PRACTICE ID (6 DIGIT NUMERIC)
Practice randomization group: I or C
PRACTICE ID IN WEB DATABASE
Unique ID of provider
Patient requested advice emails stopped
FU QA1: Smoked any cigarettes past 30 day (1-y, 0-n)
FU QA1A: Number days smoked (in past 30)
FU QA1B: Smoked within the past 7 days
FU QA2: Used no other tobacco products
FU QA2: Used cigar
FU QA2: Used smokeless tobacco product
FU QA2: Used tobacco candy
FU QA2: Product used- DON’T KNOW/NOT SURE
FU S1: Number of cigarettes smoke per day
FU S2: Since register, stop smok >=1 day b/c trying to quit
FU NS1: Time since last smoked regularly
FU NS2: Stopped suddenly (=1) or gradually (=2)
FU A3: Since reg - used quitline
FU A3: Since reg - used in-person counseling
FU A3: Since reg - used general websites
FU A3: Since reg - used interactive online support group
FU A3: Since reg - used hypnotherapy
FU A3: Since reg - used acupuncture
FU A3: Since reg - used nicotine replace therapy
FU A3: Since reg - used quit smoking meds
FU A3: Since reg - used prayer/faith/spiritual support
FU A4a: Agree (1-5) Dcd2Q - Influenced you cut down on smoking
FU A4b: Agree (1-5) Dcd2Q - Influenced you quit smoking
FU A4c: Agree (1-5) Dcd2Q - Influenced you talk to doctor
FU A4d: Agree (1-5) Dcd2Q - Influenced you get support from others
FU A4e: Agree (1-5) Dcd2Q - Influenced you set quitting date
FU A4f: Agree (1-5) Dcd2Q - Influenced you to use Nic replace Rx
FU A4g: Agree (1-5) Dcd2Q - Influenced you make list of reasons
FU A4h: Agree (1-5) Dcd2Q - Influenced you to use behav strategies
FU A5a Helpful(0-4) My Health Risks section of website
FU A5b Helpful(0-4) Thinking about Quitting section of website
FU A5c Helpful(0-4) Family tools section of website
FU A5d Helpful(0-4) Health provider tools section of website
FU A5e Helpful(0-4) The library section of website
FU A5f Helpful(0-4) Web resources section of website
FU A5g Helpful(0-4) Communicat w/Tobacco Treatment Specialist
FU A5h Helpful(0-4) Become Ex online community
FU A5i Helpful(0-4) Our Advice column
FU A5j Helpful(0-4) Email messages from peers
FU A5k Helpful(0-4) Email messages from Decide2Quit Experts
FU A6: Agree (1-5) Would recommend Decide2Quit to friends/family
Refuse to answer FU the survey
Only answered one question
Survey was entered by research staff
Wrong phone
Could not reach
Patient randomization group: I or C
Patient regn survey ID
Q1. Patient Age groups <19 to 65+
Q14. Patient Sex
Q15. Ethnicitity
Q16. Race African American
Q16. Race White
Q2. No internet use
Q2. Internet use: Search information
Q2. Internet use: Read information
Q2. Internet use: Use email
Q2. Internet use: View videos
Q2. Internet use: Download files
Q2. Internet use: Access social network
Q2. Internet use: Fill forms, etc
Q3. Allow smoking in home
Q4. Number cigs smoke per day
Q5. Had ever visited smoking cessation website
Q6. Stopped smoking >= 1 day b/c trying to quit
Q7. Want to stop smoking cigarettes
Q17. Highest education grade/degree
Q8. Provider: Ask if you smoke cigarettes
Q9. Provider: Advise you to quit smoking
Q10. Provider: Refer to 1-800-QUIT-NOW tobacco quitline
Q11. Provider: Arrange FU visit/call about your quitting
Q12. Provider: Prescribe nicotine patches, gum or lozenges
Q13. Provider: Give handouts or pamphlets about tobacco use