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Understanding Your Tobacco and Nicotine History.

By Ryk Melck / March 14, 2019

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Question 1 of 28

1. Question
Do you use tobacco and/or e-cigarettes/vape products? Select all that Apply.
- Tobacco
- E-cigarettes/Vape Products
- None
Question 2 of 28

2. Question
Do you use tobacco and/or e-cigarettes/vape products? Select all that Apply.
- Tobacco
- E-cigarettes/Vape Products
- None
Question 3 of 28

3. Question
How many others in your household use any type of tobacco, e-cigarettes/vape products?
- * less true 4 or More321No one more true
Question 4 of 28

4. Question
How many others in your household use any type of tobacco, e-cigarettes/vape products?
- * less true 4 or More321No one more true
Question 5 of 28

5. Question
If you use tobacco, what types of tobacco are you CURRENTLY using? Select all that apply
- Cigarettes
- Chew
- Cigars
- Snuff
- Snus
- None
- N/A
Question 6 of 28

6. Question
If you use tobacco, what types of tobacco are you CURRENTLY using? Select all that apply
- Cigarettes
- Chew
- Cigars
- Snuff
- Snus
- None
- N/A
Question 7 of 28

7. Question
What types of tobacco have YOU EVER USED? Select all that apply.
- Cigarettes
- Chew
- Cigars
- Snuff
- Snus
- None
- N/A
Question 8 of 28

8. Question
What types of tobacco have YOU EVER USED? Select all that apply.
- Cigarettes
- Chew
- Cigars
- Snuff
- Snus
- None
- N/A
Question 9 of 28

9. Question
What age did you start using tobacco?
- 8 or Younger
- 9-12
- 13-17
- 18-21
- 22 or Older
- N/A
Question 10 of 28

10. Question
What age did you start using tobacco?
- 8 or Younger
- 9-12
- 13-17
- 18-21
- 22 or Older
- N/A
Question 11 of 28

11. Question
How long have you used tobacco?
- Less than one year
- 1-9 Years
- 10-19 Years
- 10-29 Years
- 30-39 Years
- 40-49 Years
- 50+
- N/A
Question 12 of 28

12. Question
How long have you used tobacco?
- Less than one year
- 1-9 Years
- 10-19 Years
- 10-29 Years
- 30-39 Years
- 40-49 Years
- 50+
- N/A
Question 13 of 28

13. Question
How much tobacco do you use per day? Select all that apply.
- Less than 1 Pack
- 1 Pack
- Between 1 and 2
- Less than a 1/2 Can of Chew
- 1/2 to 1 can of chew
- 1 to 2 cans of chew
- 2 or more cans of chew
- I don't know
- None
Question 14 of 28

14. Question
How much tobacco do you use per day? Select all that apply.
- Less than 1 Pack
- 1 Pack
- Between 1 and 2
- Less than a 1/2 Can of Chew
- 1/2 to 1 can of chew
- 1 to 2 cans of chew
- 2 or more cans of chew
- I don't know
- None
Question 15 of 28

15. Question
What is your motivation level to quit using tobacco?
- Someone is making me take the course
- You want to quit, but really like using tobacco; "Waffler"
- You are motivated to quit, but need more information to help you quit
- You are ready, committed, and just need some help to get it done
- N/A
Question 16 of 28

16. Question
What is your motivation level to quit using tobacco?
- Someone is making me take the course
- You want to quit, but really like using tobacco; "Waffler"
- You are motivated to quit, but need more information to help you quit
- You are ready, committed, and just need some help to get it done
- N/A
Question 17 of 28

17. Question
What age did you start using e-cigarettes/vape products?
- 8 Years or Younger
- 9-12
- 13-17
- 18-21
- 22 or Older
- N/A
Question 18 of 28

18. Question
What age did you start using e-cigarettes/vape products?
- 8 Years or Younger
- 9-12
- 13-17
- 18-21
- 22 or Older
- N/A
Question 19 of 28

19. Question
How long have you used e-cigarettes/vape products?
- 0-1
- 1-5
- 6-10
- 10 or more
- N/A
Question 20 of 28

20. Question
How long have you used e-cigarettes/vape products?
- 0-1
- 1-5
- 6-10
- 10 or more
- N/A
Question 21 of 28

21. Question
What is your motivation level to quit using e-cigarettes/vape products?
- Someone is making me take the course
- You kind of wan't to quit, but you really like using tobacco; "Waffler"
- You are motivated to quit, but need more information to help quit
- You are ready, committed, and just need some help to get it done
- N/A
Question 22 of 28

22. Question
What is your motivation level to quit using e-cigarettes/vape products?
- Someone is making me take the course
- You kind of wan't to quit, but you really like using tobacco; "Waffler"
- You are motivated to quit, but need more information to help quit
- You are ready, committed, and just need some help to get it done
- N/A
Question 23 of 28

23. Question
What were your risk factors?
- Family
- Peers
- Military
- Career
- Social norms
- Stress
- Boredom
- Other
- None
- N/A
Question 24 of 28

24. Question
What were your risk factors?
- Family
- Peers
- Military
- Career
- Social norms
- Stress
- Boredom
- Other
- None
- N/A
Question 25 of 28

25. Question
What motivates you to quit?
- Health
- Money
- Smell
- Work
- Social
- Family
- Other
- None
- N/A
Question 26 of 28

26. Question
What motivates you to quit?
- Health
- Money
- Smell
- Work
- Social
- Family
- Other
- None
- N/A
Question 27 of 28

27. Question
Have you ever used candy cigarettes or other candy tobacco products?
- Yes
- No
Question 28 of 28

28. Question
Have you ever used candy cigarettes or other candy tobacco products?
- Yes
- No

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