Sabish FACT Mini Grant Adult Survey Adult Survey E-Cigarette (Electronic Delivery Devices) (12 Survey Questions Total) Question Title * 1. It is very difficult for kids to get E-Cigarettes (Vapes, JUULs. etc.) in our community Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 2. Kids are attracted to E-Cigarettes, (JUULs, Vapes) because they come in candy flavors such as (Cotton Candy/Watermelon) and many other flavors. Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree OK Question Title * 3. I am aware of the following brands of E-Cigarettes (vape products). Please choose all that apply. JUUL Smoke Badge Suorin All of the above None of the above Other (please specify) OK Question Title * 4. I am aware that substances other than liquid nicotine can be used in many of the E-Cigarettes (Vapes JUUL's). Strongly agree Agree Neither agree not disagree Disagree Strongly disagree OK Question Title * 5. Unlike Conventional Cigarettes, E-Cigarettes (Vape Products) can be adevertised on radio, TV, billboards, newspaper, and social media. True False OK Question Title * 6. Currently anyone interested in selling only E-Cigarettes or liquid nicotine could do so in Wisconsin without a tobacco retail license. True False OK Question Title * 7. Currently there is not a Federal or State of Wisconsin requirement to list the ingredients in liquid used in E-Cigarettes, (JUUL's, Vapes), or bottles of the liquid nicotine/E-Juice. True False OK Question Title * 8. I am concerned that the aerosol (vapor) coming from a E-Cigarette (JUUL, Vape), contains some heavy metals such as lead and nickel as well as formaldehyde. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 9. I feel anywhere you can't smoke a cigarette (workplaces, restaurants, bars,) no one should be allowed to use (E-cigarettes, JUULs, Vapes) Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 10. I use the following Tobacco or Nicotine Products. Please choose all that apply. Cigarettes Smokeless Tobacco (Dip, Snuff, Chew) Little Cigars (e.g. swisher sweets, Black and Mild, other) E-Cigarettes (Vapes) I do not use any Smokeless Tobacco, Cigarettes, Little Cigars or E-Cigarettes Other Tobacco (please specify) OK Question Title * 11. If you answered question Q10 as using E-Cigarettes, choose all that apply from the following statements below that best describe why you use E-Cigarettes. If you do not use E-Cigarettes skip Q11. I use E-Cigarettes to stop smoking conventional cigarettes I use E-cigarettes hoping I will eventually quit all nicotine I use E-Cigarettes because I can use them at home without concerns of secondhand exposure I use E-Cigarettes because I can use them in public places where conventional cigarettes are ban I use E-Cigarettes because many of my friends use E-Cigarettes I use E-Cigarettes because I never smoked conventional cigarettes and believe the liquid coming from the E-Cigarette is mostly water vapor Other (please specify) OK Question Title * 12. In the text box below please enter the City, Village, or Township that you currently reside in (live in). OK DONE