q0_1. First and Last name





q0_4. Gender Male Female

q0_6. Date of Birth:

(mm/dd/YYYY)



q0_7. Height (feet and inches)





q0_8. Weight (lbs)





q0_9. Have you ever tried smoking any tobacco product (i.e. cigarettes / hookah / cigars) even just one or two puffs? Yes No

q0_10. Which products have you used? (Select all that apply) Cigarettes Cigars Cigarillos Hookah Little Cigars

q1_0. Section 1: CIGARETTES

q1_1. Have you smoked cigarettes on a regular basis for at least 6 months in your lifetime? Yes No

q1_2. How often have you smoked cigarettes in the past 6 months? (e.g., 5 times a day, 3 times a week, etc.)





q1_3. How many cigarettes (per day/per week) have you smoked in the past 6 months?





q1_4. Are you currently a cigarette smoker? Yes No

q1_5. How old were you when you started smoking cigarettes?





q2_0. Section 2: ELECTRONIC CIGARETTE (E-CIG)

q2_1. Have you ever tried e-cigarettes/vaping (even just one or two puffs)? Yes No

q2_2. Which products have you used? (Select all that apply) Cig-a-like / Mini e-cig / Slim mode Mid-size e-cig / Vape pen Advanced Personal Vaporizer (APV) / Mod

q2_3. Have you vaped (used e-cig) on a regular basis for at least 6 months in your lifetime? Yes No

q2_4. How often have you vaped (used e-cig) in the past 6 months? e.g., 5 times a day, 3 times a week, etc.





q2_5. Are you currently using e-cigarettes/vapes? Yes No

q2_6. When did you start / how long have you been vaping?





q2_7. Have you ever tried smokeless tobacco (even just once)? Yes No

q2_8. Which products have you used? (Select all that apply) Chewing Tobacco Snus Snuf Dip

q2_9. Have you used smokeless tobacco products in the past 6 months? Yes No

q3_0. Section 3: DRUGS: RECREATIONAL/ILLICIT

q3_1. Have you used recreational/illicit drugs on a regular basis in your lifetime? Yes No

q3_2. How often have you used recreational/illicit drugs in the past 6 months? e.g., 2 times a day, 3 times a week, etc.





q3_3. How old were you when you started using recreational/illicit drugs?





q3_4. Do you currently have any dental problems (i.e. gum disease / tooth decay / inflammation)? Yes No

q4_0. Section 4: PRESCRIPTION MEDICINE

q4_1. Have you used prescription medicine(s) in the past 5 years? Yes No

q4_2. Have you taken prescription medicine(s) in the past 6 months? Yes No

q4_2a. If YES, indicate drug(s), dose and frequency of use (e.g., Lipitor 10 mg 3 times a day).





q4_3. Are you currently taking prescription medicine(s)? Yes No

q4_3a. If YES, indicate drug(s), dose and frequency of use (e.g., Lipitor 10 mg 3 times a day).





q5_0. Section 5: ADDITIONAL QUESTIONS

q5_1. Are you or have you been pregnant within the past 6 months? Yes No

q5_2. Have you ever been diagnosed with a chronic disease (i.e. diabetes, heart disease, asthma, cancer)? Yes No

q5_3. Would you be willing to provide a blood sample? Yes No

q5_4. How did you hear about this study? (Select all that apply) Craigslist My USC Facebook Instagram Flyer Reddit ECC Other