Medical Conditions for Males

Hello,

Thank you for signing up with the Q-insights database to participate in paid studies! We have a research study regarding sexual behavior and medication.

This project is a little different than most research studies, as this will be conducted online. For this project, participants are asked to log into a secure website using ONLY a laptop or desktop computer and answer questions over a course of one to two weeks. Based on your entry during Week 1, we will be selecting a few people to participate for an additional 3 days during the following week..

Week 1 will be conducted during the week of December 9th from Monday to Friday and Week 2 will consist of 3 days during the week of December 16th. If you choose to participate, you must be available during both weeks.

We require that you spend 30-45 minutes each day online. We recognize this is during a busy holiday season, will you be able to commit to 30-45 minutes per day?

Please note that your privacy will be protected. Although other participants will see your answers, we will ask that you log in under a screen name, not your real name. We will not ask you to post any photographs or identifying information. This will not be a public forum and other than the participants, only the research team will have access to the community.

Please be assured that the information gathered will remain confidential and will be used for research purposes only. Your name will never appear with the information you provide. You will be paid $165 or your participation for Week 1 and if you are selected to continue onto Week 2, you will be paid $135.

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* 1. Gender:

Male

Female

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* 2. Age:

Example: 25 (Numbers ONLY!)

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* 3. What is your employment status?

Full time

Part time

Homemaker

Retired

Student

Unemployed, looking for work

Unemployed, not looking for work

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* 4. Which of the following best describes your current relationship status?

Married

Single, living with partner

Single, in a relationship but not living with partner

Single and not in a relationship

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* 5. Are you now or have you been sexually active in the past three months?

Yes

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* 6. What is the gender of your relationship partner or partners?

Female Only

Male Only

Female and Male

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* 7. Have you ever spoken to a physician about erectile dysfunction or ED prescription medications?

Yes

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* 8. Do you or have you ever had cancer?

Yes

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* 9. Have you ever taken any of the following medications?

Cialis

Levitra

Staxyn

Stendra

Viagra

None of the above

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* 10. Which of the following reasons did you use the medication mentioned above?

To enhance my sexual pleasure

To help get or keep an erection during intercourse

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* 11. Which of the following ways have you had access to the medication mentioned above?

Ordered online

Received it from a friend or relative

Bought it from someone

Sample from a doctor

Prescription from a doctor

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* 12. On a scale from 1 to 7, where 1 means “Not at all Interested” and 7 means “Very Interested”, please rate the following statement: How interested are you to try a drug for erectile dysfunction such as Cialis or Viagra even if you have not been diagnosed with having erectile dysfunction

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* 13. What was your last level of formal education?

Some high school

Graduated from high school

Some college

Graduated from college

Graduate or post-graduate work

Technical or vocational school

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* 14. What was your total household income for last year?

Under $15,000

$15,000 - $29,999

$30,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $150,000

Over $150,000

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* 15. What is your ethnicity?

White/Caucasian

Black/African American

Hispanic

Asian

Other

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* 16. Would you be able to participate for 1-2 weeks? If you are not able to, please let us know because we need to make sure the respondents we get are solid respondents.

Yes

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* 17. Please provide your contact information and if you qualify a recruiter will contact you to follow up.

Name: *

State: *

Email Address: *

Phone Number: *

Alt. Phone Number:

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* 1. Gender:

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* 2. Age: Example: 25 (Numbers ONLY!)

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* 3. What is your employment status?

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* 4. Which of the following best describes your current relationship status?

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* 5. Are you now or have you been sexually active in the past three months?

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* 6. What is the gender of your relationship partner or partners?

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* 7. Have you ever spoken to a physician about erectile dysfunction or ED prescription medications?

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* 8. Do you or have you ever had cancer?

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* 9. Have you ever taken any of the following medications?

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* 10. Which of the following reasons did you use the medication mentioned above?

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* 11. Which of the following ways have you had access to the medication mentioned above?

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* 12. On a scale from 1 to 7, where 1 means “Not at all Interested” and 7 means “Very Interested”, please rate the following statement: How interested are you to try a drug for erectile dysfunction such as Cialis or Viagra even if you have not been diagnosed with having erectile dysfunction

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* 13. What was your last level of formal education?

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* 14. What was your total household income for last year?

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* 15. What is your ethnicity?

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* 16. Would you be able to participate for 1-2 weeks? If you are not able to, please let us know because we need to make sure the respondents we get are solid respondents.

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* 17. Please provide your contact information and if you qualify a recruiter will contact you to follow up.

* 2. Age:

Example: 25 (Numbers ONLY!)