Tobacco Documents Online

(t)L~c.:;7 a e/: /Z& lhidg<'t burL:,u Ic% £0" It93t Exp. ~,1t ')30 ~O \.T. 2 ~lll'?tl~lli (>~ tlllt~J~,qO - tO)~ ~. D.tl$ $~,'{ Cl~ U,(;l lit. (6{,'o/ 1',7 ~# ~bS'~ ilct~l ]] )'$1(lali~ "IllO ~oLif)ll~q] Op~ll~Oll [{c,qQ~llfcl O~l/LCi'I ].rl/it, o]~liy (If (:hlc~oI ~ ~'ol/(Itl¢{ltii; lq O*le o~ t}l~ t'e~. t~lollJ~ b~ih~ Stlr,/~,t,dI bo~uso Of t]10~t ptof~.~sioll:] i!d~ic~£to:I .~llll ~lJ~.i~;ll ploco in L]le ¢o, ~/L:l~y~ iS L}iC I~liy~SCi~lL. $'h~ hL. I!O¢$~ thltll<sI OI/cI ~CO]~ I$C wish l¢ ~$DLIrC you thai L}I~ ~tirvc~ is o $~,rlou~ lC~C~,¢ch tai~dctL~Jk~l/L!~ ~tn(T thl~ o]t]~o~lglJ tile ~t~t~c~] f~hdings ~.~]1 ~o ii<%Te avo~l~b!c, th~ .ntLs~,~,r~; i~f iilTi- v;fluals M aI) i'emain ~ollf~d¢liLia], "fou~" co¢,~,ulat~on ~n flll~ii~ ou[ t},o quesr~oltn~ire ~fl] $igLi]f~¢~I~ly COl tl'ib- g~neerol¥ you~, i +" • lavu] I,, Sh¢~t$]c,y> ~lc~ot (I'f,E*'ISE ANSWI~R QLT~;S'IION 1 /.ND IdA, (~'}ii~R QULE'iIO) $ Al'PLiC',iL!~ TO *~OL;,) 1, "~'nich of the foI]olllng got.is of t01i~n¢co tl~qVe )ou ev~l u~¢d--aside fro:~ jt:$~ ~ly/rg It a 1"(~' th,:es? C1RCI!: AS N<~2Ff COI)[]S .~ . • • I L ]} YO[ lleVi; ~;?IV~; $5'~(,I<!:1} AS .~>!'~q,y• Pipe . I O/O Cig.nrs , ~( ('JCA:~ liES, SKIP lo q. lt~, ll/O Cig~,~et tes .... ~NS:¢I;R A ...... $ 17'/0 No e ~ 8?: ' 'O q-- 5- L. ~ 310 ~. ]t YOI , R S O ~Ig /~E S )~.~" ..... ¢Igrt¢~tc Scot:or? ~}ikCT,g 0):~; CO[I~:. / ]aor~nor , $'<~P ~00. ~ . , 7 ~, /,Ic you o tcgal0t o~ ~ o~c~ftl :, c garetre sr:~het~7 Re' 1 ~ g"~)n' 13/0 • "- Occa~io~iaI . . . 9 /

"2* pello~ )'O,Ll aVV y~U ,%,o}:¢d ¢I$~-¢ltes? C]}LCt,E OXL COI)[ Over h~w long o ,l life I Less th~n ] year . l 15-15 yeara , • • 5 16/0 5~9 )~,qr~ .... 3 25 3,ears ot zLole , . . 7 On tilt. ~VOI lge. lbout nile, m~ny c]g~rettes ~ ta} dO yOU snake? CJRfiI.E C,NE CODE DO~I'L smok~ eve;~ do)' . 1 5-1z, . 3 25"34 . 5 ~5-54 .... 7 Ill0 I'& ,~ d.ty . ..... 2 ID-7~ . t 35"~t . 6 55 or mo~e . . 8 ]~ t~]is mar, ~ew¢,r. el oot, ut tile some as you were ~moki /~, 31L~ot2 \ et tits ~Ilae~ CIRCLE ONE ~ODI:. Smoking ~ore now .... ] ]~/0 Smokitlg tess no,,, tie,mr} . 2 ~bout the some ...... 3 ~1~%,~ yet ever rl~¢ a $~l'lous ol[e~pt [o Stop smokil~g ¢l~,~retces entirely? CIRCLE O~E CODE . ~I ~.__~I~ EVER ~ ~I-~:D-- .-- -------..TO STOP: One ti serious attest, t? CIRCLe ONE COIJE ow long ego was tbe most roe~.~%c t~tte yoL Lticd [c z:to[l $mo;<I~13 cJgnrettes? CIRCLE ONE CODE ~f~ long ulo you ~tay CIRCLE ONE CODE Two tfmos LeSS £llan a year 1 One y~ar through 2 years 5 months, 2 2-1/2 yeats cllrous1 3 years 5 months, 3 Less than 1 week 1 1 through 3 weeks 2 1 thzough 5 ~oaLhs 5 #dld wh,ql llbOLIt .[J!f~oL.~= agO? CI[ICt,E C~EE COD[.. Smoking ~;ore ~o~, .... ~ ][910 Smoking less now (fewer) . 5 Abou~ the s~me ...... 6 Yes . ANSWER A-C l 20]0 t~o . GO %'0 r 7 2 & 3~6 times 6 21/0 7 or mor~ 7 3-I/2 years through 9 ye~z$ .... (~ 22/'0 lO > !,~r~ through 13 yeazs . . . 5 Over 13 /cars 6 l~ through ~9 nonlh~ 30 ~onths or more . 6 Ilc~w eften do you smoke a cig~recte In yovr offlcl In ~hc p*cset/ce o[ patient? CIRCLE O,~E COl)% . Frequent ly ] Occasionally . 2 Seldon . . . 3 DO UOC CreoC patients .... 5 ", 2,'dO 8. ~9~t~ ac thl~ [l~e would you like to be, . CIRCLE ONE CODE. £mok~n~ ~bout the ~lae ~unlbcl at ¢l~a~es as now? 6 smokin~ fewer cigarettes c~n no~? ........ 7 smokilg maze cigarettes t~on now? . . • . • . * . . S ~o |o~ger $[iokfng ¢igale[ce~ .......... 9 2~/0 CURVET CIGARETTE S}:OKEilS }'LtLSE SKI}' TO Q. lit.

1~. 1:01 eoch O~ the ~igCa~0s o~" eol//llt~oll:; lS~It(.d b¢lo~*s ple~s0 JEIdlcgJ~e ~,!NLhe: you ~h[nk 11o~; ila ~$(,C]/l{lOll pIt]l ttle dS~eoge ol ¢¢,rld~tio/, CIRGL£ OLI: gO[}: ON I:/C}i l,I~/i';. .... . .................. /C~USI3 CAUSK ] g]llI ~/,S!;0C:7/,'1103:, D%' [ a,. 1~1 :~ddc r cancel: ] 3 4 5 1,6/0 b. gorol~nty ~rtel). disease S 7 8 9 ~5/0 {'* Lut/g cancer 1 3 t~ 5 &6:0 "d. Ctnoll~c blvl~cbil is S ~ g 9 67/0 0~o~ ¢oncqe }- 3 I, ~ 68]0 £, Pu] n~/,nary cai~?lW s c r,w~ S ? 8 9 1,9/0 • ................. i .............................. g. I.ar) .geal cancer 1 3 t~ 5 50/0 h, Ik:~pholal v~sculc, r disease 5 7 8 9 51/(} i, I.etlkop]~k~.o (~aouLI/lip) ] 2 , ~ ~ 5 ~2/0 ,J. t,n¥ '~cd't ti~,e ]csloi1 {mouth/ ~ b */ ~; ~) ~3/t) lip) 16. Ii~ve you t~eaLcd arty p~¢ilmts it, the p:,st ~e/~t? glRCLE ON~: COI}[!. Yes . ~{s~'lk Q's, 17~25 . . 1 56/0 No . . SK1P ~0 Q, 26 . . . 2 ..................... 7 ....... 7 ................................ i .... )Frqd )i }:',: ~';.3:t~:a~: 1}. k.. ]}c~ }rou roltt]ncly [~z,d OOC :Iota Vdtl]l parnell,S ~hellleI or riot t}10g 8:tok¢ ¢Jgo:eL~o$? C][¢C].12 0}~}! C0Jli:, ~t e/ts .~, uld yea C. tJlLlate COJ)~:. All (,~ a]~nost all (95-10070 1 ~610 }~ost (65 94"/.) ....... }larty (3 S- 6!,'/,) ....... 3 ' Some {5 Y*?,) ....... ~, ' Yes ............... 7 5510 bon~t Lreat ¢,:TulLS . CO 30 q, ]~" . 9 ONE CODE• All . , .......... 1 57/0 .~lmoat ~1! .(55 99i;) .... P }:ast (65- 9~,Z) ....... 3 $ o:~e (5-3e ",,) ........ 5 I'e~ (]-4;;) ......... 6

¢i // ~ly d~d you stop ~.io1!ing ¢~I Dlc[te:,? 0¢¢~'lence of ceTtain ~yH~b[O, S I Scientific reports coaviuced lae . ? Pr~tec~ my F .uro hr~ltl . . 3 ~vo I.i~ I,iocLt. • . • • • . , • . , ~i Se!f-diselp)iL~e ........ 5 CODZ ALL T}~2 A?I'LY 26/0 Pressure fro profe~slon,~i 27/{ colle~gur~ to do ~o g 3~/0 28/0 Srt gooo e×~m~|c for patJ<nt~ 7 ~2/0 ~gfo RelJgio~s z e~,sc,,~s ....... g 33/0 SC~ good ex~,mple fez children 3010 m,d teen-~gv:~ ........ 9 34/0 dust SlOl)l)u4,,~O p~rtlculo! OIhe~ le*~sor (PLI:.A$~: $i)HCIl ~') ........................................ ~ ~6/0 10, }lc.~ long has it ])pea s£nce L~!)~ thai OI1( yeor . 1 3=I/2 ye~rs ~hrou~h you ~tepped ~mok~l g Ci~ .nrettes~ Oae yc~r it)re.ugh 9 ~e~z's ..... 4 $7/0 CIRCL~: O~41; CODE. 2 ycor~ 5 I,,ontl~S . 2 10 years thrbugh ~-1/2 ye~s tlnou~n 13 ye~r~ .... 5 ~ Di~ you mcoko cfg~rrtte~ zeg.ula~l~ Re~l~rly ..... 6 38.'0 1~' or °¢e°~i°I"~]l)'? CIRCLE OX~ CODE" Oceesionally " 7 ~fnot was the over(nge ~unber of llidn'~ ~moko every 25-3~ .... , . 5 ~9/0 / ¢~garcttes that you s~,oked per d~y . . . , . l day when you wer~ lvst ~mokfrs? 1-4 a cl~y .... ~ 35~44 ...... 6 Cl}<CI,E 0N~ CODF.. 5-1Z) .... 3 ~$~54 ...... ? ||)~. t'or t,o~¢ ]oa~ a period h~d you I.e.¢s thm~ 1 yeor . . 1 15-19 yc.ara . . . 5 40/0 Ix ~aoked~ CKgCLI: OX[: CODE. I-~ ~e~r~ ..... 2 20-?~ years . . . 6 5-9 yeors .... 3 25 yr~rs or ~,ore ? 10-]/~ years . . . or ¢~gars2 CIRCLE 0:~ COl)Z, Yes~ both pLpe ~nd Cigars . ANS~R A & B. .1 ~l/O Yes, p~pr ....... ~NS%~R A • . • 2 Yes, c~sars ..... ARSW~R B . . . 3¸ Ro, nelthe~ . . gKIP 1'O q: 15 .... 6 On the ~ver~g~, how many pipefuls do yov ~iiokv each doy? CI~L~ ONE. ]~n)t emo];e ¢vel] don • l-ll ~ day ...... 6 5-9 ....... ~ 20 or uote a day . 9 62/0 10-)9 .. .... On the ~ver,ngr, bow i~l,qny ciga~ do you s.~,oke e,~ch day? CIRCLE ONE. Don't $~oke ewry doy . l 4~/0 l-~ ~ d,ny ....... 2 3-4 .......... 3 5-8 . . . ...... 4' 9 or m~re ~ d~ . . . 5

1 + : • , l i ? -5- 18. A. II.~ you'ioutlnely .rind out flola leeil" 3[{t~(] I~o[lf-liLl~ I;]le(hor or Ilot [liey 1;:11oi<¢> cl[;0retles? C]ltC/,i: ONI¢ COl2g. l',\ "~/ /::,o,,,t I~av ~,eny of youl teen":~ge/ I/~p,71 i(at~ would you Isthll,qte .%~o,~e t'igalettcs? CIRCLE (.¢;J~ CODE, All or ,~]:,/o~t ~,11 (95"100Z) ] 5910 ilost ((,5-94"/,) ....... 2 }10i/y (35-64Z) , ...... 3 Some (5-3AZ) ....... 4 Fe~, or ~m~e (0-47.) .... 5 ~li/[tO[ {'~{~IiI3~O , * • • • • [I %'et~' . ............... 7 M;/O Ikm't t~eat Ilell-agcrs CO <10 q. ]9, 9 ~/* ,. ,And with 1,or i,la:/y of ym,1 tg£;ZT.q ~L!] g!J!'2 :~Ee~tt' s~!,'<i]!~ JK'.~J~!L~.~ hwe you discussed /~mokSog and health? C~'RCI,E OX: COD::, All .......... * .... , I 6010 kh~o.<.t ~11 (95-99Z) ........ 2 i'1o s t (65~94Z) ........... 3 }I.~ *ly (35~ 6~Z) ........... 4 so;,m (5.34%) ........... Few O" 4Z) 6 • , * • ... • , , . . , Nolie , . , , , . , . , , , , , . , ) ]9, A~,onz; yo/it Cigarette l, nlo]¢in~, p~f~el]ls who do IiO~ ]/~,v~ ~q;/), c¢>nditiotl t¢~]at DCl LO ~::ok n~,~ }10~ I+t~cty ¢]O ~,'btl aIIv~sc tO give tip c~g,qlc~ttt'!~ (or ¢&lt ¢lotra~;~i~rll]~•) ~!; a iienol:~] ~+¢olt71 1,i) ......... 1 l'1o~t (65"94%) .... 3 Sore( (5~34Z) .... 5 61/0 Almost all (95"99'/~} . 2 }bay (35-~I%) .... tl Yew (J /~Y~) ..... 6 /~. }'or Imv, maay o[ your cigmret~e ~moklng f>atSeat~ ~,il/I tho ~O~]O},~ltg ¢ondiLCol2s c[o you provide special ~'arning ebou~ etgare~tes-.~h,c is, to ~lO[, at" cul do~,n? }'1,I;~3I] C]RCI,E A}']'I ~CAI l,}g ¢0i)~1 ON l,ult~ .qile{ [)u][~ollaty co,~dittoa l P 4 $ 7 6210 Uppei Icsp~t:itor)' condf{foa l 2 4 5 7 6310 }le~ii I eondi t it,it 1 2 Ii 3 7 ~tllO t'ept 1( tdc~s 1 2 *'~ 5 ) 65/0 I'r(gnancy l 2 4 5 7 6610 + .. * ........ ~ ..................................... PerfpI,ol,~] vo~cti]~l d~ease 1 2 4 5 7 671o ~'~e>,itlt c,i lip lts~o(t ~t 7 ) Ii ~ 7 ~,~]0 • a.d i~Ise,:,nf,7 l 2 3 4 .S ~ 7 ~9/0 Any ¢onditiou 5elr~3 ~rca~ed l 2 3 4 5 6 ? 7010 ]'of tlo}, ltl./I~ O~" ~UI howl Ci~alet{{' ~IItC~I~j p{,kJ(h[8 I1~{}1 []lc~ l'©]Zo~,i;l[ C(:;;¢]j{i(~:i~ ~O you provide sl)ec~al I:alaill~ gbOut c{Sale~tcs--that isj to Sta} O~l" th~.;l? }'l,E+~Si: ACT ~t(],E ,M'Pi,JCASLE CODE 0~" }:Aoi ,.INs. i~.l.i'.4k~:o--stT[;:c>'£i I-~ <<, I s0>a-[-,.;>r {',,o:;'~"I lung and pub onary coaditi<,n 1 2 3 4 5 6 7 71/0 g[,[,et z,'spf rakoty coadit 7 on 1 P a /I 5 6 7 72/0 }[oal t Coati! t~on I ~ 3 Ii 5 G 7 *~ 3/(I epti( o ce s 1 2 3 i % 6 ? 74/0 Pt egnaacy 1 2 3 4 5 6 7 7510 }'e, sphe,•~l v•!s:u~£~<{:>ag% ...... }..+ 2 . . 3 .{+ .... { ._ ~, .... 7 7~Io • i':outh o:" IS[, Ie~fou l 2 3 4 5 6 7 77]0 gerv6usmss, lose of apletitv 1 2 3 g~ 5 6 7 78/0 ~%qr Jv~q :tlq ...... : - .............. • ,,~,< c~%l tt~o,i being v/ca+co, I 2 3 Ii 5 6 "l 79/0

• .q .f ~ s~°hJlLg? CIhCL]: Oi~g CODE" ]I~ILO .... ] 15-19 . . . 5 ZOIO ]-I~ .... 2 20-24 .... 6 5"9 ..... 3 25"29 .... 7 10..14 .... I 30 or mo~e . [ ~2, %~ell of tJ~ese h~v~ you t. ried ~n ordez tl ¢Jss~st adult ~atic;its to stop smoking fig:," Iet~es? CODE AI,L "~}~Y ~0U }b~,V}; TRIED OR (,]]LCLE COI)N 1:O,~ }~0NE. .$R¢]ntl ~moklng ~o their current cond~tion . i ).]/0 ] nfon~ the" of future health rfsk$ .... 2 12/0 I~e~o:~v~*ld plescriptlon m¢.dJcin¢ ..... 3 13/6 Reco~end non-pr~.$cr~ptlo~ products .... 4 1410 ptovld~ o'~ ~ug~cs~ e~uc~t~onz,| maLerlols . 5 15/0 Advls~ g~l, r:[e.~ ~ ~ub~tJt~tes .... ~ 1610 Advise Use of other forms of tobacco . . , ? 1710 Urge ~se of will power .......... $ |~.10 Other (D]iSCRIBE AT LEFT) ......... ] 19/0 l%t~e ................... 2 2010 23. At, ot~: lio~, naa) :Uffcrent patients do yo, see In an avcq~g~ ~cek? ~v~rage llu;~bez of patients ~I'~3/)'yF 24. ~bout ~hat" p0rcentage of youl children (12 end mder)? --- 2&'26~yyy tecn-agers (13-19)9 . ____ 27-291yyy ed~lt~ 20-34? 30-321yyy ~u]ts 35 ~nd ~'e~? . 33-35/yyy 100Z ~bout what per cent of your priv~e patients would you So) come from fm~illes with ~Ii t~nnt~nl Income of les~ thon $4,000?. . , . .,7, $6-3$/yyy ~, ~laL per cent ct,m( [rom f~m[l~ep with ~ ~nnt1~1 ~ncomo of rorc th,~n $]( 0007 ............ % ~9"&lly)'y ............. L ........................... ' -- "._ " _i_'--' "_--._7---_: .... (. ]lay+ you re~d any p,qlLS Of >"$:4"oki1~ ond }{~,~ltll," the $urgeo~ Cez/er~ ~ ~ Advl soiy Co;zaltLee'~ 1964 r~po:'~? 6~RC],E ONE CODE. yes, I have read sorm of ~t ENSI,'ER A 1 /,210 yes~ ,'1 ~sve read ~os~ of it ENSICER ~% 2 Yes~ I ~av¢ re~d ~I] of i[ fiNS1fEtl A . 3 No, ~ ]i~ve not re."d zny of ~t . GO %C Q,~7 .............. a In ~ ereral, now would you r~le those p~its t]lat ~I rco~ ~rL tc;~s of how ~cl| they I~[~.'ed th~ state of |:xcellcal . 5 ~310 knowlcdg~ ~ :hat f~e}('? CIkCLE O:~E COI)~L Cood . . ( F,~ir . . 7 }'oo~ . 8 Vc~y poor . 9.