Issuu on Google+


Onnexa Lopetegui Elena Martin Irene Palacios Laura Ponton Laida Vidaurrazaga

QUESTIONNAIRE First we will start with the FAGERSTRÖM test Are you a smoker or non smoker? If you are a smoker answer the following test if not pass to the 7 question

IN ENGLISH: 1.How long does it take you to starting to smoke since you get up?    

5 min or less 6-30 min 31-60 min More than 60 min

2.Do you find difficult not to smoke in places where smoke is forbidden? 



3.What cigarette you consider harder to give up? 

The first one


4.How many cigarettes do you smoke per day?    

Less than 10 11-20 21-30 More than 30

5.After smoking the first cigarettes, do you have anxiety to smoke? 



6.Do you smoke even if you are ill? 



In order you punctuation:   

Equal or less than four: the smoker is not so dependent to the nicotine 5-6: It is so so dependent Equal or more than 7: The smoker is very dependent

ATTITUDES 7. Which of the following describes me best:  Non smoker  Ex-smoker  Smoker who would like to quit  Smoker who want to quit

8. Which smoking policy would you support?  Complete van smoking  No smoking inside  Smoking restricted to certain areas outside and restricted to certain areas outside  Smoking restricted to certain areas outside and designated areas inside that are separately better to outside 9. Did someone push you to smoke?  Yes  No 10. Have you ever been tempted to smoke?  Yes  No 11. Do you think that breathing tobacco air is bad for your health?  Yes  No 12. Do you think quitting smoking methods are effective?  Yes  No 13. What is the worst of tobacco? 14. At what age did your friends start smoking? 15. Age of your first cigarette 16. Reasons why you started smoking 17. How many tries did you do before leaving smoking? 18. What is the worst thing of give up smoking ?

HABBITS 19. When you were little, did somebody in your house smoke?  

Yes No

20. Do you accompany your friends outside to smoke? (non smokers)  Yes  No 21. Do you go outside bars for smoking?  Yes  No 22. Do you normally respect the anti-tobacco law?  Yes  No 23. Do you ask permission before smoking?  Yes  No

24. Do you consider you have a healthy life?  Yes  No 25. What is the first thing you do when you get up?  Have a shower  Have breakfast  Smoke  Other: _______ 24. Which habit is the most important for parents to set as an example of for their children? 25. Which bad habit do you think would be the most difficult to get rid of? Why? 26. Which good habit do you think would be the most difficult to develop? Why? 27. Number of cigarettes smoked per day

Gender Age