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DIGITAL QUIT GUIDE
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Tell us a little bit about yourself.
What is your gender?
Male
Female
Other
Decline
Are you pregnant or nursing?
Pregnant
Nursing
Not pregnant or nursing
Are you of Hispanic or Latino origin?
Yes
No
Not Sure / Don't Know
Prefer Not to Answer
What is your race? Select all that apply
White or Caucasian
American Indian or Alaska Native
Black or African American
Asian
Native Hawaiian or other Pacific Islander
Other
Prefer not to answer
In which of the SD tribes are you an enrolled member?
Cheyenne River
Crow Creek
Flandreau-Santee
Lower Brule
Oglala Sioux
Rosebud
Sisseton-Wahpeton Oyate
Standing Rock
Yankton-Sioux
Not Enrolled
Enrolled Outside SD
What is the highest level of education you have completed?
Less than grade 9
Less than high school
GED
High School Graduate
Some college or university
College or university degree (AA, BA, Masters, PhD)
Refused
Have you ever served in the military?
Yes
No
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