Do you smoke? Yes / No
If āNoā, have you ever smoked? Yes / No
If you do currently smoke, how many cigarettes or ounces of tobacco do you smoke per week?
Would you like advice on giving up smoking? Yes / No
Alcohol*
1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits
MEN: How often do you have EIGHT or more drinks on one occasion?
WOMEN: How often do you have SIX or more drinks on one occasion?
Never ļæ Less than Monthly ļæ Monthly ļæ Weekly ļæ Daily ļæ
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never ļæ Less than Monthly ļæ Monthly ļæ Weekly ļæ Daily ļæ
How often during the last year have you failed to do what was normally expected of you because of drinking?
Never ļæ Less than Monthly ļæ Monthly ļæ Weekly ļæ Daily ļæ
In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?
No ļæ Yes, on one occasion ļæ Yes, more than once ļæ
