1. How soon after you wake up do you smoke your first cigarette? |
 □ Within 5 min |
 □ 6–30 min |
 □ 31–60 min |
 □ After 60 min |
2.Do you find it difficult to refrain from smoking in places where it is forbidden? |
 □ Yes |
 □ No |
3.Which cigarette would you hate most to give up? |
 □ The first one in the morning |
 □ All others |
4.How many cigarettes/day do you smoke? |
 □ 10 or less |
 □ 11–20 |
 □ 21–30 |
 □ 31 or more |
5.Do you smoke more frequently during the first hours after waking than during the rest of the day? |
 □ Yes |
 □ No |
6.Do you smoke if you are so ill that you are in bed most of the day? |
 □ Yes |
 □ No |