Tobacco Dependency Quiz

Take the Tobacco Dependency quiz below to determine your level of addiction to nicotine. You may want to print out the quiz and bring it with you to your first Tobacco Cessation counseling session.

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1.

How many cigarettes per day do you smoke?

 
Points
10 or less
0
11 - 20
1
21 - 30
2
31 or more
3

Smokeless: How many tins or pouches per week?

 
Points
Low-Less than one per week
1
Moderate-2 to 3 per week
2
Severe-More than 3 per week
3

2.

How soon after you wake up do you smoke your first cigarette or take your first dip or chew?

 
Points
Within 5 minutes
3
6 - 30 minutes
2
31 - 60 minutes
1
After 60 minutes
0

3.

Do you smoke/chew more frequently during the first hours after awakening than during the rest of the day?

 
Points
Yes
1
No
0

4.

Which cigarette/chew would you hate most to give up?

 
Points
The first one in the morning
1
Any other
0

 

5.

Do you find it difficult to refrain from tobacco in places where it is forbidden, e.g., in church, at the library, in the movie theater, etc.?

 
Points
Yes
1
No
0

6.

Do you use tobacco if you are so ill that you are in bed most of the day?

 
Points
Yes
1
No
0

 
Fagerstrom Key
Score
Level of Dependence
6 - 10
Severe
4 - 5
Moderate
<3
Mild