E-Cigarette & Pregnancy Study
Thank you for your interest in our research study about health behaviors in pregnant women. This study is being sponsored by the Presbyterian Health Foundation University Hospital Authority and Trust Team Science Grant. This screening survey will ask a few questions so we can see if you qualify for the study "Health behaviors during pregnancy" at the University of Oklahoma Health Sciences Center (IRB #: 10974).
This screener is voluntary, and you may choose not to answer any question; however, we may not be able to determine if you are eligible for the study if you do not answer all of the questions. All of your answers will be kept confidential and will not be shared without your permission or except as required by law.
By completing this screener you will be providing private health information which means there is a potential risk for loss of confidentiality. You will not be paid for taking this pre-screen survey. Your private health information will be kept separate from your personally identifiable information (name, contact information) and identified only with an ID number. Your personally identifiable information will be stored on a password protected server that can only be accessed by approved study personnel. If you have questions or want to complete the survey via phone, please call 405-271-7759 or email us at MyHealth@ouhsc.edu.
If you appear eligible based on these responses, we will contact you to tell you about the study and schedule an appointment. If you do not qualify for the study, your contact information will be retained for tracking purposes, but your personal identifying information will be kept separate from the responses you provided.
YOU MUST COMPLETE THE SURVEY FOR YOURSELF ONLY. TO AVOID BEING DISQUALIFIED, DO NOT COMPLETE THIS SURVEY FOR SOMEONE ELSE OR HAVE SOMEONE ELSE COMPLETE IT FOR YOU. ALSO, PLEASE COMPLETE THIS SURVEY ONLY ONCE.
Indicating your interest below will serve as your consent to be screened for this study. Please provide your signature
* must provide value
Are you still interested?
* must provide value
Yes, Complete the survey
No
Yes, Complete the survey
No
How did you hear about our study?
* must provide value
Study Brochure/Flyer
Website
Friend/Family/Word of Mouth
Newspaper
Instagram
Craigslist
Facebook
Local University
Listserv/Email
Directly approached
Other
Study Brochure/Flyer
Website
Friend/Family/Word of Mouth
Newspaper
Instagram
Craigslist
Facebook
Local University
Listserv/Email
Directly approached
Other
Please specify how you heard about the study.
* must provide value
Date of Birth
* must provide value
M-D-Y
View equation
How would you describe your racial or ethnic background? Select all that apply.
* must provide value
African American
American Indian/Alaska Native
Asian
Native Hawaiian/Other Pacific Islander
White
Hispanic/Latino
Other
African American
American Indian/Alaska Native
Asian
Native Hawaiian/Other Pacific Islander
White
Hispanic/Latino
Other
Have you used cigarettes, large cigars, little cigars/cigarillos, or hookah in the past 2 months?
* must provide value
Yes
No
Select the answer that best applies
* must provide value
I have used e-cigarettes before, but not in the past 2-months
I have used e-cigarettes in the past 2-months
I have never used e-cigarettes
I have used e-cigarettes before, but not in the past 2-months
I have used e-cigarettes in the past 2-months
I have never used e-cigarettes
How many days in the past 30-days have you used e-cigarettes?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Are you currently pregnant?
* must provide value
Yes
No
Are you a patient at a clinic at OU Medical for you OB/GYN appointments?
* must provide value
Yes
No
What is the name of your physician at OU Medical?
* must provide value
What is the name of the clinic at OU Medical?
* must provide value
How many weeks have you been pregnant?
* must provide value
You said you've used tobacco products before but you're not currently using. Did you stop using before you became pregnant?
* must provide value
Yes
No
How long before your pregnancy did you stop using e-cigarettes?
* must provide value
Less than one month before
1-2 months before
3-6 months before
>6 months before
Less than one month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using cigarettes?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using cigars?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using little cigars/cigarillos?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using hookah/shisha/waterpipe?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using other tobacco products (chew, dip, snuff, snus, pipe, etc.)?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
How long before your pregnancy did you stop using marijuana?
* must provide value
Less than a month before
1-2 months before
3-6 months before
>6 months before
Less than a month before
1-2 months before
3-6 months before
>6 months before
This study requires women to track their health behaviors daily via a cell phone. To know if our tracking application is compatible with your phone, please tell us what kind of cell phone platform you use. If you do not have a compatible phone, we can provide one for you.
* must provide value
No phone
Android (e.g. Samsung)
Apple (e.g. iPhone)
No phone
Android (e.g. Samsung)
Apple (e.g. iPhone)
Please click the submit button below to proceed to the next page.
Eligibility Calculation
* must provide value
View equation
1 = eligible; 0 = ineligible