Sample Tenant Survey Questions

Landlords: you can use these questions to create your own renter survey about smoking and secondhand smoke.

______

Healthy Air Survey

Renters: Please circle the answer that best describes you and your situation.

  1. Do you or anyone else in your household smoke cigarettes, cigars or a pipe?
  2. Yes, regularly (daily or weekly)
  3. Yes, occasionally (less than weekly)
  4. No

If yes to Question 1, do you or any household members smoke indoors?

  1. Yes
  2. No

2. Which of the following statements best describes the rules about smoking inside your home:

  1. No one is allowed to smoke anywhere inside your home
  2. Smoking is allowed in some places or at some times
  3. Smoking is permitted anywhere inside your home

If your answer to Question 2 was “a”, why don’t you allow smoking in your home?

Circle all that apply:

  1. The smoke makes someone in my home sick
  2. I don’t like the smell.
  3. I am worried about fires.
  4. I do not want my children to be around people smoking.
  5. Other (Please explain)______

If your answer to Question 2 was “b” or “c”, why do you allow smoking in your home?

Circle all that apply:

  1. I don’t want to smoke outside.
  2. I don’t want to ask others to smoke outside.
  3. The smoke from cigarettes does not bother me.
  4. Other (Please explain)______
  1. Do you have children or teenage minors (0-17 years) living with you?
  1. Yes
  2. No
  1. Do you have elderly residents (over 65 years) living with you?

a. Yes

  1. No

Renters: Please circle the answer that best describes you and your situation.

  1. Do you or someone who lives with you suffer from chronic illnesses such as asthma, chronic bronchitis, heart disease, diabetes, arthritis, cancer or a cancer survivor?
  1. Yes
  2. No
  3. Maybe
  4. Don’t Know
  1. Do you think secondhand smoke is harmful to people’s health?
  1. Yes
  2. No
  3. Maybe
  4. Don’t Know
  1. Have you smelled tobacco smoke in your home that comes from another apartment or from outside?
  1. Yes
  2. No
  3. Maybe

 If “yes” to Question 7, does smelling tobacco smoke in your home bother you?

  1. Yes
  2. No

If “yes” to Question 7, have you expressed your concern to management about the tobacco smoke drifting into your home?

  1. Yes
  2. No
  3. Maybe
  4. Does not apply
  1. Would you prefer to live in a building (please select your top choice):
  1. Where smoking is not allowed anywhere indoors and not allowed on outside property
  2. Where smoking is not allowed anywhere indoors, including individual apartments
  3. Where smoking is prohibited in indoor common areas, but not individual apartments
  1. Where smoking is allowed anywhere indoors and on outside property
  2. Don’t have a strong preference
  1. If your buildingbecame non-smoking (including the units), what would you do?
  1. I would thank my landlord!
  2. It would not affect me (I don’t smoke)
  3. I would take my smoking outside
  4. I would want to move
  5. Don’t Know

This is the end of the survey. Thank you for your feedback.

Portland-Vancouver Metro Area Smokefree Housing Project