Are you taking this survey for yourself or are you taking it on behalf of someone else? * Required
Myself
Someone else
Next
Please rate your level of agreement with the following statements:
I feel isolated from others * Required None of the Time Some of the Time OftenNext
I lack companionship * Required None of the Time Some of the Time OftenNext
I feel no one really knows me well * Required None of the Time Some of the Time OftenNext
I can find companionship when I want it * Required None of the Time Some of the Time OftenNext
In the past two weeks, I have participated in organizations such as:
Social clubs, residents’ groups, or committees * Required None of the Time Some of the Time OftenNext
In the past two weeks, I have participated in:
Religious groups * Required None of the Time Some of the Time OftenNext
I avoid socializing because it is hard to understand conversations, especially when there is background noise * Required None of the Time Some of the Time OftenNext
I am satisfied with the relationships I have with my family * Required None of the Time Some of the Time OftenNext
I am satisfied with the relationships I have with my friends * Required None of the Time Some of the Time OftenNext
I have as much contact as I would like with people I feel close to and who I can trust and confide * Required None of the Time Some of the Time OftenNext
There are enough people I feel close to and could call for help * Required None of the Time Some of the Time OftenNext
I am content with my friendships and relationships * Required None of the Time Some of the Time OftenNext
I miss having people around me * Required None of the Time Some of the Time OftenNext
Please tell us a little about you.
What is the 5-digit ZIP Code where you live? * Required Next
In what year were you born (YYYY)? * Required Next
What is your gender? * Required Male Female Transgender Prefer to self-describeNext
Are you of Hispanic, Latino, or Spanish origin or descent? * Required Yes NoNext
Which of the following best describes your race? * Required American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Multi-racial Other RaceNext
Do you live alone? * Required Yes NoNext
Are you married or do you live with a partner? Yes NoNext
Have you ever served in the military? * Required Yes NoNext
Are you blind or do you have difficulty seeing, even when wearing glasses? * Required Yes NoNext
Are you deaf or do you have difficulty hearing? * Required Yes NoNext
Do you have difficulty walking or climbing stairs? * Required Yes NoNext
Are you worried or stressed about having enough money to meet your basic needs? * Required Yes NoNext
Do you have a ride or the transportation you need to get where you want to go? * Required Yes NoNext
Do you own a smartphone, computer, laptop, or tablet? * Required Yes NoNext
Which of the following best represents how you think of yourself? * Required Heterosexual (Straight) Gay Bisexual Something else I prefer not to answer