C.

D.

E.

1. How old were you when you started to
smoke a pipe regularly?

2.

Age

If you have stopped smoking à pipe completely, how old were you when you stopped?

(a standard pouch of tobacco contains 1 1/2 oz.)
Does not apply

How much pipe tobacco are you smoking now?

oz. per week

Not currently smoking a pipe

Do you or did you inhale the pipe smoke?

1.

Never smoked

14A.

15A.

15B.

If you get a cold, does it usually go to your chest?
(Usually means more than 1/2 the time)

During the past year, have you had
any chest illnesses that have kept
you off work, indoors at home,
or in bed?

IF YES TO 15A:

Did you produce phlegm with any
of these chest illnesses?

1. Yes

2. No 3. Don't get colds

15C.

In the past year, how many such
illnesses with (increased) phlegm
did you have which lasted a week
or more?

Number of illnesses
No such illnesses