Parent/Guardian Survey- English Please take a few minutes to fill out this short survey about tobacco. OK Question Title * 1. What County do you live in? Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur DeKalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko LaGrange Lake La Porte Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush St. Joseph Scott Shelby Spencer Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley OK Question Title * 2. What is your age? 18-25 26-35 36-45 46-55 55+ OK Question Title * 3. What is your race and/or ethnic background? (Check all that apply) White Black Latino Asian/Pacific Islander American Indian/Native American Other (please specify) OK Question Title * 4. Do you currently use any form of tobacco? (including cigarettes, cigars, cigarillos, chewing tobacco, smokeless pouches, and/or e-cigarettes/vapes) Yes No OK NEXT