TXHC-"S.W.A.T" Mosquito-borne Illnesses Survey 2020 Question Title * 1. Please check where you live: Bloomington (Zip code: 77951) Inez (Zip code: 77968) McFadden (Zip code: 77973) Nursery (Zip code: 77976 Placedo (Zip code: 77977 Telferner (Zip code: 77988) Victoria (Zip code: 77901) Victoria (Zip code: 77902) Victoria (Zip code: 77904) Victoria (Zip code: 77905) Question Title * 2. How many people are in your household? 1-2 3-4 5+ Question Title * 3. How many children (if any) are in:*Enter a number in the field (use 0 if none) Pre-K (0-4) Elementary School (K-5th) Middle School (6th-8th) High School (9th-12th) None Question Title * 4. Which diseases do you think are spread by mosquitoes in Texas? (check all that apply) Zika Virus West Nile Virus Dengue Fever Chikungunya Virus Lyme Disease Malaria Question Title * 5. Is mosquito control an important issue to you? Yes No Don't know Question Title * 6. In the last 30 days, have you or a member of your household used mosquito repellent? Yes No Don't know Question Title * 7. If you answered no to question #6, why? Do not have access to mosquito repellent Cannot afford repellent Forget to use repellent Do not need repellent Question Title * 8. Do you have any of the following in your yard or by your house? (check all that apply) Birdbath Old tires or barrels Buckets and potted plant trays/dishes or other containers Standing water like in puddles and pools Question Title * 9. Please rank in order from 1-6 (1 being the best), trusted sources of mosquito-borne disease information: Question Title * 10. What can you do to protect yourself from mosquito-borne diseases? (select all that apply) Use a mosquito repellent Cover up (wear long-sleeve shirts and pants when possible) Keep mosquitoes outside Repair holes in screens to keep mosquitoes outside Keep grass cut short Question Title * 11. To protect yourself from mosquito-borne diseases, how often should you apply insect repellent? Every 30 minutes Every hour It depends on the percentage of active ingredient in the product Insect repellent does not protect against mosquito-borne diseases Done