[p.45]
SMOKING HABITS PAGE
(fill one smoking habits page for each person 17 years old or over)
Now I have a few questions about smoking-
2a. Has -- smoked at least one hundress cigarettes during his entire life?
[] No (go to 5)
b. During the period when -- was smoking the most, how many cigarettes a day did he usually smoke?
Per week ______
If "Yes" or "don't know" in 2a ask:
3a. Does -- smoke cigarettes now?
[] No (go to 4)
b. On the average, about how many cigarettes a day does he smoke?
Per week ________
c. Twelve months ago, how many cigarettes a day was he smoking?
Per week ________
Ask only for persons with "No" or "don't know" in 3a. If "Yes" in 3a go to 5.
b. How long has it been since --smoked cigarettes faily regularly?
Years ________
Ask question 5 and 6 only for males 17 years old or over. If female go to next person.
5a. Has -- smoked at least 10 cigars during his entire life?
[] No (go to 6)
[] No (ask 5d)
c. About how many cigars a day does -- usually smoke?
Per week ________
[] Less than 3 per week (ask 5d)
Ask only if "No" or "Don't know" in 5b or if less than 3 per week circle marked in 5c.
d. About how long has it been since -- smoked 3 or more cigars a week?
Years _________
[] Never smoked 3 or more a week
6a. Has -- smoked 3 packages of pipe tobacco during his entire life?
[] No (stop)
[] No (ask 6d)
c. About how many pipefuls of tobacco a day does -- usually smoke?
Per week ________
[] Less than 3 per week (ask 6d)
Ask only if "No" or "Don't know" if 6b or if less than 3 per week cirle marked 6c
d. About how long has it been since -- smoked 3 or more pipeful a week?
Years ________
[] Never smoked 3 or more a week