Smoke Free Families Past Participant Survey

Thank you for sharing feedback on your experience in the Smoke Free Families (SFF) Project! Your input will assist us in making important program decisions for future waves. Please complete any and all questions for which you are comfortable sharing; no answers are required or will be shared outside of the project team.

If you would like to receive the available handouts/materials for your participation, please ensure the practice name and your name is provided. If you have questions about this survey, please contact Hayley Southworth at

The Smoke Free for Me Learning Collaborative is funded by the Ohio Department of Health, Ohio Department of Medicaid, and the Medicaid Technical Assistance and Policy Program administered by the Ohio Colleges of Medicine GovernmentResource Center.

Smoke Free Families Past Participant Survey

Please rate the degree to which your practice now does the following items:

Sustainability Questions

Project Impact Questions

Which components of the monthly action period calls were most helpful? (Please assign a number for each topic from 1-4, with 1 being the most helpful and 4 the least helpful)