Smoking and Pregnancy Survey Directions: Please take this brief survey about what

Smoking and Pregnancy Survey
Directions: Please take this brief survey about what you know about smoking and pregnancy. This information will help me plan a teaching session for you on this topic. Please do not write your name on this survey. Thank you and I look forward to our session together on March 9th.
Please answer the following questions by circling your answer.
Do you think second-hand smoke is harmful to the child or mother during pregnancy?
Yes No
Can you name three effects of smoking in the unborn child?
Yes No
Do you know where to find help if you are trying to quit smoking?
Yes No
What would you like to know about the topic?
How do you learn best?
By listening to someone talk
By trying a new skill on my own
By watching a video on the topic
Thank you for your time!
Kristina G.
Purdue University Northwest
Baccalaureate Nursing Student