To the residents of Berwick, Eliot, Lebanon, Kittery, Ogunquit, North Berwick, South Berwick, York, and Wells: Please help York Hospital and the Choose To Be Healthy Partnership to focus our health improvement efforts in these Maine communities. Your answers will be used to guide our community planning, with the goal of building upon our communities’ strengths, to address areas of need. Please answer all questions – your responses will be kept anonymous. All respondents will be entered into a PRIZE DRAWING!

Grand Prize: $250 First Prize $100 Six $25 Gift Card Prizes

* 1. What is your current zip code?

* 2. Are you:

* 3. How old were you on your last birthday?

Please tell us how closely you agree with the following statements about health and health issues in the community where you live.

* 4.a

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied with the health care services available to my community. (Consider access, availability, quality of treatments, options for healthcare, etc.)

* 4.b

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I believe that my community is a good place for me to grow old. (Consider elder-friendly housing, transportation to medical services, elder day care, social support for the elderly living alone etc).

* 4.c

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied with the economic opportunities available to those living in my community. (Consider locally owned and operated businesses, available jobs, jobs with career growth, job training opportunities, livable wages & benefits, reasonable commutes, etc).

* 4.d

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied with the availability of affordable housing options in my community. (Consider cost, quality, availability, etc).

* 4.e

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied with recreational and cultural activities available to me in my community. (Consider team and spectator sports, arts, cultural activities, places to be active outdoors, etc.)

* 4.f

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied with the quality of life in my town. (Consider your overall sense of well being, and participation in community life, civic groups and religious organizations, etc).

* 4.g

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I am satisfied that my town is a good place to raise children. (Consider quality of education, size of schools, availability and cost of childcare, activities for youth, etc).

* 4.h

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I believe that the environment is clean and healthy in my town. (Consider the air, soil and water).

* 4.i

  Strongly Agree Agree Disagree Strongly Disagree I don't know
I believe that my town is a safe place to live. (Consider your sense of safety in your home, workplace, schools, parks and playgrounds.)

* 4.j

  Strongly Agree Agree Disagree Strongly Disagree I don't know
There are networks of support for me and for my family in times of stress and need. (Consider neighbors, support groups, faith communities, agencies, organizations.)

* 4.k

  Strongly Agree Agree Disagree Strongly Disagree I don't know
In my community all individuals and groups have the opportunity to contribute to and participate in the community's quality of life.

* 5. In the following list, what, in your opinion, are the top 3 health problems/issues in your community?

* 6. In the following list, what, in your opinion, are the 3 "risky behaviors" that have the greatest impact on your community's overall health?

* 7. In the following list, what, in your opinion,are the 3 most important factors for a "Healthy Community?" (Those factors that most improve the quality of life in a community.)

* 8. If money were no object, what suggestions would you have to improve the health of your community?

* 9. How would you rate your community as a "healthy community?"

Thank you for taking the Community Health Needs Assessment Survey! If you would like to give us your name and contact information to be entered into the prize drawing, you will be directed away from the survey to a place to do that.

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