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

Seeing more adverts about the free stop smoking service

Other (please specify)

This is required

Comment:

This is required

Do you know there is a free stop smoking service available in Hounslow? (Healthy Hounslow: they offer 12 weeks of Nicotine Replacement Therapy or a free nicotine vape, and 1-to-1 personal behavioural support, by telephone or face-to-face)

Yes

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:

Do you know there is a free stop smoking service available in Hounslow? (Healthy Hounslow: they offer 12 weeks of Nicotine Replacement Therapy or a free nicotine vape, and 1-to-1 personal behavioural support, by telephone or face-to-face)

Any other comments: