Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *
How often do you use nicotine-based products?
Select Never Current User None in the Last Year None in the Last two Years None in the Last three Years None in the Last four Years None in the Last five Years *
Past cigars smoked per year
Select Less than 12 per year 12-24 per year More than 24 per year
Past cigarettes smoked per day
Select Less than ½ pack per day 1 pack per day 2 packs per day More than 2 packs per day
Have you had family members (parent or siblings) diagnosed with Cancer, prior to age 70?
Select No Yes
Have you had family members (parent or siblings) diagnosed with Cardiovascular Disease, prior to age 70?