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South Plainfield Community Health Survey
1
1. How would you describe your overall health?
Excellent
Very Good
Good
Fair
Poor
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2
2. Where do you go for routine healthcare?
Physician's Office
Health Department
Emergency Room
Urgent Care Clinic
Clinic in grocery or drug store
I do not receive routine healthcare
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3
3. Are you able to visit a doctor when needed?
Yes
No
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4
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
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5
5. What type of healthcare coverage do you have?
Medicare
Medicaid
Commercial Health Insurance (Aetna, Cigna, Blue Cross)
Uninsured
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6
From the following selections, pick your TOP health challenge. (You will have the chance to pick your top three issues)
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
I don't have any health challenges
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
I don't have any health challenges
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7
From the following selections, pick your SECOND, most difficult health challenge.
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
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8
From the following selections, pick your THIRD most difficult health challenge.
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
Asthma
Cancer
Diabetes
Overweight or Obesity
Lung Disease or COPD
High Blood Pressure
HIV or AIDS
Stroke
Heart Disease
Joint or Back Pain
Mental Health Issues
Alcohol Overuse
Drug Addiction
Tuberculosis
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9
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)
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10
7. Please choose ALL statements that apply to you.
Yes
No
I exercise at least three (3) times per week
I eat at least five (5) servings of fruit and vegetables each day
I eat fast food more than once a week
I smoke cigarettes
I chew tobacco
I use illegal drugs
I abuse or overuse prescription drugs
I consume more than 4 alcoholic drinks (if female) or 5 (if male) per day
I use sunscreen or protective clothing for planned time in the sun
I receive a flu shot each year
I have access to a wellness program through my employer
I exercise at least three (3) times per week
I eat at least five (5) servings of fruit and vegetables each day
I eat fast food more than once a week
I smoke cigarettes
I chew tobacco
I use illegal drugs
I abuse or overuse prescription drugs
I consume more than 4 alcoholic drinks (if female) or 5 (if male) per day
I use sunscreen or protective clothing for planned time in the sun
I receive a flu shot each year
I have access to a wellness program through my employer
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
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11
8. Which of the following preventive procedures have you had in the past twelve (12) months
Yes
No
Mammogram (if woman)
Pap Smear (if woman)
Prostate Cancer Screening (if man)
Flu Shot
Colon / Rectal Exam
Blood Pressure Check
Skin Cancer Screening
Cholesterol Screening
Vision Screening
Hearing Screening
Bone Density Test
Dental Cleaning / X-Rays
Physical Exam
None
Mammogram (if woman)
Pap Smear (if woman)
Prostate Cancer Screening (if man)
Flu Shot
Colon / Rectal Exam
Blood Pressure Check
Skin Cancer Screening
Cholesterol Screening
Vision Screening
Hearing Screening
Bone Density Test
Dental Cleaning / X-Rays
Physical Exam
None
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
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12
9. Please help us prioritize by importance all of these potential community health issues
Most Important
Important
Not Important
Access to Quality Health Services
Cancer
Diabetes
Health Prevention Program (smoking cessation)
Heart Disease (COPD / Asthma)
Communicable Disease (HIV / AIDS)
Family - Family Planning
Healthy Environment
Maternal / Child Health (low birth weight)
Mental Health
Nutrition (access, availability, weight control)
Older Adults (aging alone, Alzheimer's)
Oral Health (availability)
Substance Abuse and Misuses (alcohol, drug, poisoning)
Wellness and Lifestyle Activity
Other
Access to Quality Health Services
Cancer
Diabetes
Health Prevention Program (smoking cessation)
Heart Disease (COPD / Asthma)
Communicable Disease (HIV / AIDS)
Family - Family Planning
Healthy Environment
Maternal / Child Health (low birth weight)
Mental Health
Nutrition (access, availability, weight control)
Older Adults (aging alone, Alzheimer's)
Oral Health (availability)
Substance Abuse and Misuses (alcohol, drug, poisoning)
Wellness and Lifestyle Activity
Other
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
Most Important
Important
Not Important
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13
If other above, please list
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14
10. What do YOU see as the greatest community health concern in South Plainfield?
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15
11. What do YOU see as the greatest community benefit in South Plainfield?
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16
12. Please indicate which programs you feel South Plainfield should implement
Needed
Undecided
Not Needed
Nutrition Seminars
Weight Control Programs
Physical Fitness Programs
Mammography Screening
Diabetes Screening
Cholesterol Screening
Seminars on Depression
Nutrition Seminars
Weight Control Programs
Physical Fitness Programs
Mammography Screening
Diabetes Screening
Cholesterol Screening
Seminars on Depression
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
Needed
Undecided
Not Needed
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17
13. What is your gender?
Female
Male
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18
14. What is your preferred language?
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15. What is your race?
African American / Black
Caucasian / White
Caucasian / Latino
Asian
South Asian
American Indian / Alaska Native
Native Hawaiian / Pacific Islander
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20
16. What is your current employment status?
Employed Full-Time
Employed Part-Time
Student
Homemaker
Unemployed
Disabled
Retired
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21
17. What is your ANNUAL household income?
$0 - $24,999
$25,000 - $49,000
$50,000 - $74,000
$75,000 - $99,000
$100,000 or more
Prefer not to answer
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22
18. What is the highest level of education you have completed?
Some High School
High School Graduate
Some College
College Graduate
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23
19. What could South Plainfield do better to help our community be healthier?
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24
20. Do you or your family engage in activities related to health and wellness at (check all that apply)
Home
School
Work
Play
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25
21. Please answer the following questions
Yes
No
Do you consider South Plainfield a healthy place to live?
My community is a good place to raise a family?
I can count on my neighbor in a time of need?
It's easy to find employment in and around South Plainfield?
Do you consider South Plainfield a healthy place to live?
My community is a good place to raise a family?
I can count on my neighbor in a time of need?
It's easy to find employment in and around South Plainfield?
Yes
No
Yes
No
Yes
No
Yes
No
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26
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 community health information (e.g., town website, library)
Access to medical facilities and medical professionals
Access to healthy foods
Access to restaurants that incorporate healthy foods into their menu
Access to indoor recreational spaceAccess to community health programs (e.g., professional speakers, activity-based programs such as yoga, healthy cooking workshops, etc.)
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27
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
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28
23. 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 the Library
Seasonal Depression Community Education Program
"Caught On A Walk" seasonal, weekly feature in The Observer and TAP Into Sough Plainfield
Mayor's Wellness Committee Logo Contests
Women's Self Defense Course at Martial Arts & Fitness Center
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