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* 1. What is the zip code that your practice/school program is located in?

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* 2. Please select your title.

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* 3. If you are a student, please select which hygiene program you are enrolled: 

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* 4. Smoking and tobacco use is a common risk factor between oral disease and other chronic diseases such as diabetes and cardiovascular disease. True or False?

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* 5. We need to close the three Research-to-Practice gaps when we talk about helping patients to be tobacco free. True or False?

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* 6. No matter how old you are, quitting smoking improves your health and can add year to your life. True or False?

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* 7. While we have made significant strides in our tobacco use rates, too many communities still struggle with high tobacco use rates and resulting health disparities. True or False?

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