sex:

Question Title

* 1. sex:

How old are you?

Question Title

* 2. How old are you?

Race (mark all that apply)

Question Title

* 3. Race (mark all that apply)

What is the highest level of education that you completed?

Question Title

* 4. What is the highest level of education that you completed?

How many people does your income support?

Question Title

* 5. How many people does your income support?

How many people live in your home?

Question Title

* 6. How many people live in your home?

What is your marital status?

Question Title

* 7. What is your marital status?

What is your employment status?

Question Title

* 8. What is your employment status?

What zip code do you currently reside in?

Question Title

* 9. What zip code do you currently reside in?

As a Davie County citizen, what is the biggest challenge you and your family members face?

Question Title

* 10. As a Davie County citizen, what is the biggest challenge you and your family members face?

Where do you get most of your health-related information?

Question Title

* 11. Where do you get most of your health-related information?

The recommendation for physical activity is 30 minutes a day, 5 days a week or 2.5 hours a week.  Pick the main reason that keeps you from getting this much physical activity.

Question Title

* 12. The recommendation for physical activity is 30 minutes a day, 5 days a week or 2.5 hours a week.  Pick the main reason that keeps you from getting this much physical activity.

In your opinion, which of the health behaviors do people in your own community need more information about?

Question Title

* 13. In your opinion, which of the health behaviors do people in your own community need more information about?

It is recommended for individuals to eat at least 5 servings of fruit and vegetables a day (this does not include French fries or potato chips).  Pick the main reason that keeps you from meeting this goal.

Question Title

* 14. It is recommended for individuals to eat at least 5 servings of fruit and vegetables a day (this does not include French fries or potato chips).  Pick the main reason that keeps you from meeting this goal.

Are you and your family up-to-date on your vaccinations (required shots)?

Question Title

* 15. Are you and your family up-to-date on your vaccinations (required shots)?

If you or your family are not up-to-date on your vaccinations (required shots), what is the main reason?

Question Title

* 16. If you or your family are not up-to-date on your vaccinations (required shots), what is the main reason?

Which of these recommended health screenings have you had in the last year?

Question Title

* 17. Which of these recommended health screenings have you had in the last year?

Where do you usually go for healthcare when you are sick? (choose one)

Question Title

* 18. Where do you usually go for healthcare when you are sick? (choose one)

Do you or anyone in your household have any of the chronic conditions listed below?

Question Title

* 19. Do you or anyone in your household have any of the chronic conditions listed below?

If you identified conditions in question 19, are you being monitored or receiving treatment for those conditions?

Question Title

* 20. If you identified conditions in question 19, are you being monitored or receiving treatment for those conditions?

Have you or a family member had difficulties getting services for mental or behavioral health in Davie County?

Question Title

* 21. Have you or a family member had difficulties getting services for mental or behavioral health in Davie County?

If a friend or family member needed help and/or counseling for suicide prevention who would you tell them to contact?

Question Title

* 22. If a friend or family member needed help and/or counseling for suicide prevention who would you tell them to contact?

In your opinion, what is the biggest substance abuse problem in this county?

Question Title

* 23. In your opinion, what is the biggest substance abuse problem in this county?

Do you currently use tobacco products? (this includes cigarettes, chew, dip, snuff)

Question Title

* 24. Do you currently use tobacco products? (this includes cigarettes, chew, dip, snuff)

Do you currently use vaping products (e-cigs, vape pen, vape mod, etc)

Question Title

* 25. Do you currently use vaping products (e-cigs, vape pen, vape mod, etc)

If you currently use tobacco or vaping products, where would you go for help if you wanted to quit?

Question Title

* 26. If you currently use tobacco or vaping products, where would you go for help if you wanted to quit?

Do you use any of the following safety measures in your home?

Question Title

* 27. Do you use any of the following safety measures in your home?

We are interested in helping young children be ready for school.  To help us help your child, please tell us what you would like to learn more about.

Question Title

* 28. We are interested in helping young children be ready for school.  To help us help your child, please tell us what you would like to learn more about.

During the past week, how many days did you or another family member read to your child (age 0-6 years old)

Question Title

* 29. During the past week, how many days did you or another family member read to your child (age 0-6 years old)

If you have children and can't find adequate child care; what is the main reason?

Question Title

* 30. If you have children and can't find adequate child care; what is the main reason?

How would you prefer to receive county-wide urgent information (choose one)

Question Title

* 31. How would you prefer to receive county-wide urgent information (choose one)

In the event of a public health emergency (i.e. Anthrax attack) what do you see as a limitation?

Question Title

* 32. In the event of a public health emergency (i.e. Anthrax attack) what do you see as a limitation?

Do you have an emergency survival kit (water, flashlight, batteries, etc.) in your home?

Question Title

* 33. Do you have an emergency survival kit (water, flashlight, batteries, etc.) in your home?

Do you have any suggestions or recommendations that the Davie County Health Department could do to make our community a better place?

Question Title

* 34. Do you have any suggestions or recommendations that the Davie County Health Department could do to make our community a better place?

Do you have a family member that is being taken care of at home due to physical or mental limitations?

Question Title

* 35. Do you have a family member that is being taken care of at home due to physical or mental limitations?

If you have a family member that's being taken care of at home; are you paying for those services?

Question Title

* 36. If you have a family member that's being taken care of at home; are you paying for those services?

T