Madison County Health & Safety Survey 2014 Question Title * 1. In the following list, what do you think are the most important things needed for a healthy Madison County? (Please check all that apply) Good place to raise children Acceptance of diversity Low crime/safe neighborhoods Good jobs and healthy economy Low level of child abuse Good schools Healthy behaviors and lifestyles Access to health care Parks and recreation Clean environment Religious or spiritual values Affordable housing Quality child care Arts and cultural events Other (please specify) Question Title * 2. In the following list, what do you think are the greatest health problems in Madison County? (Please check all that apply) Aging problems (e.g. arthritis, hearing/vision loss etc.) Cancers Breathing/ Asthma Sexually Transmitted Disease (STD) Diabetes Child Abuse/Neglect Firearm-Related injuries Heart Disease and stroke High Blood Pressure HIV/ AIDS Domestic violence/ intimate partner violence Obesity/ Physical Inactivity Dental Problems Infectious Disease (e.g., Hepatitis, TB, etc) Mental Health Problems Motor Vehicle Crash Rape Sexual Assault Homicide Infant Death Suicide Teenage pregnancy Alcohol/ Drug Abuse Shortage of food for me and my family Other (please specify) Question Title * 3. In the following list of ways a community can support the physical health of its residents, which are the most successful in Madison County? (Please check all that apply) Feeling safe in your neighborhood Religious or spiritual values Healthy behaviors and lifestyles Jobs that support a family Feeling safe at school Community involvement/ volunteering Family support for each other Feeling safe at work Schools Acceptance of diversity more jobs Feeling safe downtown Adequate supply of food for me and my family Other (please specify) Question Title * 4. How would you rate Madison County as a "Safe County"? Very unsafe Unsafe Undecided Safe Very safe Very unsafe Unsafe Undecided Safe Very safe Question Title * 5. How would you rate Madison County as a "Healthy County"? Very unhealthy Unhealthy Undecided Healthy Very healthy Very unhealthy Unhealthy Undecided Healthy Very healthy Question Title * 6. In the following list, what do you think are the most risky behaviors in Madison County? (Please check all that apply) Alcohol abuse Being overweight Dropping out of school Illegal drug abuse (Meth, Heroin, etc.) Prescription drug abuse Tobacco use Lack of exercise Poor eating habits Not using seat belts/ child safety seat Unprotected sex Not getting vaccinations School bullying Other (please specify) Question Title * 7. Listed below are some factors related to injury. Which safety problem(s) are most important for people in Madison County? (Please check all that apply) Driving under the influence of alcohol/drugs Unsafe roads (traffic, hills, curves) Not enough sidewalks Unsafe driving (speed, distractions) Traffic related injuries Other (please specify) Question Title * 8. Madison county should have or needs more of the following physical activity opportunities available, (Please check all that apply) Sidewalks Bicycle paths Walking or hiking trails Community swimming pools Places for dancing Places for yoga, ta-chi, group fitness, etc. Health/ fitness clubs Other (please specify) Question Title * 9. How many days during the past 30 days were you not able to work or do your daily activities because of physical illness or disability ? (Please write the number of days in the box below) Question Title * 10. How many days during the past 30 days were you not able to work or do your daily activities because of mental illness? (Please write the number of days in the box below) Question Title * 11. I have been told by a doctor, nurse, or other health professional that I have the following health problem, (Please check all that apply) Overweight/Obesity Arthritis Hearing/Vision loss Diabetes Risk factors for stroke Risk factors for heart attack Lung disease Asthma High blood pressure I haven't been told that I have a health problem Other (please specify) Question Title * 12. When I am sick, I usually go for treatment at: (Please select only one response) A doctor's office Urgent care center Health Department Community health center Hospital emergency room Free clinic I never go to the doctor Other (please specify) Question Title * 13. How would you rate your own personal safety? Very unsafe Unsafe Undecided Safe Very safe Very unsafe Unsafe Undecided Safe Very safe Question Title * 14. How would you rate your own personal health? Very unhealthy Unhealthy Undecided Healthy Very healthy Very unhealthy Unhealthy Undecided Healthy Very healthy Question Title * 15. Do you currently have children in your household under the age of 18? Yes No (If No, please SKIP to question #18) Question Title * 16. When my children are sick, I usually take them for treatment to: (Please select only one response) A doctor's office Urgent care center Health Department Community health center Hospital emergency room Free clinic I never take them to the doctor Other (please specify) Question Title * 17. My children get their immunizations at: (Please select only one response) A doctor's office Health Department I don't take them Community health center Pharmacy Other (please specify) Question Title * 18. Madison Country needs more of the following health services. (Please check all that apply) Group education/Support groups X-Ray & ultrasound Prenatal care Low cost health care Health department clinic services School health education School nurses Urgent treatment clinics Hospital beds Ambulance services/Paramedics Outpatient rehabilitation Home health care Medical equipment services Chiropractic Care Education on using medications correctly Weight loss programs or services Mental health services Child day care Adult day care Nursing home beds Support/relief for homebound caregivers In-patient Drug Rehabilitation services Other (please specify) Question Title * 19. Sex: Male Female Question Title * 20. Age: 18-25 26-39 40-54 55-64 65 or over Question Title * 21. Education: Less than high school High school diploma or GED College degree or higher Other (please specify) Question Title * 22. Race: Asian Black/African American Hispanic/Latino White Other Question Title * 23. What is/are your primary reason(s) for being in Madison County? (Please check all that apply) Live Go to school Work Other (please specify) Question Title * 24. How do you pay for your health care? (Please check all that apply) Pay cash (no insurance) Medicaid Health insurance Veterans' Administration Medicare Other (please specify) Next