South Shore Community Health Survey

Please take 3-5 minutes to complete the survey below. The purpose of the survey is to collect the opinions of the community about community health issues and quality of life. The information gathered from this survey will be used as input for the development of the South Shore community health assessment and community health improvement plan. Participation in this survey is voluntary and all responses are anonymous.

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* 1. What zip code do you live or work?

53110 (Cudahy)

53154 (Oak Creek)

53172 (South Milwaukee)

53235 (Saint Francis)

Other (please specify)

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* 2. How would you rate the overall health of the community

Poor

Fair

Average

Good

Excellent

Poor

Fair

Average

Good

Excellent

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* 3. In your opinion, what top 5 issues need to be addressed to improve the overall health of the community? (Please review all options)

Access to quality dental services

Access to quality education

Access to quality medical care services

Access to quality mental health services

Access to quality prenatal care services

Access to quality sexual and reproductive health services

Access to safe/affordable housing

Access to transportation

Accessibility/resources for disabilities

Accidental injury - falls

Accidental injury -other (motor vehicle accident, poisoning, etc.)

Alcohol use

Asthma or other chronic respiratory condition

Bullying

Mental health

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

Crime/safety

Dementia and Alzheimer’s disease

Drug use

Environmental conditions (air quality, water quality, etc.)

Jobs & income/wages

Nutrition/healthy food

Obesity

Pedestrian and bike safety

Distracted driving

Poverty

Physical inactivity

Racism/discrimination

Stress management

Tobacco use/vaping

Violence

Other (please specify)

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* 4. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 5. What gender do you identify with?

Male

Female

Other gender identity

Prefer not to answer

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* 6. Do you identify as Hispanic or Latino?

Yes

Prefer not to answer

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* 7. Which race(s) do you identify with? (Select all that apply)

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Prefer not to answer

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* 8. What is your current marital status?

Married

Separated

Divorced

Widowed

Live with partner

Single/Never Married

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* 9. What is your annual household income?

Under $20,000

$20,000-$29,000

$30,000-$49,000

$50,000 or more

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* 10. What is your highest level of education?

8th grade or less

Some high school

High School/GED

Some College

Associates Degree/Technical School

Bachelor's Degree

Master's Degree

Advanced Degree (PD, M.D.)

South Shore Community Health Survey

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* 1. What zip code do you live or work?

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* 2. How would you rate the overall health of the community

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* 3. In your opinion, what top 5 issues need to be addressed to improve the overall health of the community? (Please review all options)

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* 4. What is your age?

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* 5. What gender do you identify with?

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* 6. Do you identify as Hispanic or Latino?

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* 7. Which race(s) do you identify with? (Select all that apply)

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* 8. What is your current marital status?

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* 9. What is your annual household income?

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* 10. What is your highest level of education?

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* 11. Please share any additional comments or concerns: