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Impact of housing insecurity on health disparities, past and present
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1.
Race
(Required.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islanders
White
Other (please specify)
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2.
Ethnicity
(Required.)
Hispanic or Latino or Spanish origin
Not Hispanic or Latino or Spanish origin
Other (please specify)
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3.
Gender
(Required.)
Cisgender man
Cisgender woman
Transgender man
Transgender woman
Nonbinary
Intersex
Two-spirit
Agender
Genderfluid
Bigender
Genderqueer
Other (please specify)
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4.
Sexual orientation
(Required.)
Gay
Lesbian
Straight
Bisexual
Pansexual
Queer
Other (please specify)
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5.
While experiencing housing insecurity did you:
Ever miss doctors appointments due to lack of money?
(Required.)
Yes
No
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6.
While experiencing housing insecurity did you:
Ever miss appointments due to lack of transportation?
(Required.)
Yes
No
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7.
While experiencing housing insecurity did you:
Ever need medication that you couldn’t afford?
(Required.)
Yes
No
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8.
While experiencing housing insecurity did you:
Ever need urgent medical treatment that you did not receive?
(Required.)
Yes
No
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9.
While experiencing housing insecurity did you:
Ever experience discrimination by a healthcare worker?
(Required.)
Yes
No
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10.
If you are no longer experiencing housing insecurity, is your health still impacted by it? If so, how?
If you are currently experiencing housing insecurity, how is your health currently affected?
(Required.)