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Appendix F Sample Tobacco Assessment Questions Adapted from New Jersey QuitCenters Initial Assessment Date Initial Target Quit Date For Office Use Only TOBACCO SPECIFIC INFORMATION TOBACCO USE HISTORY.

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The CDS-12 scale is a 12-item scale that assesses some components of formal diagnostic systems' (e.g., DSM-IV and ICD-10) definitions of dependence with an emphasis on compulsion to smoke, withdrawal, loss of control, time allocation, neglect of other activities, and persistence despite harm.

DSM-5 criteria for tobacco use disorder Tobacco is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use. A great deal of time is spent in activities necessary to obtain or use tobacco.

One of the most frequently used tools for assessment of nicotine dependence is the Fagerstrom Test for Nicotine Dependence (FTND).

The Fagerström Test for Nicotine Dependence is a standard instrument for assessing the intensity of this physical addiction. The Fagerström test helps family physicians document the indications for prescribing medication for nicotine withdrawal.

Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The five major steps to intervention are the "5 A's": Ask, Advise, Assess, Assist, and Arrange. Ask - Identify and document tobacco use status for every patient at every visit.

The Guideline recommends that health professionals follow a brief, evidence-based cessation intervention known as the '5 A's': Ask about tobacco use, Advise tobacco users to quit, Assess willingness to make a quit attempt, Assist tobacco users in making a quit attempt, and Arrange for follow-up.

Assessing nicotine dependence To make a rapid assessment of nicotine dependence, ask: How many minutes after waking do you smoke your first cigarette? How many cigarettes do you smoke per day? Have you had cravings and withdrawal symptoms in previous quit attempts?

The framework includes 5 areas that research suggests contribute to continued tobacco use: nicotine addiction, psychological influences, behavioral dependencies, neurobiological factors, and social reinforcement.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232