Minority Veterans and Cannabis Pulse Survey

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* 1. Do you use marijuana? (Select all that apply)

Yes, I use medical marijuana

Yes, I use recreational marijuana

No, I do not use marijuana

Yes, I use both recreational and medical marijuana

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* 2. If yes, have you shared your marijuana use with your providers?

Yes, I have shared with my VA physicians

Yes, I have shared with my private healthcare providers

No, I have not shared my use with my providers

Other (please specify)

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* 3. If yes, how have your providers responded?

My provider was supportive and had productive dialogue about my care

I have faced stigmatization or discrimination in my care

I was denied access to care and/or benefits as a result of this disclosure

I have received better care as a result of my disclosure

Other (please specify)

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* 4. If no, why haven't you shared your use with providers? (Select all that apply)

For fear of losing my benefits

For fear of being stigmatized

It hasn't been relevant in my care

I haven't had the opportunity

For fear of losing access to my medicines

Other (please specify)

None of the above

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* 5. Have you faced any legal implications from your marijuana use? (If yes, please briefly describe)

Demographic information is completely voluntary and is collected in order to best understand trends and challenges faced by unique demographics within our community. Please only complete if you are comfortable and know that your privacy and anonymity is our top concern.

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* 6. What state are you located in?

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* 7. What is your racial identity?

Black or African American

Hispanic or Latin(x/o/a)

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

White or Caucasian

Other (please self-describe)

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* 8. What is your gender identity? (Select all that apply)

Woman

Nonbinary

Man

Transgender

Other (please self-describe)

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* 9. What is your sexual orientation?

Heterosexual or straight

Lesbian

Gay

Bisexual

Pansexual

Asexual

Other (please self-describe)

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* 10. Are you a veteran or have you served in the US Armed Forces?

Yes

Other (please specify - military family, spouse, child, etc.)