The Johnson County Health Department, in partnership with the University of Kansas Center for Community Health and Development and the Kansas Department of Health and Environment (KDHE), is gathering information about risk and protective factors related to violence, especially sexual violence in the community, the causes and conditions that contribute to violence, and community strengths that protect people from violence in Johnson County.

The University of Kansas Center for Community Health and Development and KDHE support the practice of protection for human subjects participating in community needs assessment. The following information is provided for you to decide whether you wish to respond to the present survey. Please be aware that even if you start responding to the survey, you are free to stop at any time without penalty. The survey is expected to take approximately 10 minutes to complete.

 Although participation may not benefit you directly, we believe that the information obtained from this study will help us gain a better understanding of community violence, causes, and community assets. The following survey items are adapted from validated questionnaires recommended by the Centers for Disease Control for use in community settings. Aggregate responses to these questions are related to risk and protective factors for violence in communities and cannot be used to draw conclusions about individuals. Your participation is solicited, although strictly voluntary. Your name will not be associated in any way with the findings from the assessment. If you would like additional information concerning this study before or after it is completed, please feel free to contact us by phone or mail.

Responding to the survey questions indicates your willingness to participate in this assessment and that you are over the age of eighteen. If you have any additional questions about your rights as a respondent, you may call Jerry Schultz at 785-864-0750.

We thank you for taking time to complete this survey.

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* 1. Are you a resident of Johnson County?

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* 2. How old are you?

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* 3. What is your zip code?

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* 4. What is your gender?

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* 5. What is your race and ethnicity? Please select all that apply.

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* 6. What is the highest grade or year of school you completed? Check one.

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* 7. Are you currently...? Check one or more.

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* 8. Your annual household  income from all sources - Check one.

Please tell us about how often you engage in the following behaviors with your neighbors.

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* 9. About how often do you and people in your neighborhood do favors for each other? By favors we mean such things as watching each other's children, helping with shopping, lending garden or house tools, and other small acts of kindness.

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* 10. How often do you and people in this neighborhood have parties or other get-togethers where other people in the neighborhood are invited?

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* 11. When a neighbor is not at home, how often do you and other neighbors watch over their property?

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* 12. How often do you and other people in this neighborhood visit in each others' homes or on the street?

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* 13. How often do you and other people in the neighborhood ask each other advice about personal things such as childrearing or job openings?

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* 14. What do you want people to know about your neighborhood in relation to connectedness?

Please tell us about how you feel about the following situations.
How afraid are you of being attacked or robbed ... (Questions 15-18)

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* 15. At home in your house or apartment?

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* 16. On the streets of your neighborhood during the day?

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* 17. Out alone at night in your neighborhood?

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* 18. Out with other people at night in your neighborhood?

Has a fear of crime in your neighborhood in Johnson County caused you to ... (Questions 19-24)

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* 19. Limit the places or the times that you go shopping?

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* 20. Limit the places or the times that you will work?

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* 21. Limit the places that you will go by yourself?

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* 22. Purchase a weapon for self-protection?

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* 23. Install a home security system or install protective devices such as bars on the windows, buzzers on windows and/or doors, etc.?

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* 24. Move to a different place to live?

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* 25. What do you want people to know about your neighborhood in relation to violence?

You will be presented with a set of statements and asked to answer whether you agree or disagree with each. These statements do not reflect the positions held by any entity involved with this survey - we are interested in your personal opinion.

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* 26. Swearing is worse for a female than for a male.

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* 27. On a date, the male should be expected to pay all expenses.

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* 28. On the average, females are as smart as males.

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* 29. More encouragement in a family should be given to males than females to go to college.

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* 30. It is all right for a female to want to play rough sports like football.

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* 31. In general, the father should have greater authority than the mother in making family decisions.

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* 32. It is all right for a female to ask a male out on a date.

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* 33. It is more important for males than females to do well in school.

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* 34. If both husband and wife have jobs, the husband should do a share of the housework such as washing dishes and doing the laundry.

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* 35. Males are better leaders than females.

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* 36. Females should be more concerned with becoming good wives and mothers rather than desiring a professional or business career.

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* 37. Females should have the same freedom as males.

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* 38. Do you have a firearm in your home?

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* 39. Lastly, do you have any additional comments or clarifications about your responses?

Thank you for completing the survey!

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