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smok

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.

First name________
Last name________
Person no ________
Age________
Sex
1 [] M
2 [] F
Coders use________

S2

1 [] Under 17(NP)
2 [] 17+ callback req (NP)
3 [] 17+ available


1. Have you smoked at least 100 cigarettes in your entire life?

1 [] Y
2 [] N (NP)


2a. About how old were you when you first started smoking cigarettes fairly regularly?

Years ________ (3)
00 [] Never smoked regularly


b. Do you smoke cigarettes now?

1 [] Y
2 [] N (NP)


c. On the average, about how many cigarettes a day do you smoke?

Number ________ (NP)


3. During the period when you were smoking the most, about how many cigarettes a day did you usually smoke?

Number ________


4a. Do you smoke cigarettes now?

1 [] Y (5)
2 [] N


b. About how long has it been since you last smoked cigarettes fairly regularly?

Number ________
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?

Number ________

S3

1 [] "Y" in 4a (6)
2 [] Less than 1 year in 4b (6)
3 [] 1+ years in 4b (NP)


6a.What brand of cigarettes do (did) you usually smoke?

Brand name ________

If more than one brand ask:
b. Which brand do (did) you smoke the most?

Brand name ________

p. 2


7. What type of cigarettes are the (brand) that you smoke (smoked)? Are they:


a. Filter tip or non-filter tip?
1 [] FT
2 [] NFT


b. Plain or menthol?
1 [] P
2 [] M


c. Hardpack or softpack?
1 [] HP
2 [] SP


d. Regular or king size or 100 millimeter?
1 [] R
2 [] K

S4

1 [] "N" in 4a (NP)
2 [] "Y" in 4a


8a. Have you ever made a serious attempt to stop smoking cigarettes?

1 [] Y
2 [] N (NP)


b. About how many times would you say you made a fairly serious attempt to stop smoking cigarettes entirely?

0 [] Never (NP)
[] 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?

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5+


9. How long ago was the start of the last time you tried to stop entirely?

Number ________
2 [] Days
3 [] Weeks
4 [] Months
5 [] Years


10. How long did you actually stay off cigarettes the last time?

Number ________
2 [] Days
3 [] Weeks
4 [] Months
5 [] Years
000 [] Did not stay off