* 1. How concerned are you about each of these HEALTH RISK FACTORS (either for yourself, your family, or your friends)?

  Not at all concerned Somewhat concerned Very concerned
Cigarette smoking/tobacco use
Elevated cholesterol/diet
High blood pressure
Physical activity/inactivity
Overweight/obesity
Alcohol consumption
Illicit drug use

* 2. How concerned are you about each of these HEALTH PROBLEMS (either for yourself, your family, or your friends)?

  Not at all concerned Somewhat concerned Very concerned
Heart disease
Cancer
Respiratory disease
Stroke
Accidents
Alzheimer's disease/dementia
Diabetes
Influenza and pneumonia
Kidney disease
Depression and other mental illnesses

* 3. How concerned are you about each of these HEALTH CARE ISSUES (either for yourself, your family, or your friends)?

  Not at all concerned Somewhat concerned Very concerned
Lack of affordable health insurance
High medical and prescription out-of-pocket expenses
Lack of prenatal and infant health care
Lack of pedatric health care
Lack of chronic disease prevention and management
Lack of affordable, quality elder/senior health care options

* 4. What HEALTH NEEDS do you, your family, and your friends have?

* 5. What HEALTH SUPPORT would be most helpful for you, your family, and your friends?

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