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Ready to quit? 2Morrow Health can help you at University of Colorado Denver Cancer Center!

- Do you live in Colorado? *-Required

Yes

No

- Email Address *-Required

- In which county do you live? *-Required Not Selected Adams Alamosa Arapahoe Archuleta Baca Bent Boulder Broomfield Chaffee Cheyenne Clear Creek Conejos Costilla Crowley Custer Delta Denver Dolores Douglas Eagle El Paso Elbert Fremont Garfield Gilpin Grand Gunnison Hinsdale Huerfano Jackson Jefferson Kiowa Kit Carson La Plata Lake Larimer Las Animas Lincoln Logan Mesa Mineral Moffat Montezuma Montrose Morgan Otero Ouray Park Phillips Pitkin Prowers Pueblo Rio Blanco Rio Grande Routt Saguache San Juan San Miguel Sedgwick Summit Teller Washington Weld Yuma

- What type(s) of tobacco and/or nicotine products do you use (excluding nicotine replacement therapy)?

Cigarettes

Cigars, cigarillos and little cigars

Pipe

Smokeless tobacco (chewing tobacco, snuff, snus)

Other oral nicotine products (e.g., pouches, toothpicks)

E-cigarette or vaping product

Hookah

Heated tobacco products (e.g., IQOS)

Other

- Do you use menthol products?

Yes

No

- How many years have you used tobacco products?

- What is your age? *-Required Not Selected < 18 18-24 25-34 35-44 45-54 55-64 65+

- What is your current gender identity?

Man

Woman

Non-binary

Other

- What sex were you assigned at birth?

Male

Female

- What is your sexual orientation?

Gay/Lesbian

Bisexual/Pansexual

Queer

Straight

Asexual

Unsure or Questioning

- Are you Hispanic, Latino/a, or of Spanish origin?

Yes

No

Don't know / Not sure

- Which of the following would you say is your race?

White

Black or African American

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Asian American

- What is the highest level of education you have completed? Not Selected Less than high school High school graduation or G.E.D. Some college College graduate

- What is your household income? Not Selected Less than $15,000 $15,000 - $24,999 $25,000 - $34,999 $35,000 - $49,999 $50,000 - $74,999 $75,000 or higher

- What is your primary source of health care coverage? Not Selected Individual or family health plan Medicaid, Medicare, VA or military Self-insured No health insurance Some other source

- Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

- How did you hear about the app? Not Selected Health professional Family/friend Website Brochure/newsletter/flyer Other

Thank you! Please review the privacy policy and then click on "Accept and Gain Access" to get your username and password. This info will provide you with free access to the cessation app. We are rooting for you!

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Need help? Email support at support@2morrowinc.com.