QUESTION:	ANSWERS:	SCORE:
1. How soon after you wake up do you smoke your first cigarette? (circle appropriate number)	a. Within 5 minutes b. 6-30 minutes c. 31-60 minutes d. After 60 minutes	3 2 1 0
2. Do you find it difficult to refrain from smoking in places where it is forbidden (such as churches, theaters, libraries, etc.)?	a. Yes b. No	1 0
3. Which of all the cigarettes you smoke in a day is the most satisfying?	a. The first one in the morning b. Any other	1 0
4. How many cigarettes do you smoke a day?	a. 10 or less b. 11-20 c. 21-30 d. 31 or more	0 1 2 3
5. Do you smoke more in the morning than during the rest of the day?	a. Yes b. No	1 0
6. Do you smoke if you are so ill that you are in bed most of the day?	a. Yes b. No	1 0
	Your Score =	_______

Score Results:

0-5 = low to moderate nicotine dependence

6-10 = high nicotine dependence