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* 1. Have you, or anyone else in your immediate family/household worked in any of the following industries within the past 5 years?

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* 2. How would you describe your current employment status?

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* 3. How would you describe your current marital status?

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* 4. Which drugstores, pharmacies, and grocery stores do you visit at least once per month?

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* 5. When it comes to shopping, do you do any of the following? Please check all that apply.

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* 6. On a regular basis, do you purchase (or share the responsibility for purchasing) the following products: (please check all that apply)

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* 7. What is your gender?

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* 8. What is your age?

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* 9. What is your first name?

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* 10. What is your last name?

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* 11. What is the best phone number we can reach you at?

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* 12. What is your email address?

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* 13. Do you have a friend who would like to take part in this study? Let us know! If they are selected to attend and they participate, you will receive a $5 Starbucks gift card.

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