heard on the TV, radio, 

movies, billboards, signs, newspapers, magazines, stores, 

or the Internet. 

68. During the past 12 months, have you participated in any 

community activities to discourage people your age from 

using cigarettes, chewing tobacco, snuff, dip, or cigars? 

a. Yes 

b. No

c. I did not know about any activities 

69. During the past 30 days, how many times did you see antismoking messages on TV? 

a. I did not watch TV in the past 30 days 

b. None 

c. 1 to 3 times in the past 30 days 

d. 1 to 3 times per week 

e. Daily or almost daily 

f. More than once a day 

70. During the past 30 days, how many times did you hear 

anti-smoking messages on the radio? 

a. I did not listen to the radio in the past 30 days 

b. None 

c. 1 to 3 times in the past 30 days 

d. 1 to 3 times per week 

e. Daily or almost daily 

f. More than once a day 

71. During the past 30 days, how many times did you see antismoking messages on the Internet? 

a. I did not use the Internet in the past 30 days 

b. None 

c. 1 to 3 times in the past 30 days 

d. 1 to 3 times per week 

e. Daily or almost daily 

f. More than once a day 

72. During the past 30 days, how many times have you seen 

anti-smoking messages on billboards or outdoor signs?

a. None in the past 30 days 

b. 1 to 3 times in the past 30 days 

c. 1 to 3 times per week 

d. Daily or almost daily 

e. More than once a day 
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73. During the past 30 days, how many times did you see antismoking messages in magazines or newspapers? 

a. I did not read magazines or newspapers 

b. None in the past 30 days 

c. 1 to 3 times in the past 30 days 

d. 1 to 3 times per week 

e. Daily or almost daily 

f. More than once a day 

74. When you watch TV or go to movies, how often do you 

see actors using tobacco?

a. I don’t watch TV or go to movies

b. Most of the time 

c. Some of the time 

d. Hardly ever 

e. Never 

75. When you are using the Internet, how often do you see 

ads for tobacco products? 

a. I do not use the Internet 

b. Most of the time 

c. Some of the time 

d. Hardly ever 

e. Never 

76. When you read newspapers or magazines, how often do 

you see ads or promotions for cigarettes and other 

tobacco products? 

a. I do not read newspapers or magazines 

b. All of the time 

c. Most of the time 

d. Some of the time 

e. Hardly ever 

f. Never 

77. When you go to a convenience store, supermarket, or gas 

station, how often do you see ads for cigarettes and other 

tobacco products or items that have tobacco company 

names or pictures on them? 

a. I never go to a convenience store, supermarket, or 

gas station 

b. All of the time 

c. Most of the time 

d. Some of the time 

e. Hardly ever 

f. Never 

The last questions ask if you were taught about tobacco in 

your classes. 

78. During this school year, did you practice ways to say “No” 

to tobacco in any of your classes (for example, by role 

playing)?

a. Yes 

b. No

c. Not sure 

79. During this school year, were you taught in any of your 

classes the reasons why people your age smoke? 

a. Yes 

b. No

c. Not sure 

80. During this school year, were you taught in any of your 

classes that most people your age do not smoke 

cigarettes? 

a. Yes 

b. No

c. Not sure 

81. During this school year, were you taught in any of your 

classes about the dangers of tobacco use? 

a. Yes 

b. No

c. Not sure 

Thank you for participating in 

this survey.

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