Thank you very much for taking this survey! As a high school student in Linn, Benton, or Lincoln County, we want to learn what you think about health issues. Samaritan Health Services hospitals are conducting their needs assessments to create local plans to improve the health of your community based on your responses.

Please share your thoughts about the health of your community or school. You will not be asked to put your name on this survey. There are no right or wrong answers. Any information you provide is useful.

Unless it says otherwise, only choose one response to each question, so please pick the response that best tells us what you think. At the end of the survey there are some extra questions that will help us understand the people we serve.

Thank you!

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* 1. How healthy is your community/school? (please choose one)

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* 2. What is the most important health issue in your community/school? (please choose one)

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* 3. Who is most likely to have health problems in your community/school? (please choose one)

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* 4. Which of the following has the worst effect on the health of families in your community/school? (please choose one)

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* 5. What behavior has the worst effect on the health of teens in your community/school? (please choose one)

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* 6. What is the most important thing that people in your community/school could do to improve their health? (please choose one)

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* 7. What kind of place has the best effect on the health of teens in your community/school? (please choose one)

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* 8. What is most needed to make a healthy community/school? (please choose one)

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* 9. What keeps teens in your community/school from getting health care? (please choose one)

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* 10. What health care service is the most important for teens in your community/school? (please choose one)

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* 11. What one thing in the environment is most important for the health of your community/school? (please choose one)

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* 12. What is the biggest concern in your neighborhood? (please choose one)

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* 13. For the following issues that affect teen health, please check how much attention you think they should get in our communities on a scale of least attention to most attention.

  Least attention Some attention Most attention Don't know
Access to dental care
Access to medical care
Access to mental health care
Afterschool activities
Alcohol abuse
Child abuse or neglect
Child care availability
Child care costs
Digital citizenship
Domestic violence
Employment
Finishing High School
Fluoridated water
Having enough food
Higher education
Homelessness
Juvenile crime
Literacy
Obesity (weighing too much)
Ongoing disease (e.g. asthma, diabetes)
Parent education
Poverty
Safe communities
Teen pregnancy
Tobacco use
Transportation

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* 14. What is your zip code?

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* 15. What county do you live in?

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* 16. Do you live in a city, in a town, or in a rural area?

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* 17. How old are you?

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* 18. What language do you usually speak at home?

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* 19. What is your race or ethnicity? (You may choose more than one response and you may give more detail if you want)

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* 20. What is your gender or gender identity?

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* 21. Are you:

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* 22. Are you living with:

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* 23. How much money does your family or household make each year before taxes?

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* 24. Where do you or your family get your health insurance? (You may choose more than one)

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* 25. Do you have enough health insurance to help you stay healthy?

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* 26. Do you have dental insurance?

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* 27. Where is the first place you usually go when you need medical care?

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* 28. What is your parent’s (or guardian’s) highest level of education?

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* 29. Are you (you may choose more than one):

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* 30. Are your parents/guardians/caregivers:

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