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Participant ID: 
Date: / /
Write the number of the answer that is most applicable on the line to the left of the question.
1. How soon after you awake do you smoke your first cigarette?
0. After 30 minutes
1. Within 30 minutes
2. Do you find it difficult to refrain from smoking in places where it is forbidden, such as the library, theater, or doctors' office?
0. No
1. Yes
3. Which of all the cigarettes you smoke in a day is the most satisfying?
0. Any other than the first one in the morning
1. The first one in the morning
4. How many cigarettes a day do you smoke?
0. 1-15
1. 16-25
2. More than 26
5. Do you smoke more during the morning than during the rest of the day?
0. No
1. Yes
6. Do you smoke when you are so ill that you are in bed most of the day?
0. No
1. Yes
7. Does the brand you smoke have a low, medium, or high nicotine content?
0. Low
1. Medium
2. High
8. How often do you inhale the smoke from your cigarette?
0. Never
1. Sometimes
2. Always
Scoring Instructions: Add up your responses to all the items.
Total scores should range from 0 to 11, where 7 or greater suggests physical dependence on nicotine.
TOTAL SCORE:
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., Fagerstrom, K. O. (1991). The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addictions, 86, 1119–1127.
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