Chautauqua County Community Health Survey

Chautauqua County Community Health Survey

We need your help!
You know a lot about where you live. You make a difference in the health and well-being of your Chautauqua County community! Please help us understand what matters most to you by taking a few minutes to fill out this confidential survey. Personal, identifiable information is not required, and responses cannot be tied back to you.

The survey should take about 5-10 minutes to complete. At the end of the survey, you will have the option to be entered into a raffle for one of five $50 Tops gift cards! You must complete the survey to be eligible to win.

The Chautauqua County Health Department, local hospitals, and community partners will use this information to find out what health issues are important to you and how to make our community a healthier place to live.
Survey Eligibility

*IF YOU DO NOT LIVE, WORK OR GO TO SCHOOL IN CHAUTAUQUA COUNTY, YOU ARE NOT ELIBILE TO COMPLETE THIS SURVEY.
1. Do you live, work or go to school in Chautauqua County? Please select one.*

I live in Chautauqua County. (proceed to Question #2)I work in Chautauqua County and live somewhere else. (skip to Question #3)I go to school in Chautauqua County and live somewhere else. (skip to Question #3)
2. What is the Zip Code of your home address in Chautauqua County
Community Issues and Concerns
3. When you think about your own health and the health of your community, which of the following issues ARE YOU MOST CONCERNED ABOUT? Please select up to three (3) choices.*

Medical health (heart disease, diabetes, obesity, cancer, asthma, chronic pain management, sexual health, memory loss, etc.)Dental healthMental health (stress, anxiety, depression, suicide, etc.)Environmental conditions (access to food/water, walkable neighborhoods, safe roadways, etc.)Housing options that are affordable and safeMaternal/infant health (prenatal care, teen pregnancy, pregnancy planning, child abuse/neglect)Physical safety (risk of falling, firearm misuse, domestic violence, etc.)Substance use (drugs, alcohol, tobacco)Other (please tell us)
4. Which of the following community factors do you feel SHOULD BE FOCUSED ON TO IMPROVE HEALTH in the next five years for Chautauqua County’s Community Health Improvement Plan? Please select up to three (3) choices.*

Access to affordable, healthy foodAccess to reliable transportation to medical appointments, grocery stores, etc.Community spaces like parks, walkways, bike paths, and community centersAccess to community groups that encourage healthy habits (physical activity, nutrition, stress reduction, diabetes prevention, fall prevention, quitting smoking, etc.)Access to quality health and wellness programs in schoolsAvailability and access to services to support healthy childrenSafety in your neighborhoodAccess to community services and resources (WIC, Social Services, Aging Services, Salvation Army, United Way, etc.)Access to health screenings available in your community (blood sugar, cholesterol, blood pressure, etc.)Other (please tell us)
5. Which of the following disease and illness conditions do you feel we should focus on to IMPROVE HEALTH in the next five years for Chautauqua County’s Community Health Improvement Plan? Please select up to five (5) choices.*

Asthma, COPD, or other chronic respiratory conditionsCancerCigarettes, tobacco products, vaping, or nicotine useDental health (cavities or tooth removal)DiabetesHeart issues (high blood pressure, cholesterol, heart disease, stroke, etc.)Infectious diseases (HIV, AIDS, hepatitis, sexually transmitted diseases, etc.)Injuries (falls, motor vehicle accidents)Lead poisoning or lead issuesMental health, depression, anxiety, and stress managementObesity, weight management, or nutritionReproductive and birth issuesSubstance use disorders (alcohol, cannabis, opioid, etc.)Violence related injury (child abuse, elder abuse, domestic violence, firearm injuries and death)Other (please tell us)
Personal, Family & Community Health
It is recommended that individuals be seen by their primary care provider once a year, and by their dentist every 6 months. (Se recomienda visitar al proveedor de cuidado primario una vez al año y al dentista cada 6 meses.)

6. What were the main reasons you did not get the MEDICAL, DENTAL, OR MENTAL HEALTH care you needed? Please select all that apply.*

	Medical	Dental	Mental Health
Cost - Without insurance, it was too expensive
Cost - Even with insurance, it was too expensive
Transportation - It was too hard to get there
Hours- They weren't open when I/we could get there
Appointment not available in a timely manner
Didn't know where to get the care I/we needed
Decided not to go, because I/we don't like going
Fear/shame/embarrassment about personal health
I/we did not have an issue receiving care
Other reason (please list below)

Other reason (please tell us)
7. Since the legalization of marijuana and cannabidiol (CBD) products, has your use of these products changed? Please select all that apply.*

I do not use marijuana/CBD productsI use marijuana/CBD products for recreational purposesI use marijuana/CBD products for medical reasons
Substance use disorders (addictions) don't just affect individuals; They impact families, friends and communities. (Los trastornos por consumo de sustancias (adicciones) no solo afectan a las personas; también afectan a las familias, los amigos y las comunidades.)
8. I have a relationship to addiction in the following way(s): Please select all that apply.*

I have a family member who uses alcohol and/or drugs.I have a family member who is in recovery from alcohol and/or drug use.I have a friend who uses alcohol and/or drugs.I have a friend who is in recovery from alcohol and/or drug use.A family member or friend has died from alcohol and/or drug use.I personally have an active alcohol and/or drug addiction.I am personally in recovery from alcohol and/or drug use.I have no close experience with alcohol and/or drug use.
9. If I had a family member or a friend suffering with an addiction, I would know how to find help.*

Strongly agreeAgreeDisagreeStrongly disagree
10. Narcan® (Naloxone) is a lifesaving medication used for the treatment of a known or suspected opioid overdose emergency. Please select all that apply.

I know where I can get Narcan® in Chautauqua County.I carry Narcan® with me or keep it in my home.I have used Narcan® to save a life.
Good nutrition and physical activity are important to overall health and well-being. (Una buena alimentación y la actividad física son importantes para la salud y el bienestar general.)
11. How often do you participate in physical activity or exercise?*

5-7 times per week for at least 30 minutes each time2-4 times per week for at least 30 minutes each time0-1 times per week for at least 30 minutes each timeI don't exercise regularly, but I try to add physical activity when possibleNo physical activity or exercise beyond regular daily activities
12. Which, if any, of the following would help you become more active? Please select all that apply.*

Transportation to a park or outdoor activities and spacesGroups or a friend to participate withWorkshops for classes about exerciseSafe places to walk or exerciseIndividual instruction/personal trainingInformation about exercise programs or gym membershipsDiscounts for exercise programs or gym membershipsWorkplace programs or equipmentActivities you can do with your childrenNone of the aboveOther (please tell us)
13. Over the past year, there were times when I or someone in my household was hungry, but didn't eat because there wasn't enough money for food.*

Often trueSometimes trueNever true
Health Insurance
14. Please describe your health insurance coverage. Please select all that apply.*

Employer/spouse's employerMedicareMedicaidVANYS of Health/Marketplace ExchangeTribal HealthI do not have health insuranceI'm not sure
Demographics
15. Do you or someone in your household have a disability? Please select one. The American with Disabilities Act defines a person with a disability as a person who has a physical or mental impairment that substantially limits one or more major life activities.*

Yes (proceed to Question #16)No (skip to Question #17)Prefer not to answer (skip to Question #17)
16. What type of disability do you or your family member have? Please select all that apply.

Developmental or intellectualMental or emotionalPhysical or mobilitySensory such as blindness or deafnessPrefer not to answerOther (please tell us)
Each of the following questions are important to help us understand health concerns associated with age, gender, race, etc. This information does not identify you. (Cada una de las siguientes preguntas es importante para ayudarnos a comprender los problemas de salud asociados con la edad, el género, la raza, etc. Esta información no le identifica.)
17. What is your age?*

20 or under21-2930-3940-4950-5960-6465 or overPrefer not to answer
18. What is your gender identity?*

MaleFemaleNon conformingNon binaryTransgenderPrefer not to answerOther (please tell us)
19. Which race/nationality do you identify with? Please select all that apply.*

White/CaucasianBlack/African AmericanHispanic/Latino/LatinXAsian or Asian AmericanAmerican Indian or Alaskan NativeNative Hawaiian or other Pacific IslanderPrefer not to answerOther (please tell us)
20. What is your approximate average household income?*

$0 - $24,999$25,000 - $49,999$50,000 - $74,999$75,000 - $99,999$100,000 - $124,999$125,000 - $149,999$150,000 +Prefer not to answer
21. Do you have access to transportation when you need it?*

YesSometimesNoPrefer not to answer
22. How many people live in your home, including yourself?*

12345 or morePrefer not to answer
23. If we wanted to reach you with a community health message or public service announcement, what would be the best way? Please select up to three (3) choices.*

Social media (Facebook, Instagram, X)TVRadio/streaming music serviceLocal Health Department websiteNewspaperBrochures and handouts
24. Where did you hear about this survey?*

Social mediaEmailNews media (radio/paper/tv)SchoolMedical providerCommunity group or organizationOther (please tell us)
Thank you for taking time to complete the Chautauqua County Community Health Survey. (Gracias por tomarse el tiempo para completar la Encuesta de Salud Comunitaria del Condado de Chautauqua.)

After form is submitted you will be redirected to another page to be entered into the gift card drawing. (Después de enviar el formulario, será redirigido a otra página para participar en el sorteo de la tarjeta de regalo.)
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Chautauqua County Community Health Survey

Survey Eligibility

Community Issues and Concerns

Personal, Family & Community Health

Health Insurance

Demographics