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| I am voluntarily giving you information so that you may use it in your research study related to helping the Deaf community. I understand that my information will be kept private and never be shared or sold. I also understand that my responses will be combined with the responses from everyone else in this research study. The discoveries will be reported for the whole group and never reported individually. |
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| * 3. Are you Hispanic or Latino? |
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| * 4. Which one of more of the following would you say is your race? (Check all that apply) |
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| * 5. What is your highest grade or year of school completed? |
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| * 7. Are you currently...? (Check all that apply) |
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* 8. Is your annual household income from all sources?
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| * 9. Have you smoked at least 100 cigarettes in your life? (Note: 5 packs = 100 cigarettes) |
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| * 10. Do you now smoke cigarettes every day, some days, or not at all? |
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| * 11. During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? |
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* 12. How long has it been since you last smoked cigarettes regularly?
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* 13. Do you currently use chewing tobacco, snuff, or snus every day, some days or not at all?
(Note: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum.) |
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