Tobacco Use and Quitting Habits Survey

The CVS Research Foundation has partnered with the National Urban League to assess the tobacco usage and quitting habits of African-Americans. The information from this survey will be used to gain an understanding of the specific and unique needs of African-Americans who use tobacco and may be interested in quitting.

 No identifying information (i.e. name, address) will be shared and we appreciate you answering all of the questions.

Have you used tobacco in the past 6 months?
(Tobacco = Bidis, chew, cigarettes, cigars, cigarillos, little cigars, dip, dissolvable tobacco, electronic cigarette or e-cig containing cartridge with nicotine, hookah, kreteks, snuff or other tobacco related product)

Question Title

* 1. Have you used tobacco in the past 6 months?
(Tobacco = Bidis, chew, cigarettes, cigars, cigarillos, little cigars, dip, dissolvable tobacco, electronic cigarette or e-cig containing cartridge with nicotine, hookah, kreteks, snuff or other tobacco related product)

Do you currently use tobacco?

Question Title

* 2. Do you currently use tobacco?

How often do you use tobacco?

Question Title

* 3. How often do you use tobacco?

Have you ever thought about quitting?

Question Title

* 4. Have you ever thought about quitting?

Have you ever tried to quit?

Question Title

* 5. Have you ever tried to quit?

What strategies or medications did you use to quit tobacco use?
Select all that apply

Question Title

* 6. What strategies or medications did you use to quit tobacco use?
Select all that apply

Are you interested in attending an Empowered to Quit informational Workshop?

Question Title

* 7. Are you interested in attending an Empowered to Quit informational Workshop?

Are you interested in participating in a tobacco quit program?

Question Title

* 8. Are you interested in participating in a tobacco quit program?

What race/ethnicity do you identify as?

Question Title

* 9. What race/ethnicity do you identify as?

About You
Optional if you would like to be contacted about workshops or our quit program.

Question Title

* 10. About You
Optional if you would like to be contacted about workshops or our quit program.

T