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Assessing the Impact: Check Your Mental Health and Smoking Connection
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Introduction:
You are being invited to participate in an online assessment designed to evaluate the impact of smoking on mental health. This form explains the purpose of the assessment, what you can expect during the testing process, and your rights as a participant.
Purpose of the Assessment:
The purpose of the “Impact of Smoking on Mental Health Assessment” is to understand the potential effects of smoking on mental well-being. The assessment will ask you a series of questions related to smoking habits, mental health symptoms, and beliefs about the relationship between smoking and mental health.
What You Can Expect:
The assessment will consist of 15 questions that you will be asked to answer honestly and to the best of your ability. The questions will cover various aspects of the impact of smoking on mental health, including smoking habits, mental health symptoms, and awareness of the potential link between smoking and mental well-being. The assessment can be completed online using a computer or mobile device with internet access and should take approximately [estimated time] to complete.
Confidentiality:
All of your responses will be kept confidential and will be used for research purposes only. Your personal information will be anonymized, and your identity will remain confidential. Your responses will be aggregated and analyzed in a way that ensures individual privacy and anonymity.
Risks and Benefits:
There are no known risks associated with participating in this assessment. The benefits of participating include contributing to the understanding of the impact of smoking on mental health and gaining insight into your own potential risks and areas of concern.
Voluntary Participation:
Your participation in this assessment is completely voluntary. You have the right to decline to participate or to withdraw from the assessment at any time without penalty. Your decision to participate or not will not affect your current or future relationship with any involved organizations or individuals.
Contact Information:
If you have any questions about the assessment or your rights as a participant, you may contact the research team at [contact information].
Consent:
By clicking the “I agree” button below, I indicate that I have read and understood the information provided in this form, and I voluntarily agree to participate in the “Impact of Smoking on Mental Health Assessment.” I understand that my responses will remain confidential and will be used for research purposes only.
I agree
Do you currently smoke?
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Yes
No
How long have you been smoking?
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Less than 1 year
1 to 5 years
5 to 10 years
More than 10 years
I don’t smoke
Have you tried to quit smoking in the past due to mental health concerns?
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Yes, multiple times
Yes, once
No
Have you experienced increased anxiety or panic attacks due to smoking?
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Yes, multiple times
Yes, once
No
Do you feel more stressed or overwhelmed when you can't smoke?
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Yes, significantly
Yes, moderately
No
Have you experienced symptoms of depression that you associate with smoking?
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Yes, frequently
Yes, occasionally
No
Are you aware of the potential link between smoking and mental health disorders?
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Yes, well-informed
Yes, somewhat aware
No, not aware
Have you received counseling or therapy for mental health issues related to smoking?
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Yes
No
Have you noticed a decline in your overall cognitive function or memory due to smoking?
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Yes, significantly
Yes, moderately
No
Do you use smoking as a coping mechanism for stress, anxiety, or other mental health issues?
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Yes, frequently
Yes, occasionally
No
Have you experienced difficulty sleeping or insomnia due to smoking?
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Yes, frequently
Yes, occasionally
No
Are you currently seeking help or support to quit smoking for the benefit of your mental health?
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Yes
No
Have you noticed a decline in your overall mood or increased irritability due to smoking?
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Yes, significantly
Yes, moderately
No
Have you noticed a decrease in your motivation or ability to concentrate due to smoking?
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Yes, significantly
Yes, moderately
No
Do you believe that quitting smoking would have a positive impact on your mental health?
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Yes, strongly believe
Yes, somewhat believe
No, not believe
Impact Assessment Checklist
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You have become more easily agitated or irritable.
You experience frequent mood swings or emotional instability.
You have noticed a decrease in your overall enjoyment or interest in activities.
You feel more anxious or experience heightened feelings of nervousness.
You have difficulty concentrating or focusing on tasks.
You have become more forgetful or have trouble with memory recall.
You feel a persistent sense of sadness or hopelessness.
You have noticed a decline in your motivation or energy levels.
You experience increased stress or have difficulty managing stress effectively.
You feel socially isolated or have withdrawn from social interactions.
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Find Authorization/ Registration ID
Pratibimba- Report Request
Counselling Services
Career Counselling
Online Counselling
Offline Counselling
Courses
Apply Now
Psychological tests
Theories
Multiple Intelligence Theory
Learning Style – VAK Module
Events
Online Events
Offline Events
Past Events
Articles
Self Care & Development
Personality Disorders
Hormones & Neurotransmitters
Activities
Downloads
Documents
Meditation Music
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