Ohio AAP Demographic Measures Survey Pediatrician and Practice Characteristics What is your gender? Female Male Prefer to self-describe Prefer to self-describe With what racial or cultural group(s) do you identify yourself? Select all that apply. White, Non-Hispanic/Latino Hispanic/Latino Black/African American Asian Native Hawaiian/Other Pacific Islander American Indian/Alaska Native OtherOther Which of the following best represents how you think of yourself? Lesbian or gay Straight, that is, not lesbian or gay Bisexual Something else Approximately what percentage of your professional time is spent in the following areas? (Total should equal 100%) General Pediatrics * Other specialty/subspecialty (specify) * Please describe the community in which your primary practice/position is located. Please indicate only ONE response. Urban, inner city Urban, not inner city Suburban Rural What racial or cultural group(s) describe your patient population? Enter a percentage or zero for each prompt. (Total should equal 100%) White, Non-Hispanic/Latino * Hispanic/Latino * Black/African American * Asian * Native Hawaiian/Other Pacific Islander * American Indian/Alaska Native * Other * Please indicate your primary employment setting, that is, the setting where you spend most of your time. Please check only ONE response. Self-employed solo practice Two physician practice Pediatric group practice, 3-10 pediatricians Pediatric group practice, >10 pediatricians Multispecialty group practice with primary care only Multispecialty group practice with specialty care only Multispecialty group practice with primary and specialty care Health Maintenance Organization (staff model) Medical School or parent university Non-government hospital/clinic Non-profit community health center City/county/state government hospital or clinic US government hospital or clinic OtherOther If you are human, leave this field blank.