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Golden Age Activity Survey

Returning?

A A A

Thank you for taking the time to complete this survey. This research study is a collaboration between the University of Wyoming and the University of Washington.

We are asking you to complete this survey because you are over the age of 65 years. The purpose of this survey is to better understand various health behaviors and activity levels in your age group.

This survey will take approximately 20-30 minutes to complete.

Your participation in this survey is entirely voluntary. You may choose to not answer any or all the questions, and you may choose to end the survey at any time.

The risk to you of taking this survey is minimal and like the risks you encounter as part of your day to day life. By participating in this study, you will not benefit directly. You may help others who are experiencing similar symptoms and help prevent disease in older adults.

We may ask you questions about your personal health. Your answers are confidential and will never be presented at an individual level. We will not be collecting personally identifiable information, such as name or social security number as a part of this research study.

Survey data will be stored securely through the University of Washington and University of Wyoming with REDCap (Research Electronic Data Capture), which is a secure, HIPAA-compliant system.

There are no right or wrong answers so please answer the questions honestly. Please answer all the questions but if a question makes you feel uncomfortable you can leave it blank.

If you have questions or comments about the research study, or if you wish to withdraw from the study, please reach out to:

Evan Johnson, PhD, Principal Investigator

Phone: 307-766-5282

Email: evan.johnson@uwyo.edu

Nathan McLaughlin, BS, Research Assistant

Email: nlml@uw.edu

By completing the electronic portion of this questionnaire, your electronic submission gives us permission to include your information and study data as a part of this study.

Please complete the survey below.

Thank you!

Are you a "Prolific" study participant?

* must provide value

Yes

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What is your "Prolific" ID number?

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What is your Prolific email address?

Date

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Y-M-D

Race

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American Indian or Alaska Native

Asian

Black, African American

Native Hawaiian or Other Pacific Islander

White

Ethnicity

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Hispanic or Latino

Non Hispanic or Latino

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Age

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Height (in inches)

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Weight (in pounds)

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Gender Identity

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Man

Woman

Other

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Personal Email

Which general location are you in?

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Seattle, WA (King County)

Laramie, WY (Albany County)

Another region of the United States

Outside of the United States

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If another region within the United States, where?

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Western/Southwestern United States

Midwestern United States

Southern/Southeastern United States

Northeastern United States

Pacific (Hawaii, Alaska)

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If outside of the United States, where?

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How did you hear about our study?

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Flyer at a health clinic/hospital

Flyer at senior center

Social Media

Friend/Family member

Recruitment company

Other

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Please specify:

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Is it okay to contact you again regarding future studies?

* must provide value

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.