Your Tobacco Use Profile |
The first step in helping you quit for good is to learn about you and your tobacco habit. The better we know you through this profile, the more exacting the intervention and support we can provide you. |
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1.Please indicate your gender |
| | (Demographic) |
2. Which best represents your age category? |
| | (Demographic) |
3. How many years have your smoked? |
| | (Intervention Strategies) |
4. Current Smoking Status |
| | (Intervention Strategies) |
5. The brand of cigarettes I smoke is |
| | (Intervention Strategies) |
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6. How ready am I to quit smoking |
| | (Behavioral: Stage of Readiness) (Time Frame) |
7. Based on readiness dynamic list from previous question: Reasons for Relapse |
| | (Triggers) |
8. If you have quit before what method did you use last time (all that apply) |
| | (Intervention Strategies) |
9. I learn most effectively when |
| | (Storyteller, Planner, Tracker) |