skip to content »

crowd

Houston, Texas

People discussing health of women with disabilities
CROWD
not shown on screen

Health Promoting Behaviors Checklist for Women with Disabilities--Smoking

1. Have you ever smoked?

_____yes, I am a current smoker

_____yes, I smoked in the past but not now

_____no, I have never smoked

2. If you smoke, how many cigarettes do you smoke daily?

_____60 or more

_____40-59

_____20-39

_____less than 20

3. If you do not smoke now but have smoked in the past, how long has it been since you had a puff of a cigarette?

_____less than 7 days

_____at least 7 days, but less than 30 days

_____at least 30 days, but less than 6 months

_____6 months or more

What is your level of self-confidence about smoking?

If you currently smoke or smoked in the past:

1. How confident are you that you could quit smoking if you tried?

_____chose a number between 1 (not at all confident) and 10 (totally confident)

2. How confident are you that you could avoid smoking permanently since you quit?

_____chose a number between 1 (not at all confident) and 10 (totally confident)

What would it take to raise your level of self-confidence about smoking?

Physical Activity

Diet

More information on smoking...

Health Behaviors Table of Contents

E-mail this page to a friend