Questionnaire for users of electronic cigarette

Q1:How old are you? (Must be 18+) ____ years old

Q2:Are you a Man or Woman?

Q3:What is your occupation? __________

Q4:What is the highest level of education that you have achieved?

Q5:Which of these best describes your current employment status?

Q6:Do you know or have you heard of electronic cigarette?

Q7:Are you currently using electronic cigarette?

Q8:In the future, do you intend to use electronic cigarette?

Q9:Do you currently smoke tobacco (cigarettes, cigars or pipe)?

Q10:Do you currently use smokeless tobacco (snuff or snus or chewing tobacco)?

Q11:Before you first used the electronic cigarette, were you a smoker or a user of smokeless tobacco?

Q12:The first time that you ever used nicotine, in which product was the nicotine?

Q13:Have you smoked any tobacco (even one puff of cigarette, cigar, pipe, etc.), or used smokeless tobacco in the past 7 days?

Q14:During the past 31 days, on how many days did you smoke or use smokelesstobacco? ____ days / 31

Q15:How old were you when you first started to smoke daily or to use smokeless tobacco daily?I was ____ years old

Q16:What kind of smoker you are ?

:Four questions for EX-smokers and EX-users of smokeless tobacco

Q17:When did you quit smoking or stop using smokeless tobacco?____ / ____ / ____ (dd / mm / yy)

Q18:Before you quit smoking, how many cigarettes (tobacco) did you smoke per day, on average?I smoked ____cig./day before I quit smoking

Q19:Before you quit smoking, how soon after waking up did you smoke your first cigarette of the day, usually? ____ minutes

Q20:Please rate your addiction to tobacco cigarettes when you were a smoker, on a scale of 0 to 100:____Addiction to tobacco cigarettes when you were a smoker (0-100)- I was NOT addicted to tobacco cigarettes at all = 0 - I was extremely addicted to tobacco cigarettes = 100

:Questions for current smokers

Q21:Currently, how many cigarettes (tobacco) do you smoke per day, on average?I currently smoke ____ cig./day (tobacco)

Q22:Usually, how soon after waking up do you smoke your first cigarette of the day? ____ minutes

Q23:Please rate your addiction to tobacco cigarettes on a scale of 0 to 100:____ Addiction to tobacco cigarettes (0-100) -I am NOT addicted to tobacco cigarettes at all = 0 - I am extremely addicted to tobacco cigarettes = 100

Q24:If you’ve already tried to quit smoking… how long did you most recent quit attempt last? My most recent quit attempt lasted__________

Q25:How long did your longest quit attempt last? My longest quit attempt lasted: ____

Q26:If you have gone back to smoking after trying to quit, when did you start smoking again the last time?I started smoking again the last time on: ____ / ____ / ____ (dd / mm / yy)

Q27:Are you currently trying to reduce your smoking?

Q28:Do you intend to quit smoking?

Q29:If you tried to quit smoking, are you sure that you could actually quit?

Q30:Is it likely that, in one month from today, you will have quit smoking?

Q31:If you have decided to quit smoking, have you set a quit date?

Q32:If you have, what is your target quit date?I have decided to quit smoking on: ____ / ____ / ____ (dd / mm / yy)

Q33:Do your relatives / friends / colleagues ask you to quit smoking?