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2022 Larimer County Community Health Survey Instrument - English

Your health matters, your voice matters

Download a PDF of the English survey here.

Your household was randomly selected to participate in the 2022 Larimer County Community Health Survey, and it is very important that we hear from you. Please have an adult (age 18 or older) fill out this survey - fill out only one survey per household (either on paper or online). Please answer the questions as they apply to you unless the question asks about your household. Answer the question with clear markings, such as an X, check mark, or fill in. Place the completed survey in the enclosed pre-paid envelope and return it by U.S. mail by June 10, 2022.

While we will keep your responses confidential, we ask that you not provide personal identifying information, such as your name, when completing the survey. If you have questions or need assistance, call our survey help line at 970-224-5209 or send an email to survey@healthdistrict.org.

This survey is a project of the Health District of Northern Larimer County. For more information or if you prefer to complete this survey online, please go to www.larimercountysurvey.org.

  1. Is there one doctors’ group, health center, or clinic that you usually go to for most of your medical care?
    1. Yes
    2. No
  2. Is there a doctor, nurse, physician assistant, or nurse practitioner that you consider to be your regular healthcare provider?
    1. Yes
    2. No
  3. Is there a particular dentist, dental hygienist, or dental practice that you consider to be your regular dental-care provider?
    1. Yes
    2. No
  4. When was the last time you had a dental exam and/or teeth cleaning?
    1. In the past year
    2. Between 1 and 2 years ago
    3. Between 2 and 3 years ago
    4. Between 3 and 5 years ago
    5. 5 years or longer
    6. Never
  5. Please rate your access to health care whenever you need it:
    1. Poor
    2. Fair
    3. Good
    4. Very good
    5. Excellent
    6. I don’t know
  6.  In the past 12 months, because of the COVID-19 pandemic, have you done any of the following? (Mark all that apply.)
    1. Skipped going to the dentist when you needed care.
    2. Skipped going to the doctor when you needed care.
    3. Avoided contact with older people or others who could be high-risk if they get COVID-19.
  7. Since the start of the pandemic, have you used telehealth (phone or virtual encounter) to receive advice or treatment from a doctor or other health care professional?
    1. Yes
    2. No (go to question 8)
  1. a. Were you satisfied with the most recent telehealth encounter?
    1. Yes
    2. No
  1. b. In the future, how much of your medical care would you like to have by telehealth rather than in person?
    1. As much as possible
    2. Some of it
    3. None, I prefer all of my care to be in person
  2.  What type(s) of health insurance do you have currently?  (Mark all that apply.) Do not include insurance plans that cover only ONE type of service like dental, vision, or prescription drug plans.
    1. I do not have health insurance of any kind. (go to question 10)
    2. Health insurance through current or former employer or union, including a partner’s or parent’s plan (including COBRA or retiree benefit).
    3. Health insurance plan that I, my parents, partner, or spouse purchase directly from an insurance company (privately or through Colorado’s marketplace/exchange).
    4. Medicaid, also called Health First Colorado.
    5. Medicare (for persons 65 years and older or with certain disabilities).
    6. Veteran’s Affairs, Military Health, TRICARE, or CHAMPUS.
    7. Student health insurance.
    8. Other (please specify)
  3. In general, would you say your health insurance is:
    1. Poor
    2. Fair
    3. Good
    4. Very good
    5. Excellent
  4. If you do not currently have health insurance, what are the reasons? (Please explain)
  5. Over the past 3 years, how many total months have you had no health insurance?
    1. None, I’ve always had insurance
    2. A total of one month without insurance
    3. A total of 2-6 months without insurance
    4. A total of 7-12 months without insurance
    5. A total of 13 months or longer without insurance
  6. How has your health insurance coverage changed because of the COVID-19 pandemic?
    1. I had no change in my coverage because of the pandemic. (go to question 13)
    2. I did not have insurance before the pandemic, but have since enrolled in health insurance. (go to question 13)
    3. I had health insurance before the pandemic, but I lost it.
  1. a. If you lost health insurance coverage, did you replace it?
    1. Yes
    2. No
  2. Do you currently have any insurance that covers at least part of the cost for the following:
    1. Prescription medicines?
      1. Yes
      2. No
      3. Don’t know
    2. Dental services?
      1. Yes
      2. No
      3. Don’t know
    3. Mental health services?
      1. Yes
      2. No
      3. Don’t know
    4. Vision services?
      1. Yes
      2. No
      3. Don’t know
    5. Hearing services?
      1. Yes
      2. No
      3. Don’t know
  3. What is your age?
  4. What is your gender? (Mark any that apply.)
    1. Woman
    2. Man
    3. Transgender
    4. (Specify)
  5. Including you, how many people (adults and children) live in your household? (If none for certain categories below, please enter “0”.)
    1. Number of people 0 to 4 years old
    2. Number of people 5 to 17 years old
    3. Number of people 18 to 29 years old
    4. Number of people 30 to 64 years old
    5. Number of people 65 years old and older
  6. How would you describe yourself? (Mark any that apply.)
    1. White (Caucasian)
    2. Hispanic or Latino/a/x
    3. Black or African American
    4. Native American or Alaskan Native
    5. Asian or Pacific Islander
    6. Other (please specify)
  7. In the past 12 months, have you ever felt that a doctor, dentist, other health care provider, or their staff judged you unfairly or discriminated against you because of any of the following? If you have not seen a health care provider in the past year, go to question 19.
    1. Your race or ethnicity
      1. Yes
      2. No
    2. Your gender
      1. Yes
      2. No
    3. Your age
      1. Yes
      2. No
    4. Your sexual orientation
      1. Yes
      2. No
    5. Your weight
      1. Yes
      2. No
    6. A health condition or disability
      1. Yes
      2. No
  8. In general, would you say your health is:
    1. Poor
    2. Fair
    3. Good
    4. Very good
    5. Excellent
  9. Have you ever tested positive for or been diagnosed with COVID-19?
    1. Yes
    2. No
    3. Don’t know
  10. Are you currently experiencing any of the following?
    1. Depression, anxiety, or other mental health problems
      1. Yes
      2. No
    2. Toothache or other problems with your teeth or gums
      1. Yes
      2. No
    3. Asthma
      1. Yes
      2. No
    4. Problems falling asleep or staying asleep
      1. Yes
      2. No
    5. A disability, handicap, or chronic disease that keeps you from participating fully in work, housework, or other daily activities
      1. Yes
      2. No
  11. Are you pregnant or did you give birth in the last 12 months?
    1. Yes
    2. No or does not apply to me
  12. Please tell us a little more about your current health:
    1. How many days during the past 30 days was your physical health (including physical illness or injuries) not good?
    2. During the past 30 days, how many days did poor physical health keep you from doing your usual activities, such as self-care, work, or recreation?
    3. How many days during the past 30 days was your mental health (including stress, depression, or other emotional problems) not good?
    4. During the past 30 days, how many days did poor mental health keep you from doing your usual activities, such as self-care, work, or recreation?
  13. Has a doctor, nurse, physician assistant, or other health professional ever told you that you had any of the following conditions?
    1. High blood pressure (also called hypertension)
      1. Yes
      2. No
    2. High cholesterol
      1. Yes
      2. No
    3. Chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis
      1. Yes
      2. No
    4. Diabetes (high blood sugar) If you were told you had diabetes only during pregnancy, answer “No.”
      1. Yes
      2. No
    5. Arthritis or rheumatism
      1. Yes
      2. No
    6. Depression
      1. Yes
      2. No
    7. An anxiety disorder
      1. Yes
      2. No
    8. Eating disorder
      1. Yes
      2. No
    9. Other mental health problem or mental illness
      1. Yes
      1. No
    1. Alcohol or substance use disorder
      1. Yes
      1. No
  1. In the past 3 months, how much of the time have you felt anxious, stressed, or depressed? Circle one number on the scale.
    1. 1 – None of the time
    2. 2
    3. 3
    4. 4 – About half of the time
    5. 5
    6. 6
    7. 7 – All of the time
  2. How often is each of the following kind of support available to you if you need it?
    1. Someone to confide in or talk to about your problems.
      1. None of the time
      1. A little of the time
      2. Some of the time
      3. Most of the time
      4. All of the time
    1. Someone to take you to the doctor if you needed it.
      1. None of the time
      1. A little of the time
      2. Some of the time
      3. Most of the time
      4. All of the time
    1. Someone to have a good time with.
      1. None of the time
      1. A little of the time
      2. Some of the time
      3. Most of the time
      4. All of the time
  1. In the past 6 months:
    1. How often did you have pain?
      1. Never
      1. Some days
      2. Most days
      3. Every day
    1. How often did pain limit your life or work activities?
      1. Never
      1. Some days
      2. Most days
      3. Every day
  1. In the past 12 months, have you considered suicide as a solution to your problems? If you or someone you know is thinking about suicide, call or live chat the National Suicide Prevention Lifeline: 1-800-273-8255 or https://suicidepreventionlifeline.org/chat/
    1. Yes
    2. No
  2. In a typical 24-hour period, how many hours of sleep do you usually get?
  3. Have you had a COVID-19 vaccine?
    1. No, I have not received any doses (go to question 31)
    2.  Yes, I had one dose of Pfizer or Moderna (mRNA)
    3. Yes, I had the initial series of Pfizer or Moderna (2 doses or 3 doses for some immunocompromised individuals)
    4. Yes, I had one dose of Johnson & Johnson (Janssen)
    5. I had some other COVID vaccine or other combination
  1. a. Have you had a booster dose of the COVID-19 vaccine?
    1. Yes
    2. No
  2. Did you get a seasonal flu shot or nasal mist during the most recent flu season (September 2021 – April 2022)?
    1. Yes
    2. No
    3. Not sure
  3. Not counting fruit juice, how many servings of fruit did you eat yesterday?  One serving is ½ cup chopped, cooked, canned, or frozen fruit; 1 small (tennis ball-sized) piece of fruit; or ¼ cup dried fruit. (If none, please enter “0”.)
  4. How many servings of vegetables did you eat yesterday?  One serving is ½ cup chopped, cooked, canned, or frozen vegetables; 1 cup raw, leafy vegetables; or 4 oz of 100% vegetable juice. (If none, please enter “0”.)
  5. The amount of fruits and vegetables you ate yesterday was:
    1. More than usual
    2. Same as usual
    3. Less than usual

Experts recommend that adults get at least 150 minutes (2 hours 30 minutes) of moderate intensity activity or at least 75 minutes (1 hour 15 minutes) of vigorous intensity activity (or some combination of both) each week.

Moderate intensity is any movement that makes you breathe hard but you can still have a conversation easily.

Vigorous intensity is any movement that makes your heart beat much faster and you can say only a few words before needing to take another breath.

  1. Would you say that you meet or exceed these recommendations most weeks?
    1. Yes
    2. No
    3. Not sure

Experts also recommend doing muscle-strengthening activities at least 2 days each weekThese activities make your muscles work harder than usual.

  1. Would you say that you meet or exceed this recommendation most weeks?
    1. Yes
    2. No
    3. Not sure
  2. In the past 30 days, have you used any of the following tobacco/nicotine products?
    1. Regular cigarettes (excluding herbal and e-cigarettes)
      1. Yes, every day
      2. Yes, some days
      3. No (go to question 37.b.)
    1. 1. I am seriously considering quitting. (Mark if applicable)
    2. E-cigarette or electronic vaping product that contains nicotine or can be filled with nicotine vape juice/liquid
      1. Yes, every day
      2. Yes, some days
      3. No (go to question 37.c.)
  1. 1. I am seriously considering quitting. (Mark if applicable)
  2. Cigars, cigarillos, or pipes, including hookah
  1. Yes, every day
  2. Yes, some days
  3. No (go to question 37.d.)
    1. 1. I am seriously considering quitting. (Mark if applicable)
  1. Chew/spit tobacco or other smokeless products (snus, ZYN, etc.)
      1. Yes, every day
      2. Yes, some days
      3. No (go to question 38)
    1. 1. I am seriously considering quitting. (Mark if applicable)
  1. In the past 12 months, have you used cannabis (marijuana)?
    1. Yes
    2. No (go to question 39)
  1. a. During the past 30 days, on how many days did you use cannabis?  If none, please enter “0” and go to question 39
  1. b. When you used cannabis during the past 30 days, was it usually:  (Mark all that apply.)
    1. To reduce stress/ relax
    2. To get high/for fun
    3. To improve sleep
    4. To socialize
    5. To reduce pain/inflammation
    6. To treat depression/anxiety
    7. Other (please specify)
  1. c. During the past 30 days, on how many days did you drive a car or other vehicle within 2 to 3 hours of using cannabis? (If none, please enter “0”.)

The next few questions are about alcoholic drinks. A drink is one bottle or one 12 oz. can of beer, a 5 oz. glass of wine, or a drink with a 1.5 ounce shot of liquor.

  1. Considering all types of alcoholic beverages, how many alcoholic drinks do you usually have in a week, including the weekend? (If none, please enter “0”.)
  2. In the past 30 days, what is the largest number of alcoholic drinks you had on any single occasion? (If none, please enter “0”.)
  3. In the past 30 days, how many times did you drive after drinking 2 or more alcoholic drinks in the hour before you drove? (If none, please enter “0”.)
  4. Thinking about how many drinks you usually had each week before the start of the pandemic and how much you drink now, would you say you are:
    1. Drinking less
    2. Drinking about the same
    3. Drinking more
    4. NA/I don’t drink alcohol
  5. When thinking about drug use, include illegal drug use and the use of prescription drugs in ways other than prescribed:   Remember that your responses are confidential.
    1. Have you ever felt that you ought to cut down on your drinking or drug use?
      1. Yes
      2. No
    2. Have people annoyed you by criticizing your drinking or drug use?
      1. Yes
      2. No
    3. Have you ever felt bad or guilty about your drinking or drug use?
      1. Yes
      2. No
  6. Mark your level of agreement with the following statements:
    1. Treatment can help people with mental illness lead normal lives.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    2. People are generally caring and sympathetic to people with mental illness.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    3. Treatment can help people with addictions lead normal lives.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    4. People are generally caring and sympathetic to people with addictions.
      1. Strongly disagree
      2. Disagree
      3. Neither agree not disagree
      4. Agree
      5. Strongly agree
      6. Don’t know

This information helps us describe the health and well-being of the entire community; honesty improves our accuracy and understanding.  We will not look at or report your individual information.

  1. How much do you weight in pounds (without shoes)?
  2. What is your height in feet and inches (without shoes)?
  3. What is your sexual orientation?
    1. Straight
    2. Lesbian or gay
    3. Queer
    4. Bisexual
    5. Something else
    6. Don’t know
  4. Which of the following best describes your current marital status?
    1. Married
    2. A member of an unmarried couple
    3. Divorced or separated
    4. Widowed
    5. Never married
  5. What is the highest level of education you have completed?
    1. Less than 12th grade, no diploma
    2. High school diploma or GED
    3. Some college, no degree
    4. Associate’s degree (e.g., AA, AS)
    5. Bachelor’s degree (g., BA, AB, BS)
    6. Graduate or professional degree
  6. What is your current employment status? (Mark all that apply.)
    1. Employed full-time for wages
    2. Employed part-time for wages
    3. Self-employed
    4. Military
    5. Full-time homemaker
    6. Retired
    7. Full-time or part-time student
    8. Disabled or unable to work
    9. Laid off or unemployed
  1. a. If you are currently employed, where do you work?
    1. At a workplace outside of the home
    2. Work at home
    3. A mix of both at home and away
  2. What was your household’s total income before taxes in 2021? Include income from all sources such as jobs, social security, public assistance, and retirement for yourself and all other persons living in your household.  If you are a college student dependent on parental financial support, estimate your family's household income.
    1. $13,000 or less
    2. $13,001 to $22,000
    3. $22,001 to $25,000
    4. $25,001 to $32,000
    5. $32,001 to $34,000
    6. $34,001 to $43,000
    7. $43,001 to $52,000
    8. $52,001 to $60,000
    9. $60,001 to $70,000
    10. $70,001 to $88,000
    11. $88,001 to $125,000
    12. $125,001 or more
  1. a. How many people, including you, were supported by this income in 2021?
  2. How much has your household income changed because of the pandemic? Circle a number on the scale.
    1. 1 – Income has decreased a lot
    2. 2
    3. 3
    4. 4 – Income has not changed
    5. 5
    6. 6
    7. 7 – Income has increased a lot
  3. How much do you have in emergency savings – money that is readily available in a checking, savings or money market account?
    1. No emergency savings
    2. Less than 3 months’ expenses
    3. 3 to 5 months’ expenses
    4. 6 or more months’ expenses
    5. Don’t know
  4. In the past 12 months, have you been contacted by a collection agency about owing money for medical bills? This could include medical bills for any family member.
    1. Yes
    2. No
    3. Don’t know
  5. How worried are you that:
    1. You won’t be able to afford the medical care you need?
      1. Very worried
      1. Somewhat worried
      2. Not too worried
      3. Not worried at all
    1. Health insurance will become so expensive that you can’t afford it?
      1. Very worried
      1. Somewhat worried
      2. Not too worried
      3. Not worried at all
  1. During the past 2 years, was there a time when you needed each of the following, but went without because you couldn’t afford it?
    1. Seeing a doctor or specialist
      1. Yes
      1. No
      2. Didn’t need
    1. Dental care
      1. Yes
      1. No
      2. Didn’t need
    1. Mental health care or counseling
      1. Yes
      1. No
      2. Didn’t need
    1. A hearing test or hearing aid
      1. Yes
      1. No
      2. Didn’t need
    1. Prescription medication
      1. Yes
      1. No
      2. Didn’t need
  1. How often in the past 12 months were you worried or stressed about:
    1. Having enough money to buy nutritious meals?
      1. Never
      1. Rarely
      2. Sometimes
      3. Usually
      4. Always
    1. Paying your rent or mortgage?
      1. Never
      1. Rarely
      2. Sometimes
      3. Usually
      4. Always
  1. In the past 12 months, did you or any member of your household need and/or use any of the community services listed below?
    1. Mental health services such as counseling or treatment for adults
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Alcohol/substance use addiction counseling or treatment, including medications
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Low or no cost dental/oral health services
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Work-related or employment services (training or help finding work)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Financial assistance (unemployment, Colo. Works/TANF, SSI/SSDI)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Food or meal assistance (Food Bank, SNAP, Food Stamps, WIC)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Child care/daycare financial assistance (including CCCAP)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Housing services (assistance with utilities, rent, or mortgage)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Transportation assistance (vouchers, reimbursements)
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
    1. Assistance understanding health insurance options and signing up
      1. Not needed and not used
      1. Needed and used
      2. Needed but did not get
      3. Don’t know
  1. Do you own or rent your resident?
    1. Own
    2. Rent
    3. Other arrangement (please specify)
  2. How many times have you moved in the past 12 months? (If none, please enter “0”.)
  3. In the past 3 months, has there been a time when you’ve been unable to pay all or part of your rent or mortgage?
    1. Yes
    2. No
    3. Does not apply
  4. If you had to move out of your current home permanently, where would you go?
    1. I would move in with family or friends.
    2. I would find another home to rent or buy.
    3. I would go to a local shelter.
    4. I would not have anywhere to go.
    5. Other (please specify)
  5. In the past 12 months, have you tried to find child care in Larimer County?
    1. Yes
    2. No (go to question 64)

Please answer these questions for the youngest child you were finding child care for.

  1. a. How much difficulty did you have finding the type of child care or early childhood program you wanted for your child?
    1. No difficulty (go to question 64)
    2. A little or some difficulty
    3. A lot of difficulty
    4. Did not find the child care program I wanted
  1. b. What was the primary reason for the difficulty finding care?
    1. Cost
    2. Quality
    3. Lack of open slots for new children
    4. Other (please specify)
  2. Before the pandemic, were you providing unpaid care to a spouse, parent, child, other relative, partner, or friend to help them take care of themselves because of a chronic illness or disability? This may include helping with personal needs, household chores, medical and nursing tasks, managing finances, or arranging for outside services. This person does not need to live with you.
    1. Yes
    2. No
  3. Are you currently providing unpaid care to a spouse, parent, child, other relative, partner, or friend to help them take care of themselves because of a chronic illness or disability?
    1. Yes
    2. No (go to question 66)
  1. Rate your level of agreement with the following statements regarding your role as a caregiver:
    1. Because of my role, I don’t have enough time for myself.
      1. Completely agree
      2. Agree
      3. Neither agree nor disagree
      4. Disagree
      5. Completely disagree
    2. I feel that my social life has suffered because of my role.
      1. Completely agree
      2. Agree
      3. Neither agree nor disagree
      4. Disagree
      5. Completely disagree
    3. I feel that my health has suffered because of my role.
      1. Completely agree
      2. Agree
      3. Neither agree nor disagree
      4. Disagree
      5. Completely disagree
  2. Have you completed an advance health care directive for yourself, such as a Living Will or a Medical Durable Power of Attorney? Advance care plans are official documents (also called advance directives) that describe your wishes for medical treatment if you are ever too ill or injured to speak for yourself.
    1. Yes
    2. No
    3. Don’t know
  3. How much of a problem are the following issues in the city, town, or rural area where you live?
    1. Polluted outdoor air (vehicle emissions, brown cloud, dust, etc.)
      1. Major problem
      2. Minor problem
      3. No problem
    2. Unclean indoor air (mold, radon, etc.)
      1. Major problem
      2. Minor problem
      3. No problem
    3. Pollution from industry (manufacturing, oil and gas drilling, et)
      1. Major problem
      2. Minor problem
      3. No problem
    4. Too many mosquitoes
      1. Major problem
      2. Minor problem
      3. No problem
    5. Changing climate conditions
      1. Major problem
      2. Minor problem
      3. No problem
    6. Wildfires (loss of lives, property or other resources; smoky air)
      1. Major problem
      2. Minor problem
      3. No problem
    7. Floods (loss of lives and property; pollution from storm water)
      1. Major problem
      2. Minor problem
      3. No problem
  4. How concerned are you that the following emergencies or disasters will affect you or your household in the future?
    1. Wildfire
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    2. Flood
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    3. Tornado
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    4. Extreme heat event
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    5. Hazardous material release
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    6. Terrorism
      1. Not concerned
      2. A little concerned
      3. Somewhat concerned
      4. Very concerned
    7. Other (please describe)
  5. If your household had to evacuate your home suddenly, due to a disaster or emergency, where would your household go initially? (Mark all that apply.)
    1. Stay with family or friends
    2. Hotel or motel
    3. Would not evacuate
    4. Emergency evacuation community shelter
    5. Vehicle/RV
    6. Other (please specify)
  6. What steps have you taken to prepare for the types of emergencies or disasters that might occur in the community?
    1. Prepared a household emergency plan.
      1. Unsure how to do
      2. Had no plans to do
      3. Plan to do
      4. Have already done
    2. Signed up for LETA, Larimer County’s emergency information and alert system.
      1. Unsure how to do
      2. Had no plans to do
      3. Plan to do
      4. Have already done
    3. Stocked up on food, water, and medications to last at least 3 days without any assistance.
      1. Unsure how to do
      2. Had no plans to do
      3. Plan to do
      4. Have already done
    4. Took photos or videos of your house and possessions.
      1. Unsure how to do
      2. Had no plans to do
      3. Plan to do
      4. Have already done
    5. Stored copies of key documents (g., marriage certificate, mortgage, insurance papers) in a secure location.
      1. Unsure how to do
      2. Had no plans to do
      3. Plan to do
      4. Have already done
    6. Other (please describe)
  7. What is your level of agreement with the following statements about the city, town, or rural area where you live?
    1. It is easy to walk in my community.
      1. Strongly disagree
      2. Disagree
      3. Neither agree not disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    2. It is easy to bike in my community.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    3. It is easy to ride public transit in my community (i.e., public bus).
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    4. It is possible for me to get to many places I need to go by walking.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
    5. It is possible for me to get to many places I need to go by biking.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6.  Don’t know
    6. It is possible for me to get to many places I need to go by public transit.
      1. Strongly disagree
      2. Disagree
      3. Neither agree nor disagree
      4. Agree
      5. Strongly agree
      6. Don’t know
  8. How often do you do the following when driving a vehicle?
    1. Make or receive phone calls
      1. Never
      2. Rarely
      3. Sometimes
      4. Usually
      5. Always
      6. I don’t drive
    2. Read or send text messages
      1. Never
      2. Rarely
      3. Sometimes
      4. Usually
      5. Always
      6. I don’t drive
    3. Use hands-free phone technology
      1. Never
      2. Rarely
      3. Sometimes
      4. Usually
      5. Always
      6. I don’t drive
  9. Do you favor or oppose policies that would:
    1. Add extra taxes to soda pop and other sugar-sweetened beverages?
      1. Strongly oppose
      2. Somewhat oppose
      3. No opinion
      4. Somewhat favor
      5. Strongly favor
    2. Restrict the use of handheld cell phones while driving?
      1. Strongly oppose
      2. Somewhat oppose
      3. No opinion
      4. Somewhat favor
      5. Strongly favor
    3. Require school districts to limit or restrict unhealthy food options for students during the school day?
      1. Strongly oppose
      2. Somewhat oppose
      3. No opinion
      4. Somewhat favor
      5. Strongly favor
    4. Prohibit smoking and vaping in outdoor public areas such as parks, recreation areas, playgrounds, or trails?
      1. Strongly oppose
      2. Somewhat oppose
      3. No opinion
      4. Somewhat favor
      5. Strongly favor
    5. Prohibit the sale of flavored (including menthol, mint, or fruit) tobacco products and vape juice flavors?
      1. Strongly oppose
      2. Somewhat oppose
      3. No opinion
      4. Somewhat favor
      5. Strongly favor
  10. What do you feel are the greatest local concerns or issues impacting the health of the people of Larimer County? While we will keep your responses confidential, we ask that you not provide personal identifying information, such as your name.