Smoking Cessation Pre-Training Survey

	Poor	Fair	Good	Very Good	Excellent
Your overall ability to help patients quit using tobacco	Your overall ability to help patients quit using tobacco Poor	Your overall ability to help patients quit using tobacco Fair	Your overall ability to help patients quit using tobacco Good	Your overall ability to help patients quit using tobacco Very Good	Your overall ability to help patients quit using tobacco Excellent
Asking patients whether they use tobacco	Asking patients whether they use tobacco Poor	Asking patients whether they use tobacco Fair	Asking patients whether they use tobacco Good	Asking patients whether they use tobacco Very Good	Asking patients whether they use tobacco Excellent
Advising patients to quit using tobacco	Advising patients to quit using tobacco Poor	Advising patients to quit using tobacco Fair	Advising patients to quit using tobacco Good	Advising patients to quit using tobacco Very Good	Advising patients to quit using tobacco Excellent
Assessing patients' readiness to quit	Assessing patients' readiness to quit Poor	Assessing patients' readiness to quit Fair	Assessing patients' readiness to quit Good	Assessing patients' readiness to quit Very Good	Assessing patients' readiness to quit Excellent
Assisting patients with quitting	Assisting patients with quitting Poor	Assisting patients with quitting Fair	Assisting patients with quitting Good	Assisting patients with quitting Very Good	Assisting patients with quitting Excellent
Arranging follow-up counseling	Arranging follow-up counseling Poor	Arranging follow-up counseling Fair	Arranging follow-up counseling Good	Arranging follow-up counseling Very Good	Arranging follow-up counseling Excellent

Poor

Fair

Good

Very Good

Excellent

Your overall ability to help patients quit using tobacco

Your overall ability to help patients quit using tobacco Poor

Your overall ability to help patients quit using tobacco Fair

Your overall ability to help patients quit using tobacco Good

Your overall ability to help patients quit using tobacco Very Good

Your overall ability to help patients quit using tobacco Excellent

Asking patients whether they use tobacco

Asking patients whether they use tobacco Poor

Asking patients whether they use tobacco Fair

Asking patients whether they use tobacco Good

Asking patients whether they use tobacco Very Good

Asking patients whether they use tobacco Excellent

Advising patients to quit using tobacco

Advising patients to quit using tobacco Poor

Advising patients to quit using tobacco Fair

Advising patients to quit using tobacco Good

Advising patients to quit using tobacco Very Good

Advising patients to quit using tobacco Excellent

Assessing patients' readiness to quit

Assessing patients' readiness to quit Poor

Assessing patients' readiness to quit Fair

Assessing patients' readiness to quit Good

Assessing patients' readiness to quit Very Good

Assessing patients' readiness to quit Excellent

Assisting patients with quitting

Assisting patients with quitting Poor

Assisting patients with quitting Fair

Assisting patients with quitting Good

Assisting patients with quitting Very Good

Assisting patients with quitting Excellent

Arranging follow-up counseling

Arranging follow-up counseling Poor

Arranging follow-up counseling Fair

Arranging follow-up counseling Good

Arranging follow-up counseling Very Good

Arranging follow-up counseling Excellent

	Not at All Confident	Not Very Confident	Moderately Confident	Very Confident	Extremely Confident
Know the appropriate questions to ask patients when providing tobacco cessation counseling?	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not at All Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not Very Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Moderately Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Very Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Extremely Confident
Have the skills needed to counsel for an addiction?	Have the skills needed to counsel for an addiction? Not at All Confident	Have the skills needed to counsel for an addiction? Not Very Confident	Have the skills needed to counsel for an addiction? Moderately Confident	Have the skills needed to counsel for an addiction? Very Confident	Have the skills needed to counsel for an addiction? Extremely Confident
Can provide motivation to patients who want to quit?	Can provide motivation to patients who want to quit? Not at All Confident	Can provide motivation to patients who want to quit? Not Very Confident	Can provide motivation to patients who want to quit? Moderately Confident	Can provide motivation to patients who want to quit? Very Confident	Can provide motivation to patients who want to quit? Extremely Confident
Have the skills to monitor and assist patients throughout their quit attempt?	Have the skills to monitor and assist patients throughout their quit attempt? Not at All Confident	Have the skills to monitor and assist patients throughout their quit attempt? Not Very Confident	Have the skills to monitor and assist patients throughout their quit attempt? Moderately Confident	Have the skills to monitor and assist patients throughout their quit attempt? Very Confident	Have the skills to monitor and assist patients throughout their quit attempt? Extremely Confident
Have the skills to assist patients who seem to be in a hurry?	Have the skills to assist patients who seem to be in a hurry? Not at All Confident	Have the skills to assist patients who seem to be in a hurry? Not Very Confident	Have the skills to assist patients who seem to be in a hurry? Moderately Confident	Have the skills to assist patients who seem to be in a hurry? Very Confident	Have the skills to assist patients who seem to be in a hurry? Extremely Confident
Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation?	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not at All Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not Very Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Moderately Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Very Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Extremely Confident
Know when a referral to a physician is appropriate?	Know when a referral to a physician is appropriate? Not at All Confident	Know when a referral to a physician is appropriate? Not Very Confident	Know when a referral to a physician is appropriate? Moderately Confident	Know when a referral to a physician is appropriate? Very Confident	Know when a referral to a physician is appropriate? Extremely Confident
Can create consumer awareness of why patients should be asked about tobacco use?	Can create consumer awareness of why patients should be asked about tobacco use? Not at All Confident	Can create consumer awareness of why patients should be asked about tobacco use? Not Very Confident	Can create consumer awareness of why patients should be asked about tobacco use? Moderately Confident	Can create consumer awareness of why patients should be asked about tobacco use? Very Confident	Can create consumer awareness of why patients should be asked about tobacco use? Extremely Confident
Can sensitively suggest tobacco cessation to patients who use tobacco?	Can sensitively suggest tobacco cessation to patients who use tobacco? Not at All Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Not Very Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Moderately Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Very Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Extremely Confident
Are able to provide adequate counseling when time is limited?	Are able to provide adequate counseling when time is limited? Not at All Confident	Are able to provide adequate counseling when time is limited? Not Very Confident	Are able to provide adequate counseling when time is limited? Moderately Confident	Are able to provide adequate counseling when time is limited? Very Confident	Are able to provide adequate counseling when time is limited? Extremely Confident
Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco?	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not at All Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not Very Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Moderately Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Very Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Extremely Confident
Can counsel patients who are not interested in quitting?	Can counsel patients who are not interested in quitting? Not at All Confident	Can counsel patients who are not interested in quitting? Not Very Confident	Can counsel patients who are not interested in quitting? Moderately Confident	Can counsel patients who are not interested in quitting? Very Confident	Can counsel patients who are not interested in quitting? Extremely Confident

Not at All Confident

Not Very Confident

Moderately Confident

Very Confident

Extremely Confident

Know the appropriate questions to ask patients when providing tobacco cessation counseling?

Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not at All Confident

Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not Very Confident

Know the appropriate questions to ask patients when providing tobacco cessation counseling? Moderately Confident

Know the appropriate questions to ask patients when providing tobacco cessation counseling? Very Confident

Know the appropriate questions to ask patients when providing tobacco cessation counseling? Extremely Confident

Have the skills needed to counsel for an addiction?

Have the skills needed to counsel for an addiction? Not at All Confident

Have the skills needed to counsel for an addiction? Not Very Confident

Have the skills needed to counsel for an addiction? Moderately Confident

Have the skills needed to counsel for an addiction? Very Confident

Have the skills needed to counsel for an addiction? Extremely Confident

Can provide motivation to patients who want to quit?

Can provide motivation to patients who want to quit? Not at All Confident

Can provide motivation to patients who want to quit? Not Very Confident

Can provide motivation to patients who want to quit? Moderately Confident

Can provide motivation to patients who want to quit? Very Confident

Can provide motivation to patients who want to quit? Extremely Confident

Have the skills to monitor and assist patients throughout their quit attempt?

Have the skills to monitor and assist patients throughout their quit attempt? Not at All Confident

Have the skills to monitor and assist patients throughout their quit attempt? Not Very Confident

Have the skills to monitor and assist patients throughout their quit attempt? Moderately Confident

Have the skills to monitor and assist patients throughout their quit attempt? Very Confident

Have the skills to monitor and assist patients throughout their quit attempt? Extremely Confident

Have the skills to assist patients who seem to be in a hurry?

Have the skills to assist patients who seem to be in a hurry? Not at All Confident

Have the skills to assist patients who seem to be in a hurry? Not Very Confident

Have the skills to assist patients who seem to be in a hurry? Moderately Confident

Have the skills to assist patients who seem to be in a hurry? Very Confident

Have the skills to assist patients who seem to be in a hurry? Extremely Confident

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation?

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not at All Confident

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not Very Confident

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Moderately Confident

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Very Confident

Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Extremely Confident

Know when a referral to a physician is appropriate?

Know when a referral to a physician is appropriate? Not at All Confident

Know when a referral to a physician is appropriate? Not Very Confident

Know when a referral to a physician is appropriate? Moderately Confident

Know when a referral to a physician is appropriate? Very Confident

Know when a referral to a physician is appropriate? Extremely Confident

Can create consumer awareness of why patients should be asked about tobacco use?

Can create consumer awareness of why patients should be asked about tobacco use? Not at All Confident

Can create consumer awareness of why patients should be asked about tobacco use? Not Very Confident

Can create consumer awareness of why patients should be asked about tobacco use? Moderately Confident

Can create consumer awareness of why patients should be asked about tobacco use? Very Confident

Can create consumer awareness of why patients should be asked about tobacco use? Extremely Confident

Can sensitively suggest tobacco cessation to patients who use tobacco?

Can sensitively suggest tobacco cessation to patients who use tobacco? Not at All Confident

Can sensitively suggest tobacco cessation to patients who use tobacco? Not Very Confident

Can sensitively suggest tobacco cessation to patients who use tobacco? Moderately Confident

Can sensitively suggest tobacco cessation to patients who use tobacco? Very Confident

Can sensitively suggest tobacco cessation to patients who use tobacco? Extremely Confident

Are able to provide adequate counseling when time is limited?

Are able to provide adequate counseling when time is limited? Not at All Confident

Are able to provide adequate counseling when time is limited? Not Very Confident

Are able to provide adequate counseling when time is limited? Moderately Confident

Are able to provide adequate counseling when time is limited? Very Confident

Are able to provide adequate counseling when time is limited? Extremely Confident

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco?

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not at All Confident

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not Very Confident

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Moderately Confident

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Very Confident

Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Extremely Confident

Can counsel patients who are not interested in quitting?

Can counsel patients who are not interested in quitting? Not at All Confident

Can counsel patients who are not interested in quitting? Not Very Confident

Can counsel patients who are not interested in quitting? Moderately Confident

Can counsel patients who are not interested in quitting? Very Confident

Can counsel patients who are not interested in quitting? Extremely Confident

Question Title

* 3. What is your opinion about whether pharmacies should sell tobacco products?

I am strongly against it

I am against it

I am neither for or against it

I am in favor of it

I am strongly in favor of it

Smoking Cessation Pre-Training Survey

1. Pre-Training Survey

Question Title

* 1. Please rate your level of counseling skills for each of the following:

Question Title

* 2. How much confidence do you have in the following aspects of counseling patients to quit using tobacco?

Question Title

* 3. What is your opinion about whether pharmacies should sell tobacco products?