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Adams County Community Health Assessment

The Adams County Health Department is conducting a Community Health Assessment—an in-depth look at the health of our county. We want to know what makes Adams County a healthy place to live, what we can do better, and what changes we need to make to become a healthier and happier community. Your frank answers to these questions is the first step of this process. Your responses are anonymous and private.

Thank you for helping our community.  


1.Do you live or work in Adams County?
2.What is your zip code?
3.Would you say, that in general, your health is
4.Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
5.Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how may days during the past 30 days was your mental health not good?
6.During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
7.Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, government plans such as Medicare or Indian Health Service?
8.Do you have one person you think of as your personal doctor or health care provider?
9.Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
10.How long has it been since you last visited a doctor for a routine checkup? A routine checkup is a general physical exam, not for a specific injury, illness, or condition.
11.During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?
12.On average, how many hours of sleep do you get in a 24-hour period? Round your response up or down to the nearest whole number. Enter "Not Sure" if you are uncertain.
13.Has a doctor, nurse, or other health professional ever told you that you had a heart attack also called a myocardial infarction?
14.Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?
15.Has a doctor, nurse, or other health professional ever told you that you had a stroke?
16.Has a doctor, nurse, or other health professional ever told you that you had asthma?
17.Has a doctor, nurse, or other health professional ever told you that you had skin cancer?
18.Has a doctor, nurse, or other health professional ever told you that you had other types of cancer?
19.Has a doctor, nurse, or other health professional ever told you that you have chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis?
20.Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
21.Has a doctor, nurse, or other health professional ever told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?
22.Has a doctor, nurse, or other health professional ever told you that you have kidney disease? Do not include kidney stone, bladder infection or incontinence.
23.Has a doctor, nurse, or other health professional ever told you that you had diabetes?
24.How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists.
25.Are you...?
26.What is your age? Enter "Don't know" or "Decline to answer" if appropriate.
27.Which one or more of the following would you say is your race?
28.Are you...?
29.What is the highest grade or year of school you completed?
30.Do you own or rent your home?
31.Are you currently...?
32.How many children less than 18 years live in your household?
33.Your annual income from all sources is...
34.Have you used the internet in the past 30 days?
35.About how much do you weigh without shoes?
36.How tall are you without shoes?
37.Have you smoked at least 100 cigarettes in your entire life?
5 packs = 100 cigarettes
38.Do you now smoke cigarettes every day, some days, or not at all?
39.During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
40.Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all?
41.Do you now use e-cigarettes or other electronic "vaping" products every day, some days, or not at all?
42.Of the past 30 days, how many days did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?
43.One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average?
44.During the past 30 days, what is the largest number of drinks you had on any occasion?
45.During the past 12 months, have you had a flu shot?
46.A pneumonia shot or pneumococcal vaccine is usually given only once or twice in a person's lifetime and is different from the flu shot. Have you ever had a pneumonia shot?
47.If you are 45 years of age or older, how many times have you fallen in the past 12 months?
48.How many of the falls reported in question number 47 caused an injury? By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor.
49.How often do you use seat belts when you drive or ride in a car?
50.During the past 30 days, how many times have you driven when you've had perhaps, too much to drink?
51.A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?
52.A Pap test is a test for cancer of the cervix. Have you ever had a Pap test?
53.During the past 30 days, on how many days did you use marijuana or hashish?
54.In general, how satisfied are you with your life?
55.Are you limited in any way in any activity because of physical, mental, or emotional problems?
56.Do you now have any health problem that requires you to use special equipment, such as a cane, wheelchair, special bed, or a special telephone?
57.What do you feel are the three most serious health problems in Adams County?
58.What do you believe makes Adams County a healthy and happy place to live? (Top three)
59.What can be done to make Adams County a healthier and happier place to live? (Top three)
60.What current and future events will have the biggest impact on the health and happiness of the people of Adams County? (Top three)