DuPage County Health Department
Community Health Survey
 

Please take a minute to complete the anonymous survey below. The purpose of this survey is to get your opinions about community health problems in DuPage County. The IPLAN 2010 Steering Committee will use the results of this survey and other information to identify the most pressing health problems which can be addressed through public health interventions and community action. Click here for more information about IPLAN www.dupagehealth.org/health_data/iplan_basics.html.

Thank you and if you have any questions, please contact Rick Barbieri, DuPage County Health Department, 630-682-7400.

 

1. In the following list, what do you think are the three most important factors for a "Healthy Community?"   (Those factors which most improve the quality of life in a community.)
 
Check only three: 
Good place to raise children
Low crime / safe neighborhoods
Low level of child abuse
Good schools
Access to health care (e. g., family doctor)
Parks and recreation 
Clean environment
Affordable housing
Arts and cultural events
Excellent race relations

Good jobs and healthy economy

Strong family life
Healthy behaviors and lifestyles
Low adult death and disease rates
Low infant deaths
Religious or spiritual values
Other
 

2. In the following list, what do you think are the three most important "health problems" in our community?   (Those problems which have the greatest impact on overall community health.)
 
Check only three: 
Aging problems (e. g., arthritis, hearing/ vision loss, etc.)
Cancers
Child abuse / neglect 
Dental problems
Diabetes
Domestic Violence  
Firearm-related injuries
Heart disease and stroke
High blood pressure
HIV / AIDS

Homicide
Infant Death
Infectious Diseases (e. g., hepatitis, TB, etc.)
Mental health problems
Motor vehicle crash injuries
Rape / sexual assault
Respiratory / lung disease
Sexually Transmitted Diseases (STDs)
Suicide
Teenage pregnancy
Other
 

3. In the following list, what do you think are the three most important "risky behaviors" in our community?   (Those behaviors which have the greatest impact on overall community health.)
 
Check only three: 
Alcohol abuse
Being overweight
Dropping out of school 
Drug abuse
Lack of exercise
Poor eating habits
Not getting "shots" to prevent disease
Racism
Tobacco use
Not using birth control

Not using seat belts / child safety seats

Unsafe sex 
Other
 
4. How would rate our community as a "Healthy Community?"

Very unhealthy

Unhealthy

Somewhat healthy

Healthy

Very healthy
 
5. How would rate your own personal health?

Very unhealthy

Unhealthy

Somewhat healthy

Healthy

Very healthy
 
6. Approximately how many hours per month do you volunteer your time to community service?
(e. g., schools, voluntary organizations, churches, hospitals, etc.)

None

1 -5 hours

6 -10 hours

Over 10 hours  
 

Please answer questions #7-15 so we can see how different types of people feel about local health issues (optional). Please know that personal identifiers such as name and e-mail address of survey respondents will not be collected.
 
7. Zip code where you live:  
 
8. Age:

25 or less

26 -39

40 -54

55 -64

65 or over  
 
9. Sex: 

Male

Female              
 
10. Ethnic/ Race group you most identify with:

African American / Black

Asian / Pacific Islander

Hispanic / Latino

Native American

White / Caucasian

Other
 
11. Marital Status: 

Married / co-habitating

Not married / Single      
 
12. Education
Less than high school
High school diploma or GED
College degree or higher
Other
 
13. Household income 
Less than $20,000
$20,000 to $29,999
$30,000 to $49,999
Over $50,000
 
14. How do you pay for your health care? (check all that apply)
Pay cash (no insurance)
Health insurance (e. g., private insurance, Blue Shield, HMO) 
Medicaid
Medicare
Veterans' Administration
Indian Health Services
Other
 
15. Where / how you got this survey: (check one)
Church
Community Meeting
Grocery Store / Shopping Mall
Mail (e-mail)
Newspaper
Newsletter
Personal Contact
Workplace
Other
 

Thank you very much for your response!