Gender (select one) Male Female Transgender Did not disclose

Age Range (select one) 0-12 13-17 18-24 25-34 35-44 45-54 55-64 65 or older Unknown or refused

Ethnicity Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Hispanic or Latino Caucasian/White Did not disclose

Marital Status (select one) Single Married Separated Remarried Widowed Refused to answer

Living situation (select one) Lives alone Roommate Spouse or partner Parents Children Friend Homeless/at risk of losing Housing Residential facility Refused to answer

Military Service (select one) Active Duty Family Member Reserves Retired Veteran N/A

Disability Disabled Not Disabled Unknown

Health Insurance Medicaid Medicare Private Insurance None Other Unknown

In Treatment Mental Health None Physical Health Substance Support Group Unsure