p. 1
Note: there are up to three entries for each set of questions asked.
S1
For each sample person enter name, person number, age, and sex from HIS-1.
Last name________
Person no ________
Age________
Sex
2 [] F
2 [] 17+ callback req (NP)
3 [] 17+ available
1. Have you smoked at least 100 cigarettes in your entire life?
2 [] N (NP)
2a. About how old were you when you first started smoking cigarettes fairly regularly?
00 [] Never smoked regularly
b. Do you smoke cigarettes now?
2 [] N (NP)
c. On the average, about how many cigarettes a day do you smoke?
3. During the period when you were smoking the most, about how many cigarettes a day did you usually smoke?
4a. Do you smoke cigarettes now?
2 [] N
b. About how long has it been since you last smoked cigarettes fairly regularly?
2 [] Days (S3)
3 [] Weeks (S3)
4 [] Months (S3)
5 [] Years (S3)
5. On the average, about how many cigarettes a day do you now smoke?
2 [] Less than 1 year in 4b (6)
3 [] 1+ years in 4b (NP)
6a. What brand of cigarettes do (did) you usually smoke?
If more than one brand ask:
b. Which brand do (did) you smoke the most?
p. 2
7. What type of cigarettes are the (brand) that you smoke (smoked)? Are they:
2 [] NFT
2 [] M
2 [] SP
2 [] K
2 [] "Y" in 4a
8a. Have you ever made a serious attempt to stop smoking cigarettes?
2 [] N (NP)
b. About how many times would you say you made a fairly serious attempt to stop smoking cigarettes entirely?
[] 1
[] 2
[] 3
[] 4
[] 5+
c. During the past 12 months, that is since (date) a year ago, about how many times would you say you made a fairly serious attempt to stop smoking cigarettes entirely?
[] 1
[] 2
[] 3
[] 4
[] 5+
9. How long ago was the start of the last time you tried to stop entirely?
2 [] Days
3 [] Weeks
4 [] Months
5 [] Years
10. How long did you actually stay off cigarettes the last time?
2 [] Days
3 [] Weeks
4 [] Months
5 [] Years
000 [] Did not stay off