Fagerstrom Test for Nicotine Dependence for each question Please tick (√) one box How soon after waking do you smoke your first Within 5 minutes 3 cigarette? 5-30 minutes 2 31-60 minutes 1 Do you find it difficult to refrain from smoking in Yes 1 places where it is forbidden? No 0 Which cigarette would you hate to give up? The first in the morning 1 Any other 0 How many cigarettes a day do you smoke? 10 or less 0 11-20 1 21-30 2 31 or more 3 Do you smoke more frequently in the morning? Yes 1 No 0 Do you smoke even if you are sick in bed most of Yes 1 the day? No 0 Add up the scores from the questionnaire Total Score SCORE 1-2 = low dependence 3-4 = low to mod dependence 5-7 = moderate dependence 8+ = high dependence Roll your own smokers If you are smoking roll ups then you can calculate an estimated number of cigarettes from the number of gms (ounces) of tobacco used. 25gms (1 ounce) is roughly equal to 50 cigarettes. Calculate a weekly total of ounces of tobacco used and from that you work out a cigarette equivalent. Scoring Score 1-2 A patient with this score is classified as having a low dependence on nicotine. This suggests that they may not need Nicotine Replacement therapy (NRT), although it is recommended that they are monitored for withdrawal symptoms. Score 3-4 A patient with this score is classified as a low to moderate dependence on nicotine and could be offered patches, lozenges or gum. Please check the NRT recommendation chart overleaf. Score 5-7 A patient with this score is classified as moderately dependent on nicotine and can be offered patches, lozenge or gum. They can also be offered the combined therapy of patches with lozenge, gum, mouth spray, nasal spray or oral strips. Please check NRT recommendations chart overleaf Score of 8 and over A patient with this score is classified as highly dependent on nicotine and can be offered patches, inhaler, lozenges, gum, mouth spray, nasal spray or oral strips. Please check NRT recommendations chart overleaf
Fagerstrom Test for Nicotine Dependence Please tick (√) one box for each question How soon after waking do you smoke your first cigarette? Within 5 minutes 3 5-30 minutes 2 31-60 minutes 1 Do you find it difficult to refrain from smoking in places where it is forbidden? Yes 1 No 0 Which cigarette would you hate to give up? The first in the morning 1 Any other 0 How many cigarettes a day do you smoke? 10 or less 0 11-20 1 21-30 2 31 or more 3 Do you smoke more frequently in the morning? Yes 1 No 0 Do you smoke even if you are sick in bed most of the day? Yes 1 No 0 Add up the scores from the questionnaire Total Score SCORE 1-2 = low dependence 3-4 = low to mod dependence 5-7 = moderate dependence 8+ = high dependence Roll your own smokers If you are smoking roll ups then you can calculate an estimated number of cigarettes from the number of gms (ounces) of tobacco used. 25gms (1 ounce) is roughly equal to 50 cigarettes. Calculate a weekly total of ounces of tobacco used and from that you work out a cigarette equivalent. Scoring Score 1-2 A patient with this score is classified as having a low dependence on nicotine. This suggests that they may not need Nicotine Replacement therapy (NRT), although it is recommended that they are monitored for withdrawal symptoms. Score 3-4 A patient with this score is classified as a low to moderate dependence on nicotine and could be offered patches, lozenges or gum. Please check the NRT recommendation chart overleaf. Score 5-7 A patient with this score is classified as moderately dependent on nicotine and can be offered patches, lozenge or gum. They can also be offered the combined therapy of patches with lozenge, gum, mouth spray, nasal spray or oral strips. Please check NRT recommendations chart overleaf Score of 8 and over A patient with this score is classified as highly dependent on nicotine and can be offered patches, inhaler, lozenges, gum, mouth spray, nasal spray or oral strips. Please check NRT recommendations chart overleaf