Douglas Do

This questionnaires goal is to assess use of conventional and e-cigarette use among young adults. This will be
a cross sectional study asked at one visit.

Smoking conventional
cigarette frequency

Electronic cigarette is first Current electronic

Smoking experience cigarette use

Education

Age

Gender

Exposure
Outcome
Conventional cigarette is first
Current conventional
Smoking experience cigarette use

Smoking electronic
cigarette frequency

Citation
1. Review Measure. PhenX Toolkit - Review Measure.
https://www.phenxtoolkit.org/index.php?pageLink=browse.protocols&filter=1&id=011000. Accessed
February 16, 2018.
2. Global Adult Tobacco Survey Collaborative Group. Tobacco Questions for Surveys: A Subset
of Key Questions from the Global Adult Tobacco Survey (GATS), 2nd Edition. Atlanta, GA:
Centers for Disease Control and Prevention, 2011.
Draft
1. When is your birthday?_____________
2. What is your gender?
a. Male
b. Female
c. Prefer not to say
d. Other _____________
3. What is the highest grade or level of school you have completed or the highest degree you have received?
(phenxtoolkit.org)
a. Never Attended
b. Elementary School
c. Middle School
d. High School
e. College
f. Other______________
4. What is your current employment status?
a. Working Now
b. Unemployed
c. Student
d. Temporary leave
e. Other_____________________
5. What is the zip code where you currently reside?
a. _____________________________
b. Other_________________________
6. Do you currently smoke conventional cigarettes on a daily basis, less than daily, or not at all??
a. Daily
b. Less than daily
c. Not at all
d. Prefer not to answer
7. Do you currently smoke electronic cigarettes on a daily basis, less than daily, or not at all??
a. Daily
b. Less than daily
c. Not at all
d. Prefer not to answer
8. Was your first smoking experience smoking with a conventional cigarette or electronic cigarette?
a. Conventional cigarette
b. Electronic cigarette
c. I don’t remember
d. I prefer not to answer
9. At what age was your first smoking experience?
a. 12 or younger
b. 13-14
c. 14-15
d. 16-17
e. 18 or older
10. Does any parent smoke conventional or electronic cigarettes?
a. Both smoke conventional cigarettes
b. One smokes conventional cigarettes
c. None smokes conventional cigarettes
d. Both smoke conventional cigarettes
e. One smokes conventional cigarettes
f. None smokes conventional cigarettes
Final Survey
1. When is your birthday?_____________(PC)
2. What is your gender?
a. Male
b. Female
c. Prefer not to say
d. Other _____________
3. What is the highest grade or level of school you have completed or the highest degree you have received?1(PC)
a. Never Attended
b. Elementary School
c. Middle School
d. High School
e. College
f. Other______________
4. What is the zip code where you currently reside? (PC)
a. _____________________________
b. Prefer not to answer
5. How often do you smoke conventional cigarettes on a daily basis, less than daily, or not at all?2(O)
a. Daily
b. Less than daily
c. Not at all
d. Prefer not to answer
6. How often do you smoke electronic cigarettes on a daily basis, less than daily, or not at all? (O)
a. Daily
b. Less than daily
c. Not at all
d. Prefer not to answer
7. Was your first smoking experience smoking with a conventional cigarette or electronic cigarette? (E)
a. Conventional cigarette
b. Electronic cigarette
c. I don’t remember
d. I prefer not to answer
8. At what age was your first smoking experience? (E)
a. 12 or younger
b. 13-14
c. 14-15
d. 16-17
e. 18 or older
9. How many of your legal guardians smoke conventional cigarettes?(C)
a. 0
b. 1
c. 2
d. Prefer not to answer
10. How many of your legal guardians smoke conventional cigarettes?(C)
a. 0
b. 1
c. 2
d. Prefer not to answer