Sex*
----MaleFemale

Any family history of cancer? (Yes/No)
---YesNo

Education Level:
---UndergraduateGraduatePostgraduate

Smoking Status:

Current smoker

Past smoker

Never Smoker

Drinking Status:

Current drinker

Drinking Frequency

Monthly or less 2–4 times a month 2–3 times a week 4 or more times per week

6+ drinks on one occasion

Never Less than monthly Monthly Weekly Daily or almost daily

Past Drinker

Never Drinker

Symptoms (check all that apply)

a) Sore throat ⁄ caught in throat
b) Hoarseness ⁄ voice changes
c) Lump on one side of mouth or cheek
d) Lump in neck, behind ear, under jaw
e) Numbness of tongue ⁄ other area
f) Sore on lips for 2+ weeks
g) Swelling causing dentures to fit poorly

Oral cancer knowledge based questions:

I think oral cancer can be prevented

YesNo

Oral cancer is a common cancer for Indian men

YesNo

Ever heard of oral cancer screening

YesNo

Ever been screened for oral cancer

YesNo

Ever seen or heard about free oral cancer screening

YesNo

Would you ever get screened?

YesNo