Q-Insights

Join Our Research Panel

Thanks for your interest in Q-Insights research. This survey keeps your contact information current so we can invite you to studies you may qualify for. Your answers are used for research purposes only.

Under 5 minutes · Fields marked * are required

First Name *

Last Name *

Email Address *

Mobile Phone *

Alternate Phone

Date of Birth *

Street Address *

City *

State *

ZIP *

What is your gender? *

Male Female Non-binary Prefer not to say

Which of the following best describes your race or ethnicity? (Select all that apply) *

White Black or African American Asian Hispanic or Latino Native American Pacific Islander

Other:

Prefer not to say

What is the highest level of education you have completed? *

Less than high school High school diploma or GED Some college Associate degree Bachelor's degree Graduate or professional degree

Which of the following best describes your current employment status? *

Employed full-time Employed part-time Self-employed Unemployed Student Retired

Other:

How many children do you have living in your home? *

Which of the following best describes your relationship status? *

Single Married Divorced Widowed Separated Partnered Prefer not to say

What other language besides English do you speak at home? (Select all that apply)

Spanish Chinese (Mandarin/Cantonese) Vietnamese Korean Tagalog Arabic Hindi/Urdu

Other:

Which nicotine products do you currently use? (Select all that apply) *

Don't Use Nicotine Cigarettes E cigarettes / vaping devices Nicotine pouches (e.g., ZYN, On!) Chewing tobacco Cigars Heated tobacco products (e.g., IQOS) Other nicotine products Prefer not to answer

Join Our Research Panel

Thanks for completing your profile!