Military Webinar Survey 1. Question Title * 1. Name Question Title * 2. Email Address: Question Title * 3. Where do you currently reside? Northern West Virginia Central West Virginia Southern West Virginia Currently on Active Duty and not in West Virginia Not on Active Duty and not in West Virginia Question Title * 4. Are you serving in the military? Select which branch. Army Navy Air Force Marine Retired Service Member I am not serving in the military Question Title * 5. Age: Under 18 18-25 26-34 35-50 51-65 Over 65 Question Title * 6. Race: White African American Native American Other (please specify) Question Title * 7. What is your primary type of tobacco use? Cigarette Pipe Cigar Smokeless Snus Other I do not use tobacco Question Title * 8. How much tobacco do you use? Please state the number of cigarettes per day, the number of bowls for pipes per day, the number of cigars per day, the number of smokeless tins per week, or the number of snus pouches you use per day. If you use more than one type of tobacco, please list each type and amount separately. Question Title * 9. What other types of tobacco do you use? (Check all that apply) Cigarette Pipe Cigar Smokeless Snus None Question Title * 10. Describe your desire to quit tobacco use. No Desire to Quit Little Desire to Quit Moderate desire to quit Strong Desire to Quit I don't know I do not use tobacco Question Title * 11. How many times have you tried to quit before? Never Once or twice 3 or more times Question Title * 12. Describe how confident you are that you can quit tobacco when you try again. Not at all A little Somewhat Very Confident I don't know I do not use tobacco Question Title * 13. Are you aware of any tobacco prevention or tobacco cessation activities in your community within the last six months? Yes No Question Title * 14. Had you ever heard of the West Virginia Tobacco Quit Line before this webinar? Yes No Question Title * 15. Did you watch this webinar to help a family member or a friend to quit tobacco use? Yes No Question Title * 16. Where did you hear about this webinar? Newspaper TV Radio Social Networking (Facebook, twitter, etc) Friend Other Done