St. Lawrence County CHA 2012

1. St. Lawrence County Healthy Options Committee

We Need Your Help!

We are doing a survey about the health and needs of county residents. Your answers are important to us and will help us make St. Lawrence County a healthier place! Please fill out this survey!

For more information call the Health Initiative at 315-261-4760, extension 221. THANK YOU!

1. Do you think this is a health problem for you or your community?

	Problem for YOU	Problem for Your Community	Don't Know or Unsure	Not a Problem
1. Ability to Access Health Care	*Do you think this is a health problem for you or your community? 1. Ability to Access Health Care Problem for YOU	1. Ability to Access Health Care Problem for Your Community	1. Ability to Access Health Care Don't Know or Unsure	1. Ability to Access Health Care Not a Problem
2. Alcohol abuse	2. Alcohol abuse Problem for YOU	2. Alcohol abuse Problem for Your Community	2. Alcohol abuse Don't Know or Unsure	2. Alcohol abuse Not a Problem
3. Arthritis, Alzheimer’s, Dementia, Memory Loss	3. Arthritis, Alzheimer’s, Dementia, Memory Loss Problem for YOU	3. Arthritis, Alzheimer’s, Dementia, Memory Loss Problem for Your Community	3. Arthritis, Alzheimer’s, Dementia, Memory Loss Don't Know or Unsure	3. Arthritis, Alzheimer’s, Dementia, Memory Loss Not a Problem
4. Arthiritis	4. Arthiritis Problem for YOU	4. Arthiritis Problem for Your Community	4. Arthiritis Don't Know or Unsure	4. Arthiritis Not a Problem
5. Behavioral Problems in Children	5. Behavioral Problems in Children Problem for YOU	5. Behavioral Problems in Children Problem for Your Community	5. Behavioral Problems in Children Don't Know or Unsure	5. Behavioral Problems in Children Not a Problem
6. Cancer	6. Cancer Problem for YOU	6. Cancer Problem for Your Community	6. Cancer Don't Know or Unsure	6. Cancer Not a Problem
7. Depression / other mental illnesses	7. Depression / other mental illnesses Problem for YOU	7. Depression / other mental illnesses Problem for Your Community	7. Depression / other mental illnesses Don't Know or Unsure	7. Depression / other mental illnesses Not a Problem
8. Diabetes	8. Diabetes Problem for YOU	8. Diabetes Problem for Your Community	8. Diabetes Don't Know or Unsure	8. Diabetes Not a Problem
9. Drug abuse/abuse of prescription drugs or illegal drugs	9. Drug abuse/abuse of prescription drugs or illegal drugs Problem for YOU	9. Drug abuse/abuse of prescription drugs or illegal drugs Problem for Your Community	9. Drug abuse/abuse of prescription drugs or illegal drugs Don't Know or Unsure	9. Drug abuse/abuse of prescription drugs or illegal drugs Not a Problem
10. Eating disorders	10. Eating disorders Problem for YOU	10. Eating disorders Problem for Your Community	10. Eating disorders Don't Know or Unsure	10. Eating disorders Not a Problem
11. Heart disease (Congestive heart failure, Angina, “A-fib”)	11. Heart disease (Congestive heart failure, Angina, “A-fib”) Problem for YOU	11. Heart disease (Congestive heart failure, Angina, “A-fib”) Problem for Your Community	11. Heart disease (Congestive heart failure, Angina, “A-fib”) Don't Know or Unsure	11. Heart disease (Congestive heart failure, Angina, “A-fib”) Not a Problem
12. High blood pressure, stroke	12. High blood pressure, stroke Problem for YOU	12. High blood pressure, stroke Problem for Your Community	12. High blood pressure, stroke Don't Know or Unsure	12. High blood pressure, stroke Not a Problem
13. Lack of physical activity	13. Lack of physical activity Problem for YOU	13. Lack of physical activity Problem for Your Community	13. Lack of physical activity Don't Know or Unsure	13. Lack of physical activity Not a Problem
14. Poor nutrition (unhealthy eating)	14. Poor nutrition (unhealthy eating) Problem for YOU	14. Poor nutrition (unhealthy eating) Problem for Your Community	14. Poor nutrition (unhealthy eating) Don't Know or Unsure	14. Poor nutrition (unhealthy eating) Not a Problem
15. Problems with teeth or gums	15. Problems with teeth or gums Problem for YOU	15. Problems with teeth or gums Problem for Your Community	15. Problems with teeth or gums Don't Know or Unsure	15. Problems with teeth or gums Not a Problem
16. Lung diseases (COPD, emphysema, asthma)	16. Lung diseases (COPD, emphysema, asthma) Problem for YOU	16. Lung diseases (COPD, emphysema, asthma) Problem for Your Community	16. Lung diseases (COPD, emphysema, asthma) Don't Know or Unsure	16. Lung diseases (COPD, emphysema, asthma) Not a Problem
17. Quality of well water	17. Quality of well water Problem for YOU	17. Quality of well water Problem for Your Community	17. Quality of well water Don't Know or Unsure	17. Quality of well water Not a Problem
18. Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea, HIV/AIDS)	18. Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea, HIV/AIDS) Problem for YOU	18. Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea, HIV/AIDS) Problem for Your Community	18. Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea, HIV/AIDS) Don't Know or Unsure	18. Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea, HIV/AIDS) Not a Problem
19. Second hand smoke	19. Second hand smoke Problem for YOU	19. Second hand smoke Problem for Your Community	19. Second hand smoke Don't Know or Unsure	19. Second hand smoke Not a Problem
20. Smoking / tobacco use	20. Smoking / tobacco use Problem for YOU	20. Smoking / tobacco use Problem for Your Community	20. Smoking / tobacco use Don't Know or Unsure	20. Smoking / tobacco use Not a Problem
21. Suicide	21. Suicide Problem for YOU	21. Suicide Problem for Your Community	21. Suicide Don't Know or Unsure	21. Suicide Not a Problem
22. Teen pregnancy	22. Teen pregnancy Problem for YOU	22. Teen pregnancy Problem for Your Community	22. Teen pregnancy Don't Know or Unsure	22. Teen pregnancy Not a Problem
23. Transportation to medical appointments and health care	23. Transportation to medical appointments and health care Problem for YOU	23. Transportation to medical appointments and health care Problem for Your Community	23. Transportation to medical appointments and health care Don't Know or Unsure	23. Transportation to medical appointments and health care Not a Problem
24. Tuberculosis	24. Tuberculosis Problem for YOU	24. Tuberculosis Problem for Your Community	24. Tuberculosis Don't Know or Unsure	24. Tuberculosis Not a Problem
25. Underweight or premature babies	25. Underweight or premature babies Problem for YOU	25. Underweight or premature babies Problem for Your Community	25. Underweight or premature babies Don't Know or Unsure	25. Underweight or premature babies Not a Problem
26. Unintended pregnancy	26. Unintended pregnancy Problem for YOU	26. Unintended pregnancy Problem for Your Community	26. Unintended pregnancy Don't Know or Unsure	26. Unintended pregnancy Not a Problem
27. Underage drinking	27. Underage drinking Problem for YOU	27. Underage drinking Problem for Your Community	27. Underage drinking Don't Know or Unsure	27. Underage drinking Not a Problem

2. From these choices pick the top 3 issues/concerns that you think should be public health priorities: Click on black triangle for choices.

	#1 Priority	#2 Priority	#3 Priority
Issues	From these choices pick the top 3 issues/concerns that you think should be public health priorities: Click on black triangle for choices. Issues #1 Priority	#2 Priority	#3 Priority

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.