How would you say things are these days in your life? Would you say that you are:
Very unhappy
Unhappy
Happy
Very Happy
In reference to LGBTQ issues, to what extent do you agree that in the Greater Pittsburgh region are generally headed in the right direction?
In your opinion, how much discrimination is there against each of these groups in Greater Pittsburgh region today?
African American
Asian American
Hispanic American
Gays and Lesbians
Transgender/Queer
Women
What sort of negative or bad experience have you faced as a LGBTQ person (during the past 5 years) in Greater Pittsburgh region?
Been subject to slurs or jokes
Rejected by family member(s)
Rejected by friend(s)
Been threatened or physically attacked
Police Brutality
Been made unwelcome at place of worship
Received poor service in restaurants/hotels
Received poor service in place of business
Unfairly rejected for employment
Unfairly treated with wage discrimination
Unfairly treated with job promotion opportunity
How would you rate your overall physical health right now?
Poor
Fair
Good
Very good
Excellent
What kind of health coverage or insurance do you have?
Obamacare
VA
Medicaid
Private insurance or HMO/HMOE (paid by employer)
Medicare
Private insurance or HMO/HMOE (paid by yourself)
None
Do you have a family doctor/PCP?
How long ago was your most recent physical check up?
1 year ago or more recent
about 2 years ago
about 3 years ago
about 4 years ago
about 5 years ago
more than 5 years ago
Please check all that apply to you:
Where did you go for your most recent medical treatment?
During the past 30 days how many days have you experienced serious depression?
During the past 30 days how many days have you experienced serious anxiety or tension?
During the past 30 days how many days have you experienced hallucinations?
During the past 30 days how many days have you experienced trouble understanding, concentrating, or remembering?
During the past 30 days how many days have you experienced trouble controlling violent behavior?
During the past 30 days how many days have you experienced eating disorders?
Which of the following activities did you typically engage as your social and leisure time activities?
Watching TV
Listening to music
Play indoor game(s)
Play outdoor sport(s)
Attending and watching sport game(s)
Spending time on excising (at home)
Spending time on excising (out of home)
Doing things with your computer (not counting work)
Spending time reading
Visiting or socializing with family member (s)
Visiting or socializing with LGBTQ friends
Visiting or socializing with friends, not including LGBTQ
Going to clubs
Going to restaurants
Viewing rented movies on TV
Going to a movie (at a theater)
Attending a faith-based service
Attending social activity of a faith-based organization
In reference to the Black LGBTQ community in Greater Pittsburgh region how good is the organized social and recreational activities (e.g., such as basketball, softball, bowling, etc.)?
Very Poor
Poor
OK/Good
Very Good
Do your parents know about your sexuality choices?
Yes
No
Does not apply
Do your parents accept you as a same gender loving (SGL)?
Yes
No
Does not apply
Do your sibling(s) accept you as a SGL?
Yes
No
Does not apply
Do your parents supporting you as a SGL?
Yes
No
Does not apply
Do your friends support you as a SGL?
Yes
No
Does not apply
Does your pastor know that you are SGL?
Yes
No
Does not apply
Does your pastor encourage you to be an active member of the faith group?
Yes
No
Does not apply
Have you felt uncomfortable with your faith group leaders?
Yes
No
Does not apply
Have you felt uncomfortable with your other faith group members?
Yes
No
Does not apply
Have you reached out to your faith group leaders/members for support?
Yes
No
Does not apply
Did you did receive support from your faith group leaders/members?
Yes
No
Does not apply
If “Yes”, please specify what type of support(s) was received?
Do you believe faith-based teachings about god or higher beings?
Yes
No
Does not apply
Do you devote time to study faith-based documents (Bible, Koran, etc.)?
Yes
No
Does not apply
Would you attend an inclusive church, mosque, temple, or others alike?
Yes
No
Does not apply
Do you attend gay film festivals?
Yes
No
Does not apply
Have you associated with Parents, Families of Lesbian and Gays (PFLAG)?
Yes
No
Does not apply
Have you associated with Gay Lesbian Straight Educational Network (GLSEN)?
Yes
No
Does not apply
Are you in need of a SGL support network?
Yes
No
Does not apply
Are you in need of a social service support network for your needs?
Yes
No
Does not apply
Do you believe that creative work by SGL artists can help change social attitude, culture, and behavior?
Yes
No
Does not apply
Are you in need of socializing with other SGL individuals?
Yes
No
Does not apply
Have you attended Pittsburgh Pride festival?
Yes
No
Does not apply
Have you attended Pittsburgh Black Pride festival?
Yes
No
Does not apply
Please indicate your human service need(s)?
Substance use/abuse problem
Learning coping skills
Mental health/ co-occurring disorders
Personal relationship problems
Dealing with trauma
Self-esteem building
Strengthening family relationship
Addressing physical health related issues
Advancing training/education
Employment and self-sufficiency
Mentoring service
Housing information
Criminal behavior/recidivism prevention
Personal growth, life and social skills development
HIV/AIDS related services
Referral to specific community-based human service(s)
What can social service & Health agencies do better?
How would you describe yourself?
Gay/SGL
Lesbian
Bisexual
Transgender
Straight
How would you describe yourself (if not listed above)?
What year were you born?
Were you ever a CYF assigned foster child?
What is your race/ethnic background?
Black
Bi/multi-racial
Hispanic/Latino/Latina
White
What is your race/ethnic background (if not listed above)?
What is your highest educational level?
Up to some high school
Home school
Completed high school
Some associates degree/4-year college degree credits
Associates degree graduate
4-year college graduate or higher
Current marital status:
Single
Divorced
Separated
Married (same gender partner)
Married (heterosexual partner)
How many SGL individuals do you know (on the first name basis) in Greater Pittsburgh region?
Do you have children (age up to 18)?
Have you ever lost the custody of your children to CYF?
What is your current employment status?
Employed-- part time (less than 35 hours per week)
Employed-- full time (35 or more hours per week)
Unemployed and seeking work
Unemployed, and not looking for work
Unemployed, disabled
Unemployed, retired
Unemployed, in school/training
Would you be willing to support a group like UHIMWE Alliance in Pittsburgh?
Name
(optional)
First Name
Last Name
Address
(optional)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How did you hear about this survey?
