Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Uludag University Students Tobacco and New Generation Nicotine Products Use Survey
Dear students,
This survey consists of questions aimed at evaluating your tobacco and nicotine use status and your level of knowledge about tobacco and tobacco products. For our evaluation to be accurate, it is of great importance that the information you provide is correct and as complete as possible. The information you provide will be kept strictly confidential. The results will be used solely for scientific purposes.
Please read each question carefully before answering it. Choose the answer that best describes what you believe and feel to be correct. For some questions choose only one answer for each question. For other questions you may choose more than one answer choice (select all that apply).
We appreciate your contributions.
Asli Gorek Dilektasli, MD
Mehmet Karadag, MD
The faculty/college/vocational school where you study
Faculty of Education
Faculty of Science and Letters
Faculty of Fine Arts
Faculty of Law
Faculty of Economics and Administrative Sciences
Faculty of Theology
Faculty of Architecture
Faculty of Engineering
Faculty of Sports Sciences
Faculty of Medicine and Health Sciences
Faculty of Veterinary Medicine
Faculty of Agriculture
State Conservatory
Vocational School
Clear selection
What is your gender?
Female
Male
Clear selection
How old are you?
Your answer
What is your nationality?
Republic of Turkey
Else, please specify:
Clear selection
Are you married?
Single
Married
Divorced
Clear selection
In which grade are you in, and how long have you been studying at the university?
1
2
3
4
5
6
7
Grade
Years at University
1
2
3
4
5
6
7
Grade
Years at University
Clear selection
Do you have a doctor-diagnosed illness?
Yes
No
Clear selection
If you have a doctor-diagnosed illness, which one(s) do you have?
Asthma
Bronchitis
COPD
Tuberculosis
Pneumonia
Allergic diseases
Other: __________
Where do you live?
At home, with parents
University dormitory
Private dormitory
At home with friends
Living alone at home
Married, with my own family
With relatives, at their home
Other: __________
Clear selection
What level of education did your parents complete? Please answer for your mother
AND
father.
Illiterate
Literate
Primary school
Secondary school
High school
University
Mother
Father
Illiterate
Literate
Primary school
Secondary school
High school
University
Mother
Father
What is your families average monthly income (please specify in Turkish Liras)
less than 20.000 TL
20.000-40.000 TL
more than 40.000 TL
Clear selection
Do your parents and your best friend smoke tobacco or any tobacco/nicotine product. Select all that apply.
*
If ever used in the past month, select current-smoker.
If never used, select non-smoker. If ever used but not in the past month, select ex-smoker.
Cigarette: Current smoker
Cigarette: Ex-smoker
Cigarette: Non-smoker
Electronic cigarette: Current smoker
Electronic cigarette: Ex-smoker
Electronic cigarette: Non-smoker
Waterpipe: Current smoker
Waterpipe: Ex-smoker
Waterpipe: Non-smoker
Your mother's smoking status and other tobacco products
Your father's smoking status and other tobacco products
Your best friend's smoking status and other tobacco products
Cigarette: Current smoker
Cigarette: Ex-smoker
Cigarette: Non-smoker
Electronic cigarette: Current smoker
Electronic cigarette: Ex-smoker
Electronic cigarette: Non-smoker
Waterpipe: Current smoker
Waterpipe: Ex-smoker
Waterpipe: Non-smoker
Your mother's smoking status and other tobacco products
Your father's smoking status and other tobacco products
Your best friend's smoking status and other tobacco products
Did you use at least 100 cigarettes throughout your lifetime?
Yes
No
Clear selection
During the past 30 days, on how many days did you smoke cigarettes?
0 days
1-10 days
10-29 days
All 30 days
Clear selection
How old were you when you first tried smoking a cigarette? Please type below.
Your answer
Please think about the days you smoke cigarettes during the past month. How many cigarettes did you usually smoke per day?
less than 5 cigarette
6-10 cigarettes
10-20 cigarettes
20-30 cigarettes
30-40 cigarettes
more than 40 cigarettes
Clear selection
If you have quit smoking, what were your reasons for quitting?
Financial reasons
For my health
It does not appeal to me
No one in my family uses it
Bad smell
None of my friends smoke
Lost loved ones because of smoking
To set an example
My spouse/partner does not use it
Pregnancy
Having a child
Due to legal sanctions
Other: __________
Do you think that tobacco products are addictive or not? Please specify for each tobacco product below.
Addictive
Not addictive
Cigarette
Electronic cigarette
Water pipe
Cigar
Pipe tobacco
Addictive
Not addictive
Cigarette
Electronic cigarette
Water pipe
Cigar
Pipe tobacco
Clear selection
Do you think tobacco products are harmful for health? Please specify your thoughts for each of the following tobacco products.
Harmful to health
Not harmful to health
Cigarette
Electronic cigarette
Water pipe
Cigar
Pipe tobacco
Harmful to health
Not harmful to health
Cigarette
Electronic cigarette
Water pipe
Cigar
Pipe tobacco
Clear selection
Have you ever tried using cigarette, electronic cigarettes, roll-your-own tobacco, water pipe, cigar, pipe tobacco, chewing tobacco even one or two times throughout your lifetime? Please select which one applies to you for each kind of tobacco product.
*
*
If ever used in the past month, select current-smoker.
If never used, select non-smoker. If ever used but not in the past month, select ex-smoker.
Non-smoker
Ex-smoker
Current smoker
Cigarette
Electronic cigarett
Rolling tobacco
Water pipe
Cigar
Pipe tobacco
Chewing tobacco
Non-smoker
Ex-smoker
Current smoker
Cigarette
Electronic cigarett
Rolling tobacco
Water pipe
Cigar
Pipe tobacco
Chewing tobacco
Clear selection
Which of the following is most suitable for you?
I smoke every day
I smoke, but not every day
I am not a smoker at all, but I smoke a tobacco product (pipe or cigar)
I quit smoking completely last year
I quit smoking completely over a year ago
I have never smoked
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report