Dickson County Community Health Assessment Survey

We would like your input as part of the Dickson County Health Assessment conducted by the Dickson County Health Council.
Please DO NOT provide your name - all answers are anonymous.
Your participation is voluntary, and you may stop at any time.
Your feedback is greatly appreciated and may help improve health outcomes in your community.

1.For each issue below, select whether you believe it is NOT A PROBLEM, a MINOR PROBLEM, or a MAJOR PROBLEM in your community.

Not a Problem

Minor Problem

Major Problem

Cancer

Not a Problem

Minor Problem

Major Problem

Diabetes

Not a Problem

Minor Problem

Major Problem

Heart Disease

Not a Problem

Minor Problem

Major Problem

Adult Obesity

Not a Problem

Minor Problem

Major Problem

Youth Obesity

Not a Problem

Minor Problem

Major Problem

Adult Mental Health

Not a Problem

Minor Problem

Major Problem

Youth Mental Health

Not a Problem

Minor Problem

Major Problem

Immunizations (childhood vaccinations & flu)

Not a Problem

Minor Problem

Major Problem

Teen Births

Not a Problem

Minor Problem

Major Problem

Adult Suicide (threats, attempts, or deaths)

Not a Problem

Minor Problem

Major Problem

Youth Suicide (threats, attempts, or deaths)

Not a Problem

Minor Problem

Major Problem

Infant Mortality (death before 1st birthday)

Not a Problem

Minor Problem

Major Problem

Childhood Trauma

Not a Problem

Minor Problem

Major Problem

Domestic Abuse (verbal, physical, emotional)

Not a Problem

Minor Problem

Major Problem

Elder Abuse (physical, emotional, financial)

Not a Problem

Minor Problem

Major Problem

Babies Born Dependent to Substances

Not a Problem

Minor Problem

Major Problem

Drug Overdose

Not a Problem

Minor Problem

Major Problem

Substance Misuse (drugs & alcohol)

Not a Problem

Minor Problem

Major Problem

Adult Nicotine/Vape Use

Not a Problem

Minor Problem

Major Problem

Lack of Exercise

Not a Problem

Minor Problem

Major Problem

Getting Education Beyond High School

Not a Problem

Minor Problem

Major Problem

Yearly Personal Income

Not a Problem

Minor Problem

Major Problem

Access to Health Insurance

Not a Problem

Minor Problem

Major Problem

Access to Affordable Health Insurance

Not a Problem

Minor Problem

Major Problem

Access to Child Care

Not a Problem

Minor Problem

Major Problem

Access to Affordable Child Care

Not a Problem

Minor Problem

Major Problem

Access to Affordable Housing

Not a Problem

Minor Problem

Major Problem

Access to Fresh Fruits & Vegetables

Not a Problem

Minor Problem

Major Problem

Access to Transportation

Not a Problem

Minor Problem

Major Problem

Access to Jobs

Not a Problem

Minor Problem

Major Problem

Youth Nicotine/Vape Use

Not a Problem

Minor Problem

Major Problem

Ability to Read at a 3rd Grade Level

Not a Problem

Minor Problem

Major Problem

2.List Your Top Three Most Serious Issues from above.

Priority 1

Priority 2

Priority 3

4.What is your gender?

Female

Male

Other

Prefer not to answer

5.What is the highest level or degree of school you have completed?

7.Are you of Hispanic, Latino or Spanish origin?

Yes

No

Prefer not to answer

9.Do you live in Dickson County?

Yes

No

10.Do you work in Dickson County?

Yes

No

11.Which of the following categories best describes your total household income?

12.Have you or anyone currently living in your household ever served in the United States Armed Forces?

Yes

No

13.Do you currently provide care or support for an adult in your household who has a disability?

Yes

No

14.Do you wear a seatbelt when driving or riding in a vehicle?

Yes

No

15.Would you be interested in attending a listening session to further discuss community health? Dates, Times, Locations TBD

Yes

No