Community Health Survey Question Title * 1. In the following list, what do you think are the 3 most important factors for a "healthy community"? (Those factors that improve the quality of a life in a community.) Check only 3. Good place to raise children Low crime/safe neighborhood Good schools Access to health care (e.g. family doctor) Parks and recreation Clean environment Affordable housing Arts and cultural events Excellent race relations Good jobs and healthy economy Strong family life Healthy behaviors and lifestyles Low adult death and disease rates Low infant deaths Religious or spiritual value Other (please specify) Question Title * 2. How would you rate our community as a community Very unhealthy Unhealthy Somewhat healthy Healthy Very Heathy Question Title * 3. In the following list, what do you think are the 3 most important "health problems" in our county? Check only 3. Aging problems (e.g. arthritis, hearing/vision loss) Alcohol/Drug abuse, including Opioids Bullying Cancers Child abuse/neglect Dental problems Diabetes Domestic Violence Firearm-related injuries Heart disease and stroke High blood pressure HIV/AIDS Lack of safe and affordable housing Homicide Infant death Infectious diseases (e.g. hepatitis, TB) Mental health problems Motor vehicle crash injuries Obesity Rape/sexual assualt Respiratory/lung disease Sexually transmitted diseases Suicide Teenage pregnancy Tobacco use by youth Other (please specify) Question Title * 4. How would you rate your own personal health Very unhealthy Unhealthy Somewhat healthy Healthy Very Healthy Question Title * 5. In the following list, what do you think are the 3 most important "risky behaviors" in our community? Alcohol abuse Being overweight Dropping out of school Drug abuse Lack of exercise Poor eating habits Not getting "shots" to prevent disease Racism Tobacco use/or electronic cigarette use Not using birth control Not using Seat belts/child safety seats Unsafe sex Texting/cell phone while driving Other (please specify) Question Title * 6. By providing the following information we can ensure we are receiving responses from a wide range of people and their feelings on local health issues.What is your zip code? Question Title * 7. Sex Male Female Question Title * 8. Age 25 or less 26-39 40-54 55-64 65 or older Question Title * 9. Which of the following best describes your current relationship status? Married/ Co-habitating Divorced Never married Separated Widowed Other Question Title * 10. Which race/ethnicity best describes you? (Please choose only one.) White Black or African American Hispanic or Latino Asian Native Hawaiian or other Pacific Islander American Indian or Alaskan Native Multiple ethnicity / Other (please specify) Question Title * 11. What is your total household income? Less than $20,000 $20,000 to $29,000 $30,000 to $49,000 $50,000 to $74,000 $75,000 to $99,999 $100,000+ Question Title * 12. What is the highest level of education you have completed? Less than high school graduate High School Diploma or GED College degree or higher Other (please specify) Question Title * 13. How do you pay for your healthcare? Pay cash/no insurance Employer's Health Insurance Benefit ACA Health Insurance Policy Medicaid Medicare Veterans Administration Indian Health Services Other (please specify) Done