North Shore Health Department Community Health Assessment

North Shore Community Health Assessment Survey

This survey is intended to collect feedback from residents of the North Shore and identify which health issues are perceived to be the highest priority. Responses will be used to highlight the needs of the community as one part of the North Shore Health Department's 2017 Community Health Assessment.

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* 1. In your opinion, what are the top issues that need to be addressed to improve the overall health of the North Shore community? (select 5 issues)

Access to healthy food

Access to quality dental services

Access to quality medical care services

Access to quality mental health services

Access to quality sexual and reproductive health services

Adult mental illness

Air quality

Alcohol use

Asthma or other chronic respiratory conditions

Bullying

Communicable disease prevention (e.g., West Nile Virus, Tuberculosis, etc.)

Cost of health care

Chronic disease prevention (e.g., heart disease, hypertension, diabetes, etc.)

Culturally and linguistically appropriate health services

Dementia and Alzheimer’s disease

Food or waterborne illnesses (e.g., Salmonella, E. coli, etc.)

Gender and sexual inclusiveness

High risk sexual behaviors

Inadequate educational opportunities

Inadequate employment opportunities or income

Insufficient sleep

Intentional injury (e.g., violence or psychological harm towards self or others)

Neighborhood safety

Obesity

Pedestrian and bike safety

Physical inactivity

Nutrition

Prescription drug abuse

Racism or segregation

Sexually transmitted diseases (including HIV/AIDS)

Street drug use (e.g., marijuana, cocaine, heroin, etc.)

Stress management

Suicide

Tobacco use

Unintentional injury (e.g., falls, motor vehicle crashes, poisoning, etc.)

Water quality

Youth mental illness

Other (please specify)

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* 2. On a scale from 1 to 5 (1=poor, 2=fair, 3=good, 4=very good, 5=excellent), how would you rate the overall health of the residents of the North Shore community?

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* 3. In what North Shore Community do you live?

Bayside

Brown Deer

Fox Point

Glendale

River Hills

Shorewood

Whitefish Bay

Other (please specify)

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* 4. How long have you lived in the North Shore?

Less than 1 year

1 to 5 years

6 to 10 years

More than 10 years

I do not live in the North Shore

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* 5. What is your age in years?

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* 6. Which gender do you identify with?

Male

Female

Other gender identity

Prefer not to answer

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* 7. Do you identify as Hispanic or Latino?

Yes

Prefer not to answer

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* 8. Which race do you identify with? (select all that apply)

White

Black or African American

Asian

American Indian or Alaskan Native

Native Hawaiian or Other Pacific Islander

Prefer not to answer

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* 9. Additional comments or concerns:

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* 10. Is this a paper survey?

Yes