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1. Is there a safe way to smoke?
 
Yes
 
No

 
 
 
Is cigarette smoking really addictive?
 
Yes
 
No

 
 
 
Does smoking main cause cancer?
 
Yes
 
No

 
 
 
Does cigarette smoking affect your heart?
 
Yes
 
No

 
 
 
How many packs per day do you currently smoke?
 
1 - 3 per day
 
4 - 10 per day
 
More than 30

 
 
 
How long have you smoked?
 
14 years and less
 
15-18
 
19-30 years
 
more than 35 years

 
 
 
Did you feel the dangers of smoking?
 
Yes
 
No
 
Sometimes
 
Often

 
 
 
How many cigarettes do you smoke on a typical day?
 
10 or less
 
11 - 20
 
21 - 30
 
31 or more

 
 
 
Are you seriously thinking about quitting smoking?
 
No
 
Yes in the next year
 
Yes in the next six weeks

 
 
 
Why do you want to quit smoking?
 
Health
 
Money
 
Family
 
Time
 
Smells Bad
 
Other

 
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