Completion

COVID-19 and HBCU Students

1. Birthday:

2. Age (circle one)

(1) 15-19 (2) 20-24

(3) 25-29 (4) 30–34

(5) 35+

 

2. Race (circle one)

African American White

Hispanic/Latino Asian

Other: ________

 

3. Employment Status (circle one)

(2) Employed

(1) Retired

(0) Unemployed

4. What HBCU do you attend

____________________________________

5. Did you receive Emergency Funding (College CARES Act, PPP, Stimulus, EBT) as a result of Covid-19? (circle one)

(2) Yes (2) No

6. Have You ever tested positive for COVID-19 (circle one)

(2) Yes (1) No (0) Unknown

7. How many days did you engage social distancing, quarantine or isolation as a result of testing positive for Covid-19? (Circle One)

(1) 0-5days (2) 5-7 days

(3) 7-10 days (4)10-14 days

Other ______

8. What were the COVID-19 restrictions that you experienced? (circle one)

a. stay-at-home order (1)

b. closing public places (2)

c. mask mandates (3)

d. travel restrictions (4)

e. all of the above (5)

f. none of the above (0)

9. Have recommendations for socially distancing caused stress for you? (circle one)

(3) A lot (2) Somewhat

(1) A little (0) Not at all

 

10. Have recommendations for socially distancing caused stress for your family and loved one? (circle one)

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

11. In the past two years have you experienced the following because of Covid-19: (Circle one)

(1) Not enough money to pay rent

(2) Not enough money to pay for gas

(3) Not enough money to pay for food

(4) Do not have a regular place to sleep or stay

(5) All The Above

 

12. In the past two years have your family or loved one experienced the following as a result of Covid-19:

(1) Not enough money to pay rent

(2) Not enough money to pay for gas

(3) Not enough money to pay for food

(4) Do not have a regular place to sleep or stay

(5) All The Above

 

13.Which aspect of Covid-19 affected you the most: (Select One)

(1) Socially Distancing

(2) Isolation & Quarantine

(3) Covid-19 Death of Immediate Family Member

(4) Covid-19 School Mandated Remote Learning

(5) Covid-19 Mandated Testing & Vaccinations

(6) Covid-19 Mandated Closings

14. To cope with your previous response, which action did you take most and how often? (Select one)

14A.Taking care of your body, such as deep breaths, stretching, or meditating

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

14B. Connecting with others, including talking with people you trust about your concerns

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14C. Smoking more cigarettes or vaping more

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14D. Using prescription drugs (like valium, etc.)

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14E. Using non-prescription drugs

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14F. Using cannabis or marijuana

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14G. Drinking alcohol

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

14H. Eating high fat or sugary foods

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

14I.Cutting or self-injury

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

  

14J. Eating more food than usual

(3) A lot (2) Somewhat

(1) A little (0) Not at all 

 

 

15. Where did you get your information about COVID-19:

Friends Family

Social media News

Unknown

 

16. I believe that Covid-19 is a serious disease:

Yes No Unsure

 

17. How much information do you feel you know about Covid-19

A lot Some

A little Nothing