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Ready to Quit?

Washington State is offering residents free access to a unique cessation program delivered via a smartphone app.

       Step 1: Answer the questions below
       Step 2: Download the app & log in
       Step 3: Create your profile

Before we provide access, we would like to know a little about you.

Why are we asking these questions?  You do not have to answer these questions, but the information you share helps us to be able to provide free programs like this app. We don’t collect any personally identifiable information, so your answers are anonymous.

- Do you live in Washington State? *-Required

Yes

No

- Email Address

- In which county do you live? Not Selected Adams Asotin Benton Chelan Clallam Clark Columbia Cowlitz Douglas Ferry Franklin Garfield Grant Grays Harbor Island Jefferson King Kitsap Kittitas Klickitat Lewis Lincoln Mason Okanogan Pacific Pend Oreille Pierce San Juan Skagit Skamania Snohomish Spokane Stevens Thurston Wahkiakum Walla Walla Whatcom Whitman Yakima

- Are you an employee of Washington State? *-Required

Yes

No

- Which Department? *-Required Not SelectedDept. of Child, Youth, & FamiliesDept. of CorrectionsDept. of HealthDept. of Higher EducationDept. of Labor & IndustriesDept. of Social and Health ServicesDept. of TransportationEmployment Security Dept.Washington State PatrolOther

- What type(s) of tobacco and/or nicotine products do you use (excluding nicotine replacement therapy)?

Cigarettes

Cigars, cigarillos and little cigars

Pipe

Smokeless tobacco (chewing tobacco, snuff, snus)

Other oral nicotine products (e.g., pouches, toothpicks)

E-cigarette or vaping product

Hookah

Heated tobacco products (e.g., IQOS)

Other

- Do you use menthol products?

Yes

No

- What is your age? Not Selected < 18 18-24 25-34 35-44 45-54 55-64 65+

- What is your current gender identity?

Man

Woman

Non-binary

Other

- What sex were you assigned at birth?

Male

Female

- What is your sexual orientation?

Gay/Lesbian

Bisexual/Pansexual

Queer

Straight

Asexual

Unsure or Questioning

- Are you Hispanic, Latino/a, or of Spanish origin?

Yes

No

Don't know / Not sure

- Which of the following would you say is your race?

White

Black or African American

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Asian - Asian Indian

Asian - Chinese

Asian - Filipino

Asian - Japanese

Asian - Korean

Asian - Vietnamese

Asian - Other

- What is the highest level of education you have completed? Not Selected Less than high school High school graduation or G.E.D. Some college College graduate

- What is your household income? Not Selected Less than $15,000 $15,000 - $24,999 $25,000 - $34,999 $35,000 - $49,999 $50,000 - $74,999 $75,000 or higher

- To your knowledge, are you now pregnant?

Yes

No

Don't know / Not sure

- Do you plan on becoming pregnant in the next 3 months?

Yes

No

- Are you currently breastfeeding?

Yes

No

- What is your primary source of health care coverage? Not Selected None (no coverage) Employer or union health plan Individual or family health plan Medicare Medicaid (Apple Health) TRICARE (formerly CHAMPUS], VA, or Military Indian or Tribal Health Services Some other source

- Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? days

- How did you hear about the app? Not Selected Health professional Family/friend Website Brochure/newsletter/flyer Other

Thank you! Please review the privacy policy and then click on "Accept and Gain Access" to get your username and password. This info will provide you with free access to the cessation app. We are rooting for you!

Privacy Notice     User Agreement I agree to the Privacy Policy and End User License Agreement:

Need help? Email support.