Selected CERA 2016 General Membership Survey Items with Embedded Survey Instructions
| Question | Response Options |
|---|---|
| 1) Do you currently provide labor and delivery maternity care within the United States? | Yes |
| No | |
| 2) How many of your pregnant patients are <18 years of age? | None (0%) |
| Very few (1% to 5%) | |
| Some (6% to 25%) | |
| Many (26% to 50%) | |
| Most (>50%) | |
| Instructions: The following questions relate to the prevalence of tobacco products (including electronic-cigarette [e-cigs] and other electronic-nicotine devices [ENDS]) and marijuana (including synthetic marijuana use) during pregnancy. An e-cigarette is a device that emits doses of vaporized nicotine to be inhaled. Synthetic marijuana refers to “Spice” or “K2,” or any other substance sold over-the-counter (often in gas stations) and commonly marketed or perceived as a synthetic cannabinoid. | |
| 3) In your practice, please estimate how many pregnant patients use the following: | |
| a) Traditional cigarettes | Don’t know |
| None (0%) | |
| Very few (1% to 5%) | |
| Some (6% to 25%) | |
| Many (26% to 50%) | |
| Most (>50%) | |
| b) E-cigarettes (or other ENDS) | Same as 3a response scale (above) |
| c) Nicotine replacement therapy (eg, patches, gum, lozenges, nasal spray, or inhaler) | Same as 3a response scale (above) |
| d) Medication for smoking cessation (Bupropion [Zyban] or Varenicline [Chantix]) | Same as 3a response scale (above) |
| e) Marijuana | Same as 3a response scale (above) |
| f) Synthetic marijuana (e.g., K2, Spice) | Same as 3a response scale (above) |
| 4) In your personal opinion, how safe is it for pregnant patients (during ANY trimester) to: | |
| a) Smoke cigarettes | Very safe |
| Safe | |
| Somewhat safe | |
| Unsafe | |
| Very unsafe | |
| b) Be exposed to secondhand smoke regularly | Same as 4a response scale (above) |
| c) Use e-cigarettes (or other ENDS) | Same as 4a response scale (above) |
| d) Use nicotine replacement therapy (e.g., patches, gum, lozenges, Nasal spray, or inhaler) | Same as 4a response scale (above) |
| e) Smoke or use marijuana | Same as 4a response scale (above) |
| f) Smoke or use synthetic marijuana (e.g., K2, Spice) | Same as 4a response scale (above) |
| g) Breastfeed while smoking (after delivery) | Same as 4a response scale (above) |
| 5) In your practice, how often do you screen your pregnant patients (via ANY method: interview, patient completed form, or laboratory testing) for the following: | |
| a) Use of traditional cigarettes | Never |
| Rarely | |
| Sometimes | |
| Often | |
| Very often | |
| Always | |
| b) Presence of a smoker (other than the pregnant patient) in the home | Same as 5a response scale (above) |
| c) Use of e-cigarettes (or other ENDS) | Same as 5a response scale (above) |
| d) Use of marijuana | Same as 5a response scale (above) |
| e) Use of synthetic marijuana (eg, K2, Spice) | Same as 5a response scale (above) |
| 6) If your practice screens pregnant patients for tobacco products (including electronic-nicotine devices [ENDS]) or marijuana (including synthetic marijuana) using any method, please select ALL methods you use. “Patient report” refers to a patient-completed form or a patient interview. | a) Patient report about tobacco/nicotine use |
| b) Patient report about marijuana use | |
| c) Laboratory test for screening for tobacco/nicotine use | |
| d) Laboratory test for screening for marijuana use | |
| 7) What have you prescribed or recommended to your pregnant patients who want to quit smoking? (choose all that apply) | a) Nicotine replacement therapy (i.e., gum, lozenges, patches, inhaler, nasal spray) |
| b) E-cigarettes | |
| c) Bupropion (Zyban) | |
| d) Varenicline (Chantix) | |
| e) Not applicable, I have not prescribed or recommended ANY of these | |
| 8) For the overall population, do you believe people who use e-cigarettes have a lower risk of cancer compared to traditional cigarettes? | Yes |
| About the same | |
| No | |
| 9) How often does each of the following patient groups ask you about the safety of e-cigarette use or their efficacy as a smoking cessation aid? | |
| a) Pregnant patients | Frequently |
| Sometimes | |
| Rarely | |
| Never | |
| b) All other patients | Same as 9a response scale (above) |
| 10) If recreational marijuana use (i.e., not prescribed) becomes legal (or already is) in my state, I would advise my patients NOT to use it: | |
| a) Pregnant patients | True |
| False | |
| b) All other patients | True |
| False | |