The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Untitled form
Send
Untitled form
Section 1 of 1
Title
Loading...
Loading…
Question
Question Type
Loading image…
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)沒有
(2)有 ,是
爸爸
媽媽
爺爺或外公
奶奶或外婆
哥哥或弟弟
姊姊或妹妹
其他住在一起的親友
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Title
Loading...
Loading…
Question
Question Type
Loading image…
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)過去30天內我沒有吸菸
(2)1或2天
(3)3到5天
(4)6至9天
(5)10到19天
(6)20到29天
(7)每天都有
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)我連一口菸都沒吸過
(2)否,我曾經吸菸但從未在學校裡吸菸
(3)是,我通常和同學一起在學校吸菸
(4)是,通常只有我一個人在學校吸菸
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)完全有把握100%
(2)很有把握75%
(3)有一半把握50%
(4)有少許把握25%
(5)完全沒把握0%
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)完全有把握100%
(2)很有把握75%
(3)有一半把握50%
(4)有少許把握25%
(5)完全沒把握0%
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)一定不會吸 (4)一定會吸
(2)可能不會吸
(3)可能會吸
(4)一定會吸
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)一定不會
(2)可能不會
(3)可能會
(4)一定會
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)一定不會
(2)可能不會
(3)可能會
(4)一定會
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)非常同意
(2)同意
(3)不同意
(4)非常不同意
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)非常同意
(2)同意
(3)不同意
(4)非常不同意
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)非常同意
(2)同意
(3)不同意
(4)非常不同意
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
0天
1天
2天
3天
4天
5天
6天
7天
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)沒有人在我面前吸菸
(2)校長
(3)老師
(4)行政人員
(5)警衛、工友
(6)同學
(7)其他校外人士
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
0天
1天
2天
3天
4天
5天
6天
7天
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Question
Question Type
Loading image…
(1)我連一口菸都沒吸過
(2)我戒菸已經超過一年了