MPox Survey

Question Title

* 1. What is your gender?

Female

Male

Other (specify)

Question Title

* 2. Which category below includes your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 3. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

Question Title

* 4. Which of the following categories best describes your employment status?

Employed, working 40 or more hours per week

Employed, working 1-39 hours per week

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

Question Title

* 5. How much total combined money did all members of your HOUSEHOLD earn last year?

$0 to $9,999

$10,000 to $24,999

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $124,999

$125,000 to $149,999

$150,000 to $174,999

$175,000 to $199,999

$200,000 and up

Prefer not to answer

Question Title

* 6. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

From multiple races

Some other race (please specify)

Question Title

* 7. Are you Spanish, Hispanic, or Latino?

Yes