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South Plainfield Community Health Survey

South Plainfield Community Health Survey

  
1. How would you describe your overall health? Excellent
Very Good
Good
Fair
Poor
2. Where do you go for routine healthcare?
If other above, please list
3. Are you able to visit a doctor when needed? Yes
No
4. If you have NOT been able to visit a doctor when needed, please indicate the reason No appointment available
Cannot afford it
Cannot take time off from work
Language barriers - Could not communicate
No transportation
No specialist in my community for my condition
Other
If other above, please list the reason
5. What type of healthcare coverage do you have? Medicare
Medicaid
Commercial Health Insurance (Aetna, Cigna, Blue Cross)
Uninsured
Other
If you listed other above, please list
6. Please select the TOP 3 health challenges that you face. Please select only three (3)
Asthma Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Cancer Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Diabetes Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Overweight or Obesity Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Lung Disease or COPD Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
High Blood Pressure Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
HIV or AIDS Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Stroke Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Heart Disease Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Joint Pain or Back Pain Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Mental Health Issue Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Alcohol Overuse Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Drug Addiction Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
Tuberculosis Top Health Challenge
Second Most Important Challenge
Third Most Important Challenge
Not Important
I don't have any health challenges
If you have another health challenge, and it's not listed above, please list it here (and note the order it should appear; 1st, 2nd, 3rd)
7. Please choose ALL statements that applies to you.
I exercise at least three (3) times per week Yes
No
I east at least five (5) servings of fruits and vegetables each day Yes
No
I east fast food more than once per week Yes
No
I smoke cigarettes Yes
No
I chew tabacco Yes
No
I use illegal drugs Yes
No
I abuse or overuse prescription drugs Yes
No
I consume more than four alcoholic drinks (if female) or five (if male) a day Yes
No
I use sunscreen or protective clothing for planned time in the sun Yes
No
I receive a flu shot each year Yes
No
I have access to a wellness program through my employer Yes
No
None of the above apply to me Yes
No
8. Which of the following preventive procedures have you had in the past 12 months?
Mammogram Yes
No
Not a woman
Pap Smear Yes
No
Not a woman
Prostate Cancer Screening Yes
No
Not a man
Prostate Cancer Screening Yes
No
Not a man
Flu Shot Yes
No
Colon - Rectal Exam Yes
No
Blood Pressure Check Yes
No
Skin Cancer Screening Yes
No
Cholesterol Screening Yes
No
Vision Screening Yes
No
Hearing Screening Yes
No
Bone Density Test Yes
No
Dental Cleaning & X-rays Yes
No
Physical Exam Yes
No
None of the Above Yes
No
9. Please help us prioritize by importance all of these potential community health issues.
Access to Quality Health Services Most Important
Important
Not Important
Cancer Most Important
Important
Not Important
Diabetes Most Important
Important
Not Important
Prevention Most Important
Important
Not Important
Heart Disease (COPD - Asthma) Most Important
Important
Not Important
Communicable Disease, e.g., HIV, AIDS Most Important
Important
Not Important
Family - Family Planning Most Important
Important
Not Important
Healthy Environment Most Important
Important
Not Important
Maternal - Child Health Care (e.g., low birth weight, etc.) Most Important
Important
Not Important
Nutrition - Access, Availability, Weight Control Most Important
Important
Not Important
Older Adults (Aging Alone, Alzheimers's, etc.) Most Important
Important
Not Important
Oral Health (Availability, etc.) Most Important
Important
Not Important
Substance Abuse and Misuses (Alcohol, Drug, Poisoning, etc.) Most Important
Important
Not Important
Wellness and Lifestyle Activity Most Important
Important
Not Important
Other Most Important
Important
Not Important
If you selected other above, please list it here
10. What do YOU see as the greatest community health concern in South Plainfield?
11. What do YOU see as the greatest community benefit in South Plainfield?
12. Please indicate which programs you feel South Plainfield should implement\ Nutrition Seminars Needed
Undecided
Not Needed
Weight Control Programs Needed
Undecided
Not Needed
Weight Control Programs Needed
Undecided
Not Needed
Physical Control Programs Needed
Undecided
Not Needed
Mammography Screening Needed
Undecided
Not Needed
Diabetes Screening Needed
Undecided
Not Needed
Cholesterol Screening Needed
Undecided
Not Needed
Seminars on depression Needed
Undecided
Not Needed
13. What is your gender Female
Male
14. What is your preferred language?
15. What is your race? African American - Black
Caucasian - White
Caucasian - Latino
Asian
South Asian
American Indian - Alaska Native
Native Hawaiian - Pacific Islander
Other
If you checked other above, please list
16. What is your current employment status? Employed Full-Time
Employed Part-Time
Student
Homemaker
Unemployed
Disabled
Retired
17. What is your annual household income? $0 - $24,000
$25,000 - $49,000
$50,000 - $74,000
$75,000 - $99,000
$100,000 or more
Prefer not to answer
18. What is the highest level of education you have completed? Some High School
High School Graduate
Some College
College Graduate
19. What could South Plainfield do better to help our community be healthier?
20. Do you or your family engage in activities related to health and wellness at (check all that apply) Home
School
Work
Play
21. Do you consider South Plainfield a healthy place to live? Yes
No
22. What would make South Plainfield a healthier place to live (check all that apply)? Access to outdoor recreational space (e.g., parks, walking paths, etc.)
Access to indoor recreational space
Access to community health information (e.g., town website, library, etc.)
Access to medical facilities and medical professionals
More convenient hours to access medical facilities and medical professionals
Access to healthy food
Access to restaurants that incorporate healthy foods into their menu
Access to community health programs (e.g., professional speakers, activity based programs such as yoga, healthy cooking workshops, etc.)
23. How safe do you feel when conducting activities in town (outside of your home) e.g., exercising outdoors, walking, shopping, using public parks, etc? Very Unsafe
Somewhat Unsafe
Safe
Very Safe
24. The South Plainfield Mayor’s Wellness Committee has organized and promoted a variety of health activities and programs for the community during the past several years. Have you heard of or participated in any of the following programs? (select all that apply) Fall Community Health Fair
Spring Community Health Fair
Walk - Bike to School Day
Step it Up South Plainfield (walking challenge)
Substance Abuse Awareness Workshop at Library
Seasonal Depression Community Education Program
Caught On a Walk seasonal, weekly feature in The Observer and TAP into South Plainfield
Mayor's Wellness Committee Logo Contests
Women's Self Defense Course at Martial Arts & Fitness Center

  

Borough of South Plainfield
2480 Plainfield Avenue    South Plainfield NJ 07080
908-754-9000



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