Burning a substance releases harmful gases in to the atmosphere which leads to pollution of air, every anthropogenic activity leads to smoke which is directly or indirectly affecting mankind in the form of diseases. To know ones response and expert guidance to decrease release of harmful substances in to air and what is leading to smoke this questionnaire on smoke is wished for.

Fill your details:

Name: ________________
Gender: _______________
How old are you:  ________________
Profession: _______________
Income: ______________
Area/ district you live: ______________


Sample Questionnaire On Smoking:


Do you have a habit of smoking?

Yes or no

What do you smoke?

Tobacco, cigarette, any other

From how many days you are smoking?

1-30 days, 30-90 days, 90-180 days, 180-360 days, more than 1 year

How smoke effect people?

Specify: ________________

While smoke are injuries to health?

Leads to cancer
Leads to lung disorders
Any other ______________

Why smoking is prohibited in public places?

Causes health disorders to nearby people
Suffocation to people
Pollution
Any other___________________

Which brand cigarette you smoke?

Marlboro
Silk cut
So lent
Capstan
Wood bine
Diplomat
cadets
Any other _________________

Which brand cigarette is the best you use?

Marlboro
Silk cut
So lent
Capstan
Wood bine
Diplomat
cadets
Any other _________________

Which flavor you smoke?

Strawberry
Chocolate
Crème
Dark mint

Why you are addicted to smoking?

Fashion
Friends, family
Taste
Any other _________________

Which among the following you use while smoking?

Match box
Lighter

Why smoking causes health dis orders?

Ingredients used in manufacture are harmful
Smoke released contains chemicals, pollutants
Any other ________________

According to you government should band the manufacture of smoke causing agents?

Yes or no

What are the precautions or caution you will give to smokers?

Don’t change your habit of smoking
Bad for health
Use some medicine to avoid smoking
Any other ____________

Why smoking is mainly prohibited in petrol bunks?

Causes health dis orders to people
Blasting of petrol bunks take place
Increases the quantity of petrol
Any other________________

Why smoking is mainly prohibited in hospitals?

Causes health dis orders to people
Blasting of petrol bunks take place
Increases the quantity of petrol
Any other________________

Why most of the youth is addicted to smoking?

Fashion/ trend
Unexpectedly
For taste and flavor
Any other ________________________

Do you smoke while driving?

Yes, no, any other _____________

According to you who are responsible for increase in number of smokers?

Government
People
Every individual
youth