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Peel Health would like to find out what community residents think about this issue. Participation in this survey is optional and should only take about five minutes. The survey is anonymous - you are not required to identify yourself.  This information will be used to assist Public Health staff with program planning to support tobacco prevention programming. Please click here for more information.

1. Where have you seen these ads? (check all that apply)

Take the Smoke Outside   Thanx Mom

  • Internet
  • On a bus
    Newspaper
  • Magazine
  • Other (please specify)

2. Smoking in Cars with children...

  • Is the personal choice of the parent/caregiver
  • Is thankfully now illegal in Ontario
  • Does not concern me

3. Demographic Information

Please tell us about yourself. This information is anonymous and will be kept confidential. It will only be used to help Public Health staff understand the overall results from this survey.
  • Are you male or female?
       

  • What age group are you in?


  • Where do you live?

4. Do you smoke?

  • Daily
  • Occasionally
  • Never

5. Additional Comments:

Thank you for taking the time to provide us with your feedback!

This information is being collected pursuant to the Health Protection and Promotion Act, R.S.O. 1990, c.H.7 and will be retained, used, disclosed and disposed of in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56, the Personal Health Information Protection Act, 2004, S.O. 2004, c.3 and all applicable federal and provincial legislation and regulations governing the collection, retention, use, disclosure and disposal of information. This information will be used to assist public health staff with program planning to support tobacco prevention programming. Any questions regarding this collection may be directed to the Medical Officer of Health, Peel Public Health, 44 Peel Centre Drive, Brampton, Ontario, L6T 4B5, 905-791-7800.

For more information, please contact the Region of Peel at 905-799-7700 (or toll-free from Caledon at 905-584-2216). The Region of Peel can provide information about the health effects of smoking, second-hand smoke, resources on how to create smoke-free spaces (e.g. homes, cars) and offers free support/counselling to those interested in quitting smoking.

Please review the Region of Peel’s website privacy statement.

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