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Check Your Smoking

How does my smoking compare to others?
Your Level of Nicotine Dependence
  1. How soon after you wake up do you smoke your first cigarette?



  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)?

  3. Which cigarette(s) of the day would you hate to give up most?

  4. Do you smoke more often during the first 3 hours after waking than during the rest of the day?

  5. Do you smoke even when you’re sick, or when you have a sore throat, cold, or cough?
  1. How many cigarettes do you or did you smoke on the days that you smoke?    

  2. Are you a male or female?
     
  3. What country do you live in?   

  4. What is your approximate age?   

Are you ready to quit?
  1. 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


  2. At this point, would you say that your BENEFITS from Quitting are:

       
  3. Have you taken small steps towards quitting?

     
  4. What is your first name (if you are concerned about your privacy use your nickname or an alias):