Table 1.

Baseline Survey Components and Sources

Domain	Areas of assessment	Source(s) of questions
Tobacco use and quit attempts	Smoking history	Adapted from the California Tobacco Survey27
	Attitude toward smoking
	Interest in quitting
Process of care for smoking cessation	Provider counseled patient to stop smoking in past 12 months	Adapted from an earlier survey12
	Provider offered medications to help quit
	Receipt of smoking cessation medications
	Provider referral to in-person or telephone smoking cessation program
	Use of smoking cessation program
Health status	Self-reported health status	Adapted from the 12-item SF-12 V, a version of the SF-12 specifically for VA users28
	Physical functioning
	Mental functioning
Medical comorbidity	Pulmonary conditions	Adapted from the Medical Outcomes Study and other sources12,29
Living arrangements and demographics	Whether patient lived with family and friends	Adapted from the California Tobacco Survey27 and other sources30; demographic questions derived from an earlier survey12
	Rules about smoking in the home
	Education level
	Employment status
	Income