Table 2.

Codes, sub themes and themes identified (with examples from raw data)

Theme/sub theme	Example
Theme 1: Pharmacists' negative perceptions towards initiating tobacco-cessation discussion (10, 46)*
Sub theme 1a: Pharmacists' expectation of negative responses from patients
Fear of offending patients (9, 11)*	“Its just one of those things where you want to step lightly you don't offend someone, you know.”
AAR will be perceived by tobacco users as nagging (6, 7)	“You know people get to the point where the, –you know, do they really want someone nagging? Yeah I know I should quit, I have tried.”
Fear of tobacco users getting defensive (3, 5)	“But to tell them to quit, they get a little more, smokers tend to be a group that's a little more standoffish, you know”, “Some are very defensive about it, so it could be hard to bring it up.”
Sub theme 1b: Pharmacists' perceiving tobacco use as a sensitive issue
Stigma/taboo (3, 4)	“So it's very, a, there is a stigma attached to it.”
Choice (2, 4)	“I think we are treading on, a, personal choices.”
Private matter (1, 1)	“Its like one of those things with religion and birth control you know, you want to respect their privacy.”
Sub theme 1c: Pharmacists' assumption of negative interactions of patients with others (physicians, specialists and family members)
Others are already badgering patients to quit (3, 5)	“You know the doctor already harps on them”, “You know they have already been to the allergist, to the pulmonologist, do you want to be one more person lecturing them.”
Physician has already accounted for drug and tobacco interaction	“You know what to be honest, I sort of think that the doctor has probably, a you know, taken into consideration when they prescribed it, you know, has made those modifications.”
Theme 2: Pharmacist perceiving a rationale for initiating tobacco cessation (7, 22)
Relevance of tobacco-cessation counselling to a tobacco user's medication/disease (6, 8)	“Patient is struggling with their asthma, getting chronically sick, you know then you might be able to worm it in”, “With a birth control medication we mention it in passing”, “If they just had their wisdom teeth removed, I am not going to ask them at this point.”
Necessity/importance of discussing tobacco cessation (5, 13)	“Because right now the reason why I don't ask everyone is I don't think it's necessary. I understand its importance in health care but how am I going to use that information.”
Having something to offer (1, 1)	“If it's a, it's, there is a new program or they can get incentive for something to get them interested.”
Theme 3: Pharmacy environment (7, 19)
Remembering to implement AAR (3, 4)
Motivation of pharmacy staff (3, 3)
Ability to track patient information on pharmacy computer (3, 3)
Reimbursement for AAR (2, 2)
Other (pharmacy busyness, lack of privacy, corporate approval, quick availability of referral resource, initiation of AAR by technician, computer-system prompts)
Theme 4: Pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit (7, 15)
Patient interest in discussing tobacco cessation. (5, 8)	“I think if I knew that there was somebody there who was interested, you know, it was brought to my attention, I would make the time or, you know say, why don't we talk about it further.”
Patient readiness to consider quitting (5, 7)	“I don't want to beat on them but when they are ready, Boy I am there for them, if they are on the edge, `I am thinking about it'.”
	“I like to let people you know approach me or bring it up to me first before I actually start really going with them”, “Somebody is coming in and say I feel like crap, and then you could explore further, smoking could be one of them.” (Note: initial in-vivo codes were converted to a theme)
Theme 5: Patient initiation of tobacco cessation/worsening health discussion (7, 11)	“I like to let people you know approach me or bring it up to me first before I actually start really going with them.”, “Somebody is coming in and say I feel like crap, and then you could explore further, smoking could be one of them.” (Note: Initial in vivo codes were converted to a theme)
Theme 6: AAR characteristics (6, 12)
This theme consisted of the following in-vivo codes:
Time required for implementation of AAR (6, 6)
Ease of implementing AAR (2, 2)
Benefit to patients (2, 2)
Belief in AAR (1,1)	“You know, like anything else you got to believe in it.”
Cost to implement AAR (1,1)
Theme 7: Length of pharmacist-patient relationship/rapport with patients (5, 7)	“For someone who has been coming for a long time I am not going to ask”, “With people, people that we know, people that we have a good rapport with, then we might just mention something in passing.” (Note: initial in-vivo codes were converted to a theme)
Theme 8: Low expectations of patients (5, 7)
Patients are in a hurry (3, 4)	“And at my store, patients too, always have a rush to leave.”
Patients only want to get their medications (1, 1)	“…and patients too just, they just want to drop off and pick it up.”
Patients want limited pharmacist involvement (1, 1)	“I am just coming here to get my prescriptions filled, I don't want to tell you anything else, that, kind of attitude is probably prevalent.”
Theme 9: Pharmacists' tobacco-cessation related communication abilities (3, 5)
Ability to phrase questions non-judgmentally/empathically	“It all depends on the manner of your question and how you are going to phrase that question to come across nicely”, “So if you are sympathetic in saying yeah, I've heard its really hard to quit and they seem to have some connection, you know, are you on their side”, “Trying to identify if now is the time without trying to be offensive, you know.”

^*The first number in parentheses indicates the number of pharmacists who commented on that theme/code and the second number indicates the total number of comments.