Professional Documents
Culture Documents
4401 Q2 V1-Eng
4401 Q2 V1-Eng
Province
School board
School
Grade
Student No.
Final
status
ly
Language of interview
INTRODUCTION
on
English. . . 1
at
io
To all Students:
or
m
Thousands of students across Canada, just like you, have been selected to take part in this
survey. Most of the questions are about smoking with a few questions about alcohol and
drugs as well.
This important survey will help Health Canada to prepare information related to smoking,
alcohol and drugs.
nf
There are NO RIGHT or WRONG ANSWERS. This is NOT a test. DO NOT WRITE YOUR
NAME ON THE QUESTIONNAIRE.
Fo
ri
All your answers will be kept confidential by Statistics Canada. No one, not even your
parents or teachers, will ever know what you answered. So please, be honest and accurate
when you answer the questions.
While your participation is voluntary, your help today is very important to us.
Thank You!
8-5300-474.1 2002-07-05
STC/HLD-040-05521
ABOUT YOU
1. How old are you?
I am
years old
boy?
on
girl?
English
French
Other (specify)
Fo
ri
nf
or
m
at
io
ly
4. Are you an Aboriginal person, that is, North American Indian, Mtis or Inuit (Eskimo)?
(Mark all that apply)
1
No
Yes, Mtis
8-5300-474.1
ABOUT YOU
5. In the last 12 months, how often have you...
Never
1 to 3
times a
week
02
03
4 or more
times a
week
04
on
ly
01
at
io
09
05
06
07
08
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
nf
or
m
ri
Less than
once a
week
g.
Fo
f.
Page 3
ABOUT YOU
6. On average, about how many hours a day do you watch TV or videos?
1 to 2 hours a day
3 to 4 hours a day
5 to 6 hours a day
at
io
on
ly
Every day
Once a week
Almost never
Fo
ri
nf
or
m
I don't know
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
Page 4
8-5300-474.1
ABOUT YOU
Choose the answer that best describes how you feel.
False
Mostly
true
True
01
02
03
04
05
06
07
08
09
10
11
12
13
14
d. When I do something,
I do it well.
19
20
ly
on
9.
16
17
18
21
22
23
24
28
29
30
at
io
15
25
26
27
or
m
No
b.
c.
d.
Fo
ri
nf
a.
11a. Have you ever tried cigarette smoking, even just a few puffs?
1
Yes
No
Yes
No
Page 5
15.
Yes
No
I don't know
ly
I already smoke
I already smoke
Difficult
Easy
I don't know
or
m
Yes
No
How old were you when you smoked your first whole cigarette?
(Mark one only)
95
I was
16.
at
io
on
Do you think it would be difficult or easy for you to get cigarettes if you wanted to try
smoking?
nf
14.
ri
13.
Do you think you might try smoking within the next month?
Fo
12.
years old
Yes
No
I don't know
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
Page 6
8-5300-474.1
18.
Have you ever smoked every day for at least 7 days in a row?
4
Yes
No
I don't know
How old were you when you first did this (smoked every day for at least 7 days in a
row)? (Mark one only)
95
ly
17.
I was
on
OR
years old
OR
at
io
None
1 - 5 days
6 - 10 days
11 - 20 days
21 - 29 days
30 days (everyday)
nf
or
m
ri
20.
On how many of the last 30 days did you smoke one or more cigarettes?
(Mark one only)
On those days that you smoked, how many cigarettes did you usually smoke?
(Mark one only)
1
2
Fo
19.
I don't know
97
6 - 10 cigarettes
11 - 15 cigarettes
16 - 20 cigarettes
21 - 25 cigarettes
8-5300-474.1
Page 7
Thinking back over the last 7 days, starting with yesterday, how many cigarettes did
you smoke on each day?
8
ri
nf
or
m
at
io
on
ly
(Find yesterday's day on the wheel and follow the arrows for the past 7 days.)
Fo
Yes
No
8-5300-474.1
02
Belmont
18
03
19
04
20
05
21
06
22
07
23
08
09
10
on
ly
01
at
io
Number 7
25
26
11
27
12
28
13
29
14
30
nf
ri
Fo
15
or
m
24
16
31
No regular brand
17
32
Other (specify)
Page 9
24.
03
04
05
06
07
08
09
10
11
12
on
02
I don't smoke
ri
nf
or
m
at
io
01
ly
Fo
23.
I don't smoke
Yes
No
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
Page 10
8-5300-474.1
I don't smoke
02
03
04
05
06
07
08
09
10
or
m
at
io
on
ly
01
nf
I don't smoke
3
4
ri
26.
Fo
25.
8-5300-474.1
Page 11
30.
Yes
No
Yes
No
on
ly
Have you ever been asked for an ID when trying to buy cigarettes?
at
io
Yes
No
or
m
29.
Yes
No
nf
28.
Have you ever been asked your age when buying cigarettes in a store for yourself or
for someone else?
ri
27.
1
2
Fo
Yes
No
8-5300-474.1
Yes
No
95
ly
33.
on
32.
OR
at
io
34.
I don't know
or
m
97
How old were you when you first tried to quit smoking?
(Mark one only)
94
ri
95
nf
OR
OR
35.
Fo
I was
years old
In the last 6 months, I have not smoked or have only smoked a few times
Yes
No
Page 13
02
03
1 day or less
04
2 - 7 days
05
8 - 31 days
06
1 - 3 months
07
4 - 6 months
08
7 - 12 months
09
10
I don't know
at
io
on
ly
01
or
m
36.
nf
Yes
Fo
ri
No
Yes
No
I don't know
I don't know
8-5300-474.1
He approves
He doesn't care
He doesn't like it
on
ly
at
io
38.
Yes
No
or
m
No
I don't know
3
4
Fo
ri
nf
I don't know
I don't live with a mother or anyone who is like a mother
Page 15
41.
She approves
on
ly
at
io
40.
Excluding yourself, how many people smoke INSIDE your home every day or almost
every day? Do not count those who usually smoke outside.
43.
Yes
No
ri
nf
Fo
42.
or
m
How many close friends do you have (that is, very good friends)?
Write in number (If none, enter 00)
44.
Page 16
8-5300-474.1
not at all?
I don't know
ly
45.
46.
on
at
io
Yes
No
I don't
know
01
02
03
04
05
06
c.
07
08
09
d.
10
11
12
e.
13
14
15
f.
16
17
18
g.
19
20
21
22
23
24
i.
25
26
27
j.
28
29
30
k.
31
32
33
nf
ri
Fo
h.
or
m
b.
Page 17
It's relaxing
For something to do
10
It's cool
11
Other (specify)
ly
on
at
io
What health problems can people get if they smoke for many years?
(Please print clearly)
Fo
ri
nf
48.
or
m
47.
8-5300-474.1
According to the law in your province, how old does a person have to be in order to
buy cigarettes?
Years old
OR
97
I don't know
50a. Have you ever seen health warning messages on cigarette packages?
No
ly
Yes
About how often if ever do you find yourself looking at these health warning messages?
(Mark one only)
1
2
Fo
51.
ri
nf
or
m
at
io
on
Never
8-5300-474.1
Page 19
agree a lot?
agree a little?
disagree a little?
disagree a lot?
on
ly
Do you believe the health warnings that you see on cigarette packages?
Yes
No
I don't know
at
io
53.
How much do you agree or disagree with cigarette packages having health warning
messages? Do you...
(Mark one only)
or
m
52.
55.
nf
How are you doing in school compared to other students in your class?
Would you say...
better than average?
average?
below average?
ri
Fo
54.
I don't know
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
Page 20
8-5300-474.1
Yes
No
I don't know
on
Other (specify)
or
m
at
io
Have you ever been taught in school about health problems due to smoking?
1
2
3
59.
ly
nf
58.
ri
57.
Yes
Fo
56.
No
I don't know
About how much money do you usually get each week to spend on yourself or to
save? (Include money from allowances and from jobs)
$
97
.0
I don't know
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
8-5300-474.1
Page 21
64.
No
Yes
No
on
ly
Has a doctor ever talked to you about what smoking or using smokeless tobacco
does to your health?
I don't smoke
Yes
No
at
io
or
m
63.
Yes
Has a dentist ever asked you whether you smoke cigarettes or use smokeless
tobacco?
4
Yes
No
nf
62.
ri
61.
Has a doctor ever asked you whether you smoke cigarettes or use smokeless tobacco?
Fo
60.
Has a dentist ever talked to you about what smoking or using smokeless tobacco
does to your health?
1
Yes
No
8-5300-474.1
Yes
65b. If yes, what age were you when you first did this?
I was
No
on
years old
ly
66a. Have you ever had five drinks or more of alcohol on one occasion?
66b. If yes, what age were you when you first did this?
I was
No
Yes
years old
at
io
Yes
or
m
67a. Have you ever used or tried any of the following drugs:
Marijuana or cannabis (a joint, pot, weed, hash...)?
67b. If yes, what age were you when you first did this?
I was
No
nf
years old
Yes
Fo
ri
years old
No
Yes
69b. If yes, what age were you when you first did this?
I was
years old
No
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
8-5300-474.1
Page 23
Yes
70b. If yes, what age were you when you first did this?
I was
years old
No
71b. If yes, what age were you when you first did this?
I was
years old
No
Yes
72b. If yes, what age were you when you first did this?
years old
or
m
I was
4
at
io
on
Yes
ly
No
73b. If yes, what age were you when you first did this?
ri
Yes
I was
years old
Fo
nf
73a. Have you ever used steroids (testosterone, growth hormones, Dianobol, juice, roids) to
do better at sports or to change the way you look?
No
74a. Have you ever sniffed glue, gasoline or other products (solvents) to get high?
Yes
74b. If yes, what age were you when you first did this?
I was
years old
No
8-5300-474.1
Yes
75b. If yes, what age were you when you first did this?
I was
years old
No
Yes
76b. If yes, what age were you when you first did this?
I was
No
at
io
years old
on
ly
76a. Have you ever used or tried painkillers (Talwin, Oxycontin, etc.) to get high and NOT
for medical purposes?
77a. Have you ever used or tried Ephedrine or Pseudoephedrine (Sudafed, Ephedra,
Herbal ecstasy,...) to get high and NOT for medical purposes?
Yes
77b. If yes, what age were you when you first did this?
or
m
I was
No
years old
78b. If yes, what age were you when you first did this?
ri
Yes
I was
years old
Fo
nf
78a. Have you ever used or tried Gravol to get high and NOT for medical purposes?
No
79a. Have you ever used a needle for any of the drugs mentioned earlier?
(For example: heroin, cocaine, speed, steroids,...)
1
Yes
79b. If yes, what age were you when you first did this?
I was
years old
No
Statistics Canada will keep your answers PRIVATE.
No one from your home or your school will see what you write.
8-5300-474.1
Page 25
The next questions are about the number of deaths in Canada due to cigarette
smoking. Mark if you agree or disagree with these questions.
Agree
I don't
know
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
on
at
io
f.
5,000
15,000
25,000
45,000
6
7
8
nf
1,000
ri
or
m
Which of the following, do you think, is closest to the number of Canadians that die
each year as a result of smoking cigarettes?
Fo
81.
Disagree
ly
80.
75,000
100,000
More than 100,000
8-5300-474.1