Health Counts in Chemung County 2012

You count, and we need your help!

Chemung County Health and Human Service Providers are conducting this survey to determine how best to meet your healthcare needs over the next five years. We are asking residents to tell us what they think about health-related needs in Chemung County. Remember to think about all age groups when answering questions. This is not a test and there are no wrong answers. Your opinion is important to us. The results will help to shape health programs and services in the County over the next few years. Questions? Call the Chemung County Public Health Department at (607) 737-2028. THANK YOU!

Please be assured your responses are important - and - completely anonymous.

1. Please take a few moments to click on those boxes that you think are issues with the most important needs facing you and Chemung County today.

	Problem for YOU	Problem in Chemung County	Don't know or unsure
1. Access to home care	Please take a few moments to click on those boxes that you think are issues with the most important needs facing you and Chemung County today. 1. Access to home care Problem for YOU	1. Access to home care Problem in Chemung County	1. Access to home care Don't know or unsure
2. Access to pregnancy care	2. Access to pregnancy care Problem for YOU	2. Access to pregnancy care Problem in Chemung County	2. Access to pregnancy care Don't know or unsure
3. Access to specialty health care	3. Access to specialty health care Problem for YOU	3. Access to specialty health care Problem in Chemung County	3. Access to specialty health care Don't know or unsure
4. Alcohol abuse	4. Alcohol abuse Problem for YOU	4. Alcohol abuse Problem in Chemung County	4. Alcohol abuse Don't know or unsure
5. Alzheimer’s, Dementia, Memory Loss	5. Alzheimer’s, Dementia, Memory Loss Problem for YOU	5. Alzheimer’s, Dementia, Memory Loss Problem in Chemung County	5. Alzheimer’s, Dementia, Memory Loss Don't know or unsure
6. Behavioral problems in children	6. Behavioral problems in children Problem for YOU	6. Behavioral problems in children Problem in Chemung County	6. Behavioral problems in children Don't know or unsure
7. Birth defects	7. Birth defects Problem for YOU	7. Birth defects Problem in Chemung County	7. Birth defects Don't know or unsure
8. Cancer	8. Cancer Problem for YOU	8. Cancer Problem in Chemung County	8. Cancer Don't know or unsure
9. Depression / other mental illnesses	9. Depression / other mental illnesses Problem for YOU	9. Depression / other mental illnesses Problem in Chemung County	9. Depression / other mental illnesses Don't know or unsure
10. Diabetes	10. Diabetes Problem for YOU	10. Diabetes Problem in Chemung County	10. Diabetes Don't know or unsure
11. Drug abuse/abuse of prescription drugs or illegal drugs	11. Drug abuse/abuse of prescription drugs or illegal drugs Problem for YOU	11. Drug abuse/abuse of prescription drugs or illegal drugs Problem in Chemung County	11. Drug abuse/abuse of prescription drugs or illegal drugs Don't know or unsure
12. Heart disease (Congestive Heart Failure, Angina, “A-fib”)	12. Heart disease (Congestive Heart Failure, Angina, “A-fib”) Problem for YOU	12. Heart disease (Congestive Heart Failure, Angina, “A-fib”) Problem in Chemung County	12. Heart disease (Congestive Heart Failure, Angina, “A-fib”) Don't know or unsure
13. High blood pressure, stroke	13. High blood pressure, stroke Problem for YOU	13. High blood pressure, stroke Problem in Chemung County	13. High blood pressure, stroke Don't know or unsure
14. Lack of physical activity & fitness	14. Lack of physical activity & fitness Problem for YOU	14. Lack of physical activity & fitness Problem in Chemung County	14. Lack of physical activity & fitness Don't know or unsure
15. Obesity / Overweight	15. Obesity / Overweight Problem for YOU	15. Obesity / Overweight Problem in Chemung County	15. Obesity / Overweight Don't know or unsure
16. Poor nutrition (unhealthy eating)	16. Poor nutrition (unhealthy eating) Problem for YOU	16. Poor nutrition (unhealthy eating) Problem in Chemung County	16. Poor nutrition (unhealthy eating) Don't know or unsure
17. Problems with teeth or gums (dental health)	17. Problems with teeth or gums (dental health) Problem for YOU	17. Problems with teeth or gums (dental health) Problem in Chemung County	17. Problems with teeth or gums (dental health) Don't know or unsure
18. Pulmonary diseases (COPD, Emphysema, Asthma)	18. Pulmonary diseases (COPD, Emphysema, Asthma) Problem for YOU	18. Pulmonary diseases (COPD, Emphysema, Asthma) Problem in Chemung County	18. Pulmonary diseases (COPD, Emphysema, Asthma) Don't know or unsure
19. Quality of well water	19. Quality of well water Problem for YOU	19. Quality of well water Problem in Chemung County	19. Quality of well water Don't know or unsure
20. Sexually transmitted diseases (Chlamydia, Herpes, HIV/AIDS)	20. Sexually transmitted diseases (Chlamydia, Herpes, HIV/AIDS) Problem for YOU	20. Sexually transmitted diseases (Chlamydia, Herpes, HIV/AIDS) Problem in Chemung County	20. Sexually transmitted diseases (Chlamydia, Herpes, HIV/AIDS) Don't know or unsure
21. Smoking / tobacco use	21. Smoking / tobacco use Problem for YOU	21. Smoking / tobacco use Problem in Chemung County	21. Smoking / tobacco use Don't know or unsure
22. Teen pregnancy	22. Teen pregnancy Problem for YOU	22. Teen pregnancy Problem in Chemung County	22. Teen pregnancy Don't know or unsure
23. Transportation to health care	23. Transportation to health care Problem for YOU	23. Transportation to health care Problem in Chemung County	23. Transportation to health care Don't know or unsure
24. Underweight or premature babies	24. Underweight or premature babies Problem for YOU	24. Underweight or premature babies Problem in Chemung County	24. Underweight or premature babies Don't know or unsure
25. Unplanned pregnancy	25. Unplanned pregnancy Problem for YOU	25. Unplanned pregnancy Problem in Chemung County	25. Unplanned pregnancy Don't know or unsure
26. Arthritis, muscle or bone problem	26. Arthritis, muscle or bone problem Problem for YOU	26. Arthritis, muscle or bone problem Problem in Chemung County	26. Arthritis, muscle or bone problem Don't know or unsure

2. From these choices pick YOUR top 3 priority items (click on black triangle for list of choices)

	#1 Priority for YOU	#2 Priority for YOU	#3 Priority for YOU
Issue	From these choices pick YOUR top 3 priority items (click on black triangle for list of choices) Issue #1 Priority for YOU	#2 Priority for YOU	#3 Priority for YOU

3. Please choose the problem that is the most important one, in your opinion (click on black triangle for choices)

	Most important need to your community
Problem with greatest community need	Please choose the problem that is the most important one, in your opinion (click on black triangle for choices) Problem with greatest community need Most important need to your community

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