Health and Wellness Research Study Question Title * 1. Contact Information Name * City/Town State/Province Phone Number * Question Title * 2. What age range do you fall into? Under 18 18 - 25 26 - 35 36 - 45 46 - 55 Over 55 Question Title * 3. What is your ethnicity? White/Caucasian Black/African American American Indian or Alaska Native Asian Hispanic or Latino Native Hawaiian or other Pacific Islander Other (please specify) Question Title * 4. During the past 30 days, which of the following have you used? Marijuana or hashish Cigarettes/Tobacco E-cigarettes Alcohol None of the above Next