TEST OF FAGERSTRÖM : Test to measure the tobacco dependence.
+-----------------------------------------------------------------------------------+
| How soon after you wake up do you smoke your first cigarette? |
| - within 5 minutes............... 3 |
| - 6 to 30 minutes................ 2 |
| - 31 to 60 minutes............... 1 |
| - after 60 minutes............... 0 |
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| Do you find it difficult to refrain from smoking in places where it is forbidden? |
| - yes............................ 1 |
| - no............................. 0 |
+-----------------------------------------------------------------------------------+
| Which cigarette of the day would it be most difficult for you to give up? |
| - the first one in the morning... 1 |
| - all others..................... 0 |
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| How many cigarettes a day do you smoke? |
| - 10 or less..................... 0 |
| - from 11 to 20.................. 1 |
| - from 21 to 30.................. 2 |
| - 31 or more..................... 3 |
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| Do you smoke more frequently in the morning than in the afternoon? |
| - yes............................ 1 |
| - no............................. 0 |
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| Do you smoke when you're so ill that you have to stay in bed almost all day? |
| - yes............................ 1 |
| - no............................. 0 |
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Add the points, then :
0 ā 2 points : Not addicted to nicotine.
3 ā 4 points : Weakly addicted to nicotine.
5 ā 6 points : Moderately addicted to nicotine.
7 ā 8 points : Highly addicted to nicotine.
9 ā 10 points : Very heavily addicted to nicotine.
TEST OF DEMARIA, GRIMALDI AND LAGRUE : Test to measure the motivation for smoking cessation
Pts
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| 1 | I come to the consultation spontaneously, by personal decision | 2 |
| | I come to the consultation on medical advice | 1 |
| | I come to the consultation on my family's advice | 1 |
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| 2 | I have already stopped smoking for more than one week | 1 |
+----+----------------------------------------------------------------+---+
| 3 | Currently, I have no professional problems | 1 |
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| 4 | Currently I do not have family problems | 1 |
+----+----------------------------------------------------------------+---+
| 5 | I want to break free of this slavery | 2 |
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| 6 | I do sports or intend to start doing sports | 1 |
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| 7 | I want to be in better physical condition | 1 |
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| 8 | I want to preserve my physical appearance | 1 |
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| 9 | I?m pregnant or my wife is pregnant | 1 |
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| 10 | I have young children | 2 |
+----+----------------------------------------------------------------+---+
| 11 | I am currently in good spirits | 2 |
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| 12 | I usually succeed in what I do | 1 |
+----+----------------------------------------------------------------+---+
| 13 | I am rather a calm, relaxed person | 1 |
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| 14 | My weight is usually stable | 1 |
+----+----------------------------------------------------------------+---+
| 15 | I want to have a better quality of life | 2 |
+----+----------------------------------------------------------------+---+
Add the points, then :
1 to 5 : Is this the good moment to stop smoking?
6 to 11 : Weak motivation. Chances to succeed in stopping smoking but of the difficulties to envisaging.
12 to 15 : Average motivation. Great chances to succeed in stopping smoking.
16 and + : Strong motivation. Very great chances to succeed in stopping smoking.
TEST OF HORN : Determines the psychological profile of tobacco dependence.
<---- Score ---->
+---+-------------------------------------------------------------+---+---+---+---+---+
| A | I smoke to boost myself | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+ POINTS:
| B | I take pleasure in smoking and to hold my cigarette | 5 | 4 | 3 | 2 | 1 | 1. Never
+---+-------------------------------------------------------------+---+---+---+---+---+ 2. Sometimes
| C | Drawing on one's cigarette is relaxing | 5 | 4 | 3 | 2 | 1 | 3. Moderatly
+---+-------------------------------------------------------------+---+---+---+---+---+ 4. Often
| D | I light a cigarette when I am worried | 5 | 4 | 3 | 2 | 1 | 5. Always
+---+-------------------------------------------------------------+---+---+---+---+---+
| E | When I do not have any more cigarettes I run to buy some | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| F | I smoke with automatism | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| G | I smoke to give me courage | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| H | The pleasure is initially to handle my cigarette | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| I | There is quantity of pleasures in the act of smoking | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| J | I smoke when I am badly at ease | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| K | I am not in on it when I do not smoke | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| L | I light a cigarette whereas another burns in the ashtray | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| M | I smoke to overawe others | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| N | I am pleased to look at the volutes of smoke | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| O | I smoke even if I'm relaxed | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| P | I smoke to forget when I'm depressed | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| Q | I always need to handle something | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
| R | I forget the cigarette which is in my mouth | 5 | 4 | 3 | 2 | 1 |
+---+-------------------------------------------------------------+---+---+---+---+---+
Add the points in the following topics :
- Stimulation............... : (A) + (G) + (M) % = A+G+M/sum(A:R)
- Pleasure of the gesture... : (B) + (H) + (N) % = B+H+N/sum(A:R)
- Relaxation................ : (C) + (I) + (O) % = C+I+O/sum(A:R)
- Anxiety-support........... : (D) + (J) + (P) % = D+J+P/sum(A:R)
- Absolute need............. : (E) + (K) + (Q) % = E+K+Q/sum(A:R)
- Acquired habit............ : (F) + (L) + (R) % = F+L+R/sum(A:R)
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