9/15/2021 Smoking Behavior Research Questionnaire

Participant ID
Date survey was completed MM/DD/YYYY

1. About how many cigarettes have you smoked in your entire life?
a. 10 cigarettes or less
b. 11 - 100 cigarettes (up to 5 packs)
c. More than 100 cigarettes (more than 5 packs)

2. At any time in your life, have you smoked 1 or more cigare

ttes per day for 30 days straight?
a. Yes
b. No

3. Do you currently use any of the following tobacco or nicot ine products? Chewing tobacco or snuff,
cigars, tobacco pipes, clove cigarettes or bidis, nicotine replacement products such as gum or patch, or any
other tobacco products besides cigarettes?
a. Yes
b. No

4. When was the last time you smoked?

a. Over 12 months (1 year) ago -> GO TO QUESTION #12
b. Between 1 and 12 months (1 year) ago -> GO TO QUESTION #12
c. Within the last 30 days (1 month) -> GO TO QUESTION #5

5. During the past 30 days (1 month) on how many days did you smoke cigarettes?
a. Every day or almost every day
b. Some days
c. No days

6. How soon after you wake up do you smoke your first cigarette?
a. After 60 minutes
b. 31-60 minutes
c. 6-30 minutes
d. Within 5 minutes

7. Do you find it difficult to refrain from smoking in places where it is forbidden?

a. No
b. Yes

8. Which cigarette would you hate most to give up?

a. The first cigarette in the morning
b. Any other

9. How many cigarettes a day do you smoke?

a. 10 cigarettes or less
b. 11-20
c. 21-30
d. 31 or more

10. Do you smoke more frequently during the first hours after waking than during the rest of the day?
a. No
b. Yes

11. Do you smoke even if you are so ill that you are in bed most of the day?
a. No
b. Yes
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12. How old were you when you tried a cigarette, even a single puff?
a. I have never smoked cigarettes
b. 7 years old or younger
c. 8 or 9 years old
d. 10 or 11 years old
e. 12 or 13 years old
f. 14 or 15 years old
g. 16 or 17 years old
h. 18 - 21 years old
i. 22 years old or older

13. How old were you when you first smoked an entire cigarette?
a. I have never smoked cigarettes
b. 7 years old or younger
c. 8 or 9 years old
d. 10 or 11 years old
e. 12 or 13 years old
f. 14 or 15 years old
g. 16 or 17 years old
h. 18 - 21 years old
i. 22 years old or older

14. About how long did your experimental smoking phase last?
� If you are a current non-smoker, please
indicate the length of time you experimented with smoking before you stopped completely.
� If you are a
current smoker, please indicate the amount of time you experimented with smoking before becoming a
regular (daily or almost daily) smoker.
a. Less than 1 month
b. At least 1 month, but less than 6 months
c. At least 6 months, but less than 12 months (1 year)
d. At least 1 year, but less than 2 years
e. At least 2 years, but less than 4 years
f. 4 years or more
g. Don't know/not sure

15. During your experimental smoking phase, you may have smoked more frequently at some times and less
frequently at others. When you were smoking most frequently during this phase, about how often did you
smoke?
a. Daily or almost daily
b. At least weekly, but less than daily
c. At least monthly, but less than weekly
d. Less than monthly
e. Don't know/not sure

16. During your experimental smoking phase, you may have smoked more cigarettes at some times than
others. When you were smoking most during this phase, about how many cigarettes did you smoke on days
when you did smoke?
a. less than 1 cigarette per day
b. 1 cigarette per day
c. 2-5 cigarettes per day
d. 6-10 cigarettes per day
e. 11-20
f. 21 or more cigarettes per day
g. Other

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17. During your experimental smoking phase, where did you usually smoke? (Select only one response.)
a. At home
b. At school
c. At work
d. At friends' homes
e. At social events
f. In public places (e.g. parks, shopping centers, street corners)

18. During your experimental smoking phase, did you experience any of the following regularly?

18.1. A pleasurable feeling

a. Yes
b. No
c. Don't know/not sure

18.2. A "buzz"
a. Yes
b. No
c. Don't know/not sure

18.3. A good taste in your mouth

a. Yes
b. No
c. Don't know/not sure

18.4. A bad taste in your mouth

a. Yes
b. No
c. Don't know/not sure

18.5. A relaxed feeling

a. Yes
b. No
c. Don't know/not sure

18.6. An increase in focus or concentration

a. Yes
b. No
c. Don't know/not sure

18.7. A decrease in stress

a. Yes
b. No
c. Don't know/not sure

18.8. A craving for cigarettes

a. Yes
b. No
c. Don't know/not sure

18.9. A decrease in appetite

a. Yes
b. No
c. Don't know/not sure

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19. During your experimental smoking phase, did you believe that smoking cigarettes could be harmful to
your health?
a. Yes
b. No
c. Don't know/not sure

20. During your experimental smoking phase, did you believe that you could become addicted to cigarettes?
a. Yes
b. No
c. Don't know/not sure

21. During your experimental smoking phase, did you think that smoking was "cool"?
a. Yes
b. No
c. Don't know/not sure

22. During your experimental smoking phase, did you use any of the following tobacco or nicotine products?
Chewing tobacco or snuff, cigars, tobacco pipes, clove cigarettes or bidis, nicotine replacement products
such as gum or patch, or any other tobacco products besides cigarettes.
a. Yes
b. No

23. When did you become a regular smoker?

a. I have never been a regular smoker
b. Before age 10
c. 10-13 years old
d. 14-17 years old
e. 18 - 21 years old
f. 22 years old or older

24. Why did you become a regular smoker? (Check up to 3 reasons)

a. I have never been a regular smoker
b. I craved cigarettes if I didn�t smoke regularly
c. I was around smokers a lot of the time
d. I found smoking pleasurable
e. I got a �buzz� when I smoked
f. I enjoyed the taste
g. Smoking relaxed me
h. Smoking helped me focus and concentrate better
i. Smoking made me feel less stressed
j. I smoked to fit in with other people
k. I liked the image of a smoker
l. Smoking helped me control my weight
m. Since others in my family smoked, it was easy to see myself as a smoker too
n. Other

25. Why didn't you become a regular smoker? Check up to 3 reasons)

a. I did become a regular smoker
b. I did not enjoy smoking
c. Smoking cigarettes made me feel sick
d. I did not like the taste and/or the smell of cigarettes
e. I did not want to become addicted to nicotine
f. I was concerned about the effects of smoking on my health
g. I was concerned about the effects of my smoking on the health of the people around me
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h. I stopped hanging out with people who were smokers

i. I was encouraged to stop smoking by my friends
j. I was encouraged to stop smoking by an adult such as my parents/guardians, a teacher, or a doctor
k. I did not like the image of being a smoker
l. It was hard for me to obtain cigarettes
m. I could not afford to buy cigarettes
n. I had trouble finding places I could smoke
o. Since I grew up in a non-smoking family, I just could not see myself as a smoker
p. Other

26. While you were growing up, how many of your parents/guardians smoked at all?
a. None
b. One
c. More than one
d. Don't know/not sure

27. While you were growing up, what was your oldest age when at least one of your parents/guardians
smoked?
a. None of my parents/guardians smoked when I was growing up
b. 6 years old or less
c. 7-10 years old
d. 11-13 years old
e. 14-18 years old
f. Don't know/not sure

28. While you were growing up, did any of your brothers or sisters who lived with you smoke?
a. Yes
b. No
c. I do not have any brothers or sisters who lived with me while I was growing up
d. Don't know/not sure

29. While you were growing up, did any of your parents/guardians smoke inside your home?
a. Yes
b. No
c. Don't know/not sure

30. While you were growing up, did your parents/guardians allow visitors and guests to smoke inside your
home?
a. Yes
b. No
c. Don't know/not sure

31. While you were growing up, did your parents/guardians allo
w you to smoke inside your home?
a. Yes
b. No
c. Don't know/not sure

32. While you were growing up, did your parents/guardians ever talk to you about the dangers of smoking?
a. Yes
b. No
c. Don't know/not sure

33. While you were growing up, did your parents/guardians tell you that you were not allowed to smoke?
a. Yes

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b. No
c. Don't know/not sure

34. While you were growing up, did you have a close relationship with your parents/guardians?
a. Yes
b. No
c. Don't know/not sure

35. When you were growing up and your family went out to eat dinner in a restaurant, where did your
parents/guardians usually ask to be seated?
a. My family never went out to restaurants
b. Non-smoking section
c. Smoking section
d. Non-smoking or smoking section (no preference)
e. My family chose restaurants where smoking was not allowed
f. Non-smoking sections in restaurants did not exist back then
g. Don't know/not sure

36. While you were growing up, did your parents/guardians ever ask nearby smokers to stop smoking?
a. Yes
b. No
c. Don't know/not sure

37. During your experimental smoking phase, was it common for people your age to smoke cigarettes?
a. Not at all common
b. Less than half the people my age smoked
c. About half the people my age smoked
d. Almost everyone my age smoked
e. Don't know/not sure

38. During your experimental smoking phase, did any of your closest friends smoke cigarettes?
a. None
b. Some
c. Most or all
d. Don't know/not sure

39. During your experimental smoking phase, did people your age think that smoking was "cool"?
a. None
b. Some
c. Most or all
d. Don't know/not sure

40. During your experimental smoking phase, did your friends think that smoking was "cool"?
a. None
b. Some
c. Most or all
d. Don't know/not sure

41. When you were in school, were you taught about the dangers of smoking (for example, lung cancer, heart
disease, fire hazards)?
a. Yes
b. No
c. I did not attend school
d. Don't know/not sure

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42. When you were in school, did you discuss the reasons why people smoke in any of your classes?
a. Yes
b. No
c. I did not attend school
d. Don't know/not sure

43. When you were in school, were you taught about the side effects of smoking, such as making teeth
yellow, causing wrinkles, or making smokers smell bad?
a. Yes
b. No
c. I did not attend school
d. Don't know/not sure

44. In what grades did you discuss smoking and health in your classes at school? (Check all that apply.)
a. Kindergarten to 6th grade
b. 7th to 9th grade
c. 10th to 12th grade
d. I did not discuss this in school
e. Don't know/not sure

45. When you were in high school, were there designated smoking areas for students?
a. I did not attend high school
b. Yes
c. No
d. Don't know/not sure

46. When you were in high school, were adults such as teachers and administrators allowed to smoke at the
school?
a. Yes
b. No
c. Don't know/not sure

47. During your experimental smoking phase, did you work at a job for at least 10 hours per week?
a. Yes
b. No
c. Don't know/not sure

48. During your experimental smoking phase, were you serving on active duty in the military?
a. Yes
b. No
c. Don't know/not sure

49. During your experimental smoking phase, was smoking allowed in any of the following areas in your
workplace? (Check all that apply.)
a. In my work area
b. In common areas (lobbies, rest rooms, lunch rooms)
c. In designated smoking areas
d. Don't know/not sure
e. Smoking was not allowed anywhere in my workplace
f. I was not working during my experimental smoking phase

50. During your experimental smoking phase, how many of your coworkers smoked?
a. I was not working during my experimental smoking phase
b. Most or all
c. Some
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d. None
e. Don't know/not sure

51. When you were growing up, did the religious community you belonged to have a general attitude toward
smoking tobacco?
a. I did not belong to a religious community
b. My religious community did not approve of smoking
c. My religious community did not have a dominant attitude toward smoking
d. Smoking was accepted by my religious community
e. My religious community used tobacco in its ceremonies
f. Don't know/not sure

52. When you were growing up, did the ethnic community you belonged to have a general attitude toward
smoking tobacco?
a. I did not belong to an ethnic community
b. My ethnic community did not approve of smoking
c. My ethnic community did not have a dominant attitude toward smoking
d. Smoking was accepted by my ethnic community
e. Don't know/not sure

53. While you were growing up, how often did you see or hear anti-smoking messages on television, radio,
billboards, posters, newspapers, magazines, or movies?
a. Never
b. Sometimes
c. A lot
d. Don't know/not sure

54. While you were growing up, how often did you see smoking advertisements on television, radio,
billboards, posters, newspapers, and magazines?
a. Never
b. Sometimes
c. A lot
d. Don't know/not sure

55. While you were growing up, how often did you see actors smoking when you watched TV, movies, or
videos?
a. Never
b. Sometimes
c. A lot
d. I did not watch TV, movies, or videos
e. Don't know/not sure

56. During your experimental smoking phase, were you influenced by the warning labels on cigarette
packages?
a. They influenced me to quit smoking
b. They made me worry about my smoking
c. They had no effect
d. They amused me
e. They angered me
f. There were no warning labels on cigarette packages
g. Don't know/not sure

57. During your experimental smoking phase, how did you get your cigarettes? (Check all that apply.)
a. I bought them in a store
b. I bought them from a vending machine
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c. I gave someone else money to buy them for me

d. Someone else gave them to me
e. I stole them
f. I was given a free sample to try
g. I bought them from a catalog
h. I bought them over the Internet
i. Other

58. During your experimental smoking phase, was there a minimum legal age for buying cigarettes?
a. Yes
b. No
c. Don't know/not sure

59. During your experimental smoking phase, was it easy for you to get cigarettes?
a. Yes
b. Somewhat
c. No
d. Don't know/not sure

60. During your experimental smoking phase, did anyone refuse to sell you cigarettes because of your age?
a. No
b. Sometimes
c. Often
d. I did not try to buy cigarettes
e. Don't know/not sure

61. During your experimental smoking phase, could you usually afford cigarettes?
a. Yes
b. No
c. I did not try to buy cigarettes
d. Don't know/not sure

62. As a teen, do you think you had a healthy lifestyle?

a. Yes
b. Somewhat
c. No
d. Don't know/not sure

63. As a teen, how often did you eat fruits and vegetables?
a. Less than 1 serving a day
b. Usually 1 serving a day
c. Usually 2-3 servings a day
d. Usually 4-5 servings or more a day
e. Don't know/not sure

64. As a teen, did you have a healthy diet? A healthy diet contains a wide variety of foods and is high in
fruits and vegetables, lean protein, low-fat dairy products, and whole grain. It is low in sugar, fat, and salt.
a. Not at all
b. Some of the time
c. Most or all of the time
d. Don't know/not sure

65. As a teen, how often did you get moderate to vigorous exercise (for example, fast walking, running,
swimming, skating, or playing a sport)?

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a. Less than once a week

b. 1-2 times a week
c. 3-5 times a week
d. 6-7 times a week
e. Don't know/not sure

66. As a teen, about how often did you participate in supervised activities after school such as organized
sports, scouting, volunteer activities, etc.?
a. 0 times a week
b. 1-2 times a week
c. 3 or more times a week
d. Don't know/not sure

67. As a teen, how often did you drink alcohol?

a. Often
b. Sometimes
c. Rarely
d. Never
e. Don't know/not sure

68. As a teen, how satisfied were you with your life? Consider all aspects of your life at this time.
a. Not at all or slightly satisfied
b. Somewhat satisfied
c. Very satisfied
d. Don't know/not sure

69. As a teen, how much stress did you experience in your life?
a. None or very little
b. Some
c. A lot
d. Don't know/not sure

70. As a teen, did you have high self-esteem?

a. Not at all
b. Somewhat
c. Very
d. Don't know/not sure

71. As a teen, did a doctor or dentist ever talk to you about the dangers of smoking?
a. Yes
b. No
c. I did not see a doctor or dentist
d. Don't know/not sure

72. As a teen, do you think you received adequate information about smoking and its risks?
a. Yes
b. No
c. Don't know/not sure

73. In what year were you born?

74. What is your age in years?

75. What is your sex?

a. Male
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b. Female

76. Are you Hispanic or Latino?

a. Yes
b. No
c. Dont Know/Not Sure

77. What is your race or ethnic group? (Check all that apply.)
a. American Indian or Alaska Native
b. Asian
c. Black or African American
d. Native Hawaiian or Other Pacific Islander
e. White
f. Other
g. Don't know/not sure

78. Which of these groups would you say best represents you race? (Check only one.)
a. American Indian or Alaska Native
b. Asian
c. Black or African American
d. Native Hawaiian or Other Pacific Islander
e. White
f. Other
g. Don't know/not sure

79. When you were growing up, what language did you speak most often at home?
a. Chinese
b. English
c. Indonesian
d. Korean
e. Russian
f. Spanish
g. Tagalog
h. Telugu
i. No Response
j. Other

80. What is the highest grade or year of school you have completed?
a. Did not graduate from high school
b. High school graduate or equivalent (GED)
c. Some college or technical/vocational school, but no degree or certificate
d. Junior college or technical/vocational school degree or certificate
e. Bachelors degree or higher

81. What is the highest grade or year of school your parents/guardians completed? (Answer on a separate
line for each parent/guardian.)

81.1. Parent/guardian 1
a. Did not graduate from high school
b. High school graduate or equivalent (GED)
c. Some college or technical/vocational school, but no degree or certificate
d. Junior college or technical/vocational school degree or certificate
e. Bachelors degree or higher

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81.2. Parent/guardian 2
a. Did not graduate from high school
b. High school graduate or equivalent (GED)
c. Some college or technical/vocational school, but no degree or certificate
d. Junior college or technical/vocational school degree or certificate
e. Bachelors degree or higher

81.3. Parent/guardian 3
a. Did not graduate from high school
b. High school graduate or equivalent (GED)
c. Some college or technical/vocational school, but no degree or certificate
d. Junior college or technical/vocational school degree or certificate
e. Bachelors degree or higher

81.4. Parent/guardian 4
a. Did not graduate from high school
b. High school graduate or equivalent (GED)
c. Some college or technical/vocational school, but no degree or certificate
d. Junior college or technical/vocational school degree or certificate
e. Bachelors degree or higher

82. When you were a teen, how well off was the family you lived with?
a. We struggled to make ends meet
b. We lived comfortably
c. We were very well off
d. Don't know/not sure

83. How well off is your current family/household?

a. We struggle to make ends meet
b. We live comfortably
c. We are very well off
d. Don't know/not sure

84. In what county do you currently live?

a. Island
b. King
c. Pierce
d. Skagit
e. Snohomish
f. Thurston
g. Other

85. When you were a teen, in what one state did you mostly live? (write in state)
Alabama

86. How would you describe the area where you live?
a. Urban
b. Suburban
c. Rural

101. Is the subject a case, a control, or neither?

a. Case
b. Control
c. Neither
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102. What is the FTND for this subject?

a. 0
b. 1
c. 2
d. 3
e. 4
f. 5
g. 6
h. 7
i. 8
j. 9
k. 10

103. Subject's genotype for DRD2 C957T is:

a. C/C
b. T/T
c. C/T
d. not known

104. Subject�s genotype for DRD2 -141 Ins/Del is:

a. I/I
b. D/D
c. I/D
d. not known

105. Subject�s genotype for DDC is:

a. G/G
b. A/A
c. G/A
d. not known

106. Subject�s combined genotype is:

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