Smoking in pregnancy survey

We are carrying out a survey to find out more about smoking cigarettes/tobacco products during pregnancy and the support that people may need to help quit during this time. We would appreciate a couple of minutes of your time to answer some questions.
 
In line with data protection law, your information will remain anonymous and will only be used to inform these plans. Thank you for your time.
1.Do you smoke cigarettes/tobacco products?
2.Does your partner smoke?
3.Do any other household members smoke?
(If you have answered NO to questions 1-3, then you do not need to continue with this survey)
4.Are you pregnant or have been pregnant?
5.Have you smoked cigarettes or tobacco while you are pregnant?
(If you have answered NO to questions 4-5, then you do not need to continue with this survey)
6.Did you have any support to reduce or quit smoking during pregnancy?
7.If you answered no, could you tell us why you did not receive support to quit smoking?
8.If you did have support to stop smoking, how was this given to you and how would you rate the advice? Please tick the support that you were given and how good you thought it was.
Not applicable
Very poor
Poor
Fair
Good
Very good
Leaflets
Online
Advice from a practitioner. E.g. GP, nurse, stop smoking advisor, midwife
9.Did you quit smoking during pregnancy as a result of advice or support? 
10.Do you feel any options below would help you to stop smoking? (Please tick all that you feel are relevant).
11.If you received support to quit smoking along with a payment incentive, what amount of money spread over the course of your pregnancy would make this a worthwhile option for you?
12.Are there any other comments you have about smoking during and after pregnancy, or about the support that you or family/friends may need?
About you

We would like to ask some questions about you. The information you provide will be kept entirely confidential and will never be traced back to you as an individual.

We are asking these questions because we want to make sure that we have asked lots of different people for their views. These questions are optional and you do not have to answer these questions if you do not want to.
13.What is the first part of your postcode? E.g. YO1
14.Please state your age from the groupings below:
15.Do you identify as?
16.What is your ethnicity?
17.What is your religion or belief?
18.Do you consider yourself to have a disability or a mental health condition? Please tick most appropriate