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. Author manuscript; available in PMC: 2016 Feb 25.
Published in final edited form as: Pediatr Emerg Care. 2014 Aug;30(8):546–551. doi: 10.1097/PEC.0000000000000179

TABLE 1.

Assessment Questions and Response Options

Personal and child health risk: if you keep smoking, how likely is it do you feel that you/your child will develop a serious disease because of smoking? (Likert scale 1–7: no chance to 100% certain)
Quitting and personal/child health benefit: if you stopped smoking, how do you think you/your child’s current health would change? (Likert scale 1–6, not at all to completely better)
Personal/child smoking related illness: have you/your child ever had a serious health problem that you believe was caused or made worse by smoking? (Yes, no, don’t know)
Importance-Readiness-Confidence Rulers
Importance: how important is stopping smoking to you? (Scale 1–10, not at all important to most important goal of my life)
Readiness: how ready are you to quit smoking within the next month? (Scale 1–10, not at all ready to 100% ready)
Confidence: how confident are you that you could quit smoking within the next month and stay quit for good? (Scale 1–10, not at all confident to 100% confident)