2017 Community Health Assessment Question Title * 1. sex: Male Female Question Title * 2. How old are you? 18-20 21-24 25-34 35-44 45-54 55-64 65-74 75 or older Question Title * 3. Race (mark all that apply) Black/African American White/Caucasian Asian Native Hawaiian/Pacific Islander American Indian/Alaskan Native Hispanic/Latin Other Question Title * 4. What is the highest level of education that you completed? Less than high school Some high school, no diploma High school diploma or GED Associates degree Some college (no degree) Bachelor's degree Graduate or professional degree Question Title * 5. How many people does your income support? 1-3 4-6 7-9 10 + Question Title * 6. How many people live in your home? 1-3 4-6 7-9 10 + Question Title * 7. What is your marital status? Never married/single Married Unmarried partner Separated Divorced Widowed Question Title * 8. What is your employment status? Employed full time Employed part time Retired Armed Forces Unemployed for more than one year Disabled Student Homemaker Self-employed Question Title * 9. What zip code do you currently reside in? 27028 27006 27014 Question Title * 10. As a Davie County citizen, what is the biggest challenge you and your family members face? None Access to affordable recreational facilities, parks, camps or after-school programs Access to affordable high quality child care Availability of high quality child care near home or work Access to affordable housing Transportation Unemployment, underemployment, or availability of jobs Hunger (food shortage) Crime or safety issues Discrimination (racial, ethical, sexual orientation, pregnancy, other) Alcohol/drug abuse Teen pregnancy Family violence/domestic abuse/child neglect Literacy, trouble reading or writing Language barriers Access to care for individuals with special needs Access to affordable medical care (including dental, mental, prenatal) Service/care for children with special needs/challenging behaviors (speech, physical, occupational therapies) Other (please specify) Question Title * 11. Where do you get most of your health-related information? Friends and family Doctor/nurse Pharmacist Storehouse for Jesus Internet TV Health department Book/magazine Hospital Other (please specify) 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. I receive this amount of activity I feel like I get this much physical activity at my job I am physically disabled I don't have enough time to exercise It cost too much to exercise Other (please specify) Question Title * 13. In your opinion, which of the health behaviors do people in your own community need more information about? Eating well/nutrition Exercising/fitness Getting prenatal care during pregnancy Using child safety seats Quitting smoking/tobacco use prevention Safe sex-condom use, STD prevention and family planning Substance abuse Other (please specify) 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. I receive the recommended amount I/my family will not eat them They will go bad before we eat them I do not think they're important I don't have time to fix them I don't know how to fix them Limited access to them They are too expensive Other (please specify) Question Title * 15. Are you and your family up-to-date on your vaccinations (required shots)? Yes No Question Title * 16. If you or your family are not up-to-date on your vaccinations (required shots), what is the main reason? Cost of vaccinations Fearing of seeing child in pain Conflict in religious beliefs Fear of possible side effects Belief that vaccinations cause diseases Lack of information on when they're due Other (please specify) Question Title * 17. Which of these recommended health screenings have you had in the last year? Colonoscopy (50+ years old) Annual prostate exam (males, 40+ years old) Annual mammogram (female, 40+ years old) Pap smear (female 21+, at least every other year) Skin screenings (everyone, any age, annually) Physical exams (everyone, any age, annually) Other/None Question Title * 18. Where do you usually go for healthcare when you are sick? (choose one) Private doctor's office Hospital Pharmacy/minute clinic Health department Urgent care center Storehouse for Jesus I don't receive treatment when sick VA (Veterans Affairs) Other (please specify) Question Title * 19. Do you or anyone in your household have any of the chronic conditions listed below? Asthma Diabetes Heart disease Mental illness COPD Arthritis Alzheimer's Cancer Other (please specify) Question Title * 20. If you identified conditions in question 19, are you being monitored or receiving treatment for those conditions? Yes No Question Title * 21. Have you or a family member had difficulties getting services for mental or behavioral health in Davie County? Yes No If yes, please explain Question Title * 22. If a friend or family member needed help and/or counseling for suicide prevention who would you tell them to contact? Private counselor/therapist Support group/hot line School counselor Doctor Religious official Family member I don't know Other (please specify) Question Title * 23. In your opinion, what is the biggest substance abuse problem in this county? Prescription drugs Alcohol Heroin Huffing- inhalation of fumes/vapors (paint or gasoline) through the mouth/nose Marijuana Methamphetamine Over the counter medications/products Synthetics Cocaine/crack I don't know Other (please specify) Question Title * 24. Do you currently use tobacco products? (this includes cigarettes, chew, dip, snuff) Yes No Question Title * 25. Do you currently use vaping products (e-cigs, vape pen, vape mod, etc) Yes No Question Title * 26. If you currently use tobacco or vaping products, where would you go for help if you wanted to quit? Quit Line NC Doctor Church Friends and Family Pharmacy Health Department I don't know Other Question Title * 27. Do you use any of the following safety measures in your home? Carbon monoxide detectors Smoke detectors Furniture straps Gun safety (gun safe, etc.) Safety seats (car seats, booster seats, etc.) Seatbelts Outlet covers Bike helmets 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. Child development Behavior management Education Health and safety Parenting Other 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) 0-1 2-3 4-5 6-7 Question Title * 30. If you have children and can't find adequate child care; what is the main reason? Can't afford child care Cannot find a child care provider that's able to care for my child The hours and locations didn't fit my need (2nd/3rd shifts) Child care subsidy (financial assistance) isn't available to me and my family Child care provider could not address my child's special physical or developmental needs Other Question Title * 31. How would you prefer to receive county-wide urgent information (choose one) County website Email Government Access Channel (for cable TV only) Radio Telephone (text or call) Other (please specify) Question Title * 32. In the event of a public health emergency (i.e. Anthrax attack) what do you see as a limitation? Transportation Getting important information Homebound populations-certain populations that might not have the same access to supplies as others like the elderly population Other (please specify) Question Title * 33. Do you have an emergency survival kit (water, flashlight, batteries, etc.) in your home? Yes No 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? Yes, please explain below No Please explain Question Title * 35. Do you have a family member that is being taken care of at home due to physical or mental limitations? Yes No Question Title * 36. If you have a family member that's being taken care of at home; are you paying for those services? Yes No N/A Done