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Smoking Questionnaire (SQ)

Weitkunat Rolf; Coggins Christopher RE; Sponsiello-Wang Zheng; Kallischnigg Gerd; Dempsey Ruth

Distributed by Mapi Research Trust

Distributed by Mapi Research Trust

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Basic description

Published in 2013.

The instrument provides a core set of questions that cover the major dimensions of cigarette smoking and is consitent with current criteria used for defining smoking history and status.

It can be used on its own but was designed as a set of questions meant to be included:

  • in a larger study-specific questionnaire;
  • in a case report form.
Authors

Weitkunat Rolf; Coggins Christopher RE; Sponsiello-Wang Zheng; Kallischnigg Gerd; Dempsey Ruth

Copyright
© Philip Morris Products S.A. All rights reserved
Objective
To assess current and past cigarette smoking behavior.
To measure individual exposure related to active cigarette smoking behavior.
Therapeutic area
  • Behavior and Behavior Mechanisms
Therapeutic indication

Smoking

Type of Clinical Outcome Assessment (COA)
  • PRO PRO
Original language(s)
  • English for the USA
Bibliographic reference(s) of the original questionnaire

R Weitkunat, CRE Coggins,  Z Sponsiello-Wang, G Kallischnigg, R Dempsey. Assessment of Cigarette Smoking in Epidemiologic Studies. Beiträge zur Tabakforschung / Contributions to Tobacco Research. Volume 25, Issue 7, Pages 638–648 (Full Text)


Contact and conditions of use

Authors

Weitkunat Rolf; Coggins Christopher RE; Sponsiello-Wang Zheng; Kallischnigg Gerd; Dempsey Ruth

Contact information

Mapi Research Trust
PROVIDE™
27 rue de la Villette
69003 Lyon
France
Phone: +33 (0)4 72 13 66 66

Conditions of use

Non-Commercial Users

If you do not receive specific funding for your study, you may download the questionnaire directly:

  1. Log in or Register for free
  2. Click the 'Online distribution' tab in the left menu bar and follow the instructions

Tutorials are available on our FAQs.

Commercial Users

All requests have to be submitted through our online request management:

  1. Log in or Register for free
  2. Submit your request (Tutorials are available on our FAQs)
  3. In order to accelerate the process, you may attach the User Agreement (even if not finalized) to your online request. Click the link below for the user agreement template.
  4. Our PROVIDE team will get back to you with the needed information in a timely manner

Access fees

ROYALTY FEES* Commercial users Cost per study 1100 €
Cost per language 550 €
Funded academic research Cost per study N/A
Cost per language N/A
Not funded academic users Cost per study N/A
Cost per language N/A
DISTRIBUTION FEES* Commercial users Cost per study 1000 €
Cost per language 500 €
Funded academic research Cost per study Free
Cost per language Free
Not funded academic users Cost per study Free
Cost per language Free

* Excluding VAT
Commercial users: Industry, CRO, any for-profit companies
Funded Academic research: Projects receiving funding from commerce, government, EU or registered charity. Funded academic research– sponsored by industry fits the “commercial users” category.
Not funded academic users, individual medical practice: Projects are not explicitly funded, but funding comes from overall departmental funds or from the University or individual funds

Conditions to translate

Please refer to the "Languages" tab

Conditions to implement in electronic applications

Exclusive licensor for e-versions of the questionnaireMapi Research Trust

Academic and Commercial Users
  • Shall follow the “Conditions of use”  mentioned above
  • In addition, in case the electronic version of the questionnaire is developed by a third party (IT Company, e-PRO vendor…), User shall check with Mapi Research Trust that this third party has signed the necessary License Agreement with Mapi Research Trust before developing the electronic version of the Questionnaire.

Information Technology (IT) Companies (incl. ePRO vendors)
  • In case of a one-shot development and commercial use of an electronic version of the questionnaire by the IT Company, the IT Company shall:
    • Sign a “Specific-Study License Agreement with IT Company” with Mapi Research Trust
      • authorizing the electronic implementation of the questionnaire for the specific study only
      • shall not permit the IT Company to promote the electronic version of the questionnaire or its use for another study or another client
    • Pay a one-shot license fee per study to Mapi Research Trust: 500 Euros
  • In case of an IT Company who wishes to develop an electronic version of the questionnaire and would like to obtain a non-exclusive license to market and promote their devices / tablets / smartphones / e-applications using the questionnaire, the IT Company shall:
    • Sign a “General License Agreement with IT Company” with Mapi Research Trust
      • authorizing the electronic implementation of the questionnaire on multiple devices for multiple studies and clients
      • permitting the IT Company to promote the electronic versions of the questionnaire by any marketing means (including, but not limited to, IT Company’s  promotional documents / websites / press release / communication during conferences / webinars)
    • Pay an annual administrative fee of 2,500 Euros to Mapi Research Trust

Review copy

Examination copies can only be used for the limited purpose of examining the suitability of the Questionnaire for subsequent research and/or clinical use, and cannot be used in research or in clinical practice or distributed to others.
You are not authorized to modify, retype, translate, copy or otherwise duplicate the Questionnaire except with the further and prior written permission of Mapi Research Trust / the developers / copyright holders / distributors.

Online distribution

For Non-Funded Academic Studies

The following licensing process is restricted to academic users:

  • Who do not receive specific funding for their study
  • Who intend to use the questionnaire in individual clinical practice or research study

Should you not correspond to this category of users, please send us a request.

Note: This site aims at providing you with the original version and existing translations of the questionnaire. However some modules/versions may not be downloadable in the language you need.

If you are interested in specific language(s), please first consult the list of existing translations in PROQOLID.

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To access this section, please complete a client account.

Languages

Original language(s)

  • English for the USA

Translations

The translations listed may not have undergone a full linguistic validation process and may require further work to be suitable for use in a study. This list is subject to constant changes, therefore please check the status of translations with Mapi Research Trust / the developers / copyright holders / distributors.

SQ

Japanese
Spanish for the USA

The author has selected Mapi as exclusive linguistic validation company to ensure the production of harmonized and consistent language versions.

For additional information on available translations of this instrument, or for a project involving new languages, please submit a request (tutorials available on our FAQs).

Conditions to translate

Commercial Users

Exclusive vendor for translation work for commercial users: Mapi

Mapi Language Services has exclusivity for e-versions.

Last update: May 2017
For additional information, please submit a request. More information in our FAQs.