100% of survey complete.

* 1. Are you a Guernsey County Resident?

If you selected "No", please do not proceed. Survey is to be completed by Guernsey County residents only. Thank you for your interest.

* 2. What is your age?

* 3. Would you say that in general your health is___?

* 4. Now thinking about your mental health , which includes stress, depression, and problems with emotions, for how many days in the past 30 days was your mental health NOT good?

* 5. Do you have any kind of health care coverage, including health insurance, prepaid plans (such as HMO's) or goverment plans, (such as Medicare or Medicaid)?

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

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

* 8. Have you EVER been told by a doctor, nurse or other health care professional that you had the following? (Check all that apply)

* 9. Blood cholesterol is a fatty substance found in the blood.  Have you EVER had your blood cholesterol checked?

* 10. About how long has it been since you last had your cholesterol checked?

* 11. Do you smoke cigarettes every day, some days, or not at all?

* 12. During the 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

* 13. Do you currently use chewing tobacco, snuff, or snus (pouch tobacco) every day, some days, or not at all?

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

* 15. Are you...?

* 16. What is the highest level of school you have completed or the highest degree you have received?

* 17. Are you currently---?

* 18. What is your annual household income from all sources?

* 19. What is your current weight in pounds?

* 20. What is your height in feet and inches?

* 21. What is your zipcode where you live?

* 22. What is your gender?

* 23. During the past month, not counting juice, how many times per day did you eat fruit? Count fresh, frozen or canned?

* 24. During the past month, on average, how many  times per day  did you eat vegetables? Count fresh, frozen or canned.

* 25. During the past month, other than your job, did you participate in any physical activities or excercise such as walking, running, swimming, golf, softball, tennis, gardening for exercise?

* 26. How many times per week did you take part in activity during this past month?

* 27. When taking part in physical activity described above, how many minutes did you usually exercise per day?

* 28. During the past 30 days how many days per week did you have at least one drink of any alcoholic beverage such as beer, wine, malt beverage or liquor?

* 29. One drink is equivalent to a 12 ounce beer, a 5 ounce glass of wine or a drink made with one shot of liquor. On the days you drank alcoholic beverages in the past 30 days, about how many did you have each day?

* 30. During the past 30 days, what is the largest number of drinks you had on any occasion?

* 31. Have you had a test for high bood pressure or diabetes within the past three years?

* 32. Have you ever been told you have diabetes?

If answered no to question 32 and do not have diabetes, please skip to question 37

* 33. If you have diabetes, about how often do you check your blood glucose or sugar? Include times when checked by yourself, family member or friend.  DO NOT include times when checked by a health care professional.

* 34. If you have diabetes, about how often do you check your feet for any sores or irritations? Include times checked by yourself, family member or friend, DO NOT count times checked by a health care professional"

* 35. If you have diabetes, a test for "A1C" measures the average level of blood sugar, over the past three months.  About how many times in the past 12 months has a doctor,nurse,or other health professional checked your A1C?

* 36. Have you ever taken a class or course in how to manage your diabetes yourself?

* 37. During the past 30 days, for about how many days have you felt sad, blue or depressed?

* 38. About how often do you drink regular soda or pop that contains sugar? Do not count diet soda or pop.

* 39. When calorie information is available at a restaurant, how often does this information help you to decide what to order?

* 40. Which of the following do you think is a symptom of a heart attack? Check all that apply.

* 41. Which of the following do you think is a symptom of a stroke? Check all that apply.

* 42. A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?

* 43. How long has it been since you had your last mammogram?

* 44. A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood.  Have you ever had this test using a home kit?

* 45. A Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.  This is recommended for people over 50 years of age and older.  Have you ever had either of these exams?

* 46. How long has it been since you had your last sigmoidoscopy or colonoscopy?

* 47. Would you say that shortness of breath affects the quality of your life?

* 48. Did you have to visit the emergency room or be admitted to the hospital in the past 12 months because of your COPD (chronic obstructive pulmonary disease), chronic bronchitis, or emphysema?

* 49. How well prepared do you feel your household is to handle a large-scale disaster or emergency?
( such as a tornado, snow storm, flood ect.)

* 50. Has there been a time in the past 12 months when you thought of taking your own life?

* 51. During the past 12 months, did you attempt suicide?

* 52. Over the last 2 weeks, how many days have you had little interest or pleasure in doing things you enjoy?

* 53. Are you now taking medicine or recieving treatment form a doctor or other health professional for any type of mental health condition or emotional problem?

* 54. Has a doctor or other health care professional ever told you that you have an anxiety disorder (including acute stress, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, post-traumatic stress or social anxiety disorder)?

* 55. How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent or mortgage?

* 56. How often in the past 12 months would you say you were worried or stressed about having enough money to buy nutritious meals?  Would you say you were worried or stressed---

* 57. How often do you get the social and emotional support you need? ( family, friends, co-workers, others)

* 58. Have you ever lived with someone who was depressed, mentally ill, or who has thought of or committed suicide?

* 59. Have you ever lived with anyone who is a problem drinker or alcoholic?

* 60. Have you ever lived with anyone who uses illegal street drugs or who abuses prescription medications?

* 61. In the following list,select what you think are the five most important health issues in Guernsey County.

* 62. In the following list, select what you think are the top five safety/health risk behaviors in Guernsey County.  Please choose 5

* 63. How many children less than 18 years of age live in your household?

If you do not have children less than 18 years of age, please skip to question 69

* 64. How many meals do your children eat from a fast food restaraunt in a  week? ( on average)

* 65. How many hours do your children spend watching TV each week, on average?

* 66. How many hours do your children spend using the computer or playing video games each week?

* 67. Do you believe any of your children under the age of 18 participate in any of the following activities? ( Check all that apply)

* 68. Do you believe any of your children are considered to be overweight or obese?

* 69. What is the best way to get information to you about community health issues? (Check all that apply)

* 70. Comments:

Thank you for your contribution to our Community Health Needs Assessment. The report will be available to the public in 2016.

* 71. What zip code do you live in?

T