Inclusion Criteria:

• * Male and female patients 18 years of age or older
• * Patients being seen at one of the UI Health Centers for an ear, nose, or throat related concern.
• * Patients who have a history of both smoking and drinking.
• * Patients must be willing to complete a study survey.
• * Patients must understand the purpose and procedures of the study and be willing to participate.
• * Patients who speak English.
• * All adult men and women who meet the study criteria will be asked to participate in the study without regard to race, gender or socioeconomic status.
• * For Part 2 of the study, inclusion criteria includes all patients 40 and over with a history or smoking and drinking as well as patients 18 years of age and older who present with dysphasia and/or pain when swallowing. Patients eligible for Part 2 of the study will be informed of the study, but they will not be consented during their clinic visit.

Exclusion Criteria:

• * Male and Female patients under the age of 18.
• * Patients who are not being seen at one of the UI Health Community Health
• * Centers for an ear, nose or throat related concern.
• * Patients who do not have a history of both drinking and smoking.
• * Patients unwilling to complete the study survey.
• * Women who are pregnant will be excluded from both Part 1 and Part 2 of the study.
• * Patients unable to understand the purpose and procedures of the study and/or who are not willing to participate.
• * Patients who do not speak English.
• Excluded or Vulnerable Populations
• * Minors will be excluded from the study because they are not at risk for the factors being studied in the research.
• * Subjects who are not English speaking will be excluded due to the limited capacity of the primary investigators to obtain informed consent in this population.