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Smoking and Vaping

Smoking can lead to a number of health conditions and overall poor health. The Smoking module helps patients track their smoking habits, whether they are smoking cigarettes or e-cigarettes (vapes).

Questions​

Question 1​

Have you ever smoked?

Choose one of the following

  • Yes, and I still do
  • Yes, but I quit
  • No

Question 2​

What kind of smoker are you?

Choose one of the following

  • Regular Smoker
  • Social Smoker

Question 3​

How many years have you been a smoker

Choose one of the following

  • Less than a year
  • 1 to 5 years
  • 6 to 10 years
  • 11 to 15 years
  • More than 15 years

Question 4​

Roughly how many cigarettes do you smoke a day?

Provide a numeric answer

Question 5​

How long ago did you quit smoking?

Choose one of the following

  • Less than a year
  • 1 to 5 years
  • 6 to 10 years
  • 11 to 15 years
  • More than 15 years

Question 6​

What kind of smoker were you?

Choose one of the following

  • Regular Smoker
  • Social Smoker

Question 7​

How many years were you a smoker

Choose one of the following

  • Less than a year
  • 1 to 5 years
  • 6 to 10 years
  • 11 to 15 years
  • More than 15 years

Question 8​

Roughly how many cigarettes did you smoke a month?

Provide a numeric answer

Question 9​

Have you ever vaped?

Choose one of the following

  • Yes, and I still do
  • Yes, but I quit
  • No

Question 10​

How often do you vape?

Choose one of the following

  • Rarely
  • Occasionally
  • Often
  • Every day

Question 11​

How long ago did you quit vaping?

Choose one of the following

  • Less than a year
  • 1 to 5 years
  • 6 to 10 years
  • 11 to 15 years
  • More than 15 years

Question 11​

How often did you vape?

Choose one of the following

  • Rarely
  • Occasionaly
  • Often
  • Every day