Question A Ire Revised2

The following survey is designed to explore your perception and attitudes towards smoking cessation aids (these are aids to help someone stop smoking). 1.

2. Which of the following statements best describes your experience with cigarette smoking?     

You never smoked You used to smoke, but have completely quit You currently smoke even though you have tried to quit You are a social smoker who does not smoke every day You currently smoke and have never tried to quit

3. 4. What age did you begin smoking?         

Before 18 18-25 26-30 31-36 36-40 41-45 46-50 50+ N/A

5. How long have you been smoking?      

Less than 1 year 1-3 years 4-7 years 8-10 years 10+ years N/A

6. How frequently do you smoke?    

A few times per week (1-4) At least once a day Five cigarettes a day Half a pack a day

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Pack a day More than pack a day N/A

7. Do you ever worry about the effects of tobacco use on your health?   

Yes No N/A

8. Have you ever tried to quit smoking?   

Yes No N/A

9. If YES, what method(s) did you try? (Check all that apply).        

Nicotine Patch Cold-turkey (Stopping immediately without aids) Gradual Reduction Nicotine Gum Counseling Self-Help Books Hypnosis Other, please specify ______________________________

10. Please indicate how strongly you agree or disagree with the following statements regarding smoking cessation aids? 11. Neither Agree nor Disagree

Strongly Disagree I would use a smoking cessation aid to help me quit I wouldn’t use an aid because they cost to much I wouldn’t use an aid because I’m worried about the side effects I wouldn’t use an aid because I’m not sure which one to try I wouldn’t use an aid because I don’t think they work

Strongly Agree

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12. On a scale of 1-10, how badly do you want to quit? Please circle the number that corresponds to the level of the intensity that describes your attitude Do not want Desperately to quit want to quit N/A 10

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9

13. How many times have you tried to quit?      

Never Once Twice Three times Four times More than four times

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14. You are basing your assessment on smoking cessation aids from which of the following sources: (Check all that apply)        

TV ads Newspaper Internet Healthcare professionals Employer Friends Family Members Other, please specify_____________________________

15. 16. Please rank the methods on your perception of their effectiveness. This can be based on experience or what you have heard. Circle the number that corresponds to your opinion (1=Completely Ineffective, 7=Completely Effective 17. )

18. Neither Effective nor Ineffective

Completely Ineffective

Completely Effective

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7

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Nicotine Patch Cold-turkey Gradual Reduction Nicotine Gum Counseling Self-Help Books Hypnosis 19.  

20. 

21. Rank these attributes in order of important they are to in a smoking cessation aid? Circle the number that corresponds to your opinion (1= Not Important at all, 7= Extremely Important). Not Important at All Very Effective (How well it works) Use only once a day Can be taken orally (placed in mouth)

Extremely Important

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Tastes good (if oral) Can be hidden beneath clothing Includes self-help CD Can be administered by oneself Does not involve nicotine therapy Is relatively inexpensive

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22. Rank these side effects in order of how much they would prevent you from purchasing a smoking cessation aid? Circle the number that corresponds to your opinion (7= Definitely Would Not Prevent You, 1= Definitely Would Prevent You). Definitely Would Not Prevent You Mild irritation at the Patch adherence site Dizziness Nausea Perspiration Awful Taste Moodiness/Irritability Duration of treatment exceeding two months Higher chances of weight gain

May or May Not Prevent You

Definitely Would Prevent You

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23. What is the main reason you want to quit smoking? (Check all that apply).      

Heath Social Economic Family Other, please specify ______________________ Not interested in quitting

24. Currently, there are Smoking Cessation Aids that are gums and lozenges –oral products rather nicotine patches. Are these products more preferable to you?   

Yes, I prefer gums/lozenges No, I would prefer Patch I wouldn’t care/ no preference.

25. Currently, there are clear and flesh colored transdermal patches available, would you have a preference for either?    

Clear Flesh colored No preference Other, please specify ________________________

The following questions are for classification purposes only      

26. What is your age? 18-22 23-25  26-30  31-35  36-40  41-45  46-50 50+  

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27. What is your race?      

American Indian Asian Black/African American Hispanic/Latino White/Caucasian Other, please specify____________________

28. What is your gender?  

Male Female

29. 30. What is the highest level of education completed?      

High School Associate’s degree Bachelor’s degree Master’s degree Doctorate Other, please specify ____________________

31. Which of the following groups does your total annual household income fall into?      

< $ 24,999 $25,000-$44,999 $45,000-$64,999 $65,000-$84,999 $85,000-$99,999 $100,000-$149,999  $150,000 or More