2015
Community Survey
Speak to Your Health
Survey Committee Co-Chairs
Community Based Organization Partners
Genesee County Health Department
Elder Sarah Bailey, Ph.D.
Bridges Into The Future
G3100 Miller Rd.
Suite 6B
Flint, MI 48507
Phone: (810) 287-6888
E-mail: [email protected]
Suzanne Cupal, M.P.H.
Genesee County Health Department
630 S. Saginaw Street
Suite 4
Flint, MI 48502
Phone: (810) 768-7970
E-mail : [email protected]
The next set of questions are about smoking.
25a. Have you ever smoked cigarettes?
Yes
No [Please skip to Question 29]
25b. Have you smoked at least 100 cigarettes in your entire life? (5 packs = 100 cigarettes)
Yes
No [Please skip to Question 29]
26. Currently, do you smoke cigarettes...
Every day
Some days
Not at all [Please skip to Question 29]
27. During the past 12 months, have you stopped smoking for
one day or longer because you were trying to quit smoking?
Yes
No
28. In the past 12 months, has a doctor, nurse, or other health
professional advised you to quit smoking?
Yes
No
29. Does anyone else in your household smoke?
Yes
No
30. Have you ever used an electronic vapor product?
(e-cigarette, hookah sticks, other electronic smoking device)
Yes
No [Please skip to Question 33]
31. During the past 30 days, on how many days did you use an electronic vapor product?
_____ days
32. Why do you use an electronic vapor product? (Please check all that apply)
Trying to quit nicotine
Convenience
Replacement for cigarettes
Can use in more places than cigarettes
Other: ____________________
33. Do you believe that electronic vapor products are harmful to your health?
Yes
No
34. Do you favor or oppose raising the legal minimum age to purchase all tobacco products from 18 to 21?
Strongly favor
Somewhat favor
Somewhat oppose
Strongly oppose
The next set of questions will be about your current neighborhood.
35a. What are the cross streets in the nearest intersection to where you live? ________________________________________
35b. What is your ZIP Code? _________________
35c. How long have you lived in your current neighborhood?
____________________
36.
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
38. How often do you and other people in
Never
Rarely
Sometimes
Often
39. Please tell us how much you agree or disagree with the following statements about your neighborhood:
Strongly
agree
Agree
People in this neighborhood are willing to help
their neighbors.
People in this neighborhood can be trusted.
I live in a neighborhood where people know
each other.
There are adults in my neighborhood that
children can look up to.
3
Neither agree
nor disagree
Disagree
Strongly
disagree
40. How fearful are you about crime in your neighborhood?
Very fearful
Somewhat fearful
Not very fearful
Not at all fearful
41. How safe is it to walk around alone in your neighborhood...
Extremely dangerous
Somewhat dangerous
Fairly safe
Completely safe
... during the daytime?
... after dark?
42.
Very high
High
About the same
Low
Very low
43. Have you or any member of your household been involved in the following activities in the last 12 months to improve the
conditions of your neighborhood?
Yes
No
Neighborhood clean-up, beautification project or community garden project.
Neighborhood crime watch.
Meeting of a block or neighborhood group.
Took action with neighbors to do something about a neighborhood problem.
Volunteer in a program at a local school, church, or other neighborhood institution.
44. Please tell us the extent to which you agree or disagree with the following statements about your neighborhood. For these
questions, please think about your street and the surrounding streets.
Strongly
agree
Agree
Neither agree
nor disagree
Disagree
Strongly
disagree
Strongly
agree
Agree
Neither agree
nor disagree
Disagree
Strongly
disagree
There is a lot of graffiti.
My neighborhood is noisy.
Vandalism is common.
There are a lot of abandoned buildings.
My neighborhood is clean.
People take good care of their houses.
People take good care of their yards.
There is a lot of criminal activity.
45. The police in my neighborhood...
Explain their decisions to people they deal with.
Treat people fairly.
Dominate other people.
Treat people with respect.
Enjoy their power.
Take time to listen to people.
Can be trusted.
Keep the neighborhood safe.
Treat people in the community like enemies.
4
46. How likely would you be to contact the police...
Very
Unlikely
Unlikely
Somewhat
Unlikely
Undecided
Somewhat
Likely
Likely
Very
Likely
Somewhat
Likely
Likely
Very
Likely
...if you were a victim of a crime.
...to report a crime in your neighborhood.
...to report suspicious activity in your neighborhood.
...if you had information about a suspected criminal.
...to find out about crime in your neighborhood.
47. If you saw a police officer walking towards you on the sidewalk, how likely would you be to...
Very
Unlikely
Unlikely
Somewhat
Unlikely
Undecided
...say hello.
...say hello back if the officer says hello to you.
...start an informal conversation.
...avoid contact.
48. Is there a park in your neighborhood?
49. Do you feel safe using your neighborhood park for physical activity?
50. How often are you physically active in your neighborhood park?
Never
Less than Once a
Once a Month
2-3 Times a
Month
Month
Yes
Yes
No [Please skip to Question 51]
No
Once a Week
2-3 Times a
Week
Daily
The next section will ask for some general information about you.
51. What is your month and year of birth? Month: ___________________ Year: ________________
52. What is your sex?
Female
Male
53. How would you describe your racial/ethnic background? Please check all that apply.
White
American Indian or Alaska Native
Black or African American
Arab American (please specify):
Hispanic or Latino/a
Multiracial (please specify):
Asian
Other (please specify):
Native Hawaiian or other Pacific Islander
Don't know
54.
Elementary (3rd grade) or less
Middle (6th grade)
Junior High (8th or 9th grade)
High School graduate (12th)
GED
Technical school
Some college, no degree
Associate's Degree
55. What is your current relationship status?
Single never married
Separated
Married
Widowed
Other committed relationship
Divorced
56. About how tall are you without shoes?
Feet: __________ Inches: __________
57. About how much do you weigh without shoes? (in pounds) __________
5
Master
Professional (MD, DO, JD, PharmD, etc.)
PhD
Other ____________________