Thank you for participating in the Harford County Community Health Survey.  All information gathered in this survey will be anonymous and confidential.  We want to hear from you.  The information gathered from this survey will be used to help better understand the health issues and needs of our community.  It will then be used to create better services and community health programs.  The survey should take about 10-15 minutes to complete. After completing the survey, you will be offered the opportunity to enter your name and email for a chance to win a $200 Walmart Gift Card.  Your name and email will NOT be connected to your health survey answers.  Thank you for taking the time to complete the survey.

* 1. Do you live in Harford County, MD?

* 2. In what zip code is your home located?

* 3. What is your age?

* 4. What is your gender?

* 5. Are you...?

* 6. Are you Hispanic, Latino/a, or Spanish origin?

* 7. Which one of these groups would you say best represents your race?

* 8. What is the highest grade or year of school you completed?

* 9. Which of the following categories best describes your employment status?

* 10. What is your annual household income from all sources (before taxes)?

* 11. Are you currently covered by any of the following types of health insurance or health coverage plans? (select all that apply)

* 12. Would you say that in general your health is...

* 13. Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

* 14. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

* 15. Do you have one person you think of as your personal doctor or health care provider?

* 16. Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?

* 17. Have you delayed getting needed medical care for any of the following reasons in the past 12 months?  Select the most important reason.

* 18. About how long has it been since you last visited a doctor for a routine checkup?  A routine exam is a general physical exam, not an exam for a specific injury, illness, or condition.

* 19. Do you travel outside of Harford County for medical care?

* 20. Where do you get your health information?

* 21. On average, how many hours of sleep do you get in a 24 hour period?

* 22. How often do you do the following?

  Always More of the time Sometimes Rarely Never N/A
Wear a seatbelt
Wear a helmet while riding a bicycle, scooter, roller blading, etc.
Eat fast food more than once a week
Use electronic cigarettes/vape
Get exposed to second hand smoke or vaping mist at home or work
Use marijuana
Misuse prescription drugs, opiods, herion, or other illegal drugs
Exercise 30 mins a day, 3 times a week
Use sunscreen regularly
Practice safe sex i.e. use a condom, monogamous, get tested
Feel stressed out or overwhelmed
Drive responsibly, follow safe rules of the road, drive within the speed limit

* 23. Have you smoked at least 100 cigarettes in your entire life? Note: 5 packs = 100 cigarettes

* 24. If yes, do you now smoke cigarettes every day, some days, or not at all?

* 25. Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 drinks (for men) and 4 drinks (for women) on an occasion?

* 26. During the past 30 days, how often did you drink regular soda or pop that contains sugar? Do not include diet soda or diet pop.  You can answer time per day, week or month: for example, twice a day, once a week, and so forth.

* 27. During the past 30 days, how often did you drink sugar sweetened fruit drinks (such as Kool-Aid and lemonade) sweet tea, and sports or energy drinks (such as Gatorade and Red Bull)?  Do not include 100% fruit juice, diet drinks, or artificially sweetened drinks.  You can answer times per day, week, or month: for example twice a day, once a week, and so forth.

* 28. During the past 30 days, not counting juice, how many times per day, week or month did you eat fruit? Count fresh, frozen, or canned fruit.  Do not include jam, jelly, or fruit preserves.

* 29. During the past 30 days, how many times did you eat dark green vegetables for example broccoli or dark leafy greens such as romaine, chard, collard, greens, spinach, or kale?

* 30. Are you currently watching or reducing your sodium or salt intake?

* 31. During the past 30 days, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

* 32. How many times per week OR per month did you take part in physical activity?

* 33. And when you took part in this activity, for how many minutes or hours did you usually keep at it?

* 34. Have you ever been told by a doctor, nurse, or other health professional that you have:

  Yes No
Anxiety disorder
Depressive disorder
Asthma
Cancer
Angina or coronary disease
High cholesterol
Heart attack, also called myocardial infarction
Stroke
High blood pressure
Chronic obstructive pulmonary disease (COPD)
Diabetes
Arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia

* 35. Do you have routine health screenings for:

  Yes No N/A
Skin
Mammogram (female only)
Prostate (male only)
Oral/ Throat
Colorectal

* 36. During the past 12 months, have you a flu shot/vaccine?

* 37. Have you ever had cancer?

* 38. If yes, please specify the type of cancer

* 39. What do you think are the top 3 most pressing health issues facing Harford County? (CHOOSE only 3)

* 40. What are the most significant barriers that keep people in the community from accessing health care when they  need it?  (Select all that apply)

* 41. Related to health, what resources or services do you think are missing in the community? (Select all that apply)

* 42. In the following list, what do you think are  the three most important "risky behaviors in our community? (Those behaviors which have the greatest effect on overall community health.)  CHOOSE only 3.

* 43. In the following list, what do you think are the three most important things needed for a "Healthy Community?"  (Those things which most improve the quality of life in a community.)  CHOOSE only 3.

* 44. What prevents you from being healthy in Harford County?

* 45. The Harford County Community will use the information from this survey to plan community health programs.  Please share any additional comments you have below:

* 46. Thank you for your input. *To be entered for a chance to win a $200 Walmart Gift Card, please provide your name, email address and/or phone number.*  We will contact the winner of the gift card when the survey is complete.  Note that your answers will remain confidential and anonymous and will not be connected to your name, email address, or phone number.  Your information will not be used for marketing purposes.  Entering the gift card raffle drawing is optional.

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