Adult Health Survey (ages 18 and up)

Thank you in advance for completing the General Conference Health Commission Survey 2016! The information collected will be used for research and to refine the work of the Health Commission. Rest assured that your information will be protected. This instrument allows you to remain anonymous and the data will be examined without the use of personal identifiers. We would appreciate it if you would share your email or phone number for follow-up in the future, but again your contact information will not be kept with your responses. Your participation is voluntary and by submitting this survey, you are agreeing to the use of your information for the above purposes. If you have any questions about this survey or it's results, please email us at CHCAMECSURVEY@GMAIL.COM

Thank you for doing your part to help the Health Commission foster the atmosphere of wellness and strength throughout the connection!

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* 1. What is your sex?

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* 2. How do you self-identify your race/ethnicity?

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* 3. What is your marital status?

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* 4. What is your age?

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* 5. Including you, how many people live in your household?

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* 6. What is your highest level of education?

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* 7. What is your current employment status?

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* 8. What is your yearly income range before taxes?

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* 9. What is your zipcode?

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* 10. How would you rate your general health?

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* 11. Do you exercise?

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* 12. If yes to Q11, how often?

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* 13. Do you generally eat healthy?

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* 14. How many servings of fruits do you eat daily?

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* 15. How many servings of vegetables do you eat daily?

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* 16. Do you eat breakfast, lunch and dinner everyday?

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* 17. If no to Q16, how many days per week do you get enough food for the day?

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* 18. Are you concerned that there may be a large-scale disaster or emergency in your area?

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* 19. How prepared are you and your household for a large-scale disaster or emergency?

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* 20. Check all of the natural disasters common to the area where you live?

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* 21. Does your family have a 3-day supply per person of the following? (Check all that apply)

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* 22. If you you were asked to evacuate in an emergency, would you be able to?

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* 23. Please state your barriers to evacuation e.g. transportation?

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* 24. Do you have a written or verbally agreed upon disaster plan for your family?

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* 25. If yes to Q24, does your disaster plan include?

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* 26. How do these typical life stressors rank for you? (give each a score of 1 to 10 with 10 as the highest)

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* 27.  How often would you say that you are stressed in the week?

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* 28. How would you describe your weight?

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* 29. Have you ever been diagnosed by a primary care provider with...? Please mark all that apply to you.

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* 30. Have you ever received care from a mental health provider?

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* 31. Have you ever been sad/depressed for more than 2 weeks?

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* 32. Have you ever been diagnosed with any of the following mental MH conditions? (Check all that apply)

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* 33. What does religion mean to you?

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* 34. What does faith mean to you?

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* 35. How important is religion in your life?

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* 36. How important is faith to you in your life?

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* 37. In the past 30 days, how many days have you attended church or any religious service?

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* 38. Do you think that faith affects physical and/or mental health?

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* 39. Do you talk to your Pastor about your health problems?

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* 40. Do you have a belief that faith can change a person’s health crisis status?

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* 41. When did you last see your medical doctor?

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* 42. When did you last see a mental health provider?

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* 43. How do you pay for your medical care?

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* 44. What do you do when responding to a personal health problem(check all that apply)

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* 45. Do you seek advice from other church members regarding major health decisions?

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