Tobacco Documents Online

c 1. Do you actively seek to help your patients stop:smoking? Yes No 2. a. Do you advise all yotir smoking patients to stop smoking? Yes No b. Or do you just advise those who~have a medical contraindication to smoking? Yes No 3. On average,,how many patients did you advise to stop smoking each of the last three weeks? 4. Have your patients asked you for assistance in,stopping smoking? Yes No 5. Which of the following methods do you; recommend'for your patients who have difficulties in giving up smoking? (check those used) Persuasion (by yourself) Self-help materials (National Cancer Institute;,ACCP, etc.) Group therapy (American Lung Association Stop Smoking Program, Smoke Enders, etc.) Drug therapy (tranquilizers„etc:) Over-the-counter antismoking preparations Other (hypnosis, acupuncture, etc.) 6. Do you, in general, follow up with your patients by phone on office visit after your, advice to stop smoking? If so, at what point(s)) in time? Yes No 7. 8. 9. Which of these components of cigarette smoke do you consider to be harmful: to health? (check those considered) Tars Nicotine Carbon monoxide Irritant gases Other (please specify) Do you agree that the following diseases may be linked with smoking? (check those considered) Chronic bronchitis Angina pectoris Emphysema Intermittent claudication Lung cancer Gastric ulcer Myocardial infarction Other (please specify). What;,in youropinion, arethe three main reasons why people cannotor will not'give up smoking? (check those considered), Psychological reasons (e.g_, in times of~ stress) O Social'reasons Ni cotine dependence w Long-standing habit "A C*~ Sight, touch, smell, taste of tobacco or smoke, etc. (physical satisfaction) ~ Other (please specify) 10. Do you smoke? Yes No

C 11. It no, have you ever smoked? Yes No 12. Would you like further information when the new materials become available?' Yes No 13. Do you have any comments orsuggestions regarding smoking cessation and'adjuncts and support materials to help your patients quit smoking? Thank you, Doctor, for completing this questionnaire. aoTa ta-o30 , ® Make first fold away from you. wwuu,saa ~ue m u.su Make secood And third folds as indicated by arrows orcdrawing. JWst re-fokl Uris Guestionnairewith the remrn postage panel outside, and apply this "SeIA-stick" seaL at the dotted lilne below. No additional postage is required. Thank you! BUSINESS REPLY MAIL FIRST CLASS PERMIT NO. 304. FAIRVIEW. NJ POSTAGE WILL BE PAID BY ADDRESSEE tvtERRELIl DOW PHARMACEUTICALS dNC. Subsidiary of The Dow Chemical Company' P.O. Box 688 Fairview, NJ!07022 NO POSTNGE NECESSARY IF MAILED. IN THE UNITED STATES ~ ~ f~_

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