The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

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Required format:

Cigarette AI Screening Questionnaire

Thank you for your interest in our research study! This brief questionnaire will help us see if you are eligible to participate. Please answer the following questions below. All responses will be kept confidential.

First Name:

* must provide value

Last Name:

* must provide value

Phone Number:

* must provide value

Email:

* must provide value

Birth Date:

* must provide value

M-D-Y

Do you own a smartphone with internet access or a data plan?

* must provide value

Yes

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Are you able to read and communicate comfortably in English?

* must provide value

Yes

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In the last 2 days, have you smoked at least 10 cigarettes (including e-cigarettes)?

* must provide value

Yes

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Have you been smoking cigarettes or using e-cigarettes continuously for the past
year or longer?

* must provide value

Yes

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Are you planning to quit smoking or using e-cigarettes within the next 3 months?

* must provide value

Yes

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Do you currently use any of the following products in addition to cigarettes or e-cigarettes? (Check all that apply)

* must provide value

Cigars, cigarillos

Chewing tobacco

Nicotine pouches (e.g., Zyn, On!)

Other tobacco or nicotine products

I do not use any of these products.

Please specify:

If you use e-cigarettes, do you only use products that are labeled as nicotine-free?

* must provide value

Yes

I do not use e-cigarettes.

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Are you currently using any of the following medications or therapies? (Check all that apply)

* must provide value

Nicotine replacement therapy (e.g., patch, gum, lozenge)

Smoking cessation medication (e.g., Chantix)

A GLP-1 agonist medication (e.g., Ozempic)

I am not using any of these.

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Are you currently enrolled in any program (pharmacological or behavioral) to help you quit smoking?

* must provide value

Yes

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Have you been diagnosed with any of the following medical conditions? (Check all that apply)

* must provide value

A severe cardiovascular disease

A condition that causes excessive sweating

A movement disorder (e.g., Parkinson's disease)

A substance use disorder for something other than tobacco (e.g., alcohol, other drugs)

I have not been diagnosed with any of these conditions.

Are you currently pregnant?

* must provide value

Yes

Prefer not to answer

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.