NOATTACKS.ORG
ONLINE QUESTIONNAIRE
How did you find or hear of this Web site? (Check all that apply.)
Link from another site
Internet search engine
TV ad
TV news story or program
Radio ad
Radio news story or program
Newspaper or magazine story or article
Billboards or posters
From a doctor or other medical professional
Acquaintance/word of mouth
Other - Specify:
Not sure
Why did you come to this site? (Check all that apply.)
To learn about my child’s asthma
To learn about asthma triggers
To learn about new medications
To learn about my own asthma
To learn how to prevent attacks
To learn how to treat attacks
To find doctors
I work in the field
Happened to arrive at the site via Internet browsing
Other - Specify:
Not sure
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Easy to Navigate
Useful
How likely are you to return to this website?
Definitely will return
Probably will return
Might or might not return
Probably will not return
Definitely will not return
What is the age of the child in your household who has asthma? (Check all that apply.)
Under 2
2-6
7-12
13-18
No children in my household have asthma
Which things trigger your child’s asthma? (Check all that apply.)
Dust
Pet dander/pets
Pollen
Mold
Corckroach/pest
Tobacco/cigarette smoke
Exercise
Weather
Scents/sprays/perfume
Don’t know
No cause, it just happens
Other - Specify:
How often do you take your child to the Emergency Room because of an asthma attack?
Once a year or less
Once every few months
About once a month
2-3 times per month
Once a week or more
These last few questions are for statistical purposes only
.
How old are you?
Under 18
18-34
35-54
55+
Are you male or female?
Male
Female
Do you allow smoking in your home?
Yes
No
Please enter your state of residence below.
State
(Click here to choose)
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
British Columbia
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Is
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Trust Territories
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
With which of the following groups do you most identify?
African-American/Black
Asian-American or Pacific Islander
Hispanic/Latino
Native American
White
Other
Do you have any suggestions on how to improve the web site and/or on additional content you would like to see?
Email Address
Thank you very much for your time.