Houston ~ TOBACCO Question Title * 1. MURRAY HILL CENTER A NATIONAL MARKET RESEARCH COMPANY HAS BEEN COMMISSIONED TO INTERVIEW PARTICIPANTS FOR AN UPCOMING PROJECT. THIS WILL BE A 60 MIN LONG FOCUS GROUP AT AN EASY TO REACH LOCATION. IF YOU ARE INTERESTED IN THE PAID (75.00) STUDY, PLEASE ANSWER ALL OF THE QUESTIONS BELOW: Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. What is your exact age? Question Title * 3. What is your ethnicity? Caucasian African American / Black Asian American Indian / Native American Hispanic / Latino Other (please specify) Question Title * 4. Which, if any, of these tobacco products do you use at least once a week? Cigarettes Cigars or pipe Snus Moist snuff, which some call “dip.” Other tobacco products like chewing tobacco Other nicotine products (e.g. nicotine gum, nicotine patch, nicotine lozenges, etc.) None of the above Question Title * 5. Which ONE of the tobacco products you mentioned is your most preferred form of tobacco? Cigarettes Cigars or pipe Snus Moist snuff Question Title * 6. Which best describes your educational background? Did not finish high school High School Graduate Some College College Graduate Post Graduate Question Title * 7. What si your employement status? Employed full time Own a business Employed part time Student Homemaker Retired Looking for work Question Title * 8. What kind of work do you do for a living? Question Title * 9. Do you work in a place where smoking is prohibited or where you’re unable to smoke because you have a job that involves interacting face-to-face with customers or clients? Yes No Question Title * 10. What is your annual household income before taxes? Less than $25,000 $25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 or more Done
