| 1. How soon after you wake up do you smoke your first cigarette? |
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| 2. Do you find it difficult to refrain from smoking in places where it is forbidden (e.g., in church, at the library, cinema, etc.)? |
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| 3. Which cigarette would you hate most to give up? |
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| 4. How many cigarettes a day do you smoke? |
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| 5. Do you smoke more frequently during the first hours after waking than during the rest of the day? |
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| 6. Do you smoke if you are so ill that you are in bed most of the day? |
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Your Nicotine Dependence Score:
Several questions you completed on the smoking questionnaire can be added together to give us an idea of your level of dependence on nicotine. Higher scores typically reflect higher dependence on nicotine.
| SCORE |
NICOTINE DEPENDENCE |
| 0 |
No Dependence |
| 1-2 |
Low Dependence |
| 3-5 |
Moderately Dependent |
| 6-8 |
Highly Dependent |
| 9-10 |
Very Dependent |
If you scored in the Moderately, Highly, or Very Highly Dependent Level you may want to speak to a professional for further screening. Contact the Healthy Lifestyles Guided Self-Change Program.
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