• Thanks + + + for taking 10 minutes to answer this questionnaire.

Survey for smokers and EX-smokers

1b Have you ever smoked daily?
2b Have you smoked at least 100 cigarettes in your entire life?
3b Do you now smoke cigarettes every day, some
days, or not at all?
4b Are you currently a smoker? A) Yes, I currently smoke
B) No, I quit within the last 6 months
C) No, I quit more than 6 months ago
D) No, I have never smoked
5b During the past 30 days, on how many days did you use tobacco? In the past 30 days,
I used tobacco on days.
6 Do you now smoke cigarettes?
7 Do you now smoke cigars?
8 Do you now smoke cigarillos?
9 Do you now smoke pipes?
10 Do you now use chewing tobacco?
11 Do you now use tobacco snuff?
12 Have you used smokeless tobacco (=snuff or chewing tobacco) in the past 7 days?
13b Did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 7 days?

How confident are you about your answer to
this question?

14b If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 30 days?

How confident are you about your answer to
this question?

15b If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 6 months?

How confident are you about your answer to
this question?

16b If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 12 months?

How confident are you about your answer to
this question?

Questions for smokers and users of smokeless tobacco:
EX-smokers, please click here
17 Currently, which type of tobacco do you use mainly? Currently, I use mainly:
18b How many cigarettes per day do you smoke now? cigarettes per day
19b How soon after you wake up do you smoke your first cigarette? minutes
20b In the past 12 months, did you make a serious attempt to quit smoking?

How confident are you about your answer to
this question?

20d In the past 12 months, did you make a serious attempt to quit smoking and succeed in not smoking for at least 24 hours?

How confident are you about your answer to
this question?

21 How long did your last attempt to quit smoking last? My last quit attempt lasted:
22b In the last year, how many times have you quit smoking for at least 24 hours, as part of a serious attempt to quit smoking?

times

How confident are you about your answer to
this question?

23b In the last year, how many times have you made a serious attempt to quit smoking?

times

How confident are you about your answer to
this question?

24b Are you going to quitting smoking?
Questions for EX-smokers:
25b How long ago did you quit smoking? 

I quit smoking ago

How confident are you about your answer to
this question?

Comments on the questions above:

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[Last modified 12 June 2003, by ]