1 Yes

2 No

7 Don’t know / Not sure

9 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

Have you smoked cigarettes at any time during your current pregnancy after you foundout you were pregnant?

1 Yes

2 No (SKIP TO Q99)

7 Don’t know / Not sure (SKIP TO Q99)

9 Refused (SKIP TO Q99)

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

During this pregnancy, how many total weeks or months have you smoked cigarettes?

____ Weeks

____ Months

____ I have not smoked

7 Don’t know / Not sure

9 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

When you have smoked during this pregnancy, how many days per week have you usually smoked?

____(1-7 days)

7 Don’t know / Not sure

9 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

On the days that you have smoked during this pregnancy, about how many cigarettes have you smoked per day? [Note: one pack = 20 cigarettes ]

____ cigarettes per day

97 Don’t know / Not sure

99 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

Since learning that you are pregnant, have you quit smoking for 7 days or longer?

1 Yes

2 No

7 Don’t know / Not sure

9 Refused

(Source: NHIS, 1998; modified by SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

In what month of your pregnancy did you quit for 7 days or longer?

The _____ Month

77 Don't know / Not sure

99 Refused

(Source: NHIS, 1998; modified by SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

Did you start smoking again or have you been able to stay off cigarettes?

1. Stayed off

2 Started again

7 Don’t know / Not sure

9 Refused

(Source: NHIS, 1998; with modifications by SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001