Important: please answer ALL questions:

Data storage: We would like to store your answers on a computer file, to conduct statistical analyses. This survey is anonymous, neither your name or e-mail address will be asked from you. The IP address of your computer or server will, however, be stored with your answers. This will enable us to identify double entries from the same participants. IP addresses will be deleted after data collection is closed. Your answers will not be transmitted to anyone else. - If you do not want your answers to be stored on file, please tick this box. - Also tick this box if your answers are not to be taken seriously.	Tick if you do not want your answers to be stored:
How old are you?	I am 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 95 years old
Do you currently smoke tobacco?	Yes, I smoke every day Yes, occasionally (NOT every day) I am currently trying to quit No, I am an EX-smoker No, I never was a smoker
Do you currently use smokeless tobacco (chewed, snuff)?	Yes, every day Yes, occasionally (NOT every day) No, I am an EX-user No, I never was a user
During the past 31 days, on how many days did you smoke or use tobacco?	I smoked or used tobacco on 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 days/31
Have you used any tobacco (even one puff of cigarette, cigar, pipe, etc) in the past 7 days?	Yes No
Are you currently seriously trying to quit smoking or to stop using tobacco?	Yes No
Are you currently seriously trying to reduce your tobacco use?	Yes No
3 questions for EX-smokers : 1- When did you stop smoking?	I stopped smoking on: Day: Don't know 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: Don't know January February March April May June July August September October November December Year: 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1970 1965 1960 1955 1950
2- When you smoked, how many cigarettes did you smoke per day on average?	0 0.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 25 28 29 30 35 40 45 50 55 60 65 70 75 80 90 100 Cig./day
3- When you smoked, how soon after waking up did you smoke your first cigarette of the day, usually?	Less than 1 1 2 3 4 5 6 8 10 15 20 25 30 35 40 45 50 60 75 90 2 hours 3 hours 4 hours 5 hours 6 hours 7 hours 8 hours 10 hours 12 hours 14 hours 16 hours Minutes
...and 4 questions for smokers: 1-  On average, how many cigarettes do you smoke per day?	0 0.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 25 28 29 30 35 40 45 50 55 60 65 70 75 80 90 100 Cig./day
2-  Usually, how soon after waking up do you smoke your first cigarette of the day?	Less than 1 1 2 3 4 5 6 8 10 15 20 25 30 35 40 45 50 60 75 90 2 hours 3 hours 4 hours 5 hours 6 hours 7 hours 8 hours 10 hours 12 hours 14 hours 16 hours Minutes
3- When you started to smoke again, after an attempt to quit smoking, when did you relapse to smoking?	I relapsed on: Day: Don't know 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: Don't know January February March April May June July August September October November December Year: 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1970 1965 1960 1955 1950
4- If you made a serious attempt to quit smoking,      how long did your most recent serious quit attempt last ?	I lasted: less than 1 day 1 day 2 days 3 days 4 days 5 days 6 days 7 days 8 days 9 days 10 days 11 days 12 days 13 days 14 days 15 days 16 days 17 days 18 days 19 days 20 days 21 days 22 days 23 days 24 days 25 days 26 days 27 days 28 days 29 days 30 days 31 days 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months 2 years 3 years 4 years 5 years 5-10 years more than 10 years
Questions for all:
Have you ever used the smoking cessation drug called bupropion (Zyban, Wellbutrin or Zyntabac)?	Yes, I use it every day Yes, occasionally (NOT every day) No, but I have used it in the past No, I never used bupropion=Zyban
Have you ever used the smoking cessation drug called varenicline (Chantix or Champix)?	Yes, I use it every day Yes, occasionally (NOT every day) No, but I have used it in the past No, I never used varenicline
Have you ever used nicotine replacement products?	Please answer each line: Ever used...? Yes No Nicotine chewing gums Nicotine skin patches Nicotine tablets Nicotine lozenges Nicotine inhalers Nicotine nasal sprays
Do you currently use nicotine replacement products?	Yes, I use them every day Yes, occasionally (NOT every day) No, but I have used them in the past No, I never used these products
If you ever used any other smoking cessation medication, please specify:
Which smoking cessation medication did you use the most?	Bupropion (Zyban, Wellbutrin) Varenicline (Chantix, Champix) Nicotine patch Nicotine gum Nicotine tablet Nicotine lozenge Nicotine nasal spray Nicotine inhaler Other medication NONE OF THE ABOVE

About the authors of this survey.

Jean-Francois ETTER, PhD
is senior lecturer at the Faculty of Medicine, University of Geneva, Switzerland, and he is in charge of the Stop-tabac.ch website. He is the author of over 80 publications in peer-reviewed scientific journals.

Nina SCHNEIDER, PhD
is Chief, Nicotine Dependence Research Unit at the Greater Los Angeles Veterans Affairs Healthcare Service and Research Psychologist at the University of California in Los Angeles, California, USA and she developed the preference and withdrawal questions based on her published trials. She is the author of over 35 publications in peer-reviewed scientific journals.

[Created by JF Etter, last modified Sep 03, 2008]