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Teens Smoking Survey
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* Indicates required question
*
First and Last
Your answer
Period?
*
Period 1
Period 3
Period 4
Period 7
Your answer
Does your parent smoke?
*
Yes
No
Do you know a person that smokes?
*
Under 18
Yes
No
How old is he or she?
Optional
Your answer
What do you know about smoking?
*
Your answer
What effects are there to smoking?
*
Your answer
How do you feel about Smoking?
*
Smoking is bad
1
2
3
4
5
Smoking is good
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