WA DOH - Vaping (Teens and Young Adults)

Do you live in Washington State? *-Required

Yes

No

Email Address

In which county do you live?

Are you an employee of Washington State? *-Required

Yes

No

Which Department? *-Required

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?

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?

What is your household income?

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?

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?

How did you hear about the app?

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