Thank you for participating in the Boone County Health Department Community Context Assessment. You have chosen to share your thoughts, ideas and experiences with us to help us Build Our Best Boone because you live and/or work in Boone County. The survey is anonymous and takes less than 5 minutes.  By completing this survey, you are helping us better understand our community and your concerns.  Your responses are important so please answer as honestly and completely as possible.  The more complete and honest your answers, the more you help your community identify and address key health issues. Please help Build Our Best Boone!

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* 1. Please indicate where you live by checking one of the following?

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* 2. Do you live in Boone County?

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* 3. Do you work in Boone County?

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* 4. What do you consider the 3 most important health concerns in Boone County?

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* 5. What are the 3 greatest STRENGTHS of Boone County? Please check exactly 3.

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* 6. Where do you go when you are sick or need healthcare?

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* 7. How do you pay for healthcare?

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* 8. How do you get to work, shopping, and appointments?

Have you ever experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following situations because of your race, ethnicity, color, gender or sexual orientation? Please select an option for each scenario below:

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* 9. At school

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* 10. Getting hired or getting a job

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* 11. At work

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* 12. Getting housing

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* 13. Getting medical care

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* 14. Getting service in a store or restaurant

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* 15. Getting credit, bank loans or a mortgage

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* 16. On the street or in a public setting

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* 17. Receiving services from a government entity

How has COVID-19 had an impact on our community? Please select “negative,” “neutral,” or “positive” for each statement below:

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* 18. COVID-19 has had a/an ________ impact on my social life.

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* 19. COVID-19 has had a/an ________ impact on my personal finances.

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* 20. COVID-19 has had a/an ________ impact on my mental health/substance use disorder.

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* 21. COVID-19 has had a/an ________ impact on my view of politics and government.

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* 22. COVID-19 has had a/an ________ impact on my view of healthcare.

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* 23. COVID-19 has had a/an ________ impact on my housing.

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* 24. Which of the following Health Department services do you use?

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* 25. What gender do you most identify with?

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* 26. What is your Marital status?

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* 27. What is your age in years?

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* 28. What is your annual household income?

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* 29. What is the highest grade or year of school completed?

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* 30. Please indicate your employment status (check all that apply)

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* 31. What race do you most identify with?

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* 32. What ethnicity do you most identify with?

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