Student Status
Full-time Student
Part-time Student
Exclusively enrolled in web-based learning
Are you an international student?
Yes
No
What is your major?
Agriculture
Business
Computer Science
Education
English
Engineering
Foreign Language
Health Sciences/Nursing Science
Interdisciplinary
Journalism
Liberal Arts/Humanities
Mathematics
Physical Sciences
Social Sciences
Technology
Visual and Performing Arts
Undecided/Do not have a major
Other
Age
18
19
20
21
22
23
24
25 or older
Gender
Female
Male
Transgender
I prefer not to respond
Ethnicity
Hispanic/Latino
Non-Hispanic/Latino
I prefer not to respond
Racial/Ethnic Background
American Indian or Alaskan Native
Asian
Hawaiian or Pacific Islander
White
Black or African American
Bi-racial or Multi-racial
I prefer not to respond
Living Arrangements
On-campus housing
Off-campus housing (without parents)
Off-campus housing (with parents)
Other
Relationship Status
Single
Married/Have partner
Long-term relationship
Divorced or Separated
Widowed
Which of the following tobacco products have you used in the past year?
Do not use Tobacco products
Cigarettes
Cigars
Smokeless Tobacco (chewing, spit, dip)
Tobacco pipes
Hookah
E-cigarettes
Other
If other, Please specify
How often do you smoke hookah?
A few times a year
1-3 times a month
1-2 times a week
3-6 times a week
Everyday
Not Applicable
In which settings/occasions do you smoke hookah?
Where I live
At a hookah bar
At a friend's house
At a party
Other
Not Applicable
If other, Please specify
How often do you use e-cigarettes?
A few times a year
1-3 times a month
1-2 times a week
3-6 times a week
Everyday
Not Applicable
How often do you use smokeless tobacco?
A few times a year
1-3 times a month
1-2 times a week
3-6 times a week
Everyday
Not Applicable
In which settings/occations do you use smokeless tobacco?
Where I live
When I am bored
In class
Playing Sports
After Meals
At a party
Whenever I can't smoke a cigarette
Not Applicable
How often do you smoke cigarettes?
A few times a year
1-3 times a month
1-2 times a week
3-6 times a week
Everyday
Not Applicable
Did you smoke before you came to college?
Yes
No
Do you want to quit smoking?
Yes
No
Not Applicable
Have you attempted to quit smoking since entering college?
Yes
No
Not Applicable
Did you know that Lincoln University has resources to help you quit smoking, that is free to all students? Visit http://www.lincolnu.edu/web/thompkins-health-center/tobacco-free-lu for more information.
Yes
No
Do you know that Lincoln University has a Tobacco Free Policy that will go into effect on January 1, 2013?
Yes
No
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