Table 1.
FOR WOMEN ONLY | ||
1. | Do you currently smoke cigarettes? | |
Yes □ → (Go to the Question below) No □ →(Skip the Question below) | ||
2. | If you were thinking about becoming pregnant, what would your doctor or health professional need to say to you before you would consider quitting smoking? (“X” ALL THAT APPLY) | |
My doctor would not have to give any specific reason—I would quit smoking | □ | |
Smoking before pregnancy makes it harder to become pregnant | □ | |
Smoking during pregnancy increases the chance of having a miscarriage | □ | |
Smoking during pregnancy increases the chance of having a baby born too small or born too early | □ | |
Smoking during pregnancy increases the chance of a baby being born with cleft lip or cleft palate (birth defects of the upper lip and mouth) | □ | |
Smoking increases the chance of a baby dying of Sudden Infant Death Syndrome (SIDS) | □ | |
I would not consider quitting smoking for any of these reasons | □ | |
FOR EVERYONE | ||
3. | Which of the following have you heard could result from smoking during pregnancy? (“X” ALL THAT APPLY) | |
Miscarriage | □ | |
Problems with the placenta (mother’s organ that supplies the baby’s oxygen and nutrition) | □ | |
Baby born too small (low birth weight) or too early | □ | |
Baby born with cleft lip or cleft palate (birth defects of the upper lip and mouth) | □ | |
Baby born with hearing loss | □* | |
Baby is more likely to die from Sudden Infant Death Syndrome (SIDS) | □ | |
4. | A woman who smokes can improve the health of her unborn baby if she quits smoking during which, if any, of the following times? (“X” ALL THAT APPLY) | |
Before becoming pregnant | □ | |
Early in the pregnancy, before the 3rd month | □ | |
Later in pregnancy, after the 3rd month | □ | |
None of these | □ |
‘Baby born with hearing loss’ was added as a distracter among the responses to differentiate the respondents who checked all the responses indiscriminately.