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Copy of Allegany County CHA Survey 2022

2022 Allegany County Community Health Survey

On behalf of the Allegany County Department of Health, Cuba Memorial Hospital, Jones Memorial Hospital and the Community Wellness Committee of Allegany County; thank you for participating in the 2022 Community Health Assessment Survey.
 
The following survey is only for adults 18 years of age and older. It is an opportunity for you to voice your opinion about our community’s health and wellness. As well, health care leaders will gain knowledge about our current health care system, learn important information about our community’s health status, and find new ways to support our community in becoming the healthiest county in New York State. We encourage all Allegany County residents to participate.
 
To thank you for your participation you will be entered into a drawing for a chance to win one of six (6) $50 gas gift certificates or one of eight (8) $25 gas gift certificates. Upon completion of the survey, you will be directed to a separate page to add your contact information for a chance to win one of these prizes.
 
We appreciate your help. Surveys must be completed and received via the on-line survey or by mail no later than Thursday, June 30th, 2022.  Please mail your survey to: Attention: Theresa Moore, Allegany County Department of Health, County Office Building, Room 30, 7 Court Street, Belmont NY 14813.
1.Do you have any kind of health care coverage or health insurance? (check one)
2.How do you pay for your Health Care? (Check all that apply)
3.Where do you get most of your health information? (select up to three (3) choices) (Required.)
4.How often do you see your primary care provider (doctor)? (check one)
5.In the past year, was there any time that you needed medical care but could not - or did not get it?
6.What are the main reasons you did not get the medical care you needed? Choose all that apply.
7.In the past year, was there any time that you needed mental health care but could not - or did not get it?
8.In the past year, was there any time that you or your children needed dental care but could not - or did not get it?
9.How often do you participate in physical activity or exercise? (check one)
10.Which, if any of the following would help you become more active? (check all that apply)
11.Have you ever been told by a doctor or a nurse, that you had any of the following? (check all that apply)
12.If you are living with a chronic illness, what do you do to manage your diseases? (check all that apply)
13.Which of the following do you know how to find in Allegany County? (check all that apply)
14.What services do you leave the county for? (check all that apply)
15.What is the main reason(s) for traveling outside of your county for these services? (check all that apply)
16.In the past 30 days, have you used any of the following nicotine products? (check all that apply)
17.Check all that apply
18.Legal purchase age for tobacco products and e-cigarettes in New York is now 21.
19.In the past 30 days, have you drank any alcohol? (beer, wine, liquor, etc.)
20.How many servings of alcohol (beer, wine, liquor, etc.) do you drink in a week? (check one)
21.During the past 30 days, what drugs have you used recreationally? (not prescribed by a doctor) (check all that apply)
22.What are your drinks of choice on most days? Check all that apply
23.During the past 7 days, how many times did you drink a bottle or glass of water?  Count tap, bottle and unflavored sparkling water. (check one)
24.During the past 7 days, how many times did you eat fruit? (do not count fruit juice) (a serving is 1 cup or a fist size) (check one)
25.What keeps you from eating more fruits every day?  (check all that apply)
26.During the past 7 days, how many times did you eat vegetables? (do not count vegetable juice) (a serving is 1 cup or a fist sized piece) (check one)
27.What keeps you from eating more vegetables every day? (check all that apply)
28.On average, how many days in a week do you eat out or purchase prepared food? (fast food, deli food, sub shop, pizza, etc.) (check one)
29.Which of these is the biggest challenge or barrier keeping you from eating healthy foods? (no sugar added, preservative-free grains, non-GMO foods and poultry, meat and dairy not treated with chemicals or hormones, etc.) (check one)
30.Studies and research show that the arts are necessary to human health and community wellness.  Which creative arts activities do you use to support your overall wellness?  (check all that apply)
31.Have any of the following directly affected you or your family in the last 2 years? (consider things like coverage under your health benefit plan, cost of service, location, transportation, knowledge of providers, etc)
Very Serious Affect
Serious Affect
Somewhat of an Affect
Small Affect
No Affect
Does Not Apply (N/A)
Access to insurance coverage
Access to adult immunizations
Access to childhood immunizations
Access to general health screenings (blood pressure, cholesterol, colorectal cancer, diabetes
Access to mental health care services
Access to prenatal care
Access to transportation to medical care providers and services
Access to women's health services
Access to primary medical care providers
Availability of specialists/specialty medical care
Access to affordable health care (related to copays and deductibles)
Access to dementia care services
Access to dental care
Access to emergency shelter in the area
32.Have any of the following directly affected you or your family in the last 2 years?
Very Serious Affect
Serious Affect
Somewhat of an Affect
Small Affect
No Affect
Does Not Apply (N/A)
Alcohol abuse
Prescription drug abuse
Illegal drug use
Crime
Delinquency/youth crime
Domestic violence/abuse
Sexual abuse
Child physical abuse
Child sexual abuse
Child emotional abuse
Child neglect
Violence
Gun violence
Lack of exercise/physical activity
Sexual behaviors (unprotected, irresponsible/risky)
Teenage pregnancy
Tobacco use
Tobacco use during pregnancy
Driving under the influence of drugs or alcohol
Texting and driving
Motor vehicle crash deaths
Gambling
Suicide
Mental health issues (depression, anxiety, etc.)
33.In the future, what might help you make healthy changes in your life? (please select three (3))
34.What category best describes your race? (check all that apply)
35.What is your age?
36.What is your gender?
37.What is your employment status? (check one)
38.During the past 12 months, what was your total household income before taxes? (check one)
39.During the past 12 months, how many people lived in your home, including yourself? Please enter the number for each age group and the total.
40.Are you an Allegany County resident or a student attending college in Allegany County??
41.What is your zip code?
42.On behalf of the Allegany County Department of Health, Cuba Memorial Hospital, Jones Memorial Hospital, and the Community Wellness Committee of Allegany County, thank you for participating in the 2022 Community Health Assessment Survey.

To thank you for your participation, you will be entered into a drawing for a chance to win one of six (6) $50 gas gift certificates or one of eight (8) $25 gas gift certificates. 

Please complete the information below to be entered into drawings for the gas gift certificates.