Smoking


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Several questions about smoking are listed below. For the first four, use the scale below to select your answer. For the rest of the questions, simply respond as honestly as possible. We are looking for many different types of smokers, so don't worry that certain answers will make you ineligible for the study. If you feel uncomfotable answering a certain question, please select the "0" option. If you are eligible for the study, you will receive an email from us with more information shortly. Thanks!

1 = Not at all
2 = A little bit
3 = Somewhat
4 = Mostly
5 = Without a doubt
0 = Prefer not to answer


   1. I consider myself a Smoker      

   2. Being a smoker is part of my identity      

   3. Smoking is part of who I am      

   4. The important people in my life know me as a smoker      

   5. Have you ever tried unsuccessfully to quite smoking?      

   6. Have you ever felt like you were addicted to tobacco?      

   7. Do you have a cigarette within 15 minutes of waking up?      

   8. Is it hard to keep from smoking in places you’re not supposed to, like school?      

   9. When you are unable to smoke for a while, do you feel nervous, restless or anxious?      

   10. When you are unable to smoke for a while, do you feel a strong urge or need to smoke?      

   11. Are you currently in psychiatric treatment for a major psychological disorder (e.g., schizophrenia, major depression)?      

   12. Are you currently in therapy for a major drug dependency (e.g. heroin, cocaine)?      

   13. Are you currently trying to quit smoking, or do you plan to in the near future?      

   14. Have you smoked in the last three months?      

   15. How many days have you smoked in the past 30? (Write your answer in the box on the left)     



   16. How many cigarettes have you smoked or partially smoked in the last 7 days? (Write your answer in the box on the left)     



   17. What is your age? (Write your answer in the box on the left)     



   18. Do you have reliable transportation?      



Please check this form to make sure you have answered all questions. Once you are ready to submit, click on the button below. Please do not submit more than once.