Lung Cancer Questionnaire for Patients

Demographics

The following questions are designed to better understand your background.

New England (Connecticut, Maine, Massachusetts, Rhode Island, Vermont)

Mid-Atlantic (New Jersey, New York, Pennsylvania)

East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin)

West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota)

South Atlantic (Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, Washington DC, West Virginia)

East South Central (Alabama, Kentucky, Mississippi, Tennessee)

West South Central (Arkansas, Louisiana, Texas)

Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming)

Pacific (Alaska, California, Hawaii, Oregon, Washington)

Younger than 30

31 – 40

41 – 50

51 – 60

61 – 70

71 or greater

Male

Female

White

Black or African American

American Indian or Alaskan Native

Asian Indian

Asian

Pacific Islander

Yes