Q01
Message
All templates
Vaping and Nicotine Use Patterns Survey
A public health research survey measuring vaping and nicotine product use among adults — what products are used, how often, quit attempts, and how flavor and price shape behavior. An AI follow-up probes the story behind a respondent's most recent quit attempt to surface real barriers and triggers that closed questions miss.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
15 questions · ~8 min
Q02
Multiple ChoiceRequired
Are you 18 years of age or older?
- Yes
- No
Q03
Multiple ChoiceRequired
Have you used any vaping or nicotine products (e-cigarettes, vapes, pouches, cigarettes, etc.) in the last 12 months?
- Yes
- No
Q04
Multiple ChoiceRequired
Which of the following nicotine or vaping products have you used in the last 30 days?
- Disposable e-cigarette/vape
- Refillable/pod-based vape device
- Nicotine pouches (e.g., placeholder brand)
- Traditional cigarettes
- Cigars or cigarillos
- Chewing tobacco/snuff
- None of the above
Q05
Opinion ScaleRequired
In the last 30 days, how often did you use any vaping or nicotine product?
Scale: 1 – 7
Min:NeverMax:Multiple times a day
Q06
Multiple ChoiceRequired
In the past 12 months, have you tried to quit or cut back on vaping or nicotine use?
- Yes, tried to quit completely
- Yes, tried to cut back
- No, have not tried
- Not applicable — I don't currently use
Q07
Number
In the past 12 months, how many separate quit attempts have you made (enter 0 if none)?
Q08
MatrixRequired
How much does each factor influence your choice to keep using or to try a particular product?
6 rows × 5 columns
- Flavor options available
- Price/cost of the product
- Perceived health risk
- Availability where I shop
- Habit or routine
- +1 more
Columns: No influence · Slight influence · Moderate influence · Strong influence · Very strong influence
Q09
Ranking
Rank the flavors you use or prefer most, from most to least preferred.
- Tobacco/unflavored
- Menthol/mint
- Fruit
- Sweet/dessert
- Candy
- Other/mixed flavors
Drag to rank
Q10
Opinion ScaleRequired
If prices for your usual product increased by 20%, how likely would you be to reduce your use or switch to a cheaper alternative?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q11
AI Interview
Reconstruct the story of the respondent's most recent quit attempt (or, if they've never tried, why not): what triggered the attempt, what method or product substitution they used, how long it lasted, and what specifically caused relapse or made them stop trying — cravings, social settings, stress, price, or flavor cravings. If they say flavor or price 'strongly' influences their use, probe a concrete recent example of a purchase or switch decision driven by that factor.
Q12
Multiple Choice
Which age group do you belong to?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q13
Multiple Choice
What is your gender?
- Male
- Female
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q14
Multiple Choice
What is the highest level of education you have completed?
- Less than high school
- High school diploma/GED
- Some college
- Associate degree
- Bachelor's degree
- Graduate degree
- Prefer not to say
Q15
Message
That completes the survey — thank you for your honesty. Your responses will be combined anonymously with others to help researchers understand nicotine and vaping trends and inform public health guidance.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
Why this template
What this template is built to do — we found no directly comparable template from other survey tools to review.
What sets it apart
- Goes beyond the standard product-use and quit-attempt questions with an AI follow-up that reconstructs the actual story behind a respondent's most recent quit attempt, surfacing barriers and triggers closed questions miss
- Captures nuanced behavioral data through an opinion scale on usage frequency, a matrix on factors influencing product choice, and a ranking question on flavor preference
- Tests price sensitivity directly with a 20% price-increase likelihood-to-switch question, useful for policy and market research
- Includes standard demographic and screening questions (age, gender, education, 18+ gate) alongside quit-attempt counts for clean segmentation and reporting
Frequently asked questions
What questions are in the “Vaping and Nicotine Use Patterns Survey” template?
The template includes 15 ready-to-use questions, starting with: “Thanks for taking part in this public health research survey on vaping and nicotine use. It's for adults 18 and older, t…” · “Are you 18 years of age or older?” · “Have you used any vaping or nicotine products (e-cigarettes, vapes, pouches, cigarettes, etc.) in the last 12 months?”. The full set is previewed above, and every question is editable.
How long does this survey take to complete?
Respondents typically finish the 15 questions in about 8 minutes.
Can I customize this template?
Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.
Is this template free to use?
Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.