| APPENDIX A- The questionnaire
A Pilot Survey on characteristics of difficult-to-quit smokers (有關持續吸煙人士性質之導向調查) |
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| Please circle the most appropriate
answers from the following questions: 請在以下選擇題選出適當的答案: |
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| 1. | What is your sex? 性別?
1 = M 男 2 = F 女 |
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| 2. | What is your age? 年齡組別?
1 = 0-20歲 2 = 21-40歲 3 = 41-60歲 4 = 61歲或以上 |
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| 3. | What is your marital status? 婚姻狀況?
1 = Married 已婚 2 = Single 未婚 3 = Separated 分居 4=Divorce 離婚 5= Widowed 喪偶 |
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| 4. | When did you start smoking? 你開始吸煙的年齡? 1 =<20歲 2 = 21-30歲 3 = 31-40歲 4 = >41歲或以上 |
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| 5. | How many cigarettes do you consume per day?
你每日平均吸多少支煙? 1 = 0-10支 2 = 11-20支 3 = 21-30支 4 = >31支或以上 |
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| 6. | Do you drink? 你有沒有飲酒的習慣?
1 = Y 有 2 = N 沒有 3=Unknown 不知道
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| 7. | Do your parents ever smoke? 你父母曾否有吸煙習慣? 1 = Y 有 2 = N 沒有 3=Unknown 不知道 |
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| 8. | Do your sibling(s) smoke? 你的兄弟姊妹曾否有吸煙習慣? 1 = Y 有 2 = N 沒有 3=Unknown 不知道 |
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| 9. | Do your household member(s) smoke? 與你同住的人曾否有吸煙習慣?
1 = Y 有 2 = N 沒有 3=Unknown 不知道 |
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| 10. | Do your friend(s) smoke? 你的朋友曾否有吸煙習慣?
1 = Y 有 2 = N 沒有 3=Unknown 不知道 |
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| 11. | Do your colleagues at work smoke? 與你工作的同事曾否有吸煙習慣?
1 = Y 有 2 = N 沒有 3=Unknown 不知道 |
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| 12. | What is your education level? 你的教育程度
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| 13. | What is your monthly income? 你每月平均的收入(港幣)
1 = 0 - $10000 2 = $10001 - 20000 3 = $20001 - 30000 4=>$30000 |
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| 14. | What type of housing do you live in? 你居住在什麼類型的住所呢? 1 = Privately owned 私人擁有 2 = Rented 租住居所 3 = Public housing 公共屋苑 |
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| 15. | Do you have exercise regularly? 你有沒有定期運動的習慣?
1 = None 沒有 2 = 1 - 2 times/week 每週一至兩次 3 = >3 times/week 每週多過三次 |
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| 16. | How frequent do you eat in "Hong Kong
style" caf ? 你平均一星期裡有多少次往茶餐廳用膳呢?1 = None 沒有 2 = 1 - 2 times/week 一至兩次 3 = >3 times/week 多過三次 |
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| 17. | How frequent do you eat in fastfood shop?
你平均一星期裡有多少次往快餐店用膳呢? 1 = None 沒有 2 = 1 - 2 times/week 一至兩次 3 = >3 times/week 多過三次 |
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| 18. | How many hours do you spend in watching
television? 你平均每天花多少時間看電視呢? 1 = 0-1 hour/day 零至一小時 2 = 2 - 4 hours/day 兩至四小時 3 = >3 hours/day 多過五小時 |
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| 19. | What is/are your reason(s) for not quitting smoking? 你不戒煙的原因是什麼? | |||||||||||||||||||||||||||
| For each of the following statements please
circle one of the numbers below according to your level of agreement
with the statement. Please note there is no right or wrong answer.
We are merely seeking your opinion. 請在以下選出最同意的答案 : |
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| 20. | You think smoking is not affecting your
health. 你認為吸煙不會影響你的健康
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| 21. | You have good social support. 你有很好的支持去應付困難(例如家人，朋友的支持)
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| 22. | You have a lot of stresses in your daily
life. 你生活中面對很多壓力
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| 23. | You have emotional problem such as anxiety/depression.
你有情緒困擾例如精神緊張/情緒低落
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| 24. | You have a good coping strategy to stress.
你可以有效地舒緩壓力
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| 25. | You reject comment from others about your
smoking. 你討厭別人批評你吸煙的習慣
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| 26. | You think smoking can boost up your sexual
performance 你認為吸煙可提高性能力
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| 27. | You think smoking can improve your sleeping
quality 你認為吸煙可改善睡眠質素
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| 28. | You think smoking can help maintain body
shape 你認為吸煙可幫助保持美好的身段
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Thank
you for your opinions
多謝你的意見
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