Online Discussion of Healthcare Issues -- pays $150! (F091224)

We are studying current healthcare issues, and we’d like to get your views. If you qualify for this study, we will invite you to join us on ZOOM on September 12th for a two hour discussion. After the discussion, we will send you $150 as thanks for your time and help. This is not a sales meeting, and no one will try to recruit you for anything.

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* 1. Please enter your first and last names.

First name:

Last name:

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* 2. Please enter your phone number as 10 digits without any other characters. (Ex: 1234567890)

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* 3. Please enter an e-mail where you can be reached.

*By providing my email and/or cell phone number I agree to receive communications via email, phone, and text to that number and email address from Atkins Research Global, Inc. with updates and opportunities. Standard message & data rates may apply. Text STOP to opt-out at any time. Text HELP for more info. Recurring messages. https://www.atkinsresearch.com/privacy-policy/

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* 4. May we text you at the number above?

Yes

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* 5. Please enter your city, county, and state of residence.

City:

County (ex. Orange):

State:

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* 6. Please enter your ZIP Code.

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* 7. What is your gender?

Female

Male

Non-Binary

Prefer to self-describe

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* 8. Think about the jobs and occupations that you or your immediate family currently hold or have held. Have you or any member of your household ever been employed by any of the following types of companies? Select all that apply.

Market research

Marketing, advertising, or public relations

Radio, TV, newspaper, magazine, Internet, or other media

Pharmaceutical manufacturer or sales organization

Physician or Medical Care Provider who prescribes pain medication

Pharmacist or Pharmacy Technician

None of the above

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* 9. Please enter your job title, industry, and employer. If you are not currently working for any reason, please enter the information from your last job.

Job Title:

Industry:

Employer:

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* 10. What is your age?

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* 11. What is your date of birth?

MM/DD/AAAA

Date

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* 12. Which of the following best describes your current employment status?

Working full-time

Working part-time

Stay at home parent/caregiver

Student

Unemployed/looking for work

Retired

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* 13. What is your current living situation? Select all that apply.

Living with partner

Living with roommates

Living with parents/family

Living alone

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* 14. What ethnic background do you identify with most?

White/Caucasian

African-American

Asian/Pacific Islander

Latino/a/x

Native American

Not Listed (please specify)

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* 15. Regardless of your answer above, do you consider yourself to be of Hispanic origin?

Yes

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* 16. If you identify as Asian/Pacific Islander, what are your family’s nation/s of origin?

I do not identify as Asian/Pacific Islander.

My family’s nation/s of origin are:

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* 17. Which of the following languages do you speak (e.g., at home, work, socially, etc.)? Select all that apply.

Armenian

Cantonese

Chinese

English

French

German

Japanese

Korean

Persian

Punjabi

Russian

Spanish

Tagalog

Ukrainian/Other Slavic

Vietnamese

Other (please specify)

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* 18. How well can you speak English?

Very Well

Well

Not Well

Not at All

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* 19. How well can you speak Spanish?

Very Well

Well

Not Well

Not at All

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* 20. On a scale of 1 to 10, please select how knowledgeable you are on the following topics in regards to VENTURA County. A 1 rating means “I am not at all knowledgeable” and a 10 rating means “I am extremely knowledgeable.”

	1	2	3	4	5	6	7	8	9	10
Drinking water quality	Drinking water quality 1	Drinking water quality 2	Drinking water quality 3	Drinking water quality 4	Drinking water quality 5	Drinking water quality 6	Drinking water quality 7	Drinking water quality 8	Drinking water quality 9	Drinking water quality 10
Quality of public schools	Quality of public schools 1	Quality of public schools 2	Quality of public schools 3	Quality of public schools 4	Quality of public schools 5	Quality of public schools 6	Quality of public schools 7	Quality of public schools 8	Quality of public schools 9	Quality of public schools 10
Voting rights and procedures	Voting rights and procedures 1	Voting rights and procedures 2	Voting rights and procedures 3	Voting rights and procedures 4	Voting rights and procedures 5	Voting rights and procedures 6	Voting rights and procedures 7	Voting rights and procedures 8	Voting rights and procedures 9	Voting rights and procedures 10
Opioid crisis	Opioid crisis 1	Opioid crisis 2	Opioid crisis 3	Opioid crisis 4	Opioid crisis 5	Opioid crisis 6	Opioid crisis 7	Opioid crisis 8	Opioid crisis 9	Opioid crisis 10
Climate change initiatives	Climate change initiatives 1	Climate change initiatives 2	Climate change initiatives 3	Climate change initiatives 4	Climate change initiatives 5	Climate change initiatives 6	Climate change initiatives 7	Climate change initiatives 8	Climate change initiatives 9	Climate change initiatives 10
Homelessness	Homelessness 1	Homelessness 2	Homelessness 3	Homelessness 4	Homelessness 5	Homelessness 6	Homelessness 7	Homelessness 8	Homelessness 9	Homelessness 10
Fentanyl usage	Fentanyl usage 1	Fentanyl usage 2	Fentanyl usage 3	Fentanyl usage 4	Fentanyl usage 5	Fentanyl usage 6	Fentanyl usage 7	Fentanyl usage 8	Fentanyl usage 9	Fentanyl usage 10
Housing costs	Housing costs 1	Housing costs 2	Housing costs 3	Housing costs 4	Housing costs 5	Housing costs 6	Housing costs 7	Housing costs 8	Housing costs 9	Housing costs 10

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* 21. On a scale of 1 to 10, please state how strongly you feel about your personal beliefs and opinions when it comes to the following topics, as they relate to VENTURA County. A 1 rating means “I do not feel strongly about my personal beliefs or opinions on the topic” and a 10 rating means “I feel extremely strongly about personal beliefs and opinions on the topic.”

	1	2	3	4	5	6	7	8	9	10
Drinking water quality	Drinking water quality 1	Drinking water quality 2	Drinking water quality 3	Drinking water quality 4	Drinking water quality 5	Drinking water quality 6	Drinking water quality 7	Drinking water quality 8	Drinking water quality 9	Drinking water quality 10
Quality of public schools	Quality of public schools 1	Quality of public schools 2	Quality of public schools 3	Quality of public schools 4	Quality of public schools 5	Quality of public schools 6	Quality of public schools 7	Quality of public schools 8	Quality of public schools 9	Quality of public schools 10
Voting rights and procedures	Voting rights and procedures 1	Voting rights and procedures 2	Voting rights and procedures 3	Voting rights and procedures 4	Voting rights and procedures 5	Voting rights and procedures 6	Voting rights and procedures 7	Voting rights and procedures 8	Voting rights and procedures 9	Voting rights and procedures 10
Opioid crisis	Opioid crisis 1	Opioid crisis 2	Opioid crisis 3	Opioid crisis 4	Opioid crisis 5	Opioid crisis 6	Opioid crisis 7	Opioid crisis 8	Opioid crisis 9	Opioid crisis 10
Climate change initiatives	Climate change initiatives 1	Climate change initiatives 2	Climate change initiatives 3	Climate change initiatives 4	Climate change initiatives 5	Climate change initiatives 6	Climate change initiatives 7	Climate change initiatives 8	Climate change initiatives 9	Climate change initiatives 10
Homelessness	Homelessness 1	Homelessness 2	Homelessness 3	Homelessness 4	Homelessness 5	Homelessness 6	Homelessness 7	Homelessness 8	Homelessness 9	Homelessness 10
Fentanyl usage	Fentanyl usage 1	Fentanyl usage 2	Fentanyl usage 3	Fentanyl usage 4	Fentanyl usage 5	Fentanyl usage 6	Fentanyl usage 7	Fentanyl usage 8	Fentanyl usage 9	Fentanyl usage 10
Housing costs	Housing costs 1	Housing costs 2	Housing costs 3	Housing costs 4	Housing costs 5	Housing costs 6	Housing costs 7	Housing costs 8	Housing costs 9	Housing costs 10

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* 22. For which of the following have you personally ever used PRESCRIPTION medications? Select all that apply. Do not include antibiotics or over the counter medications like Tylenol, Advil, Herbal Supplements, Caffeine/Energy Stimulants, etc.

To help with drowsiness / keep me alert

To help study / complete work / accomplish necessary tasks

To help with stress

To help with pain

To cope with problems

To help when feeling anxious

To help with depression

To help relax

None of the above

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* 23. Do you or a close family member currently use prescription medications for pain management, depression or anxiety on a regular basis? Select all that apply.

Yes, I do

Yes, someone in my family does

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* 24. How long have you used prescription pain medications to treat pain, if at all?

Less than 6 months

6 months to a less than a year

1 year to 5 years

More than 5 years

This question does not apply to me.

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* 25. How long has your family member used prescription pain medications to treat pain, if at all?

Less than 6 months

6 months to a less than a year

1 year to 5 years

More than 5 years

Not Sure

This question does not apply to me.

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* 26. On average, how frequently do you use prescription pain medications to treat pain, if at all?

Daily

Multiple times / week

Once a week

Once every 2-3 weeks

Once a month

Less often than once a month

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* 27. On average, how frequently does a close family member use prescription pain medications to treat pain, if at all?

Daily

Multiple times / week

Once a week

Once every 2-3 weeks

Once a month

Less often than once a month

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* 28. Which of the following prescription medications have you used during the past year for pain management, anxiety or depression? Select all that apply.

Ativan

Benzodiazepines

Brisdelle

Cannabinoid

Celexa

Cocaine

Codeine

Cymbalta

Demerol (meperidine)

Desyrel

Effexor

Ethanol

Fentanyl

Gabapentin

Heroin

Klonopin

Lexapro

Lortab

Luvox

Methadone

Methamphetamine

Morphine

Niravam

Norco

OxyContin/Oxycodone

Paxeva

Paxil

Percocet

Pristiq

Prozac

Sarafem

Tramadol

Valium

Vicodin

Viibryd

Xanax

Zoloft

General Opioid

Other (please specify)

None of the above

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* 29. Which of the following prescription medications has a close family member used during the past year for pain management, anxiety or depression? Select all that apply.

Ativan

Benzodiazepines

Brisdelle

Cannabinoid

Celexa

Cocaine

Codeine

Cymbalta

Demerol (meperidine)

Desyrel

Effexor

Ethanol

Fentanyl

Gabapentin

Heroin

Klonopin

Lexapro

Lortab

Luvox

Methadone

Methamphetamine

Morphine

Niravam

Norco

OxyContin/Oxycodone

Paxeva

Paxil

Percocet

Pristiq

Prozac

Sarafem

Tramadol

Valium

Vicodin

Viibryd

Xanax

Zoloft

General Opioid

Other (please specify)

None of the above

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* 30. For which, if any, of the following medical conditions have you or a family member been treated in the past 12 months? Select all that apply.

Acute pain due to injury

Anxiety

Cancer treatment

Chronic pain

Coughing

Depression

Diarrhea

Pain due to disease

Palliative Care / Hospice Care

Surgical procedure

None of the above

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* 31. For which, if any, of the following medical conditions have you or a family member been prescribed medication in the past 12 months? Select all that apply.

Acute pain due to injury

Anxiety

Cancer treatment

Chronic pain

Coughing

Depression

Diarrhea

Pain due to disease

Palliative Care / Hospice Care

Surgical procedure

None of the above

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* 32. If you have been treated for and/or prescribed medication for a SURGICAL procedure in the past 12 months, how long ago was the surgical procedure?

In the past 2 months

3-4 months ago

5-6 months ago

6 or more months ago

This question does not apply to me.

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* 33. Have you ever participated in a group discussion or interview for research purposes (e.g., focus groups, interviews, etc.)? If so, when was the last time you participated in such a group, and what was the topic(s)? If not, enter ‘0’ in the top box.

Time (MM/YY):

Topic/s:

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* 34. If you use corrective lenses, we will need you to have them with you. Can you do that?

Yes

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* 35. To participate in this study, you must:

Have a computer, either a laptop or a desktop, with a video camera and high-speed Internet access. Please note that tablets (including Chromebooks/Netbooks) and/or smartphones DO NOT work for this platform. It must be a regular desktop or laptop computer.

You must be able to join us by HIGH SPEED Internet powerful enough to run ZOOM for two hours without interruptions. If your Internet is interrupted during the session, we will not be able to compensate you.

Will you be able to arrange all of these things for the group discussion?

Yes

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* 36. For this session you will need to be in a room by yourself with a closed door in a quiet location. This includes having no children or pets in the room with you. You cannot participate in this session in a car or in a public area. Is this something you are sure you can do?

Yes

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* 37. If you qualify for this study, we will invite you to join us on ZOOM on September 12th, 2004 for a two hour discussion. After the discussion, we will send you $150 as thanks for your time and help.

You must log on AT LEAST 15 minutes before the start of your session so that we can test your connection. If you do not do this, we will not be able to include or pay you.

Please select ALL of the times you can join us. Times are Pacific.

September 12th at 5:00

September 12th at 7:30

Neither of the Above

Online Discussion of Healthcare Issues -- pays $150! (F091224)

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* 1. Please enter your first and last names.

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* 2. Please enter your phone number as 10 digits without any other characters. (Ex: 1234567890)

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* 3. Please enter an e-mail where you can be reached.

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* 4. May we text you at the number above?

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* 5. Please enter your city, county, and state of residence.

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* 6. Please enter your ZIP Code.

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* 7. What is your gender?

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* 8. Think about the jobs and occupations that you or your immediate family currently hold or have held. Have you or any member of your household ever been employed by any of the following types of companies? Select all that apply.

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* 9. Please enter your job title, industry, and employer. If you are not currently working for any reason, please enter the information from your last job.

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* 10. What is your age?

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* 11. What is your date of birth?

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* 12. Which of the following best describes your current employment status?

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* 13. What is your current living situation? Select all that apply.

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* 14. What ethnic background do you identify with most?

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* 15. Regardless of your answer above, do you consider yourself to be of Hispanic origin?

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* 16. If you identify as Asian/Pacific Islander, what are your family’s nation/s of origin?

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* 17. Which of the following languages do you speak (e.g., at home, work, socially, etc.)? Select all that apply.

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* 18. How well can you speak English?

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* 19. How well can you speak Spanish?

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* 20. On a scale of 1 to 10, please select how knowledgeable you are on the following topics in regards to VENTURA County. A 1 rating means “I am not at all knowledgeable” and a 10 rating means “I am extremely knowledgeable.”

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* 22. For which of the following have you personally ever used PRESCRIPTION medications? Select all that apply. Do not include antibiotics or over the counter medications like Tylenol, Advil, Herbal Supplements, Caffeine/Energy Stimulants, etc.

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* 23. Do you or a close family member currently use prescription medications for pain management, depression or anxiety on a regular basis? Select all that apply.

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* 24. How long have you used prescription pain medications to treat pain, if at all?

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* 25. How long has your family member used prescription pain medications to treat pain, if at all?

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* 26. On average, how frequently do you use prescription pain medications to treat pain, if at all?

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* 27. On average, how frequently does a close family member use prescription pain medications to treat pain, if at all?

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* 28. Which of the following prescription medications have you used during the past year for pain management, anxiety or depression? Select all that apply.

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* 29. Which of the following prescription medications has a close family member used during the past year for pain management, anxiety or depression? Select all that apply.

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* 30. For which, if any, of the following medical conditions have you or a family member been treated in the past 12 months? Select all that apply.

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* 31. For which, if any, of the following medical conditions have you or a family member been prescribed medication in the past 12 months? Select all that apply.

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* 32. If you have been treated for and/or prescribed medication for a SURGICAL procedure in the past 12 months, how long ago was the surgical procedure?

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* 33. Have you ever participated in a group discussion or interview for research purposes (e.g., focus groups, interviews, etc.)? If so, when was the last time you participated in such a group, and what was the topic(s)? If not, enter ‘0’ in the top box.

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* 34. If you use corrective lenses, we will need you to have them with you. Can you do that?

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* 36. For this session you will need to be in a room by yourself with a closed door in a quiet location. This includes having no children or pets in the room with you. You cannot participate in this session in a car or in a public area. Is this something you are sure you can do?

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* 38. Enter your street address.