POW'R Cessation Center - For Tobacco Users

FOR TOBACCO USERS

TAKE THE QUIZ

Take the Quiz: Why Do I Smoke?

Here are some statements made by individuals describing why they smoke. Do you feel this way when smoking? Circle the number for each statement. Important: ANSWER EVERY QUESTION. (The term smoke or smoking refers to cigarettes, cigars, and pipes.)

5	4	3	2	1
Always	Frequently	Occasionally	Seldom	Never

I smoke in order to keep myself from slowing down

Handling a cigarette, cigar, or pipe is part of the enjoyment of smoking

Smoking is pleasant & relaxing

I light up when I feel angry

When I run out of tobacco, I find it almost unbearable until I can get some more

I smoke automatically without even being aware of it

I smoke for stimulation, to perk myself up

Part of the enjoyment of smoking comes from the steps I take to light up

I find smoking pleasurable

When I feel uncomfortable or upset something, I light up

I am very much aware of the fact that I am not smoking

I light up without realizing I still have one burning in the ashtray

I smoke to give me a “lift”

When I smoke, part of the enjoyment is watching the smoke as I exhale

I want to smoke most when I am comfortable and relaxed

When I feel “blue” or want to take my mind off cares and worries, I smoke

I get a real knawing hunger when I haven’t smoked for a while

I’ve Found a cigarette, cigar or pipe in my mouth and didn’t remember putting it there

HOW TO SCORE

1. Enter the number you have circled for each question in the spaces below. Put the number you have circled to Question A over Line A, to Question B over Line B., etc.

2. Add the three scores on each line to get your totals. For example, the sum of your scores over lines A, G, and M gives you a score on Stimulation; lines B, H and N gives you your score on Handling, etc.

Untitled Document

A ____
+
G_____
+
M_____
=

Totals ______Stimulation

B ____
+
H_____
+
N_____
=

Totals ______Handling

C ____
+
I_____
+
O_____
=

Totals ______Pleasurable Relaxation

D ____
+
J_____
+
P_____
=

Totals ______Crutch / Psychological Addiction

E ____
+
K_____
+
O_____
=

Totals ______Craving / Chemical Addition

F ____
+
F_____
+
R_____
=

Totals ______Habit

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POW'R To Be Tobacco Free Cessation Center (also known as POW'R Cessation Center) is one of 19 Cessation Centers in New York State which is funded through a grant by the New York State Department of Health Tobacco Control Program (NYS TCP). POW'R Cessation Centers main goal is to provide training and technical support to health care institutions and providers such as, clinics, home healthcare agencies, private practices, chemical dependency treatment centers, mental health agencies and dental offices in the design and implementation of systems to screen, identify and provide interventions and treatment for their tobacco-using patients based on the Public Health Service Clinical Practice Guidelines - "Treating Tobacco Use and Dependence" - 2000. POW'R Cessation Centers catchment area consists of Putnam, Orange, Westchester and Rockland Counties. We also assist hospitals and other healthcare facilities in all phases of becoming tobacco-free (including their entire campus). To further assist their patients and community to quit smoking, POW'R Cessation Center will train your staff to become smoking cessation facilitators.