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* 1. North Country Hospital is seeking feedback to learn more about the healthcare needs that impact people who live in Orleans County and northern Essex County. From your viewpoint, how important is each of the following issues?

1. Vision needs

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* 2. Dental needs

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* 3. Infections like pneumonia, flu and/or hepatitis that can be prevented by immunizations

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* 4. Infant or childhood diseases that can be prevented by immunizations

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* 5. Child abuse or neglect

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* 6. Violence in the home

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* 7. Rape and/or sexual assault

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* 8. Homelessness

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* 9. Alcohol abuse among adults

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* 10. Alcohol use among youth under 21 years old

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* 11. Tobacco use among youth under 18 years old

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* 12. Tobacco use among adults age 18 and older

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* 13. Abuse of prescription medications among adults 18 years and older

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* 14. Abuse of prescription medications among youth under 18 years old

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* 15. Use of street drugs such as heroin, cocaine, etc. among adults 18 years and older

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* 16. Use of street drugs such as heroin, cocaine, etc. among youth under 18 years old

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* 17. Abuse of prescription medications among youth under 18 years old

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* 18. Mental health problems such as anxiety and depression

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* 19. Suicide or attempted suicide

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* 20. Being overweight – adults age 18 years and older

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* 21. Being overweight – youth under 18

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* 22. Physical activity/exercise (at least 150 minutes per week)

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* 23. Healthy eating habits such as eating fruits & vegetables daily

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* 24. Lack of affordable healthy food choices

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* 25. Listed below are healthcare services and/or community resources. From your viewpoint, how do they meet the needs in our community? For each item, please select the choice that best describes your opinion.

25. Elderly care services: Housing

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* 26. Elderly care services: Meal programs

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* 27. Elderly care services: Home Care

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* 28. Elderly care services: Nursing Homes

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* 29. Elderly care services: Adult day care

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* 30. Elderly care services: Other, such as help with completing forms

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* 31. Cancer Care: Screening/testing

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* 32. Cancer Care: Treatment

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* 33. Cancer Care: Prevention

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* 34. Dental Care

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* 35. Services specializing in eye care

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* 36. Services for women who are pregnant

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* 37. Services for new moms/dads and babies

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* 38. Support services for people who need end of life care (hospice)

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* 39. Services for people of any age to remain in their home

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* 40. Services for people who have heart and/or breathing problems and/or diabetes

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* 41. Services to quit tobacco use

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* 42. Childcare

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* 43. Services for people experiencing violence in the home or sexual assault

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* 44. Addiction support services

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* 45. Mental health care when you need it

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* 46. Alcohol treatment when you need it

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* 47. Drug treatment when you need it

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* 48. Medical care when you need it without going to the Emergency Department

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* 49. Services for adults wanting a high school education

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* 50. Services that encourage healthy eating, such as farmers markets, community gardens, etc.

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* 51. Affordable exercise/fitness programs

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* 52. Access to bicycles for adults

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* 53. Access to bicycles for children

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* 54. Recreation activities, such as swimming, hiking

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* 55. Transportation for medical appointments

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* 56. Transportation for other reasons

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* 57. Safe walking and/or biking paths and sidewalks

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* 58. Use this space to write in services that you believe are not available but are needed:

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* 59. In the last 18 months have you had a visit with any of the following?

An eye doctor

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* 60. A dental provider

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* 61. A doctor/medical provider

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* 62. A mental health provider

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* 63. A substance abuse provider

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* 64. What is your gender?

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* 65. What is your age?

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* 66. Please select the town you live in:

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* 67. My household yearly income is:

This Community Health Survey was designed with help from representatives of local organizations including, The Vermont Department of Health, Orleans Essex VNA & Hospice, Northeast Kingdom Learning Services, Newport City Elementary School, North Country Hospital and Northeast Kingdom Human Services.

Thank you for your participation!

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