What is your gender?
* must provide value
Male Female
What is your age?
* must provide value
Are you able to read and write in English?
* must provide value
Yes No
Have you ever been diagnosed with cancer of any kind before?
* must provide value
Yes No
Specify cancer diagnosis
* must provide value
Are you currently or have you been treated with chemotherapy before?
* must provide value
Yes No
Are you currently or have you been treated with radiation before?
* must provide value
Yes No
Are you currently pregnant or breastfeeding?
* must provide value
Yes No
Are you planning to get pregnant in next two weeks?
* must provide value
Yes No
Have you used marijuana or illicit drugs during the past 3 months?
* must provide value
Yes No
Have you used marijuana or cannabis within the past month?
* must provide value
Yes No
Have you used marijuana or cannabis in the last 3 months?
* must provide value
Yes No
Indicate whether you have used marijuana or cannabis in the following ways.
* must provide value
Smoked (eg. A joint, bong, pipe or blunt)
Eaten it in food (eg. Brownies, cakes, cookies or candy)
Drank it (eg. Tea, cola, alcohol, or other drinks)
Vaporized it (vape)
Dabbed it
Used it some other way
Smoked (eg. A joint, bong, pipe or blunt)
Eaten it in food (eg. Brownies, cakes, cookies or candy)
Drank it (eg. Tea, cola, alcohol, or other drinks)
Vaporized it (vape)
Dabbed it
Used it some other way
select all that apply
Have you used illicit drugs within the past month?
* must provide value
Yes No
Have you used illicit drugs in the last 3 months?
* must provide value
Yes No
Indicate whether you have used the following drugs in the past?
* must provide value
Do you have heart disease?
* must provide value
Yes No
Specify heart disease
* must provide value
Have you been diagnosed with any lung disease including asthma, cystic fibrosis, or chronic obstructive pulmonary disease?
* must provide value
Yes No
Specify lung disease
* must provide value
Are you currently using or have you used systemic anti-viral or immunosuppressant therapy within the last 3 months?
* must provide value
Yes No
Specify
* must provide value
Do you have an active oral mucosa disease (e.g., wound, infection, pemphigus or pemphigoid)?
* must provide value
Yes No
Specify
* must provide value
Do you currently have orthodontic appliances?
* must provide value
Yes No
Specify
* must provide value
Did you have dental implants in the last 3 months?
* must provide value
Yes No
Have you been diagnosed with unstable or significant psychiatric conditions?
* must provide value
Yes No
Are you currently engaged in any smoking cessation attempt?
* must provide value
Yes No
Are you using any of the following medications?
* must provide value
Yes No
Have you smoked more than 100 cigarettes (5 packs) in your life time?
* must provide value
Yes No
Have you ever vaped?
* must provide value
Yes No
Have you smoked cigarettes or vaped in the last 3 months, even 1 or 2 puffs?
* must provide value
Yes No
Have you used any other type of tobacco products in the last 3 months?
* must provide value
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Others - Not listed above
None
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Others - Not listed above
None
select all that apply
Do you live with someone who smokes inside the house/car when you are present?
* must provide value
Yes No
Do you live with someone who vapes inside the house/car when you are present?
* must provide value
Yes No
Do you currently smoke cigarettes?
* must provide value
Yes No
Would you consider yourself as a daily smoker?
* must provide value
Yes No
Have you smoked for more than 3 months?
* must provide value
Yes No
Are you planning to quit smoking?
* must provide value
Yes No
When are you planning to quit smoking?
* must provide value
In next 2 weeks Next month Next year I Don't know I have already quit
Have you ever vaped?.
* must provide value
Yes No
Do you currently vape?
* must provide value
Yes No
Did you use an electronic cigarette in the past 3 months?
* must provide value
Yes No
Have you vaped for more than 3 months?
* must provide value
Yes No
Are you planning to quit vaping?
* must provide value
Yes No
When are you planning to quit vaping?
* must provide value
In next 2 weeks Next month Next year I Don't know I have already quit
Have you used any other type of tobacco products in the last 3 months?
* must provide value
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Electronic cigarettes
Others - Not listed above
None
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Electronic cigarettes
Others - Not listed above
None
select all that apply
If you choose "Others" please specify what are they.
Are you currently using smokeless tobacco?
* must provide value
Yes No
Specify what type of smokeless tobacco
* must provide value
eg. Snuff/Snus
If you choose "Others" please specify what type of smokeless tobacco
* must provide value
Are you currently using nicotine replacement therapy ?
* must provide value
Yes No
Do you currently vape?.
* must provide value
Yes No
Would you consider yourself as a daily electronic cigarette (EC) user?
* must provide value
Yes No
Have you vaped for more than 3 months?
* must provide value
Yes No
Have you vaped more than 5 vaping sessions?
* must provide value
Yes No
Have you vaped in the last 3 months, even 1 or 2 puffs?
* must provide value
Yes No
Are you planning to quit vaping?
* must provide value
Yes No
When are you planning to quit vaping?
* must provide value
In next 2 weeks Next month Next year I Don't know I have already quit
Have you used any other type of tobacco products (eg, Hookah, pipe, little cigars) in the last 3 months?
* must provide value
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Others - Not listed above
None
Cigarettes
Pipe
Little cigars (like Black & Milds, Swisher Sweets, Phillies Blunt, or Captain Black)
Large cigars (like Arturo Fuente, Padrón, Ashton, Davidoff, Cohiba or Romeo y Julieta)
Hookah/shisha/waterpipe
Blunts (removing all or some of the tobacco from a cigar and replacing it with marijuana)
"Heat-not-burn" tobacco products (eg. IQOS, eTron, Firefly or PAX)
Others - Not listed above
None
select all that apply
If you choose "Others" please specify what are they.
* must provide value
Have you used smokeless tobacco in the past 3 months?
* must provide value
Yes No
Specify what type of smokeless tobacco
* must provide value
eg. Snuff/Snus
Have you used nicotine replacement therapy /products in the past 3 months?
* must provide value
Yes No
What kind of electronic cigarette (EC) device are you using?
* must provide value
MOD device POD device Using both types I don't know Others, not listed here
Select all that apply
Do you use more than one type of electronic cigarette (EC) device(s)?
* must provide value
Yes No
Please specify the BRANDS & MODEL # of EC device(s) you are currently using.
* must provide value
eg. Name/Brand/Model No
Please specify the approximate "Wattage" you are currently using the most in your EC device.
eg. 30W
From the above list, which electronic device do you use the most?
What type of Nicotine do you use the most in your electronic cigarette (EC) device?
* must provide value
Nicotine salts
Freebase nicotine
Don't know
Nicotine salts
Freebase nicotine
Don't know
Please specify the "nicotine concentration/level" you are currently using the most in your EC device.
What flavor(s) are you using in your EC device(s)?
Please provide your email address so we can contact you about your eligibility
* must provide value
Please provide the best contact phone number to contact you
* must provide value
Please specify your most preferred contact method
* must provide value
Email Phone
Thank you for taking the time to complete this survey. Our research personnel will contact you based on the eligibility. We look forward to talking with you.