Survey on Vaping Cessation

Share Your Quit Journey to Help Others Quit

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1. Please enter your first and last name.

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2. Please enter your city and zip code.

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3. What is your phone number?

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5. How long did you vape?

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6. When did you quit vaping?

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7. Are you willing to share your quit vaping story on film for an ad campaign?

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8. What is your age?

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9. What race/ethnicity best describes you?

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