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* 1. Contact Info

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* 2. Have you or has any member of your household or immediate family ever been employed in any of the following professions?

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* 3. Which of the following best reflects how you would identify your ethnicity/culture?

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* 4. With which of the following medical conditions have you been diagnosed with?

**CAN BE NONE OF THESE **

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* 5. Because this study is focused on sexual health, you will be asked some potentially sensitive personal questions about your sexual preference and behaviors as part of our conversation right now and during your individual interview. As a reminder, your responses will be kept completely confidential, and will be separated from your identity. Do you feel comfortable honestly answering these types of questions in this context?

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