[BACK]Background Information

[B0] Demographics

Name |__| 
Address |__| 

[B1] How old are you today?
|__|__|

[B2] What is the highest level of school that you have completed?
[] Grade school (grades 1-8)
[] Some high school (grades 9-11)
[] High school graduate or GED
[] Some college
[] Technical or trade school beyond high school
[] Associate’s degree
[] College graduate (Bachelor’s degree)
[] Advanced degree (Master’s, Doctorate, etc.)
[] Other ( specify ) [text box]

[B3] What is your current marital/partner status?
[] Never married
[] Not married but living with partner
[] Married
[] Divorced
[] Widowed
[] Separated
[] Prefer not to answer

[B4] What best describes your race? Select all that apply to you.
[] American Indian or Alaska native
[] Asian
[] Black or African American
[] Middle Eastern or North African
[] Native Hawaiian or other Pacific Islander
[] White
[] Other ( specify ) [text box]
[] Do not know
[] Prefer not to answer
[SEX] Later questions in this survey will ask about surgeries and medical procedures. We want to make sure that you are asked the right questions. 
Please select the body parts that you were born with.
[1] Penis
[2] Testes
[3] Prostate
[4] Vagina
[5] Cervix
[6] Uterus
[7] Ovaries
[8] Fallopian Tubes

|grid|id="grid_SECSM"|People in Household|[ [SECSMA,displayif=equals(SEX,1)] Birth to 5 years of age; [SECSMB] Ages 6 to 10; [SECSMC] Ages 11 to 14; [SECSMD] Ages 15 to 17;]|(1:Every day, at least 2 hours each day
) (2:Every day, less than 2 hours each day
) (3:Most days of the week) (4:A few days per week) (5:One day per week) (6: A few days per month) (7: One day per month) (8:  few days per year) (9: Never)|

[HRMED2?] What medication did you use to treat thinning hair or hair loss? Select all that apply.
[1] Rogaine, Minoxidil, or Ioniten
[2,displayif=equals(SEX,1)]Finasteride
[3] Other: Please describe [text box]