Community Survey on Prescription Drug Misuse and Abuse

Demographics

 
Survey respondent demographics.
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1. What county do you live in?
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2. Are you male or female?
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3. How old are you?
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4. How would you describe yourself? Check all that apply.
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5. Do you consider yourself to be mainly of Spanish, Hispanic, or Latino heritage?
6. If you answered yes to the question above, what country do you come from?
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7. Are you currently employed either full or part-time?
8. If you answered no, why are you not currently working either full or part-time?
9. Please check any of the places that you have ever worked at or currently work:
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10. Are you employed in the medical or dental field with the authority to prescribe medication?
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