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Welcome to UCLA’s Medical Marijuana Research Web survey. Please be aware that this research is completely voluntary. The information obtained here will be anonymous and no individual results will be reported or disclosed to any dispensary or law enforcement. The goal of the research is to better understand whether or not the increasing numbers of dispensaries in California are related to changes in local crime and medical marijuana abuse or dependence. To thank you for taking part in this survey we will send you a $30 gift redeemable at amazon.com or its affiliates. An e-mail address will be required to send you confirmation of your e-gift. This e-mail address will remain confidential and will not be used for any other purpose but to send you the e-gift. You may end completion of this survey at any time, but the gift will only be administered to those who complete the entire survey. If you agree to participate, please click “I agree.” If not, please click “I disagree” and you will be logged out of the system.
 
 
 
Background
 
 
What is you marital status?
 
married
 
single
 
divorced/widowed
 
living with a partner
 
Other
 
 
 
How many people live in your home?
Related Non-Related
Adults
Children
 
 
 
Marijuana Use Information
 
 
 
1. On how many days in the past four weeks (28 days) did you use marijuana or hashish? (question type wouldn't allow me to add a "don't know" option)
   
 
 
 
2.Have you used marijuana or marijuana products today? (skip/branching logic can be added, however, the free trial doesn't allow us to use this service)
 
Yes
 
No
 
Don't Know
 
 
 
If yes, in what form? (Select all that apply)
 
Smoke (in pipe or as a joint)
 
Vaporized
 
Edibles
 
Other
 

 
 
 
Health
 
 
The following items are about activities you might do during a typical day.

Does your health now limit you in these activities? If so, how much? (Select one option on each line)
Yes, Limited a Lot Yes, Limited a Little No, Not limited at All
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Lifting or carrying groceries
Climbing several flights of stairs
Climbing one flight of stairs
Bending, kneeling, or stooping
Walking more than a mileWalking several blocks
Walking one blockBathing or dressing yourself
 
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