1b	Have you ever smoked daily?	Yes No
2b	Have you smoked at least 100 cigarettes in your entire life?	Yes No
3b	Do you now smoke cigarettes every day, some days, or not at all?	Every days Some days 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 A B C D
5b	During the past 30 days, on how many days did you use tobacco?	In the past 30 days, I used tobacco on 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30days.
6	Do you now smoke cigarettes?	Yes No
7	Do you now smoke cigars?	Yes No
8	Do you now smoke cigarillos?	Yes No
9	Do you now smoke pipes?	Yes No
10	Do you now use chewing tobacco?	Yes No
11	Do you now use tobacco snuff?	Yes No
12	Have you used smokeless tobacco (=snuff or chewing tobacco) in the past 7 days?	Yes No
13b	Did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 7 days?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
14b	If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 30 days?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
15b	If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 6 months?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
16b	If not, did you smoke tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 12 months?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
	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: Cigarettes Smokeless tobacco-snuff Cigars/Cigarillos Pipes
18b	How many cigarettes per day do you smoke now?	0 0.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 25 28 29 30 35 40 45 50 55 60 65 70 75 80 90 100 cigarettes per day
19b	How soon after you wake up do you smoke your first cigarette?	0 0.5 1 2 3 4 5 6 8 10 15 20 25 30 35 40 45 50 60 75 90 120 180 240 300 360 420 480 600 720 840 960 minutes
20b	In the past 12 months, did you make a serious attempt to quit smoking?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
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?	Yes No How confident are you about your answer to this question? extremely very moderately slightly
21	How long did your last attempt to quit smoking last?	My last quit attempt lasted: I never made a quit attempt 2 hours 4 hours 8 hours 12 hours 16 hours 1 day 2 days 3 days 4 days 5 days 6 days 7 days 8 days 9 days 10 days 11 days 12 days 13 days 14 days 15 days 16 days 17 days 18 days 19 days 20 days 21 days 28 days 30 days 35 days 40 days 45 days 50 days 55 days 60 days 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 1 year 18 months 2 years 2.5 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 12 years 15 years 17 years 20 years 25 years 30 years 40 years 50 years
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?	0 1 2 3 4 5 6 7 8 9 10 15 20 30 40 50 60 70times How confident are you about your answer to this question? extremely very moderately slightly
23b	In the last year, how many times have you made a serious attempt to quit smoking?	0 1 2 3 4 5 6 7 8 9 10 15 20 30 40 50 60 70times How confident are you about your answer to this question? extremely very moderately slightly
24b	Are you going to quitting smoking?	Yes, within the next 30 days Yes, within the next 6 months No, I am not going to quit
	Questions for EX-smokers:
25b	How long ago did you quit smoking?	I quit smoking 30 minutes 1 hour 2 hours 5 hours 12 hours 24 hours 2 days 3 days 4 days 5 days 6 days 7 days 10 days 2 weeks 3 weeks 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 1 year 1.5 year 2 years 3 years 4 years 5 years 10 years 12 years 15 years 20 years 30 years 40+ yearsago How confident are you about your answer to this question? extremely very moderately slightly
	Comments on the questions above:	Question no.

[Back to Stop-Tabac.ch]

[Last modified 12 June 2003, by ]