We are interested in understanding how the local community feels about the impact of the COVID-19 pandemic on their families and community. We will take all possible steps to protect your privacy and will use your answers only for statistical research. This means that no individual will be identified in any of the analyses or reports from this study. The survey will take about five minutes to complete. We greatly appreciate you taking the time to share your thoughts.

1.How concerned are you about the impact of COVID-19 on your own health?

Not at allSomewhatVeryExtremely

2.How concerned are you about the impact of COVID-19 on somebody else's health (e.g., friend or relative)?

Not at allSomewhatVeryExtremely

3.What other concerns do you have about the impact of COVID-19 on your community? Can include fraying social ties, negative behaviors, etc.

4.What concerns do you have about the impact of COVID-19 on your well-being? Can include stress, social isolation, etc.

5.Since the start of the pandemic, has your consumption of alcohol changed?

IncreasedDecreasedNo changeI don't consume alcohol

6.Since the start of the pandemic, has your consumption of tobacco products changed?

IncreasedDecreasedNo changeI don't consume tobacco

7.Since the start of the pandemic, has your consumption of illicit drugs changed?

IncreasedDecreasedNo change I don't consume illicit drugs

8.Has your consumption of junk food and sweets changed?

IncreasedDecreasedNo changeI don't consume junk food and sweets

9.Has your consumption of healthy, nutritious food changed?

IncreasedDecreasedNo changeI don't consume healthy, nutritious food

10.Has your access to healthy, nutritious food changed?

IncreasedDecreasedNo changeI don't consume healthy, nutritious food

11.Has your frequency of exercising changed?

IncreasedDecreasedNo changeI don't exercise

12.Has your time spent being inactive changed?

Increased DecreasedNo changeI don't exercise

13.Has your time spent on the internet changed?

IncreasedDecreasedNo changeI don't spent time on the internet

14.What is your employment status?

Employed and currently engaged in work duties

Employed, in receipt of employment income, but not carrying out work duties

Unemployed

Other

Other (please specify)

15.Which of the following best describes the impact of COVID-19 on your household's ability to meet financial obligations (loan repayments, household bills, etc.)?

Major negative

Moderate negative

Minor negative

No impact

Positive impact

16.How has COVID-19 impacted your household's wages and employment? Select all that apply.

Earned less money

Worked fewer hours

Expect to lose job soon

Lost job

Had to take off from work without pay

Had to close business

Other (please specify)

None of the above

17.What is your household income?

Less than $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

More than $150,000

18.Do you feel that if you needed non-material help (e.g., somebody to talk to, help with doing something, or collecting something) you could receive it from relatives, friends, neighbors or other persons that you know?

Yes

No

Other (please specify)

19.Given the topics discussed in this survey, how can your local health department better serve you?

20.What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

21.What is your sex?

Female

Male

22.In what ZIP code is your home located? (enter five-digit ZIP code; for example, 00544 or 94305)

23.Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicities / Other (please specify)

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