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Today M-D-Y
Thank you for your interest in the UQuit Study, a research study that aims to understand barriers to quitting menthol cigarettes among Black/African American adults who try to quit smoking.
Please fill out the form below to determine your eligibility.
This brief survey will help us learn whether or not you are initially eligible to participate in a research study on quitting smoking at the University of Arkansas for Medical Sciences (UAMS).
Please enter your first name:
* must provide value
Please enter your last (family) name:
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What is the best email to use to contact you?
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What is an alternative email to use to contact you?
What is the best phone number to contact you?
Please enter your phone number without any dashes or parentheses (i.e., 5018675309). Do not include 1 before the phone number.
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Can we send you text messages at this number?
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Yes
No
May we have your permission to leave a voicemail at this number?
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Yes
No
What is an alternative phone number to contact you?
* must provide value
Can we send text messages at this number?
Yes
No
May we leave a voicemail at this number?
Yes
No
How did you hear about this study? (Check all that apply)
Please specify the friend or family member who informed you about the study
Please specify the community partner who informed you about the study
Please specify where you saw the study flyer
Please specify the event where you learned about the study
Please specify how you heard about the study
What is your age?
* must provide value
What is your date of birth?
* must provide value
Today M-D-Y
Age from DOB
*FOR STUDY STAFF* *This field is calculated based on the provided date of birth, use this field to verify that the # age the prospective participant provided matches the age generated from the date of birth they provided*
View equation Years
What is your gender?
* must provide value
Man
Woman
Other (specify)
Please specify your gender identity
What is your racial/ethnic group?
* must provide value
Black/African American
White
Asian
American Indian/Alaska Native
Native Hawaiian or Pacific Islander
Middle Eastern
Multiple Race/Biracial
Other
Black/African American
White
Asian
American Indian/Alaska Native
Native Hawaiian or Pacific Islander
Middle Eastern
Multiple Race/Biracial
Other
You described yourself as multi-racial, bi-racial, or other. Can you describe what races or ethnicities make up your background? (Check all that apply)
Describe other race/ethnicity.
Which racial/ethnic group do you identify with most?
* must provide value
Black/African American
White
Asian
American Indian/Alaska Native
Native Hawaiian or Pacific Islander
Middle Eastern
Multiple Race/Biracial
Other
Black/African American
White
Asian
American Indian/Alaska Native
Native Hawaiian or Pacific Islander
Middle Eastern
Multiple Race/Biracial
Other
Please describe your other racial/ethnic background.
How well do you speak, read, and write English? Would you say...
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Very well
Well
Not well
Not at all
Very well
Well
Not well
Not at all
Have you smoked 100 cigarettes in your lifetime? 100 cigarettes is about 5 packs.
* must provide value
Yes
No
Do you now smoke menthol cigarettes every day, some days, or not at all?
* must provide value
Every Day
Some Days
Not At All
Every Day
Some Days
Not At All
In the past 30 days, have you smoked a menthol cigarette, even one or two puffs?
* must provide value
Yes
No
Are you planning or willing to quit cigarette smoking within the next 30 days without professional help?
* must provide value
Yes
No
Don't Know
Are you seriously considering quitting smoking within the next 6 months?
Yes
No
Do you have Internet access? This can include mobile data or internet access through your cellular network.
* must provide value
Yes
No
Do you have a laptop, smartphone, or tablet with a camera? (Choose all that apply)
Laptop or Desktop computer with a camera
Tablet computer (for example, an iPad, Samsung Galaxy, Motorola Xoom, or Kindle Fire)
Smartphone (for example, an iPhone, Android, Blackberry, or Windows phone)
Basic cell phone only
I do not have any of the above
Other (please specify)
Laptop or Desktop computer with a camera
Tablet computer (for example, an iPad, Samsung Galaxy, Motorola Xoom, or Kindle Fire)
Smartphone (for example, an iPhone, Android, Blackberry, or Windows phone)
Basic cell phone only
I do not have any of the above
Other (please specify)
Please specify the type of device you have
Do you have a cellphone or smartphone with a monthly plan?
* must provide value
Yes
No
Can you download and install Android or Apple iOS apps on your cellphone or smartphone?
* must provide value
Yes
No
Do you have regular access to your cellphone or smartphone?
* must provide value
Yes
No
I don't know
Do you live in Arkansas?
* must provide value
Yes
No
What county do you live in?
I do not live in Arkansas Arkansas Ashley Baxter Benton Boone Bradley Calhoun Carroll Chicot Clark Clay Cleburne Cleveland Columbia Conway Craighead Crawford Crittenden Cross Dallas Desha Drew Faulkner Franklin Fulton Garland Grant Greene Hempstead Hot Spring Howard Independence Izard Jackson Jefferson Johnson Lafayette Lawrence Lee Lincoln Little River Logan Lonoke Madison Marion Miller Mississippi Monroe Montgomery Nevada Newton Ouachita Perry Phillips Pike Poinsett Polk Pope Prairie Pulaski Randolph Saline Scott Searcy Sebastian Sevier Sharp St. Francis Stone Union Van Buren Washington White Woodruff Yell
Please specify what state you live in
Are you willing to attend an online or in-person screening visit, 1 baseline visit, and 1 follow-up visit?
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Yes
No
Thank you so much for answering these questions! We would like your permission to keep your information on file in our confidential recruitment database. At any time you can request that your information be removed from this database.
* must provide value
Yes
No
We may have other studies like this one that you may be eligible to participate in.
With your permission, we would like to keep your name and contact information in our research database so that we can contact you for any new studies.
* must provide value
Yes
No
Is this person eligible for the study? *FOR STUDY STAFF*
Participants must: 1) be aged 21 to 75; 2) be a current menthol cigarette smoker (e.g., smoked at least 100 cigarettes in their lifetime and now smoke menthol cigarettes 'every day' or 'some days' and in the past 30 days); 3) have a carbon monoxide (CO) reading of at least 5 parts per million (ppm) or positive rapid salivary cotinine test (30 ng/mL cut-off); 4) currently reside in Arkansas; 5) be able to provide a home address; 6) have regular access to a working cell phone; 7) be able to read, write, and speak English; 8) have internet access and a working cell phone with a monthly data plan and allows installation of apps; 9) be planning or willing to quit smoking in the next 30 days without professional help; 10) be willing to quit smoking 7 days from their baseline session; 11) be willing to take daily EMA surveys for a 14 day period; and 12) provide written informed consent.
Exclusion criteria
Prospective participants will be excluded if they: 1) are a minor (< 18 years old) and 2) do not currently smoke cigarettes.
Online/Written consent and CO level/salivary cotine level will be assessed at the time of consent. Please do not help prospective participants qualify for the study by discussing the details of the qualifications.
Yes
No
Pre-screen eligibility determination
View equation THIS PERSON IS ELIGIBLE*This is an automatically generated message based on skip patterns. If your response does not match please double check whether this person is eligible for the study*
THIS PERSON IS NOT ELIGIBLE This person answered ______ to age and ______ based on their date of birth ______ to how well they speak/read/write English
______ to smoking at least 100 cigarettes/ 5 packs in lifetime
______ to currently smoking menthol cigarettes
______ to smoking menthol cigarettes in the past 30 day
______
______ to internet access
______ to phone with a monthly plan
______ to download and install apps on phone
______
______
______ *This is an automatically generated message based on skip patterns. If your response does not match, please double check whether this person is eligible for the study BEFORE you finish the telephone screener*
Did your eligibility determination match REDCap's?
Yes
No
Why was this person not eligible for the study?*FOR STUDY STAFF WHO MAY REVIEW SCREENERS*
Today M-D-Y
Today M-D-Y