Have you or anyone you know ever thought about quitting smoking?Many people really want to quit smoking and are not sure if they can. For some, it may not be the right time in their life. Answer the questions below to see if you are ready to stop smoking.
Do you want to quit smoking?Yes (Score: 1)
No (Score: 0)
Within 30 Days (Score: 1)
When do you plan to stop smoking?
Beyond 30 Days (Score: 0)
For Self (Score: 2)
Why do you want to stop smoking?
For Family or Others (Provider) (Score: 1)
2 or More Times (Score: 2)
How many times have you tried to stop smoking?
Once (Score: 1)
None (Score: 0)
More Than a Month (Score: 2)
How long have you gone without smoking?
Less Than a Month (Score: 1)
Not Confident Most Confident 0 1 2 3 4 5 (More than 3, Score: 1)
How confident are you that you can commit the time and planning it will take you to quit?
Not Able Most Able 0 1 2 3 4 5 (More than 3, Score:1)
How would you rate your ability to manage stress in your life?
Not Helpful Most Helpful 0 1 2 3 4 5 (More than 3, Score: 1) My score is:______
How much help do you think your friends and family are going to be in your effort to quit smoking?
- Each answer is given a point.
- Total up the number of points for the answers you gave.
- If you score higher than 5 you may be ready to quit smoking.
- Good luck!