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Smoking Consequences Questionnaire

The Smoking Consequences Questionnaire is a tool used to assess the possible consequences of someone's smoking habits. The questionnaire is designed to help individuals identify areas of their life that may be negatively impacted by their smoking habits.

Time to complete

3 minutes

Eligibility

Any individual who is 18 years or older and has smoked at least 100 cigarettes in their lifetime is eligible to complete the Smoking Consequences Questionnaire.

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Questions for Smoking Consequences Questionnaire

1.

Cigarettes taste good. 

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
2.

Smoking controls my appetite.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
3.

Cigarettes help me deal with anxiety or worry.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
4.

I enjoy the taste sensations while smoking.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
5.

Smoking helps me deal with depression.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
6.

Cigarettes keep me from overeating.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
7.

Cigarettes help me deal with anger.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
8.

When I smoke the taste is pleasant.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
9.

I will enjoy the flavor of a cigarette.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
10.

I will enjoy feeling a cigarette on my tongue and lips.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
11.

By smoking I risk heart disease and lung cancer.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
12.

Cigarettes help me reduce or handle tension.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
13.

Smoking helps me control my weight.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
14.

When I'm upset with someone, a cigarette helps me cope.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
15.

The more I smoke, the more I risk my health.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
16.

Cigarettes keep me from eating more than I should.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
17.

Smoking keeps my weight down.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
18.

Smoking is hazardous to my health.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
19.

Smoking calms me down when I feel nervous.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
20.

When I'm angry a cigarette can calm me down. 

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely
21.

Smoking is taking years off my life.

The answer should be a single choice:
  1. Completely Unlikely
  2. Extremely Unlikely
  3. Very Unlikely
  4. Somewhat Unlikely
  5. A Little Unlikely
  6. A Little Likely
  7. Somewhat Likely
  8. Very Likely
  9. Extremely Likely
  10. Completely Likely

Similar Ideas

  • Health Consequences of Smoking Questionnaire
  • Quitting Smoking Consequences Survey
  • Smoking Cessation Consequences Form
  • Smoking and Its Effects Questionnaire
  • Tobacco Use and Its Health Consequences Survey
  • Smoking and Health Risks Questionnaire

Here are some FAQs and additional information
on Smoking Consequences Questionnaire

What are the long-term health risks of smoking?

Smoking can increase your risk of developing serious health conditions, including cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD). It can also increase your risk for gum disease, tooth loss, infertility, and other conditions.

What are the short-term health risks of smoking?

Smoking can cause short-term health problems, such as a decreased sense of smell and taste, wheezing and coughing, difficulty breathing, and an increased risk of infection. It can also cause increased heart rate and blood pressure, and can worsen asthma and other breathing conditions.

Are there any benefits to quitting smoking?

Yes. Quitting smoking can reduce your risk for smoking-related health conditions and can improve your overall health. It can also help you save money, improve your appearance, and reduce your risk of secondhand smoke exposure.

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