| INSTRUCTIONS: Listed below are situations that lead some people to smoke. We would like to know HOW TEMPTED you may be to smoke in each situation. Please answer the following questions using a 5-point scale with 1 = NOT AT ALL TEMPTED AND
5 = EXTREMELY TEMPTED |
| How tempted are you to smoke… |
Not at all tempted |
Not very tempted |
Moderately tempted |
Very tempted |
Extremely tempted |
| 1. At a bar or cocktail lounge having a drink. |
1 |
2 |
3 |
4 |
5 |
| 2. When I am desiring a cigarette. |
1 |
2 |
3 |
4 |
5 |
| 3. When things are just not going the way I want and I am frustrated. |
1 |
2 |
3 |
4 |
5 |
| 4. With my spouse or close friend who is smoking. |
1 |
2 |
3 |
4 |
5 |
| 5. When there are arguments and conflicts with my family. |
1 |
2 |
3 |
4 |
5 |
| 6. When I am happy and celebrating. |
1 |
2 |
3 |
4 |
5 |
| 7. When I am very angry about something or someone. |
1 |
2 |
3 |
4 |
5 |
| 8. When I would experience an emotional crisis, such as an accident or death in the family. |
1 |
2 |
3 |
4 |
5 |
| 9. When I see someone smoking and enjoying it. |
1 |
2 |
3 |
4 |
5 |
| 10. Over coffee while talking and relaxing. |
1 |
2 |
3 |
4 |
5 |
| 11. When I realize that quitting smoking is an extremely difficult task for me. |
1 |
2 |
3 |
4 |
5 |
| 12. When I am craving a cigarette. |
1 |
2 |
3 |
4 |
5 |
| 13. When I first get up in the morning. |
1 |
2 |
3 |
4 |
5 |
| 14. When I feel I need a lift. |
1 |
2 |
3 |
4 |
5 |
| 15. When I begin to let down on my concern about my health and am less physically active. |
1 |
2 |
3 |
4 |
5 |
| 16. With friends at a party. |
1 |
2 |
3 |
4 |
5 |
| 17. When I wake up in the morning and face a tough day. |
1 |
2 |
3 |
4 |
5 |
| 18. When I am extremely depressed. |
1 |
2 |
3 |
4 |
5 |
| 19. When I am extremely anxious and stressed. |
1 |
2 |
3 |
4 |
5 |
| 20. When I realize I haven't smoked for a while. |
1 |
2 |
3 |
4 |
5 |
| SCORING INSTRUCTIONS: The Self-Efficacy/Temptation Scale (Long Form) provides a measure of confidence in resisting smoking in situations represented by the items. An overall score is computed by averaging across the 20 items. In addition, there are three subscales that measure broad aspects of self-efficacy to resist smoking: Positive Affect/Social Situations (items 1, 4, 6, 9, 10, and 16); Negative Affect Situations (items 3, 5, 7, 8, 18, and 19); Habit/Craving Situations (items 11, 13, 14, 15, and 20). Subscale scores are obtained by averaging the response to items within each subscale. |
| From "Relapse Situations and Self-Efficacy: An Integrative Model" by W.F. Velicer, C.C. DiClemente, J.S. Rossi, and J. O. Prochaska, 1990, Addictive Behaviors, 15:271-283. Reprinted by permission of Elsevier Science. (velicer@uri.edu) |
