2009 Community Health Needs Assessment Survey

YMCA
BJC St. Peters
Healthy Communities St. Charles
Working to make St. Charles County a healthy place to live, work and play!
By taking a few minutes to complete the 2009 Community Health Needs Assessment, you will assist in identifying and prioritizing community health concerns. Your participation will assist in completing a thorough review of the community's health status and the unmet health needs in our community. This information will help to provide much needed outreach and wellness programs in the area, keeping you and your family as healthy as possible.
St. Charles County Dept. of Community Health
DP 		Childrens Hospital
Crider Health Center
Community News 		SSM
SSM
 Partners
Progress-West BJC
INDIVIDUAL INFORMATION
 If you are at least 18 years of age, please complete the following survey, one per household. All survey respondents will remain anonymous. Do not include your name or other identifiers on the survey. For help on an item, click the help icon
1.St. Charles County municipality
in which you live:
2.Length of time you have been
a resident in your current municipality:
3. Your 5 digit zip code:
4. County in which you work:
5. Your current age:
6. Your sex:
help7. Your racial/ethnic identification
(check all that apply):
8.Your highest level of education completed
(check one):
help9. Your employment Status
(check all that apply):
10. Your yearly income:
help11. Select the type(s) of insurance you currently have (check all that apply):
12. Select your current type of health insurance:
Private - traditional
Managed Care (HMO, PPO)
Medicare
Medicaid or MC+ (MO HealthNet)
Government (VA, CHAMPUS)
Health Savings Account
Other
Do not know
Do not have health insurance
13. Your current health status:
14: Number of days you have been too sick to work or carry out your usual activities during the past 30 days:
15. Your last routine doctor's visit:
16. Select any of the following preventive procedures you have had in the last year (select all that apply):
Mammogram
Pap smear
Glaucoma Test
Flu Shot
Colon/Rectal Examination
Blood Pressure Check
Blood Sugar Check
Skin Cancer Screening
Prostate Cancer Digital Screening
Prostate Cancer PSA Screening
Cholesterol Screen
STD (Sexually Transmitted Disease) Screening
Vision Screening
Hearing Screening
Cardiovascular Screening
Bone density test
Dental Cleaning/x-rays
help17. Where you go for routine health care (check all that apply):
18. You are able to visit a doctor when needed:
19. If you answered no to #18, select why:
20. You travel outside of St. Charles County for medical care:
21. If you travel outside of St. Charles County for medical care, select the services you seek (select all that apply):
Medical - doctor appointments
Outpatient treatment
Hospitalization
Dental appointments
Laboratory or other tests
X-Rays
Other
Not applicable (do not travel outside of St. Charles County for medical care
22. If you travel outside of St. Charles County for medical care, why?
help23. Sources where you obtain most health-related information (check all that apply):
24. Person or entity you feel is most responsible for providing health information (select one):
25. Your employer offers health promotion/wellness programs:
26. If your employer offers health promotion/wellness programs, you participate:
27. If answered no to #25, but your employer will offer health promotion/wellness programs in the future, you will participate:
28. In the past 30 days, you rode with a driver who had been drinking:
29. In the past 30 days, you have driven after you drank one or more alcoholic beverages:
30. In the following section, select which answer describes you. *Note that N/A stands for not applicable
  Always Sometimes Never N/A
You wear a seat belt:
You wear a helmet when riding a bicycle, rollerblading or skateboarding:
You wear a helmet when riding a motor scooter, ATV, or motorcycle:
You drive the posted speed limit:
You eat at least 5 servings of fruits and vegetables each day:
You eat fast food more than once a week:
You exercise at a moderate pace at least 30 minutes per day, 5 days per week:
You consume more than 3 alcoholic drinks per day (female) or more than 5 per day (male):
You smoke cigarettes:
You chew tobacco:
You are exposed to secondhand smoke in your home or at work:
You use illegal drugs (marijuana, cocaine, methamphetamine, etc.):
You perform self-exams for cancer (breast or testicular):
You wash your hands with soap and water after using the restroom:
You wash your hands with soap and water before preparing and eating meals:
You apply sunscreen before planned time outside:
You get a flu shot each year:
You practice safe sex (condom or other barrier method, etc.):
You take vitamin pills or supplements daily:
You spend money on gambling more than once a month:
You attend religious services regularly:
You volunteer in your community (church, schools, civic organizations, etc.):
You donate money to community based organizations (churches, non profit organizations, etc.):
You get enough sleep each night (7-9 hours):
You feel stressed out:
You feel happy about your life:
You feel lonely:
You worry about losing your job:
You feel safe in your community: