The goal of this brief questionnaire is to collect basic contact information and current tobacco use information from Texans at least 18 years of age in order to match them to a current study or multiple studies related to tobacco use or quitting smoking.

The questions may ask you about your current contact information, demographic information such as your race and level of education, your current tobacco use, and some medical conditions you may have. You will also be asked if you are interested in quitting smoking at this time. These questions should take about 5 to 10 minutes to complete.

After you complete these questions, you will be contacted within 3 business days by a member of the research team to discuss possible tobacco use or studies to help you quit smoking that might interest you. If you wish to learn more about or be screened for any of these studies, you may be asked to provide consent for further screening at that time. If there are available studies, you may be given separate consent forms to review and/or sign. 

If no studies are currently available that you wish to learn more about, or that may be right for you, your information will remain in the study team's database forever, and you may be contacted in the future about taking part in a research study. You may also choose not to be contacted for current or future studies at any time after completing these questions by telling a member of the research team.

The only risk to you may be a loss of confidentiality if your personal information is ever released, but the risk of this is very small. Your personal information from the questionnaire will be stored securely in a password-protected database administered by a contract company (Qualtrics).

Questionnaire Statement

You have read the description of the study, and you have decided to answer the questions attached and described here. You understand that you may refuse to answer any (or all) of the questions at this time. You understand that you will be contacted about possible participation in tobacco use or quitting smoking studies that you may be eligible for, but answering these questions do not guarantee that you will be eligible for any of these studies.

You may withdraw your authorization at any time, in writing, for any reason as long as that information can be connected to you. You can learn more about how to withdraw your authorization by calling (713) 792-2933 or by contacting Dr. Cinciripini and/or the research staff at (713) 792-2265.