Graves County 2013 Community Health Survey
Please take a few minutes to complete the survey below. The purpose of the this survey is to get your opinion about community health
concerns in Graves County. If you have any questions, please contact Stephanie at gravescohealth@gmail.com or call 270-320-7145.
1. In the following list, what do YOU think are the 5 Most Important Factors for a “Healthy” Graves County?
(Those factors which most improve the quality of life in our community). Check up to 5:
__ Access to Health Care
__ Access to Healthy Foods
__ Access to NO/Low Cost Activities
__ Affordable Housing
__ Arts & Cultural Events
__ Clean Environment
__ Low Crime/Safe Neighborhoods
__ Excellent Race Relations
__ Good Jobs & Healthy Economy
__ Good Place to Raise Children
__ Good Schools & Education
__ Healthy Behaviors & Lifestyles
__ Low Death & Disease Rates
__ Other: ____________________
__ Low Infant Deaths
__ Low Level of Child Abuse
__ Religious or spiritual values
__ Senior Citizen Activities/Programs
__ Strong Family Life
__ Quality Child Care
2. In the following list, what do YOU think are the 5 Greatest Health Problems that must be addressed in Graves
County? (Those concerns which have the greatest impact on overall community health). Check up to 5:
__ Aging Problems(e.g. arthritis/vision loss, etc) __ Heart Disease & Stroke
__ Alcohol Abuse
__ High Blood Pressure
__ Cancers
__ Suicide (Self Harm)
__ Child Abuse/Neglect
__ Homicide (Murder)
__ Dental Problems
__ Infectious Diseases(e.g. TB, Hepatitis)
__ Depression
__ Infant Death
__ Diabetes
__ Motor Vehicle Crash Injuries
__ Domestic Violence
__ Overweight/Obesity
__ Eating Disorders/Body Image
__ HIV/AIDS
__ Other Mental Health Problems(e.g. Bipolar, Schizophrenia, etc.)
__ Prescription Drug Abuse
__ Rape/Sexual Assault
__ Respiratory/Lung Disease
__ Second Hand Smoke
__ Smoking
__ Sexually Transmitted Diseases
__ Street Drug Use (Meth, Heroin, etc.)
__ Stress/Anxiety
__ Teenage Pregnancy
__ Other: _______________________
3. In the following list, what do YOU think are the 5 Most Risky Behaviors in Graves County? Please select those
behaviors that YOU believe have the greatest impact on overall community health. Check up to 5:
__ Not Having Health Insurance
__ Alcohol Abuse
__ Being Overweight
__ Distracted Driving
__ Dropping Out of School
__ Smoking/Tobacco Use
__ Lack of Exercise
__ Not Using Birth Control/Unsafe Sex
__ Poor Diet/Eating Habits
__ Not Using Seat Belts/Child Safety
__ School Bullying
__ Having Multiple Sex Partners
__ Not Getting Shots to Prevent Disease
__ Hate Crimes
__ Racism
__ Prescription Drug Use
__ Street Drug Use (Meth, Heroin, etc.) __ Other: ________________________
4. How would you rate the health of Graves County?
__ Very Unhealthy
__ Unhealthy
__ Somewhat Healthy
__ Healthy
__ Very Healthy
__ Healthy
__ Very Healthy
5. How would you rate YOUR personal health?
__ Very Unhealthy
__ Unhealthy
__ Somewhat Healthy
Graves County 2013 Community Health Survey
Please take a few minutes to complete the survey below. The purpose of the this survey is to get your opinion about community health
concerns in Graves County. If you have any questions, please contact Stephanie at gravescohealth@gmail.com or call 270-320-7145.
6. About how many hours per month do you volunteer your time to community service? (e.g. schools,
organizations, churches, hospitals, etc.)
__ None
__ 1 - 5 Hours
__ 6 - 10 Hours
Age: __ Under 18
__ 18 - 24 Years
__ 25 - 35 Years
Gender: __ Female
What is your Race?
__ Over 10 Hours
36 - 45 Years
__ 46 - 60 Years __ 61+
__ Male
__ White/Caucasian
__ Black/African American
__ American Indian/Alaskan Native
__ Asian American
__ Two or more Races
__ Other: ____________________
Are you of Hispanic Ethnicity:
__ Yes
__ No
Relationship Status:
__ Widowed
__ Single/Not Married
__ Separated
__ Divorced
__ Living with Partner/Significant Other
Highest Level of Education you have completed:
__ Less than a High School Diploma
__ High School Diploma or Equivalent
__ Associate/Technical Degree
__ Bachelor’s Degree
Household Income:
__ $50,000 to $74,999
Employment Status:
__ No Income __ Less than $20,000
__ $75,000 to $99,999
__ Some College
__ Graduate or Higher Degree
__ $20,000 to $29,999 __ $30,000 to $49,999
__ Over $100,000
__ Prefer Not to Answer
__ Employed Full-time __ Employed Part-time __ Self Employed
__ Retired
__ Unemployed
__ Student
How many ADULTS are in your household?____
household?____
How many CHILDREN less than 18 years old are in your
How many CHILDREN greater than 18 years old are in your household? ___
Are you a grandparent with grandchildren living in your home?
___ Yes
___ No
Graves County 2013 Community Health Survey
Please take a few minutes to complete the survey below. The purpose of the this survey is to get your opinion about community health
concerns in Graves County. If you have any questions, please contact Stephanie at gravescohealth@gmail.com or call 270-320-7145.
How do you pay for your health care?
__ Health Insurance (Buy Own Ins.)
__ Pay Cash (No Insurance) __ Health Insurance (Provided by Employer)
__ Veteran’s Association (VA) __ Medicaid
__ Medicare
__Other: __________________________
In the past 12 months, have you decided NOT to seek health care services because of out-of-pocket cost to you?
__Yes
__No
If you have used services at a hospital other than Jackson Purchase Medical Center in the past 12 months, why
did you choose that facility?
__ I prefer that facility
___________
__ My physician chose the facility
__ Does not apply to me
__ Other:
Where do you get your information about health? (Check all that apply)
__ Doctor/Hospital
__ Newspaper
__ Health Department
__ Family/Friends
__ Church
__ Internet
__ Other: ___________________
__ Magazines
Where do you get your information about events, news in Graves County? (Check all that apply)
__ Word of Mouth
__ Newspaper
__ Internet
__ Social Media (Facebook, Twitter, etc.)
__ Radio
__ Church
__ Other:____________________
What is the zip code where you live?
__ 42027 Boaz
__ 42039 Fancy Farm
__ 42040 Farmington
__ 42051 Hickory
__ 42069 Melber
__ 42079 Sedalia
__ 42082 Symsonia
__ 42085 Water Valley __ 42088 Wingo
__ Other
Thank you!
__ 42066 Mayfield