Bhutan W1 Smokeless Survey Code: BT1-L Languages: Dzongkha Mode: Face to Face Interview

Bhutan W1 Smokeless Survey Code: BT1-L Languages: Dzongkha Mode: Face to Face Interview i

TABLE OF CONTENTS SMOKELESS TOBACCO USE BEHAVIOR: QUESTIONS FOR ALL RESPONDENTS 001 Last tobacco purchase: Single portions 018 Last tobacco purchase: Packs 021 Where Purchased 030 AVAILABILITY 034 Ban Effects on Availability Recall questions 049 KNOWLEDGE AND THOUGHTS 056 WARNING LABELS 059 ANTI-TOBACCO CAMPAIGNS 062 TOBACCO PROMOTION 065 ENVIRONMENTAL TOBACCO SMOKE 085 PSYCHOSOCIAL: BELIEFS ABOUT SMOKING 101 PERCEIVED RISK 102 RELATIVE RISKS 107 MODERATORS 113 MARIJUANA USE 122 DEMOGRAPHICS 131 ii

Bhutan W1 Smokeless Q# VarName BT1-L 000a uniqid 000b BI64240 Gender: 000c Age 001a TF64379 001b TF64371 001c TF64373 001d TF64375 002a TF64429 002b TF64421 002c TF64423 SMOKELESS TOBACCO USE BEHAVIOR: QUESTIONS FOR ALL RESPONDENTS Circle appropriate number in USAGE Column 3 (0 = Not used, 1 = Less than Weekly, 2 = Weekly, 3 = Daily). We are going to read out a list of tobacco products and would like to know how often you use each of these products. Do you smoke/ use [product] daily, at least weekly, less than weekly, or not at all? Khaini/surti 0 Not used 1 Less than Weekly 2 Weekly 3 Daily If response=0, go to 002a/TF429. How many days does a packet/ tin last? Enter days per packet/ tin: Go to 002a/TF429. How many weeks does a packet/tin last? Enter weeks per packet/tin: How many months does a packet/tin last? Enter months per packet/tin: Circle appropriate number in USAGE Column 3 (0 = Not used, 1 = Less than Weekly, 2 = Weekly, 3 = Daily). We are going to read out a list of tobacco products and would like to know how often you use each of these products. Do you smoke/ use [product] daily, at least weekly, less than weekly, or not at all? Zarda. 0 Not used 1 Less than Weekly 2 Weekly 3 Daily If response=0, go to 003a/SL245. How many days does a packet/ tin last? Enter days per packet/ tin: Go to 003a/SL245. How many weeks does a packet/tin last? Enter weeks per packet/tin: 3

002d TF64425 How many months does a packet/tin last? Enter months per packet/tin: 003a SL64245 Circle appropriate number in USAGE Column 3 (0 = Not used, 1 = Less than Weekly, 2 = Weekly, 3 = Daily). We are going to read out a list of tobacco products and would like to know how often you use each of these products. Do you smoke/ use [product] daily, at least weekly, less than weekly, or not at all? Snuff. 0 Not used 1 Less than Weekly 2 Weekly 3 Daily If response=0, go to 004a/TF529. 003b SL64251 How many days does a packet/ tin last? Enter days per packet/ tin: Go to 004a/TF529. 003c SL64253 How many weeks does a packet/tin last? Enter weeks per packet/tin: 003d SL64255 How many months does a packet/tin last? Enter months per packet/tin: 004a TF64529 Circle appropriate number in USAGE Column 3 (0 = Not used, 1 = Less than Weekly, 2 = Weekly, 3 = Daily). We are going to read out a list of tobacco products and would like to know how often you use each of these products. Do you smoke/ use [product] daily, at least weekly, less than weekly, or not at all? Other smokeless. 0 Not used 1 Less than Weekly 2 Weekly 3 Daily If response=0, go to 005a/FR760. 004b TF64529o Other smokeless (specify) 004c TF64521 How many days does a packet/ tin last? Enter days per packet/ tin: Go to 005a/FR760. 004d TF64523 How many weeks does a packet/tin last? Enter weeks per packet/tin: 004e TF64525 How many months does a packet/tin last? Enter months per packet/tin: 4

005a FR64760 005b FR64760o Ask if respondent uses more than one product in table above. Is the main reason you use a variety of smokeless products because you like the variety or because you use what is available, or is it or for some other reason? 1 Variety 2 Availability 3 Both, or 4 Some other reason (specify) If any daily use in 001a/TF379-004a/TF529 Go to 008/SB922, else continue. For some other reason (specify) 006 TF64723 Ask if no per-day answers to above question, else Go to 008/SB922. On average, how many days each week do you use tobacco? If answer=7, go to 008/SB922. 007 HI64732 Ask if 006/TF723<7 (if not daily). In the past, have you used smokeless tobacco on a daily basis? Go to 010a/HI744. 008 SB64922 Ask if any tobacco products are used per day, else: Go to 010a/HI744. How soon after waking do you first use smokeless tobacco? 1 5 min or less 2 6-30 min 3 31-60 min 4 More than 60 min 5 No specific time - none of the above (Don't read out) 009 SB64927 How hard is it to go without using smokeless tobacco for a whole day? 1 Not at all hard 2 Somewhat hard 3 Very hard 4 Extremely hard or impossible 5 Can t say 010a HI64744 At what age did you start using smokeless tobacco at least once a month? Age 5

010b HI64746 At what age did you start using smokeless tobacco at least once a month? Year 011 HI64435 Have you ever used SMOKED tobacco at least monthly? If response=2, 88, or 99, go to Last Purchase 013a/LP901. 012a HI64484 How long ago did you stop using it? Age 012b HI64485 How long ago did you stop using it? Year 013a LP64901 I am going to be asking you about buying tobacco. The last time you bought tobacco, which product or products did you buy? 1 Factory made cigarette 2 Hand-rolled tobacco 3 Bidis 4 Khaini/surti 5 Zarda 6 Snuff 7 Other (specify) 91 Never bought tobacco (Don't read) 97 Multiple products (specify) (Don't read) 98 No brand (Don't read) 99 Don't Know (Don't read) Prompt if necessary. If response=88, 99 or 98, go to 015/LP920. If response=91, go to Availability, 034a/TS891. 013b LP64901o Other (specify): 013c LP64902o Specify multiple products: 6

014a BR64712 014b BR64712o Ask if respondent's last purchase of tobacco was factory-made cigarettes (013a/LP901=1). Prompt with appropriate product categories. What brand was it? 01 Wills Navy cut 02 Wills Flake 03 Wills Classic 04 Classic 05 Gold Flake 06 Marlboro 07 Triple Five 08 Camel 09 Other cigarette brand (specify) (Don't read) Specify other. 014c LP64212 Ask if respondent's last purchase of tobacco was bidis (013a/LP901=3). What brand was it? 11 Mira Bidi 12 Mangla Bidi 13 Other Bidi (specify) (Don't read) 014d LP64612 Ask if respondent's last purchase of tobacco was smokeless tobacco (013a/LP901=4-6). 21 Baba 22 Raja Chap 23 Surti 24 Golden Khaini 25 Chaini 26 Snuff 27 Other smokeless (specify) (Don't read) 014e LP64914o Ask if respondent last purchased multiple products (013a/LP901=97). Specify multiple products: 97 Multiple products (specify) (Don't read) 98 No Brand (Don't read) 99 Don t Know (Don't read) 7

015 LP64920 The last time you bought tobacco, did you (mainly) buy it by the pack (or tin), as single pieces or sticks, or as loose tobacco? 1 Pack 2 Single piece, stick, or quid 3 Loose tobacco 4 Some combination (including packs) If response=1 or 4, go to Pack section, 021/LP935. If response=2, go to Single Portion section, 018/LP925. If response=3, go to 016a/PU551a. If response=88 or 99, go to Where Purchased section, 030a/LP961. 016a PU64551a Ask if 015/LP920=3 (Loose tobacco) Use only one, days or hours, not both. If loose tobacco: How long does the amount you bought last you for? days 016b PU64551b hours 017a PU64532 How much did you pay for that? 017b PU64533 Price How much did you pay for that? Currency 8 Refused (Don't read) 9 Don't Know (Don't read) Go to Where Purchased section, 030a/LP961. Last tobacco purchase: Single portions 018 LP64925 Ask if respondent last purchased single piece or stick (015/LP920=2). Based on your last purchase: How many <sticks of cigarettes/bidis><quids of smokeless> did you buy? sticks/ pieces 8

019a LP64927 019b LP64928 How much did each one cost? Interviewer Note: If gives total price for all units, record it here and compute per piece price later How much did each one cost? 020a LP64972 020b LP64972o Currency (If not Ngultrums) Do you usually buy tobacco this way, or do you usually buy packs? 1 Usually single cigarettes 2 Usually packs 3 Both about equally often 4 Other (specify) Go to Where Purchased section, 030a/LP961. Specify other. Last tobacco purchase: Packs 021 LP64935 Ask if 015/LP920=1 or 4. When you bought the last pack: How many packs of tobacco did you buy? If response=88 or 99, go to AQN/024/LP976. 022 LP64974 Were these all for you or did you buy some for other people as well? 1 All for self 2 Some for self, some for others 3 All for others 023a LP64939 How much did each pack cost? Interviewer Note: If gives total price for multiple packs, record it here and compute per pack price later 023b LP64940 How much did each pack cost? Currency (If not Ngultrums) 9

024 LP64976 Does the price you pay for your preferred type of tobacco vary? If response=2, 88 or 99, go to 025c/LP950. 025a LP64977 In the last 6 months: What is the lowest price you paid per pack? 025b LP64978 In the last 6 months: What is the highest price you paid per pack? 025c LP64950 026a LP64951 026b LP64952 027a LP64653 027b LP64653o 028a LP64855 028b LP64857o Can you show me a pack (one of the brand) that you last purchased, one that you are currently smoking or one that you have at home? We will give it back, we just want to get some information off it., shown, not shown If response=2, 88 or 99, go to Where Purchased, 030a/LP961. 026a/LP951 029/LP860 interviewer to record information off pack. Record Pack size: No. of sticks per pack Weight per pack or tin 999 Weight not specified (Don't read) 026a/LP951 029/LP860 interviewer to record information off pack. What product is the pack for? 1 Daba 2 Raja Chap 3 Surti 4 Golden Khaini 5 Chaini 6 Snuff 7 Other smokeless (specify) Other smokeless (specify) 026a/LP951 029/LP860 interviewer to record information off pack. Is an excise tax stamp visible on the pack or tin?, the pack displays an excise tax, specify country 2 Yes, the pack displays a fraction of the tax stamp or minutely visible fragments of a tax stamp 3 No, there is no excise tax stamp, nor are there any signs to indicate that a stamp was ever present Specify country 10

029 LP64860 026a/LP951 029/LP860 interviewer to record information off pack. Is a health warning label on the pack or tin? 1 No, a health warning label is not visible on the pack 2 Yes, Thai graphic 3 Yes, standard Indian 4 Yes, other (specify) 030a LP64961 030b LP64962 030c LP64963 030d LP64964 Where Purchased [Interviewer Note: If it is outside the country, probe to see if it is India (option 3) and specify the town. If it is outside the country but not India (option 4) probe to specify country. Where did you buy this tobacco product? Was it in your neighborhood, elsewhere in Bhutan, or outside the country? 1 Neighborhood 2 Elsewhere in Bhutan (specify town) 3 Outside country: India (specify town) 4 Outside country: Other (specify country) 5 Friend brought them from outside country 6 Other (specify) 99 Don't Remember (Don't read) If response=3, go to 032/TS788. If response=4, 5, 6, 88 or 99, go to 033a/TS881. Specify town in Bhutan. Specify town in India. Specify other country. 030e LP64964o Other; specify Go to 033a/TS881. 031a LP64966 If inside Bhutan (030a/LP961=1 or 2): From what sort of a place did you buy it? 1 Shops 2 Vegetable market 3 Private house 4 Other (specify) If response=88 or 99, go to Availability section, 034a/TS891. 031b LP64966o Ask if other (031a/LP966=4). Specify other place. 11

032 TS64788 Is this where you usually buy tobacco? 3 Don t have a usual purchase place If response=1, 3, 88 or 99, go to Availability section, 034a/TS891. 033a TS64881 Ask if 032/TS788=2. Read out response options. Where do you usually buy it (tobacco)? Shops 033b TS64882 Vegetable market 033c TS64883 033d TS64884 033e TS64889 033f TS64889o 034a TS64891 034b TS64892 034c TS64893 034d TS64898 034e TS64899 034f TS64899o Private house Outside country Other (specify below). Specify other place. AVAILABILITY Read out response options. What (other) sorts of places can you buy tobacco inside Bhutan? Shops Vegetable market Private house Nowhere Other (specify): Specify other place. 12

035 TS64907 Have you seen tobacco on open display in any of the shops in Bhutan? 036 TS64922 Is tobacco available all the time in the village or town where you live? 1 Available all the time 2 Nearly always 3 Mostly 4 Sometimes 5 Rarely 6 Never 037 TS64917 Are both smoked and smokeless forms of tobacco equally available? 1 Smokeless more available, 2 Smoked more available 3 No difference (equally available) 038a TS64422 [Interviewer Note: Read out response options. Mark as many as apply.] When you can't get your usual product, what do you do? Use a smoked tobacco product 038b TS64423 Use a different smokeless tobacco product 038c TS64424 038d TS64425 038e TS64426 Do without any tobacco. Travel to an area where your product is available Other 039 TS64122 How often are cigarettes available in your area? 1 Always 2 Most of the time 3 Sometimes 4 Rarely 5 Never 13

040 TS64522 How often is smokeless tobacco available in your area? 1 Always 2 Most of the time 3 Sometimes 4 Rarely 5 Never 041 TS64124 How often are bidis available in your area? 1 Always 2 Most of the time 3 Sometimes 4 Rarely 5 Never 042 TS64933 On the whole, is smoked tobacco cheaper or more expensive than smokeless tobacco, or is it about the same? 1 Smoked cheaper 2 About the same 3 More expensive 4 Don t compare as very different 043 TS64851 As far as you know, does anybody grow tobacco in Bhutan? If response=2, 88 or 99, go to 045/LP988. 044 TS64866 Do you ever use it?, often 2 Yes, sometimes 3 No 045 LP64988 Now a question on the impact of tobacco on your budget: In the last 6 months, has there been a time when the money you spent on tobacco resulted in not having enough money for household essentials like food? 14

046 TS64955 Now I want to ask some questions about importing tobacco into Bhutan: In the last six months, how often, (if at all,) have you imported tobacco products from outside Bhutan? 1 Never 2 Only once 3 2 or 3 times 4 4 to 10 times 5 More than 10 times 047 TS64960 In your opinion, should the present tobacco import quota be stopped since there is a ban of sale of tobacco products? 048 TS64963 The present import quota is 200 cigarettes, 150 gms of pipe tobacco and 50 gms of chewing tobacco for personal consumption. Do you think the present quota is 1 Too low 2 Too high 3 Just right Ban Effects on Availability Recall questions 049 TS64403 Now I want you to think back to when the national ban on the sale of tobacco products came into force in 2004. First, I need to know, were you using smokeless tobacco before the nationwide tobacco sales ban in 2004? If response=2, 88, or 99, go to Knowledge and Thoughts, 056a/SB823. 050 TS64405 Did you make any attempt to quit using smokeless tobacco within the year after the ban was introduced in 2004? 051 TS64809 After the ban on selling came in, did it suddenly become harder to get tobacco, did it gradually become harder, or did it NOT make much difference to how easy it was to get tobacco? 1 Suddenly harder 2 Gradually harder 3 No real effect 99 Cannot remember (Don t Know) (Don't read) 15

052 TS64811 Compared with those early months, is tobacco more available now, less available now, or has availability not changed much? 1 More available 2 Less available 3 No change in availability 7 Not sure (Don't read) 053 TS64815 Was there ever a time when there was no tobacco available in this area? 054 TS64741 Has the ban on selling tobacco products in Bhutan had any effects on what tobacco products you use? If response=2, 88, or 99, go to next section (Knowledge and Thoughts), 056a/SB823. 055a TS64162 If Yes to 054/TS741: What products would you use more of, if they were readily available? Manufactured Cigarettes 1 Mentioned t mentioned 055b TS64165 Bidis. 055c TS64168 055d TS64171 055e TS64262 055f TS64265 055g TS64251 055h TS64864 055i TS64864o Cigars. Loose tobacco (for pipe or RYO) Khaini/surti Zarda. Snuff. Other; specify Specify other. KNOWLEDGE AND THOUGHTS 16

056a SB64823 Now I am going to ask you some questions about your thoughts on tobacco. 056b SB64824 056c SB64831 056d SB64825 056e SB64893 057a KT64421 057b KT64423 057c KT64432 057d KT64460 057e KT64477 058a KT64723 058b KT64724 In the last month, how often, if at all, did you... Think about how much you enjoy using smokeless tobacco? 1 Never 2 Sometimes 3 Often Think about the harm smokeless tobacco might be doing to you? Seriously consider quitting smokeless tobacco? Think about the cost of smokeless tobacco? Think about where you might be able to get tobacco? Interviewer Note: Repeat the question if necessary. I am going to read you a list of health effects and diseases that may or may not be caused by smoking tobacco. Based on what you know or believe, does smoking tobacco cause the following...? Lung cancer in smokers? Mouth cancer in smokers? Problems breathing or getting enough breath (Bronchitis or Emphysema)? Lung cancer in non-smokers from secondhand smoke? Asthma (breathing problems) in children from secondhand smoke? Now some health effects and diseases that may or may not be caused by smokeless tobacco use. Based on what you know or believe, does smokeless tobacco cause the following... Mouth cancer? Gum disease? WARNING LABELS 17

059 WL64201 Ask all. In the last month, how often, if at all, have you NOTICED health warnings on any of the cigarette packages you have seen? 1 Once in a while 2 Often 3 Never Interviewer Note: If respondent asks, this refers to packs you have seen within Bhutan. If response=3, 88 or 99, go to Anti-Tobacco Campaigns, AQN/062a/AC711. 060 WL64121 Ask if 059/WL201=1 (once in a while) or 2 (Often): Read out response options. Select all that apply. Which of the following sorts of warnings have you noticed? 1 Text only 2 Graphic warnings only 3 Both Graphic pictures and text-only 4 No warning 061 WL64211 In the last month, how often, if at all, have you read or looked closely at the warning labels on cigarette packages? 1 Never 2 Once in a while 3 Often 062a AC64711 062b AC64716 062c AC64715 062d AC64725 062e AC64731 062f AC64714 062g AC64717 ANTI-TOBACCO CAMPAIGNS In the last 6 months, have you noticed advertising or information that talks about the dangers of smoking tobacco, or encourages quitting, in any of the following places? Television. Radio. Group education sessions (including village meetings) Posters. Newspapers or magazines. In the workplace? Public transportation vehicles or stations. 18

062h AC64720 Cigarette packs. If No to all (062a/AC711-062h/AC720=2), go to 064/AC800. 063 AC64771 Has this advertising made you think about quitting tobacco use? 3 Made no difference 064 AC64800 Now, thinking about smokeless tobacco, have you seen any information about the harms of smokeless tobacco (other than cigarettes)? 065a TA64905 065b TA64907 065c TA64912 065d TA64929 TOBACCO PROMOTION Interviewer Note: Repeat the question if necessary. In the last 6 months, have you seen or heard cigarettes or other tobacco products being advertised in any of the following places? Television. Radio. Posters. Newspapers or magazines. 066 TA64935 Have you seen anybody with clothing or other items that has a tobacco (smoked-tobacco?) brand or logo on it? 067 TA64382 In the last 6 months, about how often have you seen people smoking tobacco in the entertainment media like movies, TV, Magazines, Etc.? 1 Never 2 Once in a while 3 Often 19

068 AQ64661 Have you ever made a serious attempt to stop using smokeless tobacco? [Interviewer Note: This means all types of smoked tobacco are included in quit attempt.] If response=2, 88, or 99, go to 071/CH801. 069 AQ64665 When did this / your last quit attempt end? 1 Less than 1 month ago 2 1-3 months ago 3 3 to 6 months ago 4 6 months to 1 year ago 5 1-3 years ago 6 More than 3 years ago 070 AQ64669 On this last quit attempt, how long did you go without using any smokeless tobacco? 1 Less than a day 2 At least a day, but less than a week 3 At least a week, but less than a month 4 1-3 months 5 6 months to 1 year 6 1-3 years 7 More than 3 years 071 CH64801 In the last year, have you visited a doctor or other health professional, for any reason? If response=2, 88, or 99, go to 074a/AQ722. 072 AQ64701 During any visit to the doctor or other health professional in the last 6 months, did you receive... Advice to quit using smokeless tobacoo? If response=2, 88, or 99, go to 074a/AQ722. 20

073 AQ64702 Did this make you think about quitting smokeless tobacco? 074a AQ64722 Read each item. During the past 12 months, did you use any of the following to try to stop using smokeless tobacco? Medicines? Specify 074b AQ64722o Specify medicines. 074c AQ64725 Read each item. During the past 12 months, did you use any of the following to try to stop using smokeless tobacco? Blessing from a Lama? 074d AQ64728 Using smoked tobacco instead? 074e AQ64729 074f AQ64729o Anything else? Specify: Specify, anything else. 075 TQ64733 Now we would like to ask you some questions on any thoughts you have about quitting tobacco use. Interviewer Note: Respondent does not need to be intending to quit to respond. Emphasize IF in wording. IF you decided to give up using smokeless tobacco products completely in the next 6 months, how sure are you that you would succeed? 1 Not at all sure 2 Slightly sure 3 Sure 4 Very sure 076 TQ64735 How hard would it be for you to quit using smokeless tobacco if you wanted to? 1 Very easy 2 Somewhat easy 3 Neither easy nor hard 4 Somewhat hard 5 Very hard 21

077 TQ64741 One year from now, how much do you expect to be using smokeless tobacco, compared to now: More than now, the same amount, less than now, or not smoking at all? 1 A lot more than now 2 A little more than now 3 The same amount as now 4 A little less than now 5 A lot less than now, or 6 Not smoking at all 078 TQ64744 Are you planning to quit using smokeless tobacco 1 Within the next month 2 Within the next 6 months 3 Sometime in the future, beyond 6 months 4 No plans to quit? If response=2 or 3, go to 081/TQ750. If response=4, go to 080/TQ748. If response=88 or 99, go to 082a/TQ610. 079 TQ64746 Ask if 078/TQ744=1 (within next month). Have you set a firm date for quitting smokeless tobacco? Skip to 082a/TQ610. 080 TQ64748 Ask if 078/TQ744=4 (not planning to quit). Do you want to quit using smokeless tobacco? If response=2, 88, or 99, go to 082a/TQ610. 081 TQ64750 Ask if 078/TQ744=2-3 (plan to quit) or 088/TP125=1 (want to quit). How much do you want to quit using smokeless tobacco? 1 A little 2 Somewhat 3 A lot 22

082a TQ64610 Have any of the following reasons led you to think about quit using smokeless tobacco in the last month. Concern for your personal health? 082b TQ64616 That Bhutanese society disapproves of smokeless tobacco? 082c TQ64618 082d TQ64620 082e TQ64622 082f TQ64640 082g TQ64642 082h TQ64646 082i TQ64630 082j TQ64648 The price of smokeless tobacco? The law banning the sale of tobacco in Bhutan? The difficulty in getting smokeless tobacco? Advertisements or information about the health risks of smoking? Warning labels on cigarette packages? Setting a bad example for children? That close friends and family disapprove of use of smokeless tobacco? Your religious affiliation? 083 TQ64753 How much do you think you would benefit from health and other gains if you were to quit using smokeless tobacco permanently in the next 6 months? 1 Not at all 2 Slightly 3 Moderately 4 Very much 084 TQ64755 Still thinking about quitting permanently within the next 6 months: If you were to quit using smokeless tobacco, would your ability to enjoy life be improved, made worse, or stay the same? 1 Improved a lot 2 Improved a little 3 Stay the same 4 Made a little worse 5 Made much worse ENVIRONMENTAL TOBACCO SMOKE 23

085 TP64101 Are you aware that smoke free areas are designated in Bhutan? If response=2, 88 or 99, go to 089/TP310. 086 TP64148 Has the smoke-free policy made other people who smoke cut down on the amount of tobacco they smoke? 087 TP64121 Based on your observation, since the smoke-free policy came into effect, do you think more people or less people are smoking in smoke-free places, or has there been no change? 1 More 2 Less 3 No change 088 TP64125 In your opinion, how well is the smoke-free policy in Bhutan enforced? 1 Well enforced 2 Somehwat enforced 3 Poorly enforced 089 TP64310 Which of the following best describes smoking tobacco INSIDE your home? 1 Smoking tobacco is not allowed in any indoor room inside my home 2 Smoking tobacco is allowed only in some rooms inside my home 3 No rules or restrictions 090 TP64342 How concerned are you that other people smoking tobacco in the presence of your children will hurt your children s health? 1 Not concerned 2 A little concerned 3 Moderately concerned 4 Very concerned 5 No children in my household/no children 6 I do not smoke in the presence of my children 24

091 TP64346 Interviewer Note: Accept Don t know without pressing for an answer. How much, if at all, do you try to minimize the amount of exposure from other people's tobacco smoke? 1 A lot 2 Somewhat 3 Not at all 092 ET64233 In the last 6 months, have you visited a restaurant? If response=2, 88 or 99, go to 094/ET431. 093 TP64530 If visited: The last time you visited, were people smoking inside the restaurant? 094 ET64431 In the last 6 months, have you visited a bar? If response=2, 88 or 99, go to 096/ET542. 095 TP64630 If visited: The last time you visited, were people smoking inside the bar? 096 ET64542 In the past 6 months, have you ridden on buses/ taxis? If response=2, 88 or 99, go to 098/ET601. 25

097 TP64730 If ridden: The last time you rode on buses, were people smoking inside them? 098 ET64601 Are you currently employed outside the home? If response=2, 88 or 99, go to NEXT SECTION Psychosocial beliefs 101a/PS401. 099 ET64603 Do you usually work inside or outside a building? 1 Inside 2 Outside 3 Both inside and outside a building (do not read) If response=2, 88 or 99, go to NEXT SECTION Psychosocial beliefs 101a/PS401. 100 TP64830 In the last month, have people smoked tobacco in indoor areas where you work? 101a PS64401 101b OT64301 101c OT64501 101d OT64315 101e OT64520 101f OT64530 PSYCHOSOCIAL: BELIEFS ABOUT SMOKING Interviewer note: Repeat response options if necessary. Now I want to ask you some questions about your thoughts about tobacco use, some questions are about cigarettes, others about all smoked tobacco and others about smokeless. Listen carefully to the type of tobacco we are asking about Do you think that smoking cigarettes is a sign of sophistication/ smartness? Is it acceptable for females to smoke tobacco? Is it acceptable for females to use smokeless tobacco? Is tobacco smoke dangerous to nonsmokers? Knowing what you know now, would you have started using smokeless tobacco? Do you think that your family and friends do not want you to use smokeless tobacco? 26

101g OT64735 101h OT64540 101i OT64360 101j OT64560 101k OT64365 101l IN64509 101m OT64585 101n OT64725 Do you enjoy tobacco a lot? Does using smokeless tobacco calm you down when you are worried? Does Bhutanese society disapprove of smoking tobacco? Does Bhutanese society disapprove of smokeless tobacco? Do you believe that smoking causes less harm than what doctors say? Should the government do more to tackle the harm done by smoking tobacco? Are you worried that your use of smokeless tobacco will influence the children around you to start or continue using tobacco? Do you spend too much money on tobacco (of all kinds)? PERCEIVED RISK 102 PR64851 To what extent, if at all, has using smokeless tobacco damaged your health? 1 Not at all 2 A little 3 A lot 103 PR64953 How worried are you, if at all, that using tobacco WILL damage your health in the future? 1 Not at all worried 2 A little worried 3 Moderately worried 4 Very worried 104 PR64961 To what extent, if at all, has using tobacco lowered your quality of life? 1 Not at all 2 Just a little 3 A fair amount 4 A great deal 105 PR64963 How worried are you, if at all, that using tobacco will lower your quality of life in the future? 1 Not at all worried 2 A little worried 3 Moderately worried 4 Very worried 27

106 OT64710 In your opinion, does tobacco use increase or decrease gross national happiness? Does it 1 Increase a lot 2 Increase a little 3 No effect 4 Decrease a little 5 Decrease a lot RELATIVE RISKS 107 SB64150 Do you think smoking tobacco is? 1 Good for your health 2 Neither good nor bad 3 Bad, or 4 Very bad for your health 108 SB64160 Do you think smokeless tobacco use is 1 Good for people's health 2 Neither good nor bad 3 Bad, or 4 Very bad for your health 109 SL64305 Compared to smoking tobacco, do you think smokeless tobacco products are less harmful, more harmful or no different for health? 1 Smokeless are a lot less harmful 2 Smokeless are a little less harmful 3 Smokeless are a little more harmful 4 Smokeless are a lot more harmful 5 No difference 110 RH64405 The next questions are about smoked tobacco products only. Do you think that some types of smoked tobacco COULD be less harmful than other types, or are all types of smoked tobacco equally harmful? 1 Some less harmful 2 All equally harmful If response=2, 88 or 99, go to next section (Moderators) 113/DI211. 28

111 RH64407 What types are most harmful? 112 RH64409 What types are least harmful? MODERATORS 113 DI64211 How would you best respond to this statement: Do you often think about how what you do today will affect your life in the future. 114a DI64503 During the LAST MONTH, have you been disinterested in doing things? 114b DI64504 During the LAST MONTH, have you been unhappy most of the time? 115 PR64101 Now a question about your overall health. In general, how would you describe your health? Is it... 1 Poor 2 Average 3 Good 4 Excellent 116 DI64500 In general, how would you describe your level of happiness? Is it... 1 Poor 2 Average 3 Good 4 Excellent 29

117 DI64280 Interviewer Note: Record number between 0 and 5. Of the five closest friends or acquaintances that you spend time with on a regular basis, how many of them smoke? 0 No friends smoke If response=0, 88 or 99, go to 119/PS601. 118 DI64281 Interviewer Note: Record a number that is smaller than or equal to above answer. In the last year, how many of them have talked about wanting to quit smoking tobacco? 119 PS64601 If you were to go to the local market and gather a group of 10 strangers, on average, how many of the 10 would you expect to be tobacco smokers? 120 DI64303 Is smoking tobacco? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad 121 DI64305 Is use of smokeless tobacco? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad MARIJUANA USE 122 DI64800 Have you ever used marijuana? If response=2, 88 or 99, go to next section: Alcohol, 127/DI700. 30

123 DI64801 In the last 12 months, how often, if at all, have you used marijuana? 1 Very often 2 Often 3 Sometimes 4 Rarely 5 Never 124 DI64832 Have you ever used marijuana as a substitute to smokeless tobacco? If response=2, 88 or 99, go to 126a/DI804. 125 DI64833 In the last 12 months, how often, if at all, have you used marijuana as a substitute to smokeless tobacco? 1 Very often 2 Often 3 Sometimes 4 Rarely 5 Never 126a DI64804 How do you usually use marijuana? 1 (Smoked) by itself 2 (Smoked) mixed with tobacco 3 Other (specify) (Don t read out) 126b DI64804o Specify other. ALCOHOL 127 DI64700 Do you drink alcohol? If response=2, 88 or 99, go to next section Demographics, 131/DE111. 31

128 DI64712 How often do you drink alcoholic drinks? 1 Every day or nearly every day 2 Most days 3 2 or 3 days a week 4 About once a week 5 Less than once a week 129a DI64704 When you drink alcohol, how many cups or glasses would you drink? 1 1 cup 2 2-3 cups 3 4-6 cups 4 7 cups 5 More than 7 cups cups/glasses 129b DI64704o Specify, more than 7 cups: 130 DI64705 How often would you drink more than [4 (females)/ 6 (males)] drinks in one session? 1 Every day or nearly every day 2 Most days 3 2 or 3 days a week 4 About once a week 5 Less than once a week 6 Never 131 DE64111 Interviewer note: DO NOT read out response options. What is your marital status? 1 Married 2 Divorced or separated 3 Widowed 4 Single DEMOGRAPHICS 32

132a DE64662 Interviewer note: DO NOT read out response options. What is your religion? 1 Buddhist 2 Hindu 3 Other (Specify) 132b DE64662o Specify other religion. 133 PS64513 In your day-to-day life, how often do you refer to or use your religious beliefs and values to guide your actions? 1 Never 2 Rarely 3 Sometimes 4 All the time 5 I am not religious (Don't read out) if response=5, go to 137a/DE311. 134 PS64511 As far as you know, does your religion discourage use of tobacco? 135 PS64507 In the last year, have you been told (in a sermon) by a religious leader a lama or senior monk of a temple -- that you should try to quit tobacco use? 136 PS64505 If a lama advised you to quit using tobacco, would you quit? 3 Maybe 33

137a DE64311 137b DE64311o What is your highest level of education? 1 No education 2 Attended school, but no grade completed 3 Highest school grade completed 5 University completed 6 Post-graduate degree completed 7 NFE completed 8 Monastic school completed Highest school grade completed 138 DE64236 Which of the following best describes your main work status over the past 12 months? 01 Government employee 0n-government employee 03 Self-employed 04 Student 05 Farmer 06 Housewife 07 Retired 08 Unemployed, able to work 09 Unemployed, unable to work 139 AI64101 Thank you for your time and cooperation. We hope that we will be able to talk to you again in our follow-up survey in one year's time. 140 AI64543 Interviewer Note: This question is for you. Interviewers' overall judgment about the interview. 1 Reliable 2 Somewhat reliable 3 With some errors/ misunderstanding 4 With a lot of errors 34