SEWARD COUNTY COMMUNITY HEALTH SURVEY Please take a few minutes to complete the survey below. The purpose of this survey is to get your opinions about the health problems in our community and help us to figure out how to address these issues. Please only one survey per person. Remember your opinion is important to us! All information will remain confidential. We will first start with a little information about yourself. Question Title * 1. Which community do you reside in? Liberal, KS Kismet, KS Other (please specify) Question Title * 2. What is your gender? Female Male Question Title * 3. What is your age? Question Title * 4. How would you describe yourself? Please mark all that apply. Hispanic Alaskan Native/American Indian Native Hawaiian/Pacific Islander Asian White Black or African American Chinese/Japanese/Filipino Other (please specify) Question Title * 5. What language do you mainly speak at home? English Spanish Burmese Somali Other (please specify) Question Title * 6. During the last 12 months, what was the TOTAL income of ALL members of your household? Less than $15,000 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000 and over Question Title * 7. What is the highest level of education you have completed? Did not attend school Elementary School High School Diploma or GED Some College/Technical School Associates Degree Bachelors Degree Masters Degree or higher Other (please specify) Question Title * 8. How many children under the age of 18 live in your household? Question Title * 9. Do you have a healthcare provider? Yes No Question Title * 10. If yes, who is your healthcare provider? Emergency Room Local Physician Clinic Health Department Methodist Clinic Nurse Practitioner Question Title * 11. Where do you get your health information (resources and educational information) from? Please mark all that apply. Bulletin Boards Churches Friend/Family Healthcare Providers Health Department Internet Newspaper/Radio/TB WIC Other (please specify) Question Title * 12. Is anyone in your household currently having difficulty getting medical care? If so, please mark all that apply. Cost of Medical Care Cost of Prescription Meds No insurance coverage Inadequate insurance coverage Inability to pay Language Barriers Lack of information about medical resources Fear of being deported Transportation issues High Deductible No childcare Lack of available appointments Other (please specify) Question Title * 13. Does everyone in your household have medical insurance coverage? Yes, everyone has coverage No, at least one person does not have coverage Question Title * 14. Does everyone in your household have dental insurance? Yes, everyone has dental coverage No, at least one person does not have dental coverage Question Title * 15. Who in your household LACKS dental and/or health insurance? Please mark all that apply. Self Spouse/Partner Children Parent(s) Grandparent(s) Roommate(s) Other (please specify) Question Title * 16. Why do the above marked people in your household NOT have dental and/or health insurance? Please mark all that apply. Employer does not offer insurance benefits Unable to afford employee's contribution to insurance coverage; unable to afford individual insurance Can only afford catastrophic health insurance Rejected or dropped from plan due to pre existing conditions Other (please specify) Question Title * 17. In the past 5 years, has anyone in your household been affected by any of the following issues listed below. Mark all that apply. Inability to get prenatal care Teenage pregnancy Teenage sexual activity Unplanned pregnancy Inability to get birth control, or other reproductive health services None Other (please specify) Question Title * 18. In the past 5 years, has anyone in your household been affected by any of the chronic diseases listed below. Please mark all that apply. Asthma Diabetes Cancer Heart Disease/Stroke High Blood Pressure High Cholesterol HIV/AIDS Liver Disease Lung Disease Obesity None Other (please specify) Question Title * 19. In the past 5 years, has anyone in your household been affected by any mental health issues listed below. Please mark all that apply. Anxiety Child Abuse/Neglect Depression Eating Disorder Inability to keep job due to mental health issues Lack of affordable mental health services Lack of mental health services Suicide or Suicide Attempts Stress Other mental health issues None Other (please specify) Question Title * 20. In the past 5 years, has anyone in your household been affected by any safety issues listed below. Please mark all that apply. Domestic Violence Drunk Driving Falls Gangs Guns Lack of Helmet Use Motor Vehicle Accidents On the job injuries Sexual Assault Sport Injuries Water Safety None Other (please specify) Question Title * 21. In the past 5 years, has anyone in your household been affected by any of the infectious disease conditions listed below? Please mark all that apply. Food-borne illnesses Hepatitis HIV/AIDS Sexually Transmitted Diseases Tuberculosis Water-borne illnesses None Other (please specify) Question Title * 22. In the past 5 years, has anyone in your household been affected by vaccine or immunization issues listed below. Please mark all that apply. Religious Issues Provider not having vaccines Provider not following immunization schedule No knowing where to get reduced cost vaccines Other reasons not specified None Other (please specify) Question Title * 23. In the past 5 years, has anyone in your household been unable to get adequate physical activity due to the following listed below? Please mark all that apply. Lack of close neighborhood park or playground Lack of recreation programs or facilities Lack of time Obese/overweight Physical limitations Unaddressed medical conditions None Other (please specify) Question Title * 24. In the past 5 years, has anyone in your household been affected by any environmental conditions listed below? Please mark all that apply. Bug/Rodent infestation Difficulty affording utility bills Exposure to workplace hazardous materials Noise Outdoor air quality Sun Exposure Water quality Mold None Other (please specify) Question Title * 25. In the past 5 years, has anyone in your household been affected by the nutrition issues listed below? Please mark all that apply. Cost of healthy food Junk food and pop at school Lack of meal planning Lack of nutritional knowledge Not enough physical activity Obese/overweight Unhealthy eating habits None Other (please specify) Question Title * 26. Do you believe that tobacco use is a problem in Seward County? Please mark all that apply. Tobacco use is NOT a problem Lack of enforcement of age requirement No education/resources available for those trying to quit Pregnant women smoking Young people chewing tobacco Young people smoking tobacco Smoking in cars or at home Other (please specify) Question Title * 27. Do you believe that alcohol is a problem in Seward County? Please mark all that apply. Alcohol is NOT a problem Acceptability of use among adults Acceptability of use among youth Inadequate enforcement of laws No resources available for those trying to quit No resources available for those seeking treatment Lack of education in schools Lack of education in the public Other (please specify) Question Title * 28. Do you believe that the use of drugs is a problem in Seward County? Please mark all that apply. Drugs NOT a problem Acceptability of use among adults Acceptability of use among youth Inadequate enforcement of laws No resources available for those seeking treatment No resources available for those trying to quit Lack of education in schools Lack of education in the public Other (please specify) Question Title * 29. Overall, what do you think are the 3 most important health problems in Seward County? Please select 3 and number them 1 to 3 with 1 being the most important. Alcohol use Child abuse/neglect Child health issues Childhood Poverty Domestic Violence Drug Use Fire-arm related injuries Gang Violence High Drop out rates from school Homicide Lack of access for family planning Lack of access to dentists Lack of access to healthcare services Lack of access to physicians Lack of accurate information about community resources Lack of affordable health insurance Lack of affordable housing Lack of after school activities Lack of care for frail elders Lack of diabetic education Lack of mental health services Lack of physicians to see those without insurance Lack of specialty health care services Low paying jobs with no benefits Neighborhood crimes No access to public places for those with disabilities Poor Nutrition at home and/or school Rape/Sexual assault Suicide Teenage pregnancy Tobacco Use Unsafe roads/highways None TOGETHER WE ARE CHANGING LIVES ONE HAND AT A TIME. WE APPRECIATE YOU TAKING THE TIME TO COMPLETE THE SURVEY. THIS WILL ASSIST US IN FINDING A WAY TO HELP CORRECT THE IDENTIFIED HEALTH ISSUES/CONCERNS IN OUR COMMUNITY. IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO CONTACT THE SEWARD COUNTY HEALTH DEPARTMENT AT (620) 626-3369. THANK YOU FOR YOUR ASSISTANCE AND TIME. Next