During the past 12 months, have you quit smoking for 1 day or longer?

1 Yes

2 No

77 Don't Know

99 Refused

SOURCE: Adult RBFSS

How many times during the past 12 months have you deliberately quit smoking cigarettes for one day or longer because you were trying to quit smoking?

__________(enter number)

77 Don't Know

99 Refused

SOURCE: Adult RBFSS

Have you ever used programs, products or medicine to help you quit smoking?

1 Yes

2 No

3 Not trying to quit

77 Don't Know

99 Refused

SOURCE: Adult RBFSS

What have you used to help you quit smoking? (Check ‘Yes’ or ‘No’ for each method)

1. Nicotine patch, gum, nasal spray, or inhaler Yes_____ No_____

2. Zyban, or other non-nicotine prescription medicine Yes_____ No_____

3. A quit smoking class or group Yes_____ No_____

4. Books, pamphlets, video or audio tapes Yes_____ No_____

5. A quit smoking telephone help line Yes_____ No_____

6 Other (please indicate):_____________________________________________

77 Don't Know

99 Refused

SOURCE: Adult RBFSS

Have you ever used the nicotine patch, nicotine gum, nicotine inhaler, nicotine nasal spray as a way to delay smoking or cut down on the amount you smoke?

1 Yes

2 No

7 Don’t know / Not sure

9 Refused

(Source: Massachusetts, 1999)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

How many serious quit attempts have you made in the past?

________ (number of serious quit attempts)

77 Don’t know / Not sure

99 Refused

(Source: Brion Fox)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

Have you ever used a tobacco cessation program or service that was paid for by your health provider at the time?

1 Yes

2 No

7 Don’t know / Not sure

9 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

Did you ever try to quit smoking because of a health condition you had at the time?

Source:1987 NHIS

What was the health condition?

Source:1987 NHIS

If you were trying to quit smoking and cost were not an issue, would you use any programs, products, or medicine to help you quit?

1. YES

2. NO

7. DON'T KNOW / NOT SURE

9. REFUSED

 

Source: Minnesota 1999

If yes, would you use...

A. Nicotine patch, gum, nasal spray, or inhaler

B. Zyban, or other non-nicotine prescription medicine

C. A quit smoking class or group

D. Books, pamphlets, video, or audio tapes

E. A quit smoking telephone help line

F. Something else

Source: Minnesota 1999