Iowa CHAMPS: Cardiac Rehabilitation Guide: Exercise
Challenge-to-Quit Questionnaire
Peer Review Status: Internally Peer Reviewed
First Published: Unknown
Last Revised: October 2004
Please check "YES" if you anticipate the following to be a challenge in your quest to quit smoking. If you do not anticipate a problem, check "no".
I anticipate a possible problem toward achieving my goal of smoking cessation in the following circumstances:
| YES |
NO |
When offered a cigarette... |
| YES |
NO |
When seeing others smoking... |
| YES |
NO |
When feeling tense... |
| YES |
NO |
When feeling bored... |
| YES |
NO |
When feeling good... |
| YES |
NO |
When feeling depressed... |
| YES |
NO |
When confronted with withdrawal symptoms... |
| YES |
NO |
When craving for a cigarette... |
| YES |
NO |
When getting up in the morning... |
| YES |
NO |
When finished eating... |
| YES |
NO |
When drinking coffee/tea... |
| YES |
NO |
When at work... |
| YES |
NO |
When busy... |
| YES |
NO |
When taking a break... |
| YES |
NO |
When out with friends... |
| YES |
NO |
When drinking alcohol... |
| YES |
NO |
When feeling angry... |
| YES |
NO |
When feeling uncomfortable with others... |
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