Case Study on Smoking Among Youth

CASE STUDY: “Smoking Among Minors”
SETTING: Barangay Caditaan, Magallanes, Sorsogon
PEOPLE INVOLVED: Minors (17 year-old below)

QUESTIONAIRE

Name of Respondent (Optional): __________________________________________________
Age: _________________ Date of Interview: _____________________

DIRECTIONS: Please answer the following questions in the concept of truth. Mark check to your preferred answer.

1. At what age you learned to smoke: ______________ 2. Who taught/influence you to smoke?
_______ a. Family Member _______ c. friends
_______ b. yourself _______ d. neighbor 3. Reason/s why you try smoking:
_______ a. friends/group acceptance
_______ b. curiosity
_______ c. to boast/brag yourself 4. Does your family know that you are smoking?
_______ a. Yes _______ b. Maybe ________ c. No 5. If your answer to Question No. 3 is Yes, Did anyone of your family members scold you or tell that smoking is bad for your health? ________ a. Yes _______ b. No 6. How often do you smoke?
_______ a. once a day _______ c. thrice a day
_______ b. twice a day _______ d. four times a day or more 7. Where do you get money to buy/acquire cigarettes?
_______ a. member of the family
_______ b. to a friend/group
_______ c. neighbor
_______ d. to someone who knew you
_______ e. in your own way/s(e.g. work, gambling, rob/theft) 8. Where do you smoke?
_______ a. private place
_______ b. public place
_______ c. house
_______ d. hang-out place w/ friends 9. Do you know the bad effects of smoking to you and to others?
_______ a. Yes ________ b. No 10. Knowing the effects of smoking, do you have any plan to stop smoking?
_______ a. Yes ________ b. Maybe ________ c. No 11. When do you plan to stop smoking?
_______ a. Now
_______ b. Soon/later when I am ready
_______ c. When I experience the bad effects
_______ d. Never
Consent form

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