AdoptaDaughter is conducting a smoking survey as part of her high school science fair project. If you’re so inclined, please register your response Thanks!
Directions: Mark the appropriate box next to your chosen answer, with an x, and answer all question to the best of your ability.
How many times have you tried to smoking?
{ } 1or 2
{ } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{ } 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{ } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{ } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{ } no
Why?
Are you still smoking?
{ } yes
{ } no
Why?
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do):
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{ }Yes { }No
I consent to the use of materials involving my participation in this research.
{ }Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{x} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x} no
How many different methods for quitting have you tried?
{x} 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{x} Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{x}Other
At what age did you begin smoking?
{x} less than 13 years
{ } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why?
It’s disgusting and bad for you.
Are you still smoking?
{ } yes
{x} no
Why?
I quit successfully 02/07/00
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do):
GingeroftheNorth
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{x} 1or 2
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{ } no
x-No difference
How many different methods for quitting have you tried?
{x } 1 or 2
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x } Cold turkey
How many times have you succeeded in quitting for any period of time?
{x } 0 to 2
What’s the longest amount of time that you have quit for?
{x } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{x } Cold turkey
At what age did you begin smoking?
{ } less than 13 years
{x } 13 to 18 years
9.If you could go back to when you started smoking , would you still have started?
{x } no
Why? I know better now.
Are you still smoking?
{x } no
Why? I know better now.
To be completed By Subject:
Printed Name (screen name will do):Molly & Polly.
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{x } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{x } yes
{ } no
How many different methods for quitting have you tried?
{x } 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x } Cold turkey
{x } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x } 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{x } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{x } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x } no
Why? stupidest thing I ever did (and the candidates for this award are numerous.) Expensive, stinky, time-wasting, inconvenient, anxiety-producing (you always have to calculate when/where you can smoke) unhealthy
Are you still smoking?
{ } yes
{x } no
Why? Because the last time was sucessful! 9/1/02!
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): Cub Mistress
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x }Yes { }No
I consent to the use of materials involving my participation in this research.
{x }Yes { }No
Thanks for your replies. AdoptaDaughter is trying to get 100 responses.
She’s also said I’m eligible to participate so …
How many times have you tried to smoking?
{ } 1or 2
{ } 3 or 4
{X} 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{X} yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{X} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{X} Cold turkey
{X} Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{X} Other - hypnosis
How many times have you succeeded in quitting for any period of time?
{X} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{X} 0 to 4 months
{ } 5 to 11 months
{ } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{X} Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{X} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{X} no
Why?
Because smoking is bad for my heath, I don’t like being dependent on a substance, and it stinks.
Are you still smoking?
{X} yes
{ } no
Why? I haven’t successfully quit - yet!
Additional Comments:
I pray you don’t ever start to smoke sweetie. It’s one of the top 10 DUMB things I’ve ever done in my life and I know you’re smarter than me!
To be completed By Subject:
Printed Name (screen name will do): AdoptaMom
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{X}Yes { }No
I consent to the use of materials involving my participation in this research.
{X}Yes { }No
How many times have you tried to stop smoking?
{ } 1or 2
{X} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{X} yes
{ } no
How many different methods for quitting have you tried?
{X} 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{X} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{X} Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{X} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{X} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{X} Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{X} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{X} no
Why? Waste of time and money, plus it was a contributing factor to my frequent headaches.
Are you still smoking?
{ } yes
{X} no
Why? I’d say a major factor in my quitting was guilt. I got to where I just couldn’t smoke a cigarette without spending the entire time thinking about what a loser and a dumbass I was. (Not saying that about current smokers; it’s just how I felt towards myself.)
Additional Comments: My brother and I started to smoke around the same time. My parents and/or boyfriends would hound me about it constantly, while my younger brother smoked in relative peace. Mom even bought him cigarettes after a while! I nearly always had to sneak around to smoke even as an adult, and finally it wasn’t worth the hassle anymore. My brother still smokes. I think that’s meaningful, although at the same time, I’ll admit that no one is going to quit until they themselves decide that they’re ready.
To be completed By Subject:
Printed Name (screen name will do): Dung Beetle
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{X}Yes { }No
I consent to the use of materials involving my participation in this research.
{X}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{x} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x} no
How many different methods for quitting have you tried?
{ } 1 or 2
{x} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{x} Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{x} Gum
{x} Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{x} 5 to 11 months
{ } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{x} Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why?
Terrible for my health, extremely difficult to quit, expensive, stinky.
Are you still smoking?
{x} yes
{ } no
Why?
Extremely difficult to quit.
Additional Comments:
none
To be completed By Subject:
Printed Name (screen name will do): Vevila
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{x} 1or 2
{ } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{x} yes
{ } no
How many different methods for quitting have you tried?
{x} 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{x} Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why? Expensive, difficult to quit, pointless habit that damages your health, makes you stink and turns you into a social pariah - there’s no upside.
Are you still smoking?
{ } yes
{x} no
Why? I successfully quit nearly 6 years ago. I continue to not smoke because I don’t want to go back.
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): Cazzle
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{X} 1or 2
{ } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{X} no
How many different methods for quitting have you tried?
{X} 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{X} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{X} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{X} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{X} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{X} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{X} yes
{ } no
Why?
Are you still smoking?
{ } yes
{X} no
Why? Because I quit.
Additional Comments: I smoked while in college and quit not long after. It was difficult, but not impossible for me to quit. For my husband, however, it proved impossible, and he is still smoking 25 years later. He has tried many times, by many methods.
To be completed By Subject:
Printed Name (screen name will do): WVmom
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{X}Yes { }No
I consent to the use of materials involving my participation in this research.
{X}Yes { }No
How many times have you tried to stop smoking?
{x} 1or 2
{ } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x} no
How many different methods for quitting have you tried?
{x} 1 or 2
{ } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why?
Expensive, smelly and inconvienent habit.
Are you still smoking?
{x} yes
{ } no
Why?
I still enjoy it.
Additional Comments:
The one time I wanted to stop smoking was when I was pregnant and then nursing. I did, then resumed smoking after weaning the baby.
I quit cold turkey, possibly it’s easier to do so when popping pre-natal vitamins and marinating in pregnancy hormones, this method of quitting isn’t endorsed by any medical community I’m aware of, however successful.
To be completed By Subject:
Printed Name (screen name will do): Tonya
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
Directions: Mark the appropriate box next to your chosen answer, with an x, and answer all question to the best of your ability.
How many times have you tried to smoking?
{ } 1or 2
{x} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{x} yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{x} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{x} Gum
{x} Gradual reduction
{x} Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{ } 13 to 18 years
{x} 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why?
It’s a ridiculous habit. I hated that my clothes reeked, that I was out of breath all the time and the money I wasted makes me want to eat my own eyes.
Are you still smoking?
{ } yes
{x} no
Why?
I quit four months ago because I decided I did not want to harm my health further and I wanted to save money and smell better. (I’ve saved $1300 so far)
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): The Chao Goes Mu
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{X} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{X} yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{X} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{X} Cold turkey
{ } Nicotine patches
{X} Group therapy/Support group
{ } Self help kits
{X} Gum
{X} Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{X} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{X} 1 year or more
(I quit smoking regularly in July of 2005, and smoke only occasionally when out for dinner and drinks now)
What methods have worked best for you? (Mark all that apply.)
{X} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{X} less than 13 years
{ } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{X} yes
{ } no
Why?
Not that I would want to, but being realistic I probably would considering the environment I grew up in. Both my parents smoked like chimneys, everyone in their family and circle of friends smoked, and restaurants and public areas were much more accepting of smoking then.
Are you still smoking?
{X} yes
{ } no
Why?
Only occasionally, when out for dinner and drinks. It’s an enjoyable way to wrap up a meal, and a great accompaniment to a drink. I don’t smoke on a daily basis, and I hate having more than one or two at a time when I go out, but it remains an enjoyable activity for me, despite the health risks involved.
Additional Comments:
I had my first cigarette when I was 11, and while I wish I had never started, I think that given the environment I never really had a chance. Almost every single adult authority figure in my life smoked, including parents, relatives, and teachers. There wasn’t quite as much a stigma against smoking, and most public spaces still welcomed smoking (even indoors). I recall going to movie theaters when I was in high school where you could smoke, have a beer, and enjoy pizza while watching the film. I started smoking regularly when I got my first job at 15, and didn’t have anything to do during my mandated break period. Everyone else would go sit outside and have a smoke, and it just seemed the thing to do. Personally, while I’m not 100% behind the anti-smoking legislation sweeping the country, I’m secretly glad that smoking is becoming less acceptable socially and less common in public.
There are some great resources online, such as Quitnet (www.quitnet.com). My boyfriend quit at the same time I did, and he was able to participate in one of their studies, for which he received a modest stipend. I think having that sort of accountability, even though they were only doing a participation study and asking neutral questions, knowing that he would be asked about it again later helped motivate him to quit. Seeing his motivation, and being around someone going through the same thing helped steel my resolve as well.
To be completed By Subject:
Printed Name (screen name will do): XJETGIRLX
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{X}Yes { }No
I consent to the use of materials involving my participation in this research.
{X}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{ } 3 or 4
{x} 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{x} yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{x} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{x} Gum
{x} Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{x} Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why? It’s a horrible disgusting deadly habit.
Are you still smoking?
{ } yes
{x} no
Why?
Hated it. Quit successfully May 2006.
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): bec
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{x } 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x } no
How many different methods for quitting have you tried?
{ } 1 or 2
{x } 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{x } Self help kits
{x } Gum
{x } Gradual reduction
{ } Other
How many times have you succeeded in quitting for any period of time?
{x } 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{x } 0 to 4 months
{ } 5 to 11 months
{ } 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{x } Self help kits
{ } Gum
{ } Gradual reduction
{ }Other
At what age did you begin smoking?
{x } less than 13 years
{ } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x } no
Why?
It’s expensive and unhealthy.
Are you still smoking?
{ } yes
{x } no
Why?
I still enjoy it.
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): tdn
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x }Yes { }No
I consent to the use of materials involving my participation in this research.
{x }Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{x} 3 or 4
{ } 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x} no
How many different methods for quitting have you tried?
{ } 1 or 2
{x} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{ } Cold turkey
{ } Nicotine patches
{x} Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{x} Other
Other: hypnosis, Wellbutrin (Zyban), Allen Carr’s book (which is a form of self-hypnosis, IMHO)
How many times have you succeeded in quitting for any period of time?
{ } 0 to 2
{x} 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{x}Other
Other: hypnosis
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why?
Health risks, expense, smell, time wasted smoking
Are you still smoking?
{x} yes
{ } no
Why?
I’m not motivated to quit again, and it helps alleviate boredom
Additional Comments:
To be completed By Subject:
Printed Name (screen name will do): AuntiePam
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to quit smoking?
{ } 1or 2
{ } 3 or 4
{x} 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{x} yes
{ } no
How many different methods for quitting have you tried?
{ } 1 or 2
{ } 3 or 4
{x} 5 or more
What method(s) have you tried? (Mark all that apply.) On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{x} Nicotine patches
{x} Group therapy/Support group
{x} Self help kits
{x} Gum
{x} Gradual reduction
{x} Other – Accupuncture, Hypnosis
How many times have you succeeded in quitting for any period of time?
{ } 0 to 2
{x} 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more - Currently, four years, six months, 12 hours, 14 minutes and 58 seconds. 24,637 cigarettes not smoked, saving $4,311.70. Life saved: 12 weeks, 1 day, 13 hours, 5 minutes.
What methods have worked best for you? (Mark all that apply.)
{x} Cold turkey
{ } Nicotine patches
{x} Group therapy/Support group
{ } Self help kits
{ } Gum
{ } Gradual reduction
{ } Other
At what age did you begin smoking?
{ } less than 13 years
{x} 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{ } yes
{x} no
Why? *In spite of the fact that I am reducing my risk of smoking-related diseases (emphysema, lung cancer, heart disease, etc.) for every day I don’t smoke, I did enough damage to my body over the 20 years I did smoke, that I still carry a higher risk for developing those diseases than had I never smoked. There is also evidence that smoking was the direct cause of my autoimmune thyroid disease, symptoms of which include (but are not limited to – these are just the ones I’ve suffered); migraine headaches, sinus infections, anomia, brittle nails and hair, dry skin, depression, memory loss, sleep apnea, severe joint and muscle pain, chronic fatigue and excessive weight gain. *
Are you still smoking?
{ } yes
{x} Hell no (Can I say that on a High school survey? ;))
Why? It is a dangerous, filthy and costly habit.
Additional Comments: Don’t Smoke!
To be completed By Subject:
Printed Name (screen name will do): Shayna
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
How many times have you tried to smoking?
{ } 1or 2
{ } 3 or 4
{x} 5 or more
When you are trying to quit smoking, is it easier to quit with friends and family around to support you, rather than to do it alone?
{ } yes
{x} no
How many different methods for quitting have you tried?
{ } 1 or 2
{x} 3 or 4
{ } 5 or more
What method(s) have you tried? (Mark all that apply.)On the back of this survey, list the brands of the products, if any.
{x} Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{x} Gum
{x} Gradual reduction
{x} Other
How many times have you succeeded in quitting for any period of time?
{x} 0 to 2
{ } 3 to 4
{ } 5 or more
What’s the longest amount of time that you have quit for?
{ } 0 to 4 months
{ } 5 to 11 months
{x} 1 year or more
What methods have worked best for you? (Mark all that apply.)
{ } Cold turkey
{ } Nicotine patches
{ } Group therapy/Support group
{ } Self help kits
{ } Gum
{x} Gradual reduction
{x}Other
At what age did you begin smoking?
{x} less than 13 years
{ } 13 to 18 years
{ } 19 or older
9.If you could go back to when you started smoking , would you still have started?
{x} yes
{ } no
Why? Despite its negative consequences, I am utterly in love with tobacco in all its forms. Knowing then what I know now, however, I would not have started on cigarettes, as I’ve found those to have the most addictiveness for the least amount of pleasure gained, but have jumped straight to smoking cigars and pipes.
Are you still smoking?
{x} yes
{ } no
Why? I have quit cigarettes for the new year, but continue to smoke pipes and cigars – I greatly enjoy doing so, exploring different blends of tobacco is an engaging hobby, and I have quite a bit of money invested in the stuff, so I might as well continue to smoke it.
Additional Comments: In addition to daily smoking of pipes and/or cigars, and until very recently cigarettes, I am a heavy user of nasal snuff, which I will be primarily relying on to carry me through my most recent attempt at quitting cigarettes.
To be completed By Subject:
Printed Name (screen name will do): yBeayf
I realize that I am free to withdraw my consent and to withdraw from the study at any time without negative consequences.
{x}Yes { }No
I consent to the use of materials involving my participation in this research.
{x}Yes { }No
Thanks!