Smoking Habits and Support Survey (Hounslow)

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This survey is conducted by Healthwatch Hounslow to understand barriers and behaviors that impact smoking habits related to the aim of becoming smoke free. Your views help services within the council and the public health team continually develop services that are matched the what local Hounslow residents need.

This survey will take between 5- 10 minutes.

Do you smoke currently?

Yes

Other (please specify)

This is required

Comment:

This is required

How long have you smoked? Please select one answer:

Less than a year

1 to 5 years

6 to 10 years

11 to 20 years

21 to 30 years

More than 30 years

Is there anything you feel you would miss about smoking if you quit? (e.g. it's a break from work, chance to chat with colleagues, stress relief etc.)

Have your smoking behaviours/patterns changed over the years? If so, what influenced this change? (i.e. Do you smoke more/less now and if so, why?)

What would motivate you to engage with services to help you quit? Please tick all that apply:

A conversation with a doctor, clinician or health professional about the benefits of quitting and the positive impact it might have on my health

Diagnosis, onset or deterioration of a health condition because I smoke

The cost and financial implications of smoking

Financial reward, e.g. voucher to give up

Not wanting to smoke around children/grandchildren

Creating a smoke free home

Other (please specify)

This is required

Comment:

This is required

Do you know that there are free stop smoking support services available in Hounslow? These include Healthy Hounslow, which offers up to 12 weeks of nicotine replacement therapy or a free nicotine vape alongside one-to-one behavioural support (by telephone or face-to-face), as well as a Quit Smoking App and the Swap to Stop scheme. Select the options below that you know of.

Healthy Hounslow Stop Smoking Support

Stop Smoking App

Swap to Stop

Any other comments:

Please tell us your age

13 to 15 years

16 - 17 years

18 - 24 years

25 - 49 years

50 - 64 years

65 to 79 years

80+ years

Prefer not to say

Not known

Please tell us your gender

Woman

Man

Non-binary

Prefer not to say

Prefer to self describe:

This is required

Please select any of the following that apply to you:

I have a disability

I have a long term health condition

I am a carer

None of the above

I prefer not to say

Smoking Habits and Support Survey (Hounslow)

Do you smoke currently?

Please select on the scale where you would rate yourself:

How long have you smoked? Please select one answer:

What stops you quitting? Please tick all that apply:

Is there anything you feel you would miss about smoking if you quit? (e.g. it's a break from work, chance to chat with colleagues, stress relief etc.)

Have your smoking behaviours/patterns changed over the years? If so, what influenced this change? (i.e. Do you smoke more/less now and if so, why?)

What would motivate you to engage with services to help you quit? Please tick all that apply:

Any other comments:

Please tell us your age

Please tell us your gender

Please select your ethnicity

Please select any of the following that apply to you: