Name (optional):

Gender: Male Female

Direction: Below are statements regarding the effects of smoking. Please read them carefully and
place a check mark on the space provided for in accordance to your answer.
SA - Strongly Agree
A – Agree
D - Disagree
SD – Strongly Disagree

Effects of Cigarette Smoking to Students SA A D SD

1. Cigarette smoking causes several illnesses like
cough, colds, asthma
E
3. Cigarette Smoking makes me relax.
4. Cigarette Smoking relieves my tension or stress.
5. Cigarette Smoking causes shortness of breath
6. Cigarette smoking makes me look cool among my
peers.
7. Cigarette smoking brings “plus pogi points”
Name (optional):
Gender: Male Female

Direction: Below are statements regarding the effects of smoking. Please read them carefully and
place a check mark on the space provided for in accordance to your answer.
SA - Strongly Agree
A – Agree
D - Disagree
SD – Strongly Disagree

Effects of Cigarette Smoking to Students SA A D SD

1. Cigarette smoking causes several illnesses like
cough, colds, asthma
E
3. Cigarette Smoking makes me relax.
4. Cigarette Smoking relieves my tension or stress.
5. Cigarette Smoking causes shortness of breath
6. Cigarette smoking makes me look cool among my
peers.
7. Cigarette smoking brings “plus pogi points”