DESIGN OF THE QUESTIONNAIRE
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?
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