Prevailing social obstacles in keeping tobacco-free homes in

urban areas: Realizing ways to overcome

Questionnaire

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 Informed Consent

Dear Research Participant

Assalamu alaikum

We are going to conduct a research entiled “Prevailing social obstacles in keeping tobacco-free homes in
urban areas: Realizing ways to overcome” There is a strong association of tobacco using and serious health
hazards. It harms and kills both men and women, but women face unique and even greater health risks from
tobacco using than men at home arena. However, there prevail some social obstacles that prevent home
tobacco-free especially in urban areas. The main purpose of this research is to identify the obstacles in
keeping tobacco free homes as well as risk factors associated with it. Your participation in this study is
voluntary. It will involve an interview of approximately 20 minutes in length. You can withdraw from the
study at any time, and may decline to answer any question if you no wish. All information you provide is
completely confidential. Our final report resulting from this study, will not identify your response .There
are no known or anticipated risks to you as a participant in this study. I would like to assure you that this
study has been reviewed and received ethics clearance.

I hope that the results of my study will be of benefit to those organizations directly involved in the study as
well as to the broader research community. There is no monetary compensation to you for your
participation in this study.

If you give your consent to participate in this study, we can start your interview now.

___________________________

Signature &Name of the Respondent

Principal Investigator:
Name: Md Imdadul Haque
Department: Master of Public Health, Daffodil International University
E-mail: ianthrops@yahoo.com, Cell: 01911840296

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 ID No : Date :

Name : Cluster No:

Present Address : Clusters
Mobile no : Mohammadpur Uttara, Dhanmondi- Motijheel
Housing Society Sector-6 27 R/A Colony
(1) ( 2) (3) (4)

Section – A: Socio-economic & Demographic

Questions
Coding Categories Code

1. QA1. How old are you? …...................................................................... Years

1= Male
QA2. Gender
2= Female
1= Unnmarried
2= Married
QA3. Marital status 3= Seperated
4= Divorced
5= widow/widowerd
1= Islam
2= Hinduism
QA4.What is your religion?
3= Christianity
4= Budhism
1= With family
2 = Mess
QA5. Living place
3 = Sublet
99= Other (specify) …………………….

1= Nuclear Family
QA6. Family type 2= Joint Family

QA7. How many persons live in

...........................................................................Persons
your family, in total?
1= Illiterate
2= Primary
3= SSC
4= HSC
QA8.What is the highest level of
5= Degree/ Hons
education you have completed?
6= Masters and above
99= Others (Specify)......................................

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 1= Housewife
2= Government service
3= Private service
QA9.What is your occupation?
4= Bussiness
5= Student
6= Unemployed
99=Others( Specify).........................................

QA10.How much is your monthly

.........................................................................TK
family income?

QA11.What is your monthly family

.........................................................................TK
expenditure?

Section B: Use of Tobacco

Questions Coding Categories Code

1= Somking tobacco
QB12.What type of tobacco do you
2= Smokeless tobacco (SLT) [Skip to QB20]
use?
(SLT- Gul,Sada-pata, Zarda,Nassi etc)
3= Both (Smoking tobacco and SLT)

Smoking tobacco:

1 = Cigarettes
QB13.What type of smoking tobacco 2 = Bidis
do you use currently? 3 = Sisha
4 = E cigarette
99= Other (specify) ……………………..

QB14.Do you smoke cigarette/ 1 = Daily

bidi/…on a daily basis or sometimes? 2 = Sometimes
QB15.How many number of cigarette/
bidis do you smoke on average per / .................................. ................................... Sticks
day?
QB16.How old were you when you
first tried a cigarette? ……………………………………………...Year

QB17.How old were you when you

started to smoke regularly? ………………………………………......….Year

QB18.Which places do you prefer for 1= At home/living place

smoking cigarette or using cigarette or 2= Outside home
other smoked tobacco products most
likely?

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QB19. If you prefer outside home, 1 = Restaurant
then where? 2= University/college campus
3 = Public transport
(Multiple Responses) 4 = Shopping mall
99 = Other (specify) ………………………..

Smokeless tobacco :

QB20.What type of non-smoked 1= Jardha

tobacco do you use? 2= Gul
3= Khoini
99= Others (Specify) ……………………

QB21.Do you use this tobacco (name 1 = Daily

the tobacco product on a daily basis or 2 = Sometimes
sometimes?
QB22.How many times do you use
this tobacco on average per day? ……………………………………………… Times/day
QB23.How old were you when you
first tried this tobacco product? ……………………………………….………Year
QB24. How old were you when you
started to use this product regularly? ……...……………………………………….. Year

Section C : Factors influencing use of tobacco

Questions Coding Categories Code

QC25.Do any of your family members 0= No [Skip to QC27]
smoke cigarette or consume tobacco 1= Yes
products?
QC26.If yes, please mention their 1= Mother
relation with you 2= Father
3= Grandfather
(Multiple Responses) 4= Grandmother
99= Others (specify) ……………….....
QC27.Do any of your family member 0 = No
smoke at home? 1 = Yes
QC28.Do you allow any body using 1= Smoking allowed
tobacco at home? 2= Smokeless tobacco allowed
3= Both Smoking and SLT allowed
4= Never allowed
QC29. Is there anything which 0 = No [Skip to QC31]
provoked you to start smoking? 1 = Yes

(Smoking or SLT )

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QC30.If yes, then what was it?
(Multiple Responses)
QC31.What are the individual factors
that influence you to continue tobacco
intake ? (Smoking or SLT )
(Multiple Responses)
QC32. What are the familial factors
that promote members in tobacco
use?(Smoking or SLT )
(Multiple Responses)
QC33. What are social factors that
keep tobacco intake acceptable?
(Smoking or SLT )
(Multiple Responses)
Religious issues:
QC34.Do you practice religious
rules regularly?
QC35.What kind of religiosity do you
maintain?
(Multiple Responses)
QC36. Do your family members
practice religiosity at home?
1= Peer pressure
2= Desire to fit in with friends
3= Copying parents or older brothers or
sisters who smoke
4= The desire to appear more grown up
and sophisticated
5= Frustration
6= Curiosity -just wanted to try it
99= Others (specify) ………………….
1= Feel good
2= Look smart
3= Keep away from family problem
4= It is easily accessible
5= Keep relax from working load
6= To reduce toothache / mouth odor
started chewing tobacco
99=Others (Specify)………….…….............
1= Smoking habit of any family member
2= Tobacco is not restricted in family
3= No penalty from family for smoking
4= Children are used to buy tobacco
5= Lack of family lessons
99=Others (Specify)…................................
1= Smoking is sign of smartness
2= SLT sharing is sign of intimacy in home
3= Peer influences
4= Impact of advertisement and publicity
99=Others (Specify)……………………….
0= No [Skip to QC36]
1= Yes
2= Partially
1= Regular praying/ worshiping
2= Read holy book regularly
3= Provide things in charity
4= Observe religious festival piously
99=Others (Specify)……………………..
0= No
1= Yes
2= Partially
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QC37.Are you habituated with cultural 0= No [Skip to QC39]
practice at household level? 1= Yes
2= Partially

QC38.What type of cultural practice 1= Practicing literature, dance or songs

you pursue in family at home? 2= Enjoying cinema with family members
3= Playing Indoor games
(Multiple Responses) 4= Participate family programs culturally
99=Others (Specify)……………………….

QC39.Do you use any tobacco 0= Never

specially SLT in different cultural 1= Sometimes
program or festival at your household 2= Always
level?

Section D : Knowledge & perceptions about the risk factors of tobacc intake

Questions
Coding Categories Code
QD40. Do you know that tobacco in
0= No
any form can affect your health?
1= Yes
2= Don’t know (DK)
1= Asthma
QD41.What kind of health harm can be 2= Mouth infection
happened due to tobacco intake? 3= Stroke
4= Cancer
(Multiple Responses) 5= Loss of taste
6= Heart disease
7= Don’t know (DK)
99=Others (Specify)……………………….

QD42. From where do you know the 1= Textbook

harmful effect of tobacco use? 2= Parents
3= Teachers
(Multiple Responses) 4= Peers
5= Television
6= Newspaper
7= Physician
99=Others (Specify)....................................

QD43. Do you know that lack of 0= No

proper ventilation causing children and 1= Yes
women harm by SHS? 2= Don’t know (DK)

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QD44. Do you know that tobacco 1= Abortion
induces pregnancy related 2= Infertility
complication like 3= Low Birth Weight (LBW)
4= Still birth
(Multiple Responses) 5= Pre-eclampsia
6= Don’t know (DK)
99= Others (Specify)……………………….

QD45. Do you think that SLT is 0= No

harmful for health? 1= Yes
2= Don’t know

QD46. Do you think that tobacco 0= No

residue can also cause harm at home 1= Yes
ground? 2= Don’t know

QD47. Do you think that household 0= No

head can easily control tobacco using 1= Yes
at home? 2= Not sure

QD48. Which of the parental action

can help in reductions of children’s 1= Restrictions about smoking in the home
smoking? 2= Sitting in non-smoking sections outside
of home
(Multiple Responses) 3= Parents should first quit using tobacco
4= Provide proper lessons about harms
99=Others (Specify)………………………

Section E: Intervention at tobacco-free homes

QE49. If you think some imposing interventions to be taken for making urban areas tobacco free,
especially at residential areas, as it is not possible by individual endeavors . Please rate the following
factors:
S/L Interventions 5-point Likert scale
(1 to 5)*
1 a. Banning all tobacco items in residential areas especially in
1 2 3 4 5
household level
2 b. Good family ties within family members 1 2 3 4 5
3 c. Intervention covered things of BCC by GO/NGO 1 2 3 4 5
4 d. Home is out of tobacco region shouldgo as social campign 1 2 3 4 5
e. Everyday a little coverage in mass-media on harmful effect of 1 2 3 4 5
5
tobacco
f. School text book explicity can draw ultimate consequences of 1 2 3 4 5
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tobacco
7 g. Tobacco-company marketing should be stopped that reaches and 1 2 3 4 5

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 influences kids

h. Creating an environment where young people do not want to 1 2 3 4 5

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smoke, not the norm
i. Establishing counseling interventions for tobacco users in each 1 2 3 4 5
9.
housing community
j. Graphic health warning can reduce the extent of tobacco use in the 1 2 3 4 5
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home
k. Tobacco residue should be managed with specific guideline in 1 2 3 4 5
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residential area
N.B. * : 1=least agree, 2=somewhat agree, 3=moderately agree, 4=agree, 5=highly agree

.............................................................. .......................................................
Signature & Name of the Interviewer Signature of the Field Supervisor