About this template
This Smoking Survey template is designed for researchers, healthcare providers, and public health advocates looking to gather accurate data on tobacco use habits, addiction levels, and cessation efforts. Whether conducting academic research, community health assessments, or clinical studies, this form streamlines the data collection process by capturing vital demographic details, product preferences, and behavioral history.
The questionnaire covers core metrics including age of onset, preferred tobacco products, daily smoking frequency, and past attempts to quit. By standardizing these questions, researchers can efficiently analyze trends, identify behavioral patterns, and evaluate the effectiveness of various cessation strategies.
Built for seamless deployment using Doc2Form, this template allows you to instantly generate a clean Google Form, share it securely with participants, and begin analyzing responses in real time.
Key features
- Capture detailed demographic and smoking history data
- Track tobacco product preferences and usage frequency
- Analyze quit attempts and cessation barriers
- Fully customizable questions to fit specific research goals
- Instant conversion to Google Forms via Doc2Form
Use cases
- Academic and clinical research on tobacco consumption
- Public health surveys and community wellness assessments
- Smoking cessation program intake and evaluation
- Market research on alternative tobacco and nicotine products
What this form collects
- Gender (Dropdown)Select the option that best describes your gender identity.
- Age (Short answer)Enter your current age in years.
- Country of Residence (Short answer)Enter the country where you currently reside.
- Smoking Status (Multiple choice)Choose the category that best describes your current relationship with smoking.
- Tobacco Products Used (Checkboxes)Select all tobacco or nicotine products you currently use or have used regularly.
- Age at First Smoking Experience (Short answer)How old were you when you first tried smoking, even a single puff?
- Smoker Self-Description (Multiple choice)How do you view your smoking habits?
- Current Smoking Frequency (Short answer)On average, how many cigarettes or sessions do you have per day or week?
- Quit Attempt Status (Multiple choice)Have you ever seriously tried to quit smoking?
- Reasons for Quit Attempts (Checkboxes)If you have tried to quit, what were your primary motivations? Select all that apply.
- Reasons Quit Attempts Failed (Paragraph)If past attempts to quit were unsuccessful, what was the main reason you started again?
- Smoking Addiction Status (Multiple choice)How soon after waking do you typically smoke your first cigarette?
- Plan to Quit Smoking Status (Multiple choice)Do you plan to quit smoking in the near future?
FAQ
How can I customize this smoking survey template for my study?
Once you convert the template using Doc2Form, it opens directly in Google Forms where you can easily add, remove, or edit questions to match your specific research criteria.
Is this template suitable for academic research?
Yes, the survey includes standard questions regarding smoking frequency, age of onset, and quit attempts that align with common epidemiological research needs.
Can I collect responses anonymously?
Google Forms allows you to collect responses without requiring user sign-ins or email collection, helping ensure participant privacy in sensitive health surveys.
How do I share this survey with participants?
You can share your Google Form via a direct link, email invitation, QR code, or embed it directly on a study website.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.