INFORMATION FOR THE STUDY PARTICIPANTS S.No

CONFIDENTIAL- Prevalence of nicotine addiction among Aari-Zardozi workers in Lucknow, Uttar Pradesh, India. PAGE 1 of 10

INFORMATION FOR THE STUDY PARTICIPANTS S.No

Study Title- “Prevalence of nicotine addiction among Aari-Zardozi workers in Lucknow, Uttar

Pradesh, India”.

Dear Friend,

You are invited to take part in this sociological study.

This survey questionnaire will just take 15 min of your time. Your identity will not be recorded.

You are free to choose whether or not you wish to take part in this study.

Purpose of the study is to know:

1. The prevalence of nicotine addiction among Aari-zardozi worker.

2. Association between nicotine addiction and depression

3. Association between nicotine addiction and stress

4. Association between nicotine addiction and socio-economic status

5. Association between nicotine addiction and loneliness.

You can participate in the study if:

1- You are above 18 years of age

2- You have been working for more than 6 months as an Aari-Zardozi artist.

Would you like to participate in this Study?

Yes No

Name

Address

Your Initials: ___ ___ ___ Date DD MM YY


Section 1- Socio-Demographics

1. Age:

2. Gender: Male Female

3. Education:

Cannot read and write Can read but can’t write

Less than 8th standard Up to 12th standard

Graduate (Completed / Pursuing) Post graduate

4- Which religion do you follow?

Hinduism Islam Christianity Others (Specify)

5. What is your monthly income?

6. Are you single or married?

Single Married Separated

Section-2- Consumption of Nicotine and its addiction- Fagerström Nicotine Dependence

Scale

7- Do you consume any one of the following?

Guthka (with tobacco) Tobacco Pan (with tobacco) cigarette

8. How soon after you wake up do you have your first cigarette/guthka/Pan/tobacco?

3 Within 5 minutes

2 Within 6-30 minutes

1 Within 31-60 minutes

0 After 60 minutes

9- Do you find it difficult to refrain from having cigarette/guthka/pan/tobacco in places where it is forbidden

(e.g., in church, at the library, in cinema, etc.)?

1 Yes

0 No


10- If you have to give up cigarette/guthka/pan/tobacco at any one time of the day, which time of the day would

you hate most to give up?

1 The first one in the morning

0 Any other

11- How many cigarettes/guthka/pan/tobacco packet per day do you consume?

0 10 or less

1 11-20

2 21-30

3 31 or more

12- Do you smoke or eat guthka/pan/tobacco packet more during the first hours after waking than during the rest

of the day?

1 Yes

0 No

13- Do you smoke or eat guthka/pan/tobacco even when you are ill enough to be in bed most of the day?

1 Yes

0 No

Section -3 UCLA Loneliness Scale

Never-1 Rarely-2 Sometimes-3 Always-4

14- How often do you feel that you are “in tune” with the people around you?

15- How often do you feel that you lack companionship?

16- How often do you feel that there is no one you can turn to?

17- How often do you feel alone?

18- How often do you feel part of a group of friends?

19- How often do you feel that you have a lot in common with the people around you?

20- How often do you feel that you are no longer close to anyone?

21- How often do you feel that your ideas are not shared by those around you?

22- How often do you feel outgoing and friendly?


23- How often do you feel close to people?

24- How often do you feel left out?

25- How often do you feel that your relationship with others are not meaningful?

26- How often do you feel that no one really knows you well?

27- How often do you feel isolated from others?

28- How often do you feel you can find companionship when you want it?

29- How often do you feel that there are people who really understand you?

30- How often do you feel shy?

31- How often do you feel that people are around you but not with you?

32- How often do you feel that there are people you can talk to?

33- How often do you that there are people you can turn to?

Section- 4 BDI-II Scale (Depression scale)

34- Sadness

0 I do not feel sad

1 I feel sad much of the time

2 I am sad all the time

3 I am so sad or unhappy that I can’t stand it

21- Pessimism

0 I am not discouraged about my future

1 I feel more discouraged about my future than I used to be

2 I do not expect things to work out for me

3 I feel that my future is hopeless and will only get worse

22- Past failure

0 I do not feel like a failure

1 I have failed more than I should have

2 As I look back, I see a lot of failures


3 I feel I am a total failure as a person

23- Loss of pleasures

0 I get as much as pleasure as I ever did from the things I enjoy

1 I don’t enjoy the things as much as I used to

2 I get very little pleasure from the things I used to enjoy

1 I can’t get any pleasure from the things I used to enjoy.

24- Guilty feeling

0 I don’t feel particular guilty

1 I feel guilty over many things I have done or should have done

2 I feel quite guilty most of the time

2 I feel guilty all of the time

25- Punishment feelings

0 I don’t feel I am being punished

1 I feel I may be punished

2 I expect to be punished

3 I feel I am being punished

26- Self-Dislike

0 I feel the same about me as ever

1 I have lost confidence in myself

2 I am disappointed in myself

3 I dislike myself

27- Self-criticalness

0 I don’t criticize or blame myself more than usual.

1 I am more critical about myself than I used to be

2 I criticized myself for all of my faults

3 I blame myself for everything bad that happens


28- Suicidal thoughts or wishes

0 I don’t have any thoughts of killing myself.

1 I have thought of killing myself, but I would not carry them out

2 I would like to kill myself

3 I would killed myself if I had the chance

29- Crying

0 I don’t cry any more than I used to

1 I cry more than I used to

2 I cry for every little things

3 I feel like crying, but I can’t

30- Agitation

0 I am no more restless or wound up than usual

1 I feel more restless or wound up than usual

2 I am so restless or agitated that it’s hard to say still

3 I am so restless or agitated that I have to keep moving or doing something

31- Loss of interest

0 I have no interest in other people or activity

1 I am less interested in other people or things than before

2 I have lost most of my interest in other people or things

3 Its hard to get interested in anything

32- Indecisiveness

0 I make decision about as well as ever

1 I find it more difficult to make decision than usual

2 I have much greater difficulty in making decision as I used to

3 I have trouble making any decision


33- Worthlessness

0 I do not feel I am worthless

1 I don’t consider myself as worthwhile and useful as I used to.

2 I feel more worthless as compared to other people

3 I feel utterly worthless

34- Loss of energy

0 I have as much energy as ever.

1 I have less energy as I used to have

2 I don’t have energy to do very much

3 I don’t have enough energy to do anything

35- Changes in sleep pattern

0 I have not experienced any change in my sleeping pattern

1a I sleep somewhat more than usual

1b I sleep somewhat less than usual

2a I sleep a lot more than usual

2b I sleep a lot than usual

3a I sleep most of the day

3b I wake up 1-2 hrs early and can’t get back to sleep

36- Irritability

0 I am no more irritable than usual

1 I am more irritable than usual

2 I am much more irritable than usual

3 I am irritable all the time


37- Changes in appetite

0 I have not experienced any change in my appetite

1a My appetite is somewhat less than usual

1b My appetite is some what greater than usual

2a My appetite is much less than before

2b My appetite is much greater than usual

3a I have no appetite at all

3b I crave food all the time

38- Concentration difficulty

0 I can concentrate as well as ever

1 I can’t concentrate as well as usual

2 It’s hard to keep my mind on anything for very long

4 I find I can’t concentrate on anything for very long

39- Tiredness or fatigue

0 I am no more tired and fatigued than usual

1 I get more tired or fatigued more easily than usual

2 I am too tired or fatigued to do a lot of things I used to do

3 I am too tired or fatigued to do most of the things I used to do.

40- Loss of interest in sex

0 I have not noticed any recent changes in my interest in sex

1 I am less interest in sex than I used to be

2 I am much less interested in sex now

3 I have lost interest in sex completely.


Section 5- Magnitude of stress

Instructions: Please rate yourself on the items listed below by circling the answer that is most true

for you.

S.No. Questions

ALM

OST

NEV

ER

RA

REL

Y

A

VER

AG

E

SO

MET

IMES

A

LMO

ST A

LWA

YS

41 Do you feel hurried and pressured as if you do not have

enough time for everything?

42 Do your set self-imposed deadlines and quotas for

yourself?

43 Do you bring job problems or actual work home with you?

44 Do you see yourself as competitive, ambitious and

achievement oriented?

45 Do you have trouble just relaxing, taking it easy, or

goofing off?

46 Would your spouse or friends describe you as hard-driving

and as living a pressured life style?


47 Would you say that you put forth much more effort than

the average worker in your occupation?

48 Do you feel angry or get hostile if someone frustrates you

or gets in the way of your accomplishing your goal?

49 Do you regularly keep two or more activities or tasks going

at the same time, switching back and forth between

them?

50 Would you say your every day is filled mostly with

problems needing solutions rather than a predictable

routine of events

INFORMATION FOR THE STUDY PARTICIPANTS S.No

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