Special Populations Adult

Knowledge (4 questions)

After you learned you were pregnant, did your doctor or other health professional ask you whether or not you smoke or use tobacco in any form?

    1 Yes

    2 No

    7 Don’t know / Not sure

    9 Refused

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

After you learned you were pregnant, did your doctor or other health professional:(Check all that apply)

1. Yes

2. No

7. Don't know / Not Sure

9. Refused
     

Yes

No

  

_____

______

Advise you to stop smoking or using tobacco

_____

______

Encourage you to set a specific quit date

_____

______

Prescribe or recommend medicines such as Zyban or the nicotine patch, nicotine gum, nicotine inhaler, or nicotine nasal spray

_____

______

Give you information or refer you to a smoking cessation or tobacco cessation program

 

(Source: CTRI / SSS)

SOURCE: Wisconsin Tobacco Survey, CTRI, 2001

 Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk with you about any of the things listed below?

For each thing, circle Y(Yes) if someone talked with you about it or N(No) if no one talked with you about it.
 

Yes

No

a. How smoking could affect a pregnancy

Y

N

b. How alcohol use could affect a pregnancy

Y

N

c. How your eating habits could affect a pregnancy

Y

N

d. How health problems in your family could affect a pregnancy

Y

N

 

Source: 1995 PRAMS

During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below?

For each thing, please circle Y(Yes) if someone talked with you about it or circle N(No) if no one talked with you about it.
 

Yes

No

a. What you should eat during your pregnancy

Y

N

b. How smoking during pregnancy could affect your baby

Y

N

c. Breast-feeding your baby

Y

N

d. How drinking alcohol during pregnancy could affect your baby

Y

N

e. Using a seat belt during your pregnancy

Y

N

f. Birth control methods to use after your pregnancy

Y

N

g. The kinds of medicines that were safe to take during your pregnancy

Y

N

h. How using illegal drugs could affect your baby

Y

N

i. How your baby grows and develops during pregnancy

Y

N

j. What to do if your labor starts early

Y

N

k. How to keep from getting HIV (the virus that causes AIDS)

Y

N

l. Getting your blood tested for HIV (the virus that causes AIDS)

Y

N

m. Physical abuse to women by their husbands or partners

Y

N

Source: 1995 PRAMS