1 - How long have you been smoking? 
Less than 1 year
Less than 5 years
Less than 10 years
10 to 20 years
20 to 30 years
More than 30 years

2 - How many cigarettes do you smoke each day? 
Less than 10
10 to 20
20 to 30
More than 30

3 - After you wake up in the morning, how soon do you smoke your first cigarette? 
Within the first 5 minutes
5 to 30 minutes
30 to 60 minutes
After 60 minutes

4 - After you eat, how soon do you light up a cigarette? 
Right away
Within the first 5 to 30 minutes
30 to 60 minutes
After 60 minutes

5 - Do you ever light up a cigarette or have a cigarette burning in the ashtray during a meal? 
Never
Sometimes
A few times
Almost all the time

6 - Is it difficult for you not to smoke in places where smoking is prohibited? 
Yes
No

7 - Which one of your cigarettes would you most dislike to give up? 
My first cigarette in the morning
My after-lunch / break-time cigarette
My after-dinner cigarette
My cigarette smoked with friends in a bar

8 - Do you smoke more often during the first hours after waking up than during the remaining hours of the day?
Yes
No

9 - Do you smoke even if you are so sick that you are in bed?
Yes
No

10 - Do you see yourself smoke free? 
Yes
No

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