Johnston County Community Health Survey

1. There is a good healthcare system in Johnston County.
   Consider the cost and quality, number of options, and availability of healthcare in Johnston County.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

2. Johnston County is a good place to raise children.
   Consider the quality and safety of schools and child care programs, after-school programs, and places to play in the county.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

3. Johnston County is a good place to grow old.
   Consider the county's elder-friendly housing, transportation to medical services, recreation, and services for the elderly.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

4. There is plenty of economic opportunity in Johnston County.
   Consider the number and quality of jobs, job training, higher educational opportunities, and availability of affordable housing in the county.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

5. Johnston County is a safe place to live.
   Consider how safe you feel at home, in the workplace, in schools, at playgrounds, parks and shopping centers in the county.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

6. There is plenty of help for individuals and families during times of need in Johnston County.
   Consider social support in the county: neighbors, support groups, faith community outreach, community organizations, and emergency monetary assistance.
   Select One... Strongly Agree Agree Neither Agree Nor Disagree (Neutral) Disagree Strongly Disagree

Part Two: Community Problems and Issues

7.   Which health problems have the largest impact on the community as a whole?

In the boxes below, select up to five, in order of importance. You do not have to select all five. Select only those you think have the largest impact on the community. You can select one, two, three, four or five. Remember to select them in order of priority. Select the problems you think are most important first.

If you do not see the health problem that you consider to be one of the most important on the list, select "Other" and then type the problem in the field provided. If you do not think the county has any health problems, do not select any.
 

#1 - First Health Problem: Select One... Aging Problems (Alzheimer's, arthritis, hearing or vision loss, etc.) Asthma Birth Defects Cancer (if selected, you can enter the type below) Dental Health Diabetes Gun-related Injuries Heart Disease or Heart Attacks Autism Infant Death Infectious or Contagious Diseases (TB, Flu, Pneumonia, etc.) Kidney Disease Liver Disease Mental Health (depression, schizophrenia, suicide, etc.) Motor Vehicle Accidents Neurological Disorders (Multiple Sclerosis, Muscular Dystrophy, A.L.S.) Accidential Injuries (Drowning, Choking, Home- or Work-related) Obesity or Being Overweight Lung Disease (Emphysema, etc.) Sexually Transmitted Diseases (STDs) Stroke Teenage Pregnancy Other / Not Listed (if selected, enter disease below) If you selected "Cancer," enter the type or "all" for all cancers:  If you selected "Other / Not Listed," enter the health problem that concerns you:

#2 - Second Health Problem: Select One... Aging Problems (Alzheimer's, arthritis, hearing or vision loss, etc.) Asthma Birth Defects Cancer (if selected, you can enter the type below) Dental Health Diabetes Gun-related Injuries Heart Disease or Heart Attacks Autism Infant Death Infectious or Contagious Diseases (TB, Flu, Pneumonia, etc.) Kidney Disease Liver Disease Mental Health (depression, schizophrenia, suicide, etc.) Motor Vehicle Accidents Neurological Disorders (Multiple Sclerosis, Muscular Dystrophy, A.L.S.) Accidential Injuries (Drowning, Choking, Home- or Work-related) Obesity or Being Overweight Lung Disease (Emphysema, etc.) Sexually Transmitted Diseases (STDs) Stroke Teenage Pregnancy Other / Not Listed (if selected, enter disease below) If you selected "Cancer," enter the type or "all" for all cancers:  If you selected "Other / Not Listed," enter the health problem that concerns you:

#3 - Third Health Problem: Select One... Aging Problems (Alzheimer's, arthritis, hearing or vision loss, etc.) Asthma Birth Defects Cancer (if selected, you can enter the type below) Dental Health Diabetes Gun-related Injuries Heart Disease or Heart Attacks Autism Infant Death Infectious or Contagious Diseases (TB, Flu, Pneumonia, etc.) Kidney Disease Liver Disease Mental Health (depression, schizophrenia, suicide, etc.) Motor Vehicle Accidents Neurological Disorders (Multiple Sclerosis, Muscular Dystrophy, A.L.S.) Accidential Injuries (Drowning, Choking, Home- or Work-related) Obesity or Being Overweight Lung Disease (Emphysema, etc.) Sexually Transmitted Diseases (STDs) Stroke Teenage Pregnancy Other / Not Listed (if selected, enter disease below) If you selected "Cancer," enter the type or "all" for all cancers:  If you selected "Other / Not Listed," enter the health problem that concerns you:

#4 - Fourth Health Problem: Select One... Aging Problems (Alzheimer's, arthritis, hearing or vision loss, etc.) Asthma Birth Defects Cancer (if selected, you can enter the type below) Dental Health Diabetes Gun-related Injuries Heart Disease or Heart Attacks Autism Infant Death Infectious or Contagious Diseases (TB, Flu, Pneumonia, etc.) Kidney Disease Liver Disease Mental Health (depression, schizophrenia, suicide, etc.) Motor Vehicle Accidents Neurological Disorders (Multiple Sclerosis, Muscular Dystrophy, A.L.S.) Accidential Injuries (Drowning, Choking, Home- or Work-related) Obesity or Being Overweight Lung Disease (Emphysema, etc.) Sexually Transmitted Diseases (STDs) Stroke Teenage Pregnancy Other / Not Listed (if selected, enter disease below) If you selected "Cancer," enter the type or "all" for all cancers:  If you selected "Other / Not Listed," enter the health problem that concerns you:

#5 - Fifth Health Problem: Select One... Aging Problems (Alzheimer's, arthritis, hearing or vision loss, etc.) Asthma Birth Defects Cancer (if selected, you can enter the type below) Dental Health Diabetes Gun-related Injuries Heart Disease or Heart Attacks Autism Infant Death Infectious or Contagious Diseases (TB, Flu, Pneumonia, etc.) Kidney Disease Liver Disease Mental Health (depression, schizophrenia, suicide, etc.) Motor Vehicle Accidents Neurological Disorders (Multiple Sclerosis, Muscular Dystrophy, A.L.S.) Accidential Injuries (Drowning, Choking, Home- or Work-related) Obesity or Being Overweight Lung Disease (Emphysema, etc.) Sexually Transmitted Diseases (STDs) Stroke Teenage Pregnancy Other / Not Listed (if selected, enter disease below) If you selected "Cancer," enter the type or "all" for all cancers:  If you selected "Other / Not Listed," enter the health problem that concerns you:

8.   Which individual unhealthy behaviors have the greatest impact on the community?

In the boxes below, select up to five, in order of importance. You do not have to select all five. Select only those you think have the largest impact on the community. You can select one, two, three, four or five. Remember to select them in order of priority. Select the problems you think are most important first.

If you do not see a behavior on the list that you consider to be one of the most important, select "Other" and then type the behavior in the field provided. If you do not think the county has any individual unhealthy behaviors, do not select any.

 

#1 - First Unhealthy Behavior: Select One... Alcohol Abuse Drug Abuse Having Unsafe Sex Lack of Exercise Not Getting Immmunizations (shots) to prevent disease Not Using Child Safety Seats Not Using Seat Belts Not Seeing a Dentist Not Seeing a Doctor for Regular Checkups Not Getting Prenatal (Pregnancy) Care Poor Eating Habits Reckless or Drunken Driving Smoking or Tobacco Use Suicide Violent Behavior Other / Not Listed (if selected, enter behavior below) If you selected "Other / Not Listed," enter the behavior that concerns you:

#2 - Second Unhealthy Behavior: Select One... Alcohol Abuse Drug Abuse Having Unsafe Sex Lack of Exercise Not Getting Immmunizations (shots) to prevent disease Not Using Child Safety Seats Not Using Seat Belts Not Seeing a Dentist Not Seeing a Doctor for Regular Checkups Not Getting Prenatal (Pregnancy) Care Poor Eating Habits Reckless or Drunken Driving Smoking or Tobacco Use Suicide Violent Behavior Other / Not Listed (if selected, enter behavior below) If you selected "Other / Not Listed," enter the behavior that concerns you:

#3 - Third Unhealthy Behavior: Select One... Alcohol Abuse Drug Abuse Having Unsafe Sex Lack of Exercise Not Getting Immmunizations (shots) to prevent disease Not Using Child Safety Seats Not Using Seat Belts Not Seeing a Dentist Not Seeing a Doctor for Regular Checkups Not Getting Prenatal (Pregnancy) Care Poor Eating Habits Reckless or Drunken Driving Smoking or Tobacco Use Suicide Violent Behavior Other / Not Listed (if selected, enter behavior below) If you selected "Other / Not Listed," enter the behavior that concerns you:

#4 - Fourth Unhealthy Behavior: Select One... Alcohol Abuse Drug Abuse Having Unsafe Sex Lack of Exercise Not Getting Immmunizations (shots) to prevent disease Not Using Child Safety Seats Not Using Seat Belts Not Seeing a Dentist Not Seeing a Doctor for Regular Checkups Not Getting Prenatal (Pregnancy) Care Poor Eating Habits Reckless or Drunken Driving Smoking or Tobacco Use Suicide Violent Behavior Other / Not Listed (if selected, enter behavior below) If you selected "Other / Not Listed," enter the behavior that concerns you:

#5 - Fifth Unhealthy Behavior: Select One... Alcohol Abuse Drug Abuse Having Unsafe Sex Lack of Exercise Not Getting Immmunizations (shots) to prevent disease Not Using Child Safety Seats Not Using Seat Belts Not Seeing a Dentist Not Seeing a Doctor for Regular Checkups Not Getting Prenatal (Pregnancy) Care Poor Eating Habits Reckless or Drunken Driving Smoking or Tobacco Use Suicide Violent Behavior Other / Not Listed (if selected, enter behavior below) If you selected "Other / Not Listed," enter the behavior that concerns you:

9.   Which community issues have the largest impact on the quality of life in Johnston County?

In the boxes below, select up to five, in order of importance. You do not have to select all five. Select only those you think have the largest impact on the overall quality of life. You can select one, two, three, four or five. Remember to select them in order of priority. Select the problems you think are most important first.

If you do not see a community issue on the list that you consider to be one of the most important, select "Other" and then type the issue in the field provided. If you do not think the county has any issues that impact the quality of life, do not select any.

 

#1 - First Community Issue: Select One... Affordability of Health Services Animal Control Issues Availability of Child Care Availability of Healthy Family Activities Availability of Healthy Food Choices Availability of Positive Teen Activities Bioterrorism Child Abuse or Neglect Domestic Violence Dropping Out of School Elder Abuse or Neglect Homelessness Inadequate or Unaffordable Housing Lack of Adequate Health Insurance Lack of Culturally Appropriate Health Services Lack of Health Care Providers (if selected, enter type below) Lack of Recreational Facilities (parks, trails, community centers, etc.) Lack of Transportation Options Low Income or Poverty Pollution (Air, Water or Land) Racism Rape or Sexual Assault Unemployment Unsafe or Un-maintained Roads Violent Crime (murder, assault, etc.) Other / Not Listed (if selected, enter issue below) If you selected "Lack of Health Care Providers," enter the type of provider below: If you selected "Other / Not Listed," enter the issue that concerns you:

#2 - Second Community Issue: Select One... Affordability of Health Services Animal Control Issues Availability of Child Care Availability of Healthy Family Activities Availability of Healthy Food Choices Availability of Positive Teen Activities Bioterrorism Child Abuse or Neglect Domestic Violence Dropping Out of School Elder Abuse or Neglect Homelessness Inadequate or Unaffordable Housing Lack of Adequate Health Insurance Lack of Culturally Appropriate Health Services Lack of Health Care Providers (if selected, enter type below) Lack of Recreational Facilities (parks, trails, community centers, etc.) Lack of Transportation Options Low Income or Poverty Pollution (Air, Water or Land) Racism Rape or Sexual Assault Unemployment Unsafe or Un-maintained Roads Violent Crime (murder, assault, etc.) Other / Not Listed (if selected, enter issue below) If you selected "Lack of Health Care Providers," enter the type of provider below: If you selected "Other / Not Listed," enter the issue that concerns you:

#3 - Third Community Issue: Select One... Affordability of Health Services Animal Control Issues Availability of Child Care Availability of Healthy Family Activities Availability of Healthy Food Choices Availability of Positive Teen Activities Bioterrorism Child Abuse or Neglect Domestic Violence Dropping Out of School Elder Abuse or Neglect Homelessness Inadequate or Unaffordable Housing Lack of Adequate Health Insurance Lack of Culturally Appropriate Health Services Lack of Health Care Providers (if selected, enter type below) Lack of Recreational Facilities (parks, trails, community centers, etc.) Lack of Transportation Options Low Income or Poverty Pollution (Air, Water or Land) Racism Rape or Sexual Assault Unemployment Unsafe or Un-maintained Roads Violent Crime (murder, assault, etc.) Other / Not Listed (if selected, enter issue below) If you selected "Lack of Health Care Providers," enter the type of provider below: If you selected "Other / Not Listed," enter the issue that concerns you:

#4 - Fourth Community Issue: Select One... Affordability of Health Services Animal Control Issues Availability of Child Care Availability of Healthy Family Activities Availability of Healthy Food Choices Availability of Positive Teen Activities Bioterrorism Child Abuse or Neglect Domestic Violence Dropping Out of School Elder Abuse or Neglect Homelessness Inadequate or Unaffordable Housing Lack of Adequate Health Insurance Lack of Culturally Appropriate Health Services Lack of Health Care Providers (if selected, enter type below) Lack of Recreational Facilities (parks, trails, community centers, etc.) Lack of Transportation Options Low Income or Poverty Pollution (Air, Water or Land) Racism Rape or Sexual Assault Unemployment Unsafe or Un-maintained Roads Violent Crime (murder, assault, etc.) Other / Not Listed (if selected, enter issue below) If you selected "Lack of Health Care Providers," enter the type of provider below: If you selected "Other / Not Listed," enter the issue that concerns you:

#5 - Fifth Community Issue: Select One... Affordability of Health Services Animal Control Issues Availability of Child Care Availability of Healthy Family Activities Availability of Healthy Food Choices Availability of Positive Teen Activities Bioterrorism Child Abuse or Neglect Domestic Violence Dropping Out of School Elder Abuse or Neglect Homelessness Inadequate or Unaffordable Housing Lack of Adequate Health Insurance Lack of Culturally Appropriate Health Services Lack of Health Care Providers (if selected, enter type below) Lack of Recreational Facilities (parks, trails, community centers, etc.) Lack of Transportation Options Low Income or Poverty Pollution (Air, Water or Land) Racism Rape or Sexual Assault Unemployment Unsafe or Un-maintained Roads Violent Crime (murder, assault, etc.) Other / Not Listed (if selected, enter issue below) If you selected "Lack of Health Care Providers," enter the type of provider below: If you selected "Other / Not Listed," enter the issue that concerns you:

Part Three: Personal Health

This section includes questions about your personal health. The answers you provide are completely anonymous and will not be linked to you in any way.

10. How would you rate your own health?
    Select One... Very Healthy Healthy Mostly Healthy Somewhat Healthy Unhealthy Very Unhealthy

11. Where do you get most of your health information?
    Select One... Friends and Family Doctor, Nurse or Pharmacist Internet Hospital Help Lines Books and Magazines School Church Other (if selected, type your source in the box below)

    If you selected "Other," enter your source below:
    

12. Where do you go most often when you are sick or need advice about your health?
    Select One... Doctor's Office Health Department Hospital Medical Clinic Urgent Care Center Other (if selected, type the location in the box below)

    If you selected "Other," enter the location below:
    

13. In the last 12 months, have you had any difficulty getting the health care you needed from any type of health care provider or facility?
    Yes No

    If no, skip to question 15.

14. If you answered yes to question #13, which of these problems did you experience? Choose as many as needed. If you experienced a problem that isn't listed, check the "Other" box and write the problem in the field below.

          I didn't have health insurance.
          My insurance didn't cover what I needed.
          My share of the cost (deductible / co-pay) was too high.
          Doctor would not take my insurance or Medicaid.
          Hospital would not take my insurance.
          I didn't have a way to get there.
          I didn't know where to go.
          I couldn't get an appointment.
          Other (if checked, complete box below).

    If you checked "Other" for a problem you experienced, please describe it in the field below:
    

15. In the last 12 months, have you had a problem filling a medically necessary prescription?
    Yes No

    If no, skip to question 17.

16. If you answered yes to question #15, which of these problems did you have? Choose as many as needed. If you experienced a problem that isn't listed, check the "Other" box and write the problem in the field below.

          I didn't have health insurance.
          My insurance didn't cover what I needed.
          My share of the cost (deductible / co-pay) was too high.
          Pharmacy would not take my insurance or Medicaid.
          I didn't have a way to get there.
          I didn't know where to go.
          Other (if checked, complete box below).

    If you checked "Other," describe the problem in the field below:
    

17. In the last 12 months, was there a time when you needed to get dental care but could not?
    Yes No

    If no, skip to question 19.

18. If you answered yes to question #17, why could you not get dental care? Choose as many as needed. If you experienced a problem that isn't listed, check the "Other" box and write the problem in the field below.

          I didn't have dental insurance.
          My insurance didn't cover what I needed.
          I could not afford the cost.
          Dentist would not take my insurance or Medicaid.
          My share of the cost (deductible / co-pay) was too high.
          I didn't have a way to get there.
          I didn't know where to go.
          I couldn't get an appointment.
          Other (if checked, complete box below).

    If you checked "Other," type the problem in the field below:
    

19. If a friend or family member needed counseling for a mental health issue or a drug or alcohol abuse problem, who would you tell them to call or talk to? Choose as many as needed. If you check the "Other" box, write the contact in the field below.

          Private Counselor or Therapist
          Support Group (e.g., A.A., Al-Anon, etc.)
          County Mental Health Center
          School Counselor
          Doctor
          Minister / Religious Official
          I don't know
          Other (if checked, complete box below)

    If you checked "Other," type the contact in the field below:
    

20. In the past 30 days, have there been any days when feeling sad or worried kept you from going about your normal business?
    Yes No

21. During a normal week, other than in your regular job, do you engage in any exercise activity that lasts at least 30 minutes?
    Yes No

    If no, skip to question 24.

22. If you answered yes to question #21, how many times do you exercise for more than 30 minutes at a time during a normal week? You must enter a number in the field below.
    

23. If you answered yes to question #21, where do you go to exercise or engage in physical activity? Choose all that apply. If you check the "Other" box, write the location in the field below.

          Johnston Medical Mall
          Park
          Public Recreation Center
          Private Gym
          Home
          Other (if checked, complete box below)

    If you checked "Other," type the location below:
    

    Skip to question 25.

24. If you answered no to question #21, why do you not exercise for at least 30 minutes during a normal week? Choose all that apply. If you check the "Other" box, write the reason in the field below.

          My job is physical or hard labor.
          Exercise is not important to me.
          I don't have access to a facility that has things I need (e.g., pool, track, golf, etc.)
          I don't have enough time to exercise.
          I would need child care, and don't have it.
          I don't know how to find exercise partners or teams.
          I don't like to exercise.
          It costs too much (equipment, shoes, gym fees, etc.)
          There is no safe place to exercise.
          I'm too tired to exercise.
          I'm physically disabled.
          I don't know.
          Other (if checked, complete box below)

    If you checked "Other," type the reason below:
    

25. How many hours per day do you watch TV, play video games, or use the computer for recreation?
    0 - 1 Hour 2 - 3 Hours 4 - 5 Hours 6+ Hours

26. During the last 30 days, have you had any physical pain or health problem(s) that made it hard for you to do your usual activities (such as driving, working around the house, going to work, etc.)?
    No Yes

27. How many cups of fruits and vegetables do you eat in an average day? Do not count juice, lettuce salad, or potato products. One apple or 12 baby carrots equals one cup. You must enter numbers in the boxes below.

    Number of cups of fruit eaten in a day:   (Enter 0 if you never eat fruit.)
    Number of cups of vegetables eaten in a day:   (Enter 0 if you never eat vegetables.)

28. Are you exposed to second-hand smoke in any of the following places? Choose all that apply. If you check the "Other" box, write the location in the field below.

          Home
          Workplace
          Hospitals
          Restaurants
          School
          Other (if checked, complete box below)
          I am not exposed to second-hand smoke

    If you checked "Other," type the location below:
    

29. Do you currently smoke?
    No Yes

    If no, skip to question 31.

30. If you smoke, where would you go for help if you wanted to quit? Choose all that apply. If you check the "Other" box, write the location in the field below.

          Quit Now NC
          Doctor
          Church
          Pharmacy
          Private Counselor / Therapist
          Health Department
          I don't know
          Other (if checked, complete box below)
          Not Applicable; I don't want to quit.

    If you checked "Other," type the location below:
    

31. Have you ever been told by a doctor, nurse or other health professional that you have any of the following conditions?
          Asthma     No Yes
          Depression or Anxiety Disorder     No Yes
          High Blood Pressure     No Yes
          High Cholesterol     No Yes
          Diabetes (not during pregnancy)     No Yes
          Osteoporosis     No Yes
          Overweight or Obesity     No Yes

32. Do you have children between the ages of 9 and 19?
    No Yes

    If no, skip to question 36.

33. Do you think your child is engaging in any of the following high-risk behaviors? Please answer yes or no after each behavior. If you do not think your child is engaging in any high-risk behaviors, check the last statement.

          Alcohol Use     No Yes
          Tobacco Use     No Yes
          Eating Disorders     No Yes
          Sexual Intercourse     No Yes
          Drug Abuse     No Yes
          Reckless Driving or Speeding     No Yes

          I do not think my child is engaging in any high-risk behaviors.

34. Are you comfortable talking to your child about the risky behaviors listed in the previous question?
    Yes No

35. Do you think your child or children need more information about the following problems? Choose all that apply. If you check "Other," write the problem in the field below.

          Alcohol
          Tobacco
          HIV
          Eating Disorders
          Sexual Intercourse
          STDs
          Drug Abuse
          Reckless Driving and/or Speeding
          Mental Health Issues
          Other (if checked, complete box below)

    If you checked "Other," type the issue below:
    

Part Four: Emergency Preparedness

This section includes questions about your household's emergency preparedness. Remember, the answers you provide are completely anonymous and will not be linked to you in any way.

36. Does your household have working smoke and carbon monoxide detectors?
    Select One... Smoke Detector(s) Only Carbon Monoxide Detector(s) Only Yes, we have both No

37. Does your household have a Family Emergency Plan?
    Yes No

38. Does your household have a basic emergency supply kit?
    Yes No

    If no, skip to question 40.
    

39. If you answered yes to question 38, how many days do you have supplies for?
    Select One... Three Days One Week Two Weeks More than Two Weeks

Part Five: Demographic Questions

This section includes general questions about you, which will only be reported as a summary of all answers given by survey participants. Your answers are completely anonymous and will not be linked to you in any way.

40. How old are you?
    Select One... 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75 or older

41. What is your gender?
    Select One... Male Female

42. Are you of Hispanic origin?
    No Yes

43. What is your race? Select one only. If you do not identify with one of the categories listed, select "Other," and then write your race in the field below.
    Select One... Black or African-American Asian or Pacific Islander Hispanic or Latino White or Caucasian American Indian or Alaskan Native More than one race Other (if checked, complete box below)

    If you selected "Other," type your race below:
    

44. Do you speak a language other than English at home?
    No Yes

    If no, skip to question 46.
    

45. If you speak a language other than English at home, enter the language you speak at home in the box below.
    

46. What is your marital status?
    If you do not identify with one of the categories listed, select "Other," and then write your marital in the field below.
    Select One... Never Married/Single Married Divorced Widowed Separated Other (if checked, complete box below)

    If you selected "Other," type your marital status below:
    

47. What is the highest level of school, college or vocational training that you have finished?
    Select One... Some high school, no diploma High School Diploma or GED Associate's Degree or Vocational Training Some College (No Degree) Bachelor's Degree Graduate or Professional Degree Other (if checked, complete box below)

    If you selected "Other," type your educational status below:
    

48. What was your total household income last year, before taxes?
    Select One... Less than $14,999 $15,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 Over $75,000

49. How many people does the above income support? You must enter a number in the box below.
    

50. What is your employment status?
    Select One... Employed Full-time Employed Part-time Unemployed Retired Military Disabled Student Homemaker Self-Employed

51. Do you have access to the Internet at home?
    Yes No

52. What is your zip code? Type only the first five digits.
    

Congratulations! You have reached the end of the survey.

Thank you for taking your time to help with this effort. Please complete the verification questions in the box below and then click the "Submit the Survey" button to submit your completed survey.

Your survey has not been submitted until you answer the questions in the box below and click the "Submit the Survey" button. You will then see a completion panel with a completed survey number. Thank you for your participation!
 

Survey Verification Please answer the questions below in order to submit your completed survey to the Johnston County Health Department. Check the statements below to agree that they are correct. All boxes must be checked, and agreed to as accurate, in order to submit your survey. Thank you.       I am at least 15 years of age.       I am a resident of Johnston County, North Carolina.       I have only completed this survey once.       I have completed this survey in good faith and all my answers are true. Security Question In an effort to prevent Spambot form submissions, you will need to type the word "eight" in the box below to submit this form online. This allows us to determine that it is a human being completing the form. Please type the word "eight", but without any quotation marks. Thank you for your understanding.