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.

* 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)

* 2. Do you currently use tobacco?

* 3. How often do you use tobacco?

* 4. Have you ever thought about quitting?

* 5. Have you ever tried to quit?

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

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

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

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

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

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