Chatham Community Health Survey 2014

The Chatham Board of Health is conducting this anonymous survey to help develop a Health Improvement Plan for the Town of Chatham. The answers you provide will help us identify and prioritize health issues and address gaps in services. This survey is for residents 18 yrs. or older. Thank you for taking the time to fill out this survey.

1.	In general which of the following best describes how you feel about your health? Excellent Very Good Good/Fair Poor

2.	What is your zip code? 02633 02650 02659 02669 Other (please specify)

3.	What is your age? 18-24 25-44 45-64 65-84 85+

4.	Please let us know your gender female male

5.	Are you registered to vote in Chatham? yes no

6.	Are you a seasonal or year round resident? Seasonal Year-round

7.	Do you smoke or chew tobacco? yes no

8. Have you ever been diagnosed by a Doctor or a Health Professional with:
(please check all that apply)

Arthritis
Heart problems
Diabetes
Asthma
Depression
Emphysema or bronchitis
High cholesterol
Uncorrectable vision problems or blindness
Hearing loss
Cancer
Stroke
Chronic disease of nervous system (such as MS or muscles)
Lyme's disease or other tick-borne illness
Problems of the stomach or intestines
Weight problem
None of these diagnoses

9.	In the past 12 months have you had a: (please check any that apply) General health exam Blood pressure check Cholesterol check Flu shot Dental exam (cleaning) Blood stool test Pap test Breast exam X-ray mammogram Test for Lyme or other tick borne illness None of tests listed

10.	In the past 12 months, have you had a (please check any that apply) Hearing Test Eye exam Diabetes check If female, routine self-breast exam Skin cancer screen Pneumonia shot Rectal exam Colonoscopy Prostate cancer screen/PSA None of tests listed

11.	If you have been pregnant within the last 5 years, when in your pregnancy did you first see a Doctor or health professional? First month Between 1-3 months Between 3-5 months Between 5-7 months later than 7 months N A

12. In the last 12 months what problems have you had getting the medical care you needed?
(Please check all that may apply)

I have not had problems getting the healthcare I needed
Health care provider not available
Health care provider not accepting new patients
Lack of insurance
Health care provider would not accept your insurance
Wait list for an appointment too long
Cannot afford co-pay
Cannot afford treatment
Lack of transportation
Language barriers
Travel distance to provider too great

13. If you do not have Health insurance is it because:
(please check any that apply)

I have health insurance
Dropped by insurance company
Cannot pay for it
Citizenship status
Lost employment
Denied due to pre-existing condition
No longer qualify for Medicaid
Process is too complicated and I'm not sure where to get help

14. In the past 12 months have you had problems getting needed Dental care? If yes, please provide the reason(s) for the difficulty:
(please check any that apply)

Lack of available dentist nearby
Transportation
Lack of available insurance
Could not afford Co-Pay
Could not afford treatment
Did not have problems getting Dental Care
Don't remember last time I went to the dentist
Other (please specify)

15.	How many servings of fruits and/or vegetables do you eat per day? (Note: A serving size for fruits and vegetables is about one-half cup, and a single piece of fruit, such as an apple or an orange counts as one serving) 1 2 3 4 5 6 7

16. In the past 12 months, have you or anyone in your household needed any of the following services?
(please check any that apply)

I Needed

Household member needed

Service received

Emergency/temporary Shelter/housing

Legal assistance

Help with utilities, food, rent

Help with transportation

Help with Childcare/after-school care

I Needed

Household member needed

Service received

Relief for caregivers of older or handicapped adults

Services for elder care/caregiving

Individual or family counseling

Mediation services

Insurance counseling

I Needed

Household member needed

Service received

Learning to read/write English (adults)

Early Childhood Intervention

Help with domestic violence

Services for physical or developmental handicaps

Help finding a job

I Needed

Household member needed

Service received

Help with job training

Debt counseling

17.	In the past 30 days have you experienced intense stress, depression and/or difficulty managing your emotions for at least 2 weeks or more? Yes No

18. During the past 12 months, have you seen a mental health professional for an emotional or mental health concern(including stress or depression)? If so, did you find it helpful?

Yes, it was helpful
Yes, however, I did not find this helpful
No, I have not consulted with a mental health professional

19. In the past 12 months, have you participated in local discussion or support groups related to physical or mental health issues (including substance abuse)?

Support/discussion group for caregivers
Support/discussion group for family members
Support/discussion group for mental health or substance abuse
No I have not participated any groups or discussions.
Other (please specify)

20. In the past 12 months Have you experienced any of the following with someone in your life, someone you are living with or who lives with you? (please check any that apply)

Controlling what you do, who you see or talk to
Controlling your money against your will
Calling you names, putting you down or making you feel badly about yourself?
Making you fearful through actions, tone of voice, threats or destruction of property
Hitting, slapping, kicking or using a weapon against you
Harming children
Harming pets or animals
No I have not experienced any of these issues

21.	If you experience problems that are hard for you to handle alone to whom do you turn for help? (please check any that apply) Church Spouse/partner Family member Family counselor Friends Internet support Neighbor Self-help group Doctor No one Therapist/counselor Other (please specify)

22. During a major snow storm, hurricane or other long term power outage who checks on your well being if you are stranded?
(please check all that apply)

visiting nurse
family member
neighbor
friend
church members
senior center staff
Police or Fire Department (Emergency Management Special Assistance Program)
No one
Other (please specify)

23. In the event of an emergency, if the telephone in your house is not working due to a power outage or phone line problem, how would you get help if necessary?
(please check any that apply)

cell phone
walk to a neighbor’s house
drive
my phone works without electricity
stay home and wait
Other (please specify)

24. If you needed emergency shelter during a major storm, or long term power outage without heat of cooling, where would you seek shelter or who would you contact?
(please check any that apply)

police or fire department
senior center
family member
friend
neighbor
no one
town emergency shelter
regional emergency shelter
would not leave home
Other (please specify)

25.	Do you live alone or are you homebound? if so, who regularly checks on your well being? (please check any that apply) Police Department (Reassurance program) visiting nurse family member neighbor church members senior center staff other No one I do not live alone

26.	Do you exercise? Yes No

27. What do you most often do for exercise? (please check any that apply)

at least 1 x week

at least 2 x week

3 or more x week

Lift weights

Walk

Run

Hike

Cycling

at least 1 x week

at least 2 x week

3 or more x week

Kayaking

Swim

Cross fit

Dance

Aerobics

at least 1 x week

at least 2 x week

3 or more x week

Golf

Tennis

Pilates

Team sport

Spinning

at least 1 x week

at least 2 x week

3 or more x week

Yoga

stair climbing

Housework(vacuuming)

Other (please specify)

28.	In the past 30 days have you...( please check all that apply) Exercised to keep from gaining weight Exercised to lose weight Skipped meals Taken diet pills to lose weight or keep from gaining weight Vomited or used laxatives to keep from gaining weight I have not excercised

29. If you do not exercise, please provide the reasons or obstacles that prevent you from exercising with regular frequency
(please check any that apply)

cannot afford gym/health club
no available child-care at gym
lack of transportation
distance from gym too great
not motivated
pre-existing condition
no time
no family support for exercise plan

30.	If you have skipped meals, please indicate why: ( please check all that apply) to lose weight had no time to save money to allow other family members to eat (not enough to go around) I have not skipped meals Other (please specify)

31.	Where do you prefer to exercise? At home At gym/health club Bike path Chatham Community Center Municipal Recreation areas Beaches I do not excercise Other (please specify)

32. Thinking of your neighborhood, how easy is it for you to bicycle and walk?

33.	Thinking of your neighborhood, what prevents you from biking or walking? (Please check all that apply) nothing- I bike and/or walk when I wish no sidewalks bad sidewalks no shoulder for biking no lighting don't feel safe traffic is too fast or too much

34.	If it is not easy to walk or bicycle in your neighborhood, would you walk or bicycle if it was improved? yes no

35. Do you feel there are adequate recreational(indoor/outdoor) areas in Chatham for:

36.	Do you feel that the sidewalks in Chatham are adequate? Yes If no, why?

37.	Do you feel safe walking on the bike paths in Chatham? Yes Have never walked the bikepaths If no, why?

38.	During the past week, how many times did you have 3 or more alcoholic drinks on the same day? 1 time 2 times 3 times More than 4 times None

39.	In the past 12 months has alcohol use had a harmful effect on you or a household member ? Yes No

40. Have you ever wanted help, sought help, or received help for the following problems for yourself or a household member?
(please check all that apply)

wanted help

sought help

received help

N/A

Alcohol use

Prescription drugs

Non-prescription drugs

Illegal Drugs (Heroin, Cocaine, Marijuana)

Tobacco use

wanted help

sought help

received help

N/A

Inhalants

Bath Salts

41.	In the past 12 months has prescription, non-prescription or illegal drug use had a harmful effect on you or a household member? Yes No

42.	Do you or anyone in your household collect possessions or have pets to an extent where it may interfere with your lifestyle or prohibit normal use of intended living space in the home and/or causes embarrassment or shame? Yes No

43.	Are you the primary care-giver for (please check all that apply): A child or children under the age of 18 Grandchild Less abled adult Less abled child Senior Adult N/A

44. If you are a care-giver as described in above in question 43 do you have adequate time for your own personal:

45. If you are a care-giver, do you have access to the following:

Yes

N/A

Financial support

Family support

Transportation availability

Assisted living availability

Child day care availability

Yes

N/A

Supportive day availability

Respite care availability

Reliable information provider(Senior Center, Police)

46. As a care-giver for an adult or senior please check off what services you utilize:

Private -pay home health care
Visiting Nurses care (VNA)
Assisted Living
Adult day program
Meal on Wheels
Respite care
Other long term care
Senior Center
Housing assistance
Fuel assistance
Other (please specify)

47. As a care-giver for a child please check off what services you utilize: (Please check all that apply)

before school care (public or private)
After school care (public or private)
Tutoring (public or private)
Town sponsored recreation programs
Monomoy Community Services
Chatham Community Center activities
Pre K daycare
Private child care

48.	If you receive help from a care-giver are they: (please check any that apply) Family Volunteer (e.g.neighbor) Volunteer from a church or agency Paid (e.g. VNA or private nursing) Temporary Long term (24/7) Non-family Nauset Neighbors No help received but needed N/A

49. If anyone in your household needs help performing any of these tasks, please indicate whether: support is needed, whether you have care-giver support for these tasks or if you use a medical device, (such as a cane, walker or other "assistive technology") that helps you. (please check any that apply).

Need Support

Have assistive technology

Un-paid care-giver support

Paid support

Transportation

Getting in and out of bed

Getting around inside

Managing money

Toileting

Need Support

Have assistive technology

Un-paid care-giver support

Paid support

Eating

Taking medications

Light housework

Laundry

Telephoning

Need Support

Have assistive technology

Un-paid care-giver support

Paid support

Meal preparation

Grocery shopping

Bathing

Dressing

Other (please specify)

50.	What do you feel is the most pressing health related need for you and your family

51.	What is the most pressing health related issue for our community? What improvements/changes would you like to see?

52. Please tell us about yourself

Annual Income
Race
Education
Employment

53. What is the age of others in your household?

54.	I am completing this survey with the assistance of: Family member Relative Neighbor Visiting Nurse Senior Center Staff N/A

1.

In general which of the following best describes how you feel about your health?

2.

What is your zip code?

3.

What is your age?

4.

Please let us know your gender

5.

Are you registered to vote in Chatham?

6.

Are you a seasonal or year round resident?

7.

Do you smoke or chew tobacco?

8.

Have you ever been diagnosed by a Doctor or a Health Professional with:(please check all that apply)

9.

In the past 12 months have you had a:(please check any that apply)

10.

In the past 12 months, have you had a (please check any that apply)

11.

If you have been pregnant within the last 5 years, when in your pregnancy did you first see a Doctor or health professional?

12.

In the last 12 months what problems have you had getting the medical care you needed?(Please check all that may apply)

13.

If you do not have Health insurance is it because: (please check any that apply)

14.

In the past 12 months have you had problems getting needed Dental care? If yes, please provide the reason(s) for the difficulty:(please check any that apply)

15.

How many servings of fruits and/or vegetables do you eat per day? (Note: A serving size for fruits and vegetables is about one-half cup, and a single piece of fruit, such as an apple or an orange counts as one serving)

16.

In the past 12 months, have you or anyone in your household needed any of the following services?(please check any that apply)

17.

In the past 30 days have you experienced intense stress, depression and/or difficulty managing your emotions for at least 2 weeks or more?

18.

During the past 12 months, have you seen a mental health professional for an emotional or mental health concern(including stress or depression)? If so, did you find it helpful?

19.

In the past 12 months, have you participated in local discussion or support groups related to physical or mental health issues (including substance abuse)?

20.

In the past 12 months Have you experienced any of the following with someone in your life, someone you are living with or who lives with you? (please check any that apply)

21.

If you experience problems that are hard for you to handle alone to whom do you turn for help? (please check any that apply)

22.

During a major snow storm, hurricane or other long term power outage who checks on your well being if you are stranded?(please check all that apply)

23.

In the event of an emergency, if the telephone in your house is not working due to a power outage or phone line problem, how would you get help if necessary? (please check any that apply)

24.

If you needed emergency shelter during a major storm, or long term power outage without heat of cooling, where would you seek shelter or who would you contact?(please check any that apply)

25.

Do you live alone or are you homebound? if so, who regularly checks on your well being?(please check any that apply)

26.

Do you exercise?

27.

What do you most often do for exercise? (please check any that apply)

28.

In the past 30 days have you...( please check all that apply)

29.

If you do not exercise, please provide the reasons or obstacles that prevent you from exercising with regular frequency(please check any that apply)

30.

If you have skipped meals, please indicate why: ( please check all that apply)

31.

Where do you prefer to exercise?

32.

Thinking of your neighborhood, how easy is it for you to bicycle and walk?

33.

Thinking of your neighborhood, what prevents you from biking or walking? (Please check all that apply)

34.

If it is not easy to walk or bicycle in your neighborhood, would you walk or bicycle if it was improved?

35.

Do you feel there are adequate recreational(indoor/outdoor) areas in Chatham for:

36.

Do you feel that the sidewalks in Chatham are adequate?

37.

Do you feel safe walking on the bike paths in Chatham?

38.

During the past week, how many times did you have 3 or more alcoholic drinks on the same day?

39.

In the past 12 months has alcohol use had a harmful effect on you or a household member ?

40.

Have you ever wanted help, sought help, or received help for the following problems for yourself or a household member?(please check all that apply)

Have you ever been diagnosed by a Doctor or a Health Professional with:
(please check all that apply)

In the past 12 months have you had a:
(please check any that apply)

In the last 12 months what problems have you had getting the medical care you needed?
(Please check all that may apply)

If you do not have Health insurance is it because:
(please check any that apply)

In the past 12 months have you had problems getting needed Dental care? If yes, please provide the reason(s) for the difficulty:
(please check any that apply)

How many servings of fruits and/or vegetables do you eat per day?

(Note: A serving size for fruits and vegetables is about one-half cup, and a single piece of fruit, such as an apple or an orange counts as one serving)

In the past 12 months, have you or anyone in your household needed any of the following services?
(please check any that apply)

During a major snow storm, hurricane or other long term power outage who checks on your well being if you are stranded?
(please check all that apply)

In the event of an emergency, if the telephone in your house is not working due to a power outage or phone line problem, how would you get help if necessary?
(please check any that apply)

If you needed emergency shelter during a major storm, or long term power outage without heat of cooling, where would you seek shelter or who would you contact?
(please check any that apply)

Do you live alone or are you homebound? if so, who regularly checks on your well being?
(please check any that apply)

If you do not exercise, please provide the reasons or obstacles that prevent you from exercising with regular frequency
(please check any that apply)

If you have skipped meals, please indicate why:
( please check all that apply)

Have you ever wanted help, sought help, or received help for the following problems for yourself or a household member?
(please check all that apply)

If you receive help from a care-giver are they:
(please check any that apply)