Are you between the ages of 14 to 17? * must provide value
Yes
No
Please review this Assent form and note that your parent or guardian must also sign off on the next page consent form, since you are under 18.
I have read the Assent Form above and conditions of this project. If I had questions they were answered and I agree to participate.
I do not want to participate
We understand that you do not want to participate at this time. Have a nice day. Parent or Guardian of participants age 14-17 must complete this form:
If you have read (or have had explained to you) and have no further questions on the information on this informed consent form, AND you voluntarily agree to allow your child to join this study, please check this box.
I do not agree to have my child participate
We understand that you do not want to participate at this time. Have a nice day. Please review this consent from and check off if you agree to participate.
If you have read (or have had explained to you) and have no further questions on the information on this informed consent form, AND you voluntarily agree to join this study, please check this box.
I do not want to participate.
We understand that you do not want to participate at this time. Have a nice day. Instructions: The following questionnaire is made up of 3 sections (A-C). Please read all questions carefully, answering truthfully, and to the best of your ability. Remember there are no right or wrong answers. Section A: Demographic Information Age* must provide value
Gender Female
Male
Trans (M to F)
Trans (F to M)
Non-binary
Which racial/ethnic group best describes you? (May check more than one) White/Caucasian
Black/African American
Asian/Asian American
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Which ethnicity best describes you? Hispanic or Latino
Not Hispanic or Latino
Highest level of education completed: Elementary school
High School graduate
Some college
Undergraduate college degree
Masters degree
Doctorate or equivalent (e.g. PhD, MD)
Section B: Attitudes About Marijuana 1. Have you ever used marijuana? Yes
No
2. I don't use marijuana because: Cost
Legal Issues
I don't think it will help my pain or mood
It will have other side effects that I don't desire
Section C: Reasons for Marijuana Use 1. I use marijuana when I have acute (short term) pain due to sickle cell disease. Most of the time
Some of the time
Rarely or never
2. I use marijuana to help reduce chronic (long term) pain due to sickle cell disease. Most of the time
Some of the time
Rarely or neverjavascript:;
3. I use marijuana to help me relax. Most of the time
Some of the time
Rarely or never
4. I use marijuana to stop me feeling anxious. Most of the time
Some of the time
Rarely or never
5. I use marijuana to stop me from feeling depressed. Most of the time
Some of the time
Rarely or never
6. I use marijuana to prevent me from getting pain due to sickle cell disease. Most of the time
Some of the time
Rarely or never
7. I use marijuana to give me energy. Most of the time
Some of the time
Rarely or never
8. I use marijuana to get 'high.' Most of the time
Some of the time
Rarely or never
9. Using marijuana causes me to have fewer painful crises. Most of the time
Some of the time
Rarely or never
10. Marijuana reduces the amount of pain killers I need. Most of the time
Some of the time
Rarely or never
11. Marijuana improves my mood. Most of the time
Some of the time
Rarely or never
12. Marijuana makes me sleep better. Most of the time
Some of the time
Rarely or never
Thank you so much for taking the time to do this survey!
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