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MCRHC Community Survey
Please fill out this survey to help Monmouth County Regional Health Commission tailor health education programs and services to your community's needs. Thank you!
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* Indicates required question
What town do you live in?
*
Your answer
What is your gender?
*
Your answer
What age range do you fall under?
*
Under 20
21-30
31-40
41-50
51-60
61-70
71+
What best describes your race/ethnicity
White
Black/African American
Latino/Hispanic
Asian/Asian American
Native American
Other (Please specify):
Clear selection
What do you feel are top health concerns for adults in your community? (select 3)
*
Mental health
Nutrition and physical activity
Substance abuse
Communicable diseases
Sexually transmitted infections (STIs)
Maternal/infant health
Domestic violence/sexual violence
Chronic condition management
Access to health services
Other:
Required
What are your top concerns for children/adolescents in your community? (select 3)
*
Mental health/suicide
Tobacco and vaping
Childhood obesity
Bullying
Substance abuse
Sexually transmitted infections (STIs)
Access to health services
Other:
Required
Please identify the most important unhealthy behaviors in your community:
*
Angry behavior/violence
Alcohol abuse
Child abuse
Elder abuse
Domestic violence
Lack of exercise
Poor eating habits
Reckless driving
Risky sexual behavior
Smoking
Other:
What barriers prevent you/others in the community from getting health information?
*
Lack of awareness of availability
Lack of interest or motivation
Biases/preconceived notions
Cultural/societal barriers
Communication barriers such as language or literacy
Other:
Required
Where do you get most of your health information?
*
Doctor/physician
Friends/family
Internet
Pharmacy
Faith-based organization
Other:
What kind of health education programs are you interested in?
*
Tabling events
Full-length presentation/workshops
Other:
Required
What programs do you want to see brought to the library/your community?
Your answer
Please check the 3 programs you would be most interested in attending:
*
Substance abuse prevention program
Comprehensive sex education program for teens
Creating inclusive environments for LGBTQ+ youth workshop
Chronic disease management program
Type 2 diabetes prevention presentation
Sexual assault/domestic violence prevention workshop
Internet safety workshop
Mental health workshop
Required
Is there anything else you would like to tell us about community concerns, health programs or services in the community? Please describe below:
Your answer
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