Check Your Smoking

How does my smoking compare to others?

1. How soon after you wake up do you smoke your first cigarette? Within 5 minutes
   6 – 30 minutes
   31 – 60 minutes
   After 60 minutes


2. Do you find it difficult to not smoke in places where it’s not allowed or accepted (in the office or in the movies)? Yes
   No
   
3. Which cigarette(s) of the day would you hate to give up most? The first one in the morning
   All others
   
4. Do you smoke more often during the first 3 hours after waking than during the rest of the day? Yes
   No
   
5. Do you smoke even when you’re sick, or when you have a sore throat, cold, or cough? Yes
   No

6. 3. How many cigarettes do you or did you smoke per day?  Select 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 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100+  
   
   
7. Are you a male or female?Female
   Male  
8. What country do you live in?  -------- United States Canada United Kingdom Afghanistan Albania Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Belgium Belize Benin Bolivia Bosnia Hercegov Botswana Brazil Bulgaria Burkina Faso Byelorussia Cameroon Chad Chile China Columbia Congo Croatia Cyprus Czech Republic Denmark Djibouti Ecuador Egypt Estonia Ethiopia Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Greece Guatamala Guinea Guinea-Bissau Honduras Hong Kong Hungary Iceland India Indonisia Iran Iraq Ireland Israel Italy Ivory Coast Japan Jordan Kenya Kuwait Latvia Lebanon Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Mali Malta Martinique Mauritania Mexico Moldova Republi Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovenia Somalia South Africa South Korea Spain Sri Lanka Sudan Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emi Uruguay Uzbekistan Venezuela Viet Nam Yugoslavia Zaire Zambia Zimbabwe Other Country  
   
   
9. What is your approximate age?  Select Under 18 19-24 25-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+  

Are you ready to quit?

10. How confident are you that you could attempt to quit smoking in the next one to two months?
    

    0	1	2	3	4	5	6	7	8	9	10
    not confident		somewhat confident		confident				moderately confident		extremely confident

    
    
11. At this point, would you say that your BENEFITS from Quitting are: More important than your HARDSHIPS of Quitting (Hardships are: withdrawal symptoms, strong cravings, training your body to not smoke when you need to relax, etc.)
     About the same importance as your HARDSHIPS of Quitting (Hardships are: withdrawal symptoms, strong cravings, training your body to not smoke when you need to relax, etc.)
     Less important than your HARDSHIPS of Quitting (Hardships are: withdrawal symptoms, strong cravings, training your body to not smoke when you need to relax, etc.)    
12. Have you taken small steps towards quitting? Yes, I have
     No, I haven’t
     I’ve already quit  
13. What is your first name (if you are concerned about your privacy use your nickname or an alias):
     

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