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Antibiotic Resistance Survey

1. Do you know what an antibiotic is?

 Yes
 No

2. Have you ever taken an antibiotic medication?

 Yes
 No
 Not Sure/Don't Know

3. How often do you finish the entire amount of antibiotics prescribed to you?

NeverRarelySometimesFrequentlyAlways

4. Have you ever specifically requested antibiotics from your doctor?

 Yes
 No
 No Answer

5. Do you know what antimicrobial resistance is?

 Yes
 No

6. If so, where did you hear about it? (Please select all that apply)

 Doctor/Primary care provider
 Newspaper/Magazine
 School/Class
 Television/News
 Word of mouth
Other (Please specify)

7. If so, do you think that antimicrobial resistance is a problem?

 Yes
 No
 Not Sure/Don't Know

8. Do you know how antimicrobial resistance is developed?

 Yes
 No
 Not sure

9. Have you heard of the Centers for Disease Control and Prevention's (CDC) Get Smart campaign?

 Yes
 No

10. Have you heard of the Alliance for the Prudent Use of Antibiotics (APUA)?

 Yes
 No

11. Have you heard of the Alliance Working for Antibiotic Resistance Education (AWARE)?

 Yes
 No

12. Please enter your age.

13. What is your gender?

 Female
 Male
 Prefer Not to State

14. What is the highest level of education you have completed?

 High school or below
 Some college/in college
 Four-year degree
 Graduate/professional degree (non-science related)
 Graduate/professional degree (science related)

15. What is your primary field of study or occupation?

 Arts
 Business or Economics
 Mathematics or Engineering
 Physical/Life/Health Sciences
 Social Sciences

16. What is your ethnicity?

 African American
 Asian/Pacific Islander
 Caucasian/White
 Hispanic/Latino
 Native American
 Other/Multiple

17. Please enter the name of the school you attend or the company you work for.


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