Sl No Quiz One: Eight question, yes/no answer responses Yes No
1 Do I want to quit to improve my health or my life?
2 Is being a nonsmoker a high priority for me?
3 Have I tried to quit before?
4 Is smoking dangerous for my health?
5 Am I committed to trying to quit?
6 Do I have support systems such as family and friends that will help me quit?
7 Do I have other personal reasons to quit smoking aside from health reasons?
8 Can I recommit to quit if I slide back?
1 I spend too much money on smoking.

 

Strongly Disagree Disagree Agree Strongly Agree
2 My family will not be harmed if I get cancer, heart or lung disease.

 

Strongly Disagree Disagree Agree Strongly Agree
3 My smoking is a burden to my family.

 

Strongly Disagree Disagree Agree Strongly Agree
4 One or more of my loved ones have pleaded with me to quit.

 

Strongly Disagree Disagree Agree Strongly Agree
5 I worry that my smoking (secondhand smoke) will adversely affect the health of my family.

 

Strongly Disagree Disagree Agree Strongly Agree
6 I avoid activities such as going to the movies because it’s difficult to go that long without a cigarette.

 

Strongly Disagree Disagree Agree Strongly Agree
7 The pleasure I get from smoking is worth the hassle.

 

Strongly Disagree Disagree Agree Strongly Agree
8 It is convenient for me to smoke.

 

Strongly Disagree Disagree Agree Strongly Agree
9 I am disgusted with my smoking.

 

Strongly Disagree Disagree Agree Strongly Agree
10 I will be one of the lucky ones who avoids dying from a smoking-related illness.

 

Strongly Disagree Disagree Agree Strongly Agree
11 Smoking has limited my participation in activities that I enjoy.

 

Strongly Disagree Disagree Agree Strongly Agree
12 I have family members that would support me if I tried to quit.

 

Strongly Disagree Disagree Agree Strongly Agree
13 I have friends and/or co-workers that would support me if I tried to quit smoking.

 

Strongly Disagree Disagree Agree Strongly Agree
14 If my doctor offered a treatment that would lessen the severity of withdrawal and cravings by 30percent, I would try it.

 

Strongly Disagree Disagree Agree Strongly Agree