This survey is to help you with your nicotine use. After completing this survey, you have the option to opt in to receive LGBTQ+ friendly resources specific to your nicotine usage goals.

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* 1. What is your gender identity?

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* 2. What is your sexual orientation?

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* 3. Do you use nicotine products?

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* 4. If yes, what type of nicotine products do you use?

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* 5. How long have you been using nicotine products?

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* 6. How motivated are you to quit?

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* 7. Have you previously tried to quit?

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* 8. If yes, what methods have you tried to quit?

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* 9. What challenges do you face in quitting?

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* 10. Are you interested in receiving services to quit?

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* 11. If yes, what type of services would you be interested in?

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* 12. Would you like to be contacted regarding information and services to quit?

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