SURVEY
1. How old are you currently? 33
2. How many years have you smoked or chewed tobacco? 20
3. How old were you when you started smoking or chewing? 12-13 when I first tried them
4. How long (mo./yrs.) have you been free from tobacco use? 4 months (this time)
5. Who/What influenced you to start smoking or chewing tobacco? friends and seeing my dad smoke and my friend’s parents smoke
6. Are you currently using tobacco product(s) regularly? How often? No
7. Have you tried to QUIT using tobacco products? How many attempts? 3+ times
8. How many cigarettes or cans of chewing tobacco do/did you use per day? 1 pack
9. Does anyone in your immediate family use tobacco products regularly/daily? How often? Husband - 1/2 pack to 1 pack a day; Dad - cigars daily; brother - cigarettes and cigars occasionally
10. Do you believe tobacco use is an addictive substance? yes
11. If you are now NOT using tobacco; what method did you use to quit successfully long-term? (highlight one)
a. Group Therapy
b. Nicotine patch or gum
c. Medications or Antidepressants
d. Cold-turkey ****
e. Hypnosis
f. Other _____________(please list)
Cold Turkey (this time) because of pregnancy
12. Since quitting tobacco use, would you say your level of overall physical and mental health has: (highlight one)
a. Grown worse
b. Some what improved ****
c. Improved greatly
d. Stayed the same as before
13. What is the most significant lifestyle change you’ve made since quitting tobacco use? (explain) Pregnancy
__ PERSONAL COMMENTS:
I quit cold turkey when I was pregnant with my first and while I was nursing but started again. Hopefully, I will not make the same mistakes this time.
You guys are really awesome to help out like this. And I really, really mean that.