Tobacco Documents Online

.2. 1. Which of the to|lofting for~ Of tobacco have you ever ~sed~-aside frc~% Just trying lc a fe~t times? CIRCLE 0~ CODE FO~ F~CH. Pipe 1 2 11/y Cigars ......... 5 6 12/y Cigarettes ....... I 2 13/y ~s¢ no fo,m of *-ob~ceo, • 5 6 l&/y IF "YES" TO CIGARETTES, ANSICER 2, AND ALL SUB- BEO~ Q~ESTIOh~ T~T ApPLy. IF "NO" TO CIOAP~'rEs, BUT '~f~S" TO CIGARS Abe/OR PIPE, S~PTO q. 14. IF "NO" TO ~I~ CICAP, S. ~ C~GARETTES, SKIP TO q. 15. ZF YOU HAVE EVER ~IO~D CIGARETTES~ 2. Do you 5~oke c~garectes at the presen¢ tiw~y CIRCLE O~ CODE. Yes . (A~SW~R Q'$ 3-8). 1 ~o . .(SKIPToq. 9) . 2 15/y Are you a z~guler or an occasional ©igarecce amoke~? CIRC~ OiqE CODE. Regular .... . • • • 5 Occasional ...... 6 x61y 4. Over how lonS a period in your life have you smoked eggerettes2 ¢IRCIJ~ONE CODE. Less ~han 1 year . . • I 17/y 1-6 years . . . . . . . 2 5-9 yea~s ....... 3 10-1~ years . . * . . • 6 15"19 years ...... 5 20-2~ years ...... 6 ~years o~ore . . . 7 5. On ~fi¢ sverage, eboet how ma~y c~re~kes do you s~oke each day? CIRCLE ONE CODE. D~n~t smoke every day ; 1 l-~ t day ...... 2 5-1A a day .... . • 3 15-26 ....... '.. 4 25-34 * * ~ * ..... $ 45-~ .... ~ .... 7 55 or~re . . • . . . 8 18/y 6. A. H~¢ does ~hls co'pare with the numbe~ you were Sgokin# last year a~ thSs time? C~RCI~ ONE CODE. Smoking more now ....... I 19/y Smoking less n~w (fewer) • • • 2 ~Taok~u~ ~botlt t~e snme no~ . • 3 ~. Row does the number you are smoking now c~para to the number you were smoking zhree years a~o? CIRCLE O~CODE. Smoking more now ....... 4 20/y Smoking le~s n~¢ (fewer) .... $ S~oktng about the s~me now • . 6 ~, Have you ever ~kqde a serious at£cmpt CO 8top *~oklng cigarettes entlrely? CIRCLE 0~ CODE, Yes, (AN~R A'C, TI~ CO TO Q.8). 1 211y ~o ...... (CO TO q.8) .... 2 7* • DZCKI (Contin~ed) ZF ~/Eg TRIED TO STOp: A. About h~ many tl~ have you made a ~e¢lous Ictemp~Y CZRGL~ ONE COOE. 1 ¢~e ....... ~ ° . . 1 2Z/y 2 ¢£me~ . ~ . * ° • • . • • ° 2 ~. HOW long ago we$ ¢~ most recent £1me you trie~ to ~top imoklng el£aretces? CIRCLE O~ CODE, l~=s than a year ...... l 23/y 1 yr. buc less than 2 yrs. . 2 2 yre. but less ehaa 3 y,~.. 3 3yr=. buc leJs chart4 y~=.. 4 A yr=. but lees than $ y~, . $ $ yrs. but le~s than 10 y~s,. 6 10 y~. but less ehe, 15yrs, 7 N0re then 15 y~l. * . . . . . 8 HOW long did you ~cly off cigarettes the l~st t£me you cried ¢o stop ~mokin8 ¢lezrettes7 Ia~ss than 1 week ...... ! 26/y 1 ~hrough 6 weeks ...... 2 I month throueh $ mo~ths. . . 3 6 through 11 ~onehs ..... 12 ehrough 29 ~onth= ° . . . $ 30 months or more ° . • ° • * 6 at this time would you [tke to change the n~mber of ©Igarette= you smoke? CIRCI~ ONE CODE. NO. I would like ¢o be s~kln8 sbou~ the lam~ ~g~b¢~ Of ¢~glret~es lJ ~ow , 6 f~er c~garec~¢s than nc~ . . . . 7 Ye*, Z would like to be ~o~i~g ~o~e c~garetLms than llow * • • • Yes. I ~oul~ llke to stop s~ing ¢|garettes by then .... . . . 9 25/y IF FOR~R CIC, ARETTE SMOKER: ANSWER RE~AINING Q~ESTIONS, CURRENT SMOKERS. SKIp TO ~. I~. 9. ~hF ~id you stop smoking cl~rctte~? CIRCLE AS M~.N~COD~S AS ApPLy. Occurrence of ce~cafn symptoms • • . 1 2~/y Scientific reports convinced ~ . . . 2 27/y Prote¢~ my future health ...... 3 28/y Save~e~r~y ........... 6 29/y $clf-dis~fpllne ........... $ 30/y ~ressure f~omprofess~onal ¢olleeeu¢~ ~o do so ............. 6 31/y Set g~d example for patrons ..... 7 32/y Religious reasons ......... 8 33/y 5eL ~o0d example for ehlldre~ =nd teeaagers ............ 9 ~/y Just ~topim~°-no particular reason . 1 35/y Other reason (pLEASE SPECIFY) 2 36/y

10. Bow long has it been since you stopped a~oklr~ ¢laa~ettea? CIRCLE ONE CODE. Less than a year ....... 1 37/y 1 yr. tm¢ less than 2 yrs. . . 2 2 yrs. but less th~n 3 yrs. . 3 3 yra, bus leas than 4 yrs. * 4 4 yrs, but less than 5 yrs. . 5 • $ yrs. but less than 10 yrs. . 6 10 yre. buC less than 15 yrs.. 7 Mote than 15 yrs ....... 8 11. 12. Ded you smoke cIgareLte~ regularly or occasion- ally be£ore you stopped smok£r~? CIRCLE 0NE CODE Regularly .......... 7 38/y ccca~o~lly ......... s On the ~verages how many cigarettes did ~ou smoke per day w~en you ~ete smoking last? ¢IRCI~ 0~ CODE. Dldnlt smoke every day .... 1 39/y 1-4 each day ........ . 2 $-14 each day ......... 3 15-24 each day ........ 4 25-34each d~y . ....... $ 35-44each day ........ 6 45-~ each day . , ~ ..... 7 $5 or more each ~ay ..... 8 13. For how long a period had you smoked? O~CODE. Less than i year , , , . • . . 1-4yeaTs o . . * * * • , , , 5-9 years .......... 3 10-14 years ......... 4 15-19 years ......... $ 20-24 years ......... 6 25 years or ~ore . . ; * * . . 7 C~RCI~ 1 ~0/y 2 IF YOU ~ SHOKF A PIPE OR CIGARS: 14. t/h~ch do you smoke? CIRCLE O~ COPE. • Bo~h plpe en4 cigars (ANS~R A & B)* 1 41/y .Piae but not cigars • . (ANS~R A) . . 2 Cigars but uot p£pe. .~NS~R B) . . 3 • Netther pipe nor cigars (SKIP TO Q. 15) . , 4 • . IF PIPE: On the average~ ho~ ms~y plp~fuls de you smoke each day? CIRCLE ONe, ~on'~ s~ke every day .... $ ~2/y 1"~ • day . • • • • • • • • • 6 $-9 a day .......... ? 10-19 a day ......... g 20 o¢ Vote a day . • • * • . * 9 ~. IF CIGARS: On the ayerage. ~c~ many cigars do you amo~e each d~y? CIRCLE ONE* Don't *mo~e everyday .... 1 ~3/y ]-2 a day.. .... . * * . o 2 3-~ a day ....... " .... 3 5-8 ~ day .......... * 4 ~f -3-". ~ECK_.~ '~/ERYONE PLFJ~SE ANS~£R: l~, FOr each of the diseases or renditions |lsted belch, please indicate ~hether you think ehs¢ clearance smoking; is a major eause~ a ¢on~ribut- :[ng ©a~se, is associaeed w~th or has no aaac<[a- cton w~th the disease or eond~¢ion? CIRCLE ONE COUE OH EACH LINE, A; Coronary artery disease $ 6 7 8 9 44/y B. Luttg cancer l 2 3 4 5 '~$/y Co Chron'.(: bronchf.t is $ 6 7 8 9 46/y D. Oral cancer 1 2 3 4 $ 47/y E. Pulmonary ¢'~phya eme $ 6 7 8 9 481~ 16. Have you read any parts of "b'mokingand Eealch,'~ tbe Surgeon General's Advisory Con~lt~ee's 19~repor¢, or ehe Rapor~ on Health Consequences of Seeking published in 19677 CIRCLE ONZ CODE 1964 1967 ~OR EACH ~PORT, IRevort l Report[ YesI ~ hav~ read some O~ of the report .... I ~g/y 5 50/y ~es~ ~ have read most o~ the report ...... 2 6 Tes~ I have read all of the report ...... 3 7 ~o, I have not read any of ehe repor~ .... ~ 8 IF YOU EA~ P~EAD ANY pART 0~ EIT~R I~OKT, ANSWER A; IF YOU BAVE NOT READ ANy PART OF EIT~R P~PORT, CO ON TO QUESTION 17. A. IF YES: In general, ho~ould you rate those parts that you read In eer~ of boswell they revleved the seats of knoaledge In that fleld~ CIRCLE ONE CODE FOR EACH K~PORT, 1964 19~I [Report[ Repor~ [ l~X©ellent ...... $ 51/y 1 52/y food ......... 6 2 Yalr ...... .,. 7 3 ' 7~oOr , o , o , . . , , 8 4 Very poor . . • .... 9 $ gave not read shy of it 0 6

18 6 7 8 SB/! 6 7 8 801: 2 3 ~ 61/: 0. HC~t cigarette smokers can ~to~ 1 2 3 if the want to P, ~har~aclsts should be ~ore active than they have been in speak£~g 5 6 7 before lay groups about cigarette Q. Most p~ople rill not give up s~oklng even if thclr physician 1 2 3 tells them to* R. ~here ~$ no ~ethodaround today to reall~ help a cigarette smoker 5, 6, who ~ants ~o qpi~ but eaa"t do 1~ looking over the t~ble of contents of a professional Journal, lg you say an ~rgicle o~ a~bkln$ ~nd health, how likely uo~ld you be to re~ it~ CIRCLE ONE CODE. Very likely ........... ~ ~l/y Fairly likely .......... 6 Fa|rly unlikely ......... 7 Very unlikely ........... 8 ~f~j Ofeen do you talk Ibout the effects of s~,ktng on health withyour professional coils•guYs? CZ~LE ONE CODE, BF~I~ Frequently ............ I ll/y Occasionally .......... 2: Seldom ........... * 3 ~aver ............... ~,lch of the following profes$io~al activities b~Ve you been engaged in during the past year? CIRCLE O~ IN,ACE RO~. Oitpensfng prescriptions 1 2 12~y ~eachlog ....... $ 6 13/y Research • ...... I 2 I~/y Marketing ....... $ 6 1Sly Adm~n|atr~tion .... 1 2 16/y ][o~ many years have you been a teglstered pharmacist? ClRCL£ ONE CODE. 2 yeare or less ...... .... 1 I?/y 3 to 5 years . . . . . • * • * • "2 6 to 10 years .......... 3 tl to 2~ years .... o * . . ~ 4 21 yegrs or ~ore . . . . * • * • NOt registered . , . . o • • • • 9 ~,[ch of the following statements best ducribe~ yott~ curren~ employmenC situation? ClRCLg OK~ OII)E, Own my o~u co.unity ~larvacy , , . I lB/y ]~anage s eo~waunity pharmacy .. . 2 Work in • ©¢~uuity pharmacy • , ; I~ork i~ • hospftal or clinic dis° • po~s•ry-o~o contact with the public in the work that I do . . b ~ork in a ho~pit•l or clinic dis- pens~ryo.work|ng l~ co,tact with the ~ubl|c in the s~me way ~s in a cmonunity pharmacy .... $ Own or vor~ in wholesale phar~cy . G ~ork in re~aarrh on d~ug$ . . • , . ~ •

12 o "" If yOUR ~O?,E "IS SUC~ TtL~T ~fOU t,$~E ~ CO~ACT WITtZ ~ GENERAL pUBLTC AS CUST0~L~KS, pI,~SE ANgeR AIL ~tf¢ FOLLOWING QUeStIONS. IF yOU DO NOT HAVE CONTACT ~H ~[t~ GEl/SEAL pUBLIC ~[N 2~, TO approximately how,~lny p~rDns hsVe you suggested they glve ~p cigarettes (or euc d~n sharply} as a g@neral healt~ precautionT CIRCLE 0~E CODE. yOUR ~'ORKp SKIP TO ~UESTION 33. Which Of the ~ollc@lng statemqnts bes~ describes che place you wock~ CIRCLE ONE CODE. We dispense: ...Medl©ation 8nd hea~th rela~ed luppttes o~ly ........... 1 19/y ...~ed[catioa aud non-medicAl p~oducte Iueh ss ~ameras, statLonery, @tc.~ ~oe Including ¢taare¢~es ..... 2 ..,F~ed[ea~on an~ non-med~¢al produtts~ . £nclu~Ln8 Cigarettes ........ 3 ~* ~lcb ~f t~e fo~lo~ln~ statements is ~rue fox your ptattice? CI~CL~ ONE IN EACH ROW. ~eHing ¢~garette~ a¢~ct$ patrons uho ~hen buy o~her produet~ . . . 1 2 201y Selling ¢~gacet~es attracts pa~rofis that come tn to buy exgaret~e~ and no~ht~g else ...... $ 6 ~l/y All ........... I 29/y AlmOst ~ll (9~'9~) . . . Many (35-~4Z) ...... 4 • eople buy ct~reetea usually ~he~ they are Xn ~he pharmacy to buy ao~ething e~se ......... 1 2 Only m very 8m~ll pe~ cen~ of our clientele, s~y les~ ~han 10~, buy cigaret~es ......... $ 6 ~3/y ~f we atop se~li~g c~gere¢¢e~ ¢~orrow~ a l~r~e ~t~nber Of ~d¢~on~ would co~plaln bittezly . 1 2 2~/y to~orro~, hardly any0~e wou~d ~ot~ce ~nd ~ew w6uld eomplal~ . ] 6 25/y 2~* Bow o~cen do you smoke a c~g~rette lu your pharmacy in the presente of a patronT CIRCLE ON£ COPE, ~requent[y .... -I 26/y ~co~s~on~lly . . . 2 Seldom ...... . . 3 ~ev~ . ,-* , . . . . 4 D°~°t SmOker ..etgaret~es~ ___ $ ~6, With how mOny of your• adult pa'trons have you discussed smoking and health? CIRCLE ONE COD~. All ......... 27/y ~ost (65-%Z) .... ~any (35-6~) .... Yew (I-~Z) ...... 27. Rave you ever suggeste~ to ~ey of yo.r patrod~ that they stop smokid~1~ 29. - Bone .... e ..... TO a~prox~Pm~ely h6~ ¢any patrons have you B~E~sCed tk~ty ~f~e ir~ ctgarocee~ (or e~t¢ do~n ~harp|y) ~nly for ¢05~c reaBons~ CIRCLE ONE CODE. All o , . • . . . . . * . I Al~ost all (gS-99Z) . . . 2 Ho~t (65 -9~Z) ....... 3 Karl, (35 -6¢Z) ....... ~ev (1-~%) ....... S ];one ..... , • , , , Y dty Abou~ bow ma~y different ~trons In pt~ averag~ ~21y 30, monEb #sk yOtl for assis~anc~ or adult@ {r* giving up smoking? 0IRCLE ONE CODE. ~oue . . .... o • • 1 1-4 ........ 2 [O-[4 .., , ~ ..... 4 25-29 ........... 7 36 or ~r~ ....... 8 31. 31/y Which of thos~ have you tr~ed in ordc¢ to aSS(.S¢ a~t~lt pall-otis to StOp a~ok~og ¢[g- aretce~ CIRCLE ALL THAT ~Og I~VE TRIED OR CIRCLE COI~E POR t~NE, Relate s~k[~g to t~eir current beplth tend[tree or problem ....... | 32/y Infor~ E%em of {utu~e healtt~ ~[sks . 3 33/y I~edo~nd' t~on-pr~a~t'p~:ton pro6uct*, 7 35/y ~rov{de or suagest educational malaria 1~ ............ I 36/y Advise gum~ eto.~ Its ~ubstitutes , * 3 37/~" Adv£ae Use o~ oth~T forms of tobacco ...... ....... 5 38[y U~ge use of vtllpower ....... 7 3g/y 6EI~er (V~SCRZ~E ~ L~) 1 ~O/y

Whtch of the followln8 have you don( or wou1~ you be willtr~ to do. to influence youE cu$~o~r$ ~o ~top s~okln~? AS AFPLy IK BOTH COLUmnS. • I CIRCLE AS Z~A~y CODES I I I vould J bare b~ wLll- lng to done do -6- ~snd out literature . . AddYes$ servlce clubs and church groups . . 2 ~rtlclp~ts ~n co~un~y Ca=pslgn ....... 3 Tslk :o patrons ..... Display po$~e~s or exhlbita • , . , . • . 5 Other ($1~CIFY) 6 i 42/y i 43/y 2 3 $ 6 Nothing ......... 7 7 33. ~at Is your sex7 • .le ........ I 44/y Fe~le ....... . 2 35, Eo~ old wets you on your last blrthday~ Tears : 45-~6/Fy What is the pOpUlaC£on Of the community I~ • /hle~ you do ~OSL of your work~ ¢IRCI£ ONE CODE. 9,999 or Ie~$ .... ! 47/y |0.000~49,999 . . . 2 $O.000-99~999 .... 3 100~000-499~999 . . $00.000-2 m~ll~on . S Kore than Z ~illlon , 6 TK~NK YOU FOR yOUK TI~ A~D EFFOP~T. Please Tecurn qu~s~lonna£re ~o: NATIONAL OPIKIOH RESEA~H CEhTER 6030 South Ellis Avenue Chi©a~oj ~11~nols 606~?