Bracken County Health Department Health Survey Question Title * 1. In the following list, what do YOU think are the 3 Most Important Factors for a “Healthy” Bracken County? Those factors which most improve the quality of life in our community). Check up to 3: Access to Health Care Access to Healthy Foods Access to NO/Low Cost Activities Affordable Housing Arts & Cultural Events Clean Environment Low Crime/Safe Neighborhoods Excellent Race Relations Good Jobs & Healthy Economy Good Place to Raise Children Good Schools & Education Healthy Behaviors & Lifestyles Low Death & Disease Rates Low Infant Deaths Low Level of Child Abuse Religious or Spiritual Values Senior Citizen Activities/Programs Strong Family Life Quality Child Care Other (please specify) Question Title * 2. In the following list, what do YOU think are the 3 Greatest Health Problems that must be addressed in Bracken County? (Those concerns which have the greatest impact on overall community health). Check up to 3: Aging Problems (e.g. arthritis/vision loss, etc.) Alcohol Abuse Cancers Child Abuse/Neglect Dental Problems Depression Diabetes Domestic Violence Eating Disorders/Body Image Heart Disease & Stroke High Blood Pressure Suicide (Self Harm) Homicide (Murder) Infectious Diseases (e.g. TB, Hepatitis) Infant Death Motor Vehicle Crash Injuries Overweight/Obesity HIV/AIDS Prescription Drug Abuse Rape/Sexual Assault Respiratory/Lung Disease Second Hand Smoke Smoking Sexually Transmitted Diseases Street Drug Use (Meth, Heroin, etc.) Stress/Anxiety Teenage Pregnancy Other Mental Health Problems (e.g. Bipolar, Schizophrenia, etc.) Other (please specify) Question Title * 3. In the following list, what do YOU think are the 3 Most Risky Behaviors in Bracken County? Please select those behaviors that YOU believe have the greatest impact on overall community health. Check up to 3: Not Having Health Insurance Alcohol Abuse Being Overweight Distracted Driving Dropping Out of School Smoking/Tobacco Use Lack of Exercise Poor Diet/Eating Habits School Bullying Not Getting Shots to Prevent Disease Racism Street Drug Use (Meth, Heroin, etc.) Not Using Birth Control/Unsafe Sex Not Using Seat Belts/Child Safety Having Multiple Sex Partners Hate Crimes Prescription Drug Use Other (please specify) Question Title * 4. How would you rate the overall health of Bracken County? Very Unhealthy Unhealthy Somewhat Healthy Healthy Very Healthy Question Title * 5. How would you rate YOUR own personal health? Very Unhealthy Unhealthy Somewhat Healthy Healthy Very Healthy Question Title * 6. Age: Under 18 18-24 Years 25-35 Years 36-45 Years 46-60 Years 61 and Over Question Title * 7. Gender: Female Male Other (please specify) Question Title * 8. Race: American Indian/Alaska Native Asian Black/African American Native Hawaiian or other Pacific Islander White Other (please specify) Question Title * 9. Are you of Hispanic Ethnicity? Yes No Question Title * 10. Marital Status: Married Widowed Divorce/Separated Never Married/Single Question Title * 11. Highest Level of Education Completed: Less Than a High School Diploma High School Diploma or Equivalent (GED) Some College Associate/Technical Degree Bachelor's Degree Graduate or Higher Degree Question Title * 12. Annual Household Income: Less than $20,000 $20,000 to $29,999 $30,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 Over $100,000 Prefer Not to Answer Question Title * 13. Employment Status: Employed Full-Time Employed Part-Time Self-Employed Out of work, but looking for work Out of work, but not currently looking for work Retired Student Unable to work Question Title * 14. Number of ADULTS in your household? Question Title * 15. Number of CHILDREN (less than 18 years old) in your household? Question Title * 16. Number of CHILDREN (greater than 18 years old) in your household? Question Title * 17. Are you a grandparent with grandchildren living in your home? Yes No Question Title * 18. How do you pay for your health care? Pay Cash (No Insurance) Health Insurance (Provided by Employer) Health Insurance (Buy Own Insurance) Veteran's Association (VA) Medicaid Medicare Other (please specify) Question Title * 19. In the past 12 months, have you decided NOT to seek health care services because of out-of-pocket cost to you? Yes No Question Title * 20. Would you use an Urgent Care located in Bracken County? Yes No Question Title * 21. Where do you get your information about health? (Check all that apply) Doctor/Hospital Church Newspaper Internet Health Department Family/Friends Magazines Other (please specify) Question Title * 22. Where do you get your information about events/news in Bracken County? (Check all that apply) Word of Mouth Radio Newspaper Church Internet Social Media (Facebook, Twitter, etc.) Other (please specify) Question Title * 23. What is the zip code where you live in Bracken County? Done