Assess Nicotine dependence

Ever wonder how your body will function without smoking cigarettes?

1. How soon after you wake up, do you smoke your first cigarette?

Within 5 minutes 5 - 30 minutes 31 - 50 minutes Over 60 minutes

2. Do you find it difficult to refrain from smoking in places where it is forbidden?

Yes No

3. Where cigarette would you most hate to give up?

The first one in the morning Any other

4. How many cigarettes per day you smoke?

10 or less 11 - 20 21 - 30 over 30

5. Do you smoke more frequently during the first hours after waking than during the rest of the day?

Yes No

6. Do you smoke if you are so ill that you are in bed most of the day?

Yes No