How many servings of fresh fruits, grains and vegetables (not including potatoes, white rice and iceberg lettuce) do you eat each day? *

< 3

3 - 5

> 5

Do you currently smoke? *

Yes

No

If you've ever smoked, how many packs of cigarettes did you smoke per day? *

Never Smoked

< 1

1 - 2

> 2

How many years have you smoked? *

Never Smoked

< 5

5 - 10

> 10

If you've quit smoking, how many years ago did you quit?

Never smoked

Still smoking

< 5

5 - 10

> 10

What is the average amount of minutes do you exercise per day?

< 30

30 - 60

> 60