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(tobacco products)? Yes or No If yes, how many cigarettes per day? 0 6 7 8 9 1 2 3 4 5 10 11 12+ On average, about how many hours do you sleep: Weeknights ________ Weekends _______ Are you stressed? 1 Not at all Yes 2 A little or No 3 Moderate If yes, how stressed are you? Please circle 4 Very 5 Extremely How do you manage your stress? _____________________________________________________________________________ ___________________________________________________________.

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