Feedback Survey

 First time
 Less than once a month
 Once or more a month
 Once or more a week
 Daily

 EMail
 Text Message
 Phone Call
 None

 Yes
 No

Some information about yourself

 Under 18 years of age
 18-24 years old
 25-34 years old
 35-49 years old
 50-64 years old
 65+ years of age

 Male
 Female

 Asian & Pacific Islander
 Black
 Hispanic / Latino
 White
 Prefer Not to Answer

 Yes
 No

Smoking Fact

Oral tobacco products contain 28 carcinogens (cancer-causing agents).