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Union County On-Site Wate On-Site Water Protection Program Data 391 On-Site W 1,432 On-Site W Well Permits Issued 2,652 On-Site W Well Inspections/Site Visits 1068 Well Consultative Contacts Well Water Sampling Bacterial Analysis Bacteria Samples Type of Bacteria Contaminant Detected Number 518 Coliform bacteria Escherichia Coliform (E.coli) *Increased numbers of coli/e.coli may be attributed to the response to bacterio Inorganic Analysis Inorganic Conta Number of Samples Type of Sample Type of Nu Collected Collected Contaminant Pr Inorganic Le 326 Arsenic 72 Nitrate, Pesticide, Lead 5 224 Herbicide, Petroleum Iron 63 Manganese 11 Copper 1

er Protection Program Data Wastewater System Permits Issued 1,486 Wastewater System Inspections/Site Visits 4,995 Wastewater System Consultative Contacts 15,638 r of Samples Found to be Positive for the Presence of Contaminant 212 of 518 (40.9%)* 36 of 518 (6.9%)* ological test conducted after Hurricane Florence. aminants umber of Contaminants Above the Environmental rotection Agency’s (EPA) Maximum Contaminant evel (MCL) or Secondary Maximum Contaminant Level (SMCL) 2 of 326 were above the MCL of 0.010 parts per million (ppm) (22%) of 326 were above the MCL of 0.015 ppm (1.5%) 3 of 326 were above the SMCL of 0.3 ppm (19%) 11 of 326 were above the SMCL of 0.05 ppm (34%) of 326 were above the MCL of 1.3 ppm (0.3%)

2019 CHA Focus Are Chronic Disease Prevention • Conditions: Cancer, Diabetes, Heart Disease, Hig • Contributing Risk Factors: Nutrition / Healthy Eat Mental Health • Anxiety • Depression • Sleep Issues • Addiction • Suicide Prevention Substance Use Disorder • Alcohol • Prescription Drug Misuse • Opioids • Tobacco Use / Smoking / E-cigarettes Environmental • Vector Control • Water Quality • Access to Water • Outdoor Air Quality • Greenspace Access to Care • Insurance coverage • Affordable Health Services: Dental • Affordable Health Services: Mental Health • Affordable Health Services: Traditional Primary C • Transportation

eas To Be Prioritized gh Blood Pressure, Obesity ting, Physical Activity / Exercise, Tobacco Use Care

Appendix B: Teen, Adult, and Senior Adult Survey Questions 2019 Union County Community Health Assessment Appendix A-H

over the next six months, Union county Human Services, In collaboration with Novant Health and Atrium Health, will work together to develop the 2019 Community Health Assessment {CHA). The goal of CHA is to identify factors that affect the health of the population and determine the availability of resources within the county to address these factors. We need your input to help us identify health Issues and concerns facing Union County teens today, so we can help address them. Your voice and opinion matter to us. Please take about 10-15 minutes to complete the survey. The survey is anonymous. Your answers will not be connected to you in any way. Thank you for the gift of your time and for sharing your experiences and points of view. 1. What is your Zip Code? 0 28110 0 28173 0 28111 0 28174 0 28079 0 28112 0 28103 0 28113 0 28104 0 28105 2. In which Union County Town or Municipality do you reside? 0 Allan 0 Marvin Q Waxhaw 0 Fairview 0 Matthews Q Weddington 0 Goose Creek 0 Mineral Springs 0 Wesley Chapel 0 Wingate 0 Hemby Bridge 0 Monroe 0 Out of county 0 Unincorporated Union County 0 Indian Trail 0 New Salem 0 lake Park 0 Stallings 0 Marshville 0 Unlonville 3. What is your Age? 4. What Is your Gender? Q Female Q Transgender or Other Q Male Page 1 of 8 (Questions on both sides of page)

5, Using the categories below, what do you consider yourself? Q Black/ African American Q American Indian /Alaska Native Q Asian (Asian Indian, Chinese, Filipino, Japanese, l<orean, Vietnamese, or other Asian) Q Hispanic/ Latlno (Including Mexican, Mexican American, Chicano, Puerto Rican, Cuban, other Spanish) Q White / Caucasian/ European American Q Native Hawaiian / Pacific Islander Q Arab American / Middle Eastern Q Eastern European/ Russian /Post Soviet States Q Other (please specify) ------� 6. What type of health insurance do people in your home have? Q Q QGovernment Insurance (Affordable Healthcare Act) Q No Insurance Medicaid Private Insurance Q DoNotKnow 7. Overall, how would you rate your physical health? Q Q Q Q QVery Poor Health Poor Health Neither Poor Nor Good Health Good Health Excellent Health 8. Overall, how would you rate your mental health? QGood Mental Health Q Q QVery Poor Mental Healll1 Poor Mental Health Neither Poor Nor Good Mental Health Q Excellent Mental Health 9. Listed below are health concerns. Please check three that MOST concern you regarding your own health. 0 Obesity/ oveiweight D Asthma D Allergies O STDs D Poor dental health D HIV/AIDS D Sports Injuries 0 Eating Disorders D Cancer O Teen Pregnancy D Chronic Diseases (heart disease, diabetes, high blood pressure) Other (please specify) _] C ·---______ Page 2 of 8 (Questions on both sides of page)

10.Listed below are mental health concerns. Please check three that MOST concern you. D D ·oAddiction Bipolar Disorder Opioid or Drug Addiction D Anxiety D Depression D Schizophrenia D Attention Deficit Disorder /Attention D Intellectual Developmental Disability D Sleep Issues Deficit Hyperactivity Disorder D Obsessive Compulsive Disorder D suicide D Autism 11.Listed below are safety concerns. Please check three that MOST concern you. D Alcohol Abuse D Internet Safety D Bullying D School Violence D Domestic Violence (Violence at home) D Self-Injury/ Cutting D Drowning D Sexual Assault / Rape I Date Violence D Drug Abuse / overdosing D Suicide D Gang Violence / intimidation Other safety concern, please 11st: 12. If you have any safety concerns, who would you most likely report them to: 0 Clergy (Pastor, Minister, Reverend) 0 Parent 0 Counselor 0 Teacher 0 Friend 0 I would not report these concerns 0 Other (please specify) 13.Listed below are safety hazards related to driving. Please check ALL that apply to you. D Texting / Snap Chatting/ Use of Apps while I drive D Driving under the Influence (drugs or alcohol) D Talking on cell phone while I drive D Reckless Driving / Speeding Page 3 of 8 (Questions on both sides of page)

14. Listed below are behaviors that keep people from being healthy. Please check the three that you feel keep teens In Union county from being healthy. D Poor Eating Habits D Alcohol Use D Bullying D Tobacco Use D Drug Use D Unsafe Living condllions / Instability at Home D Internet Safety D Unsafe sex I Unprotected Sex D Lack of Exercise D Youlh Violence D Not Going to the Doctor D Marijuana Olher behaviors, please list: 15. Approximately how much time do you spend daily on social media? (I.e. lnstagram, Twitter, Snap Chatting, Textlng) Q None Q l hour or less Q 2 hours Q 3 hours Q 4 hours or more 16. How much screen time do you spend daily? (TV, video games, computer, cell phone) Q 1 hour or less Q 2 hours Q 3 hours Q 4 hours or more 17. How do you view your weight? Q Normal Q Underweight Q Overweight Q Obese Q Morbidly Obese 18. Do you feel your current weight is impacting your health status? QYes QNo 19, Do you have a medical home (doctor you see on a regular basis)? QYes QNo 20. Was there a time that you needed to see a doctor.during the last 12 months but did not? Q Yes Q No Page 4 of 8 (Questions on both sides of page)

21, /fyes, what was the main reason(s) that you did not see a doctor? (Check ALL that apply) D Old not have the money to go 0 I was afraid / I don't like to go to the doctor D No Insurance O Did not know who to call or where to go D I had no transportation 0 Office was not open when I could get there Other reason: 22. Have you ever felt that you needed mental health services and did not get them? QYes QNo 23. If yes, why did you not go for mental health services? ( Check ALL that apply) 0 Did not have the money to go 0 Did not know who to call or where to go D No insurance D I do not trust doctors 0 Insurance does not pay tor mental health services 0 Office was not open when I could get there 0 I had no transportation D Language Barrier 0 I was afraid / I don't like to go to the doctor D Embarrassed 24. Do you see a dentist on a regular basis? 0 No Q Yes 25. Was there a time during the last 12 months when you needed to see a dentist but did not? Q Yes Q No 26. Ifyes, what was the main reason that you did not see a dentist? [-] Did not have the money to go D I was afraid / I don't like to go to the dentist D No Insurance 0 Dfd not know who to call or where to go D I had no transportation 0 Otflce was not open when I could get there Other reason: C__ Page 5 of 8 (Questions on both sides of page)

27. Where do you go MOST OFTEN when you are sick and need medical care? Choose ONLY one. 0 Doctor's omce in Union County Q Emergency Department outside Union County 0 Doctor's office outside Union County Q Urgent Care Facility in Union County 0 QAtrium Health Care union Emergency Room (formeny CMC) Minute Clinic in Union County other: 28. Have you needed a prescription medication and did not get it? Q Yes Q No 29. If yes, why did you not get your medicine? D Did not have the money D Pay other bills (food, gas, utilities) D Insurance would not cover the medication D No transportation to Pharmacy Other (please specify) 30. Check ALL preventative health services you had during the past 12 months: D Physical Exam D Immunizations (flu shot, Tdap, etc.) D Eye Exam (vision) D None - Haven't been to the doctor in the last 12 months for preventative health services. D Hearing Check 31. !fyou did not receive any preventative services, please indicate why. Check ALL that apply. 0 Nomoney D I only see a doctor for an urgent medical problem 0 No insurance coverage [] I do not have a medical doctor 0 Do not feel prevention services are necessary 32. How do you normally get to your healthcare appointments? 0 Drive myself - Personal car 0 Bicycle 0 Union county Public Transportation 0 Wall< 0 Taxi I Uber/ LYFT 0 Do not have transportation, so don't go to healthcare 0 Family Member / Friend providers Page 6 of 8 (Questions on both sides of page)

33. How many days a week do you normally get 30 minutes of exercise? 0 None O 1 0 2 0 3 04 0 5ormore 34. Outside of exercising at school, are you physically active? O Yes 0 No 35. Are there enough opportunities for physical activity near your home? O Yes 0 No 36. How many servings of fruits and vegetables do you normally eat per day? 0 None O 1 02 03 0 4 0 5ormore 37. Do you buy your lunch at school? 0 No 0Yes 38. Jfyes, what do you eat most often? 0 Snack Food Qce cream, cookies, chips) 0 School Lunch (meal of the day) 0 Al La Carle Menu (french fries, pizza, chlclcen sanllwlch, etc.) 39. Is this your ONLY meal of the day? 0 No O Yes 40. lfyoudo notbuy yourlunch, why do you not buy lunch? 0 Do not like food choices D Nomoney 0 Bring my lunch from home O Don't eat lunch Other reason: 41. Where do the majority of your meals outside of school come from? Q Home prepared / cooked meals Q Prepared Foods from Grocery Store Dell (Rotisserie chicken, Q Fast Food Restaurant Q Dine�in Restaurant sub sandwich, etc) Q Frozen Food / Microwave Meals Other (please specify) ----�--·---! Page 7 of 8 (Questions on both sides of page)

42. After school gets out each day, or during the summer how do you spend your time? Check ALL that apply: D Hanging out with friends D Playlng sports (on a school or league team) 0 Playing sports (recreation • just for fun) 0 Partying (drinking I recreational drugs) [] Doing homework D Home alone, or with siblings D Working Qob) 0 Video games D Hobbies 43. Please check if you do the following: D Smoke Tobacco D Take Recreational Drugs D Drink Alcohol D Vape / .Juul / smoke e�cigarettes D Opioid Use 0 Smoke Marijuana 44. Ifyou checked any of the above, do you believe this impacts your health? Q Yes Q No 45.Do you have any other concerns about the health of teens in Union County? C_____J Thank you for taking the time to help us understand your perspective and identify key factors that impact the overall health of our local Union County residents. Please encourage your family and friends to provide their input as well. The Community Health Assessment survey can be completed on-line at UnloncountyNC.gov by clicking the survey link on the County's homepage. Page 8 of 8 (Questions on both sides of page)

2019 Union County Community Health Assessment Survey For Adults (18 - 61) Over the next six months, Union County Human Services, in collaboration with Novant Health and Atrium Health, will work together to develop the 2019 Community Health Assessment (CHA). The goal of CHA is to identify factors that affect the health of the population and determine the availability of resources within the county to address these factors. We need your input to help us identify health issues and concerns facing Union County adults today, so we can help address them. Your voice and opinion matter to us. Please take about 10-15 minutes to complete the survey. The survey is anonymous. Your answers will not be connected to you in any way. Thank you for the gift of your time and for sharing your experiences and points of view. 1. What is your Zip Code? 0 28110 0 28173 0 28111 0 28174 0 28079 0 28112 0 28103 0 28113 0 28104 0 28105 2. In which Union County town or municipality do you reside? 0 Altan 0 Marvin 0 Waxhaw 0 Fairview 0 Matthews 0 Weddington 0 Goose Creek 0 Mineral Springs 0 Wesley Chapel 0 Hemby Bridge 0 Monroe 0 Wingate 0 Indian Trail 0 New Salem 0 Out of County 0 Lake Park 0 Stallings 0 Unincorporated Union County 0 Marshville 0 Unionville 3. What is your Age? 4. What is your Gender? Q Female Q Transgender or Other Q Male Page 1 of 10 (Questions printed on both sides of page)

5. Using the categories below, what do you consider yourself? Q Black/African American Q American Indian / Alaska Native Q Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or other Asian) Q Hispanic/ Latino (including Mexican, Mexican American, Chicano, Puerto Rican, Cuban, other Spanish) Q White/ Caucasian/ European American Q Native Hawaiian / Pacific Islander Q Arab American I Middle Eastern Q Eastern European / Russian / Post Soviet States Q Other (please specify) 6. What is your highest level of education? Q Some college (no degree) Q Bachelor's degree Q Less than 9th grade Q Graduate or professional degree Q 9-12 grade, no diploma Q High School graduate (or GED/equivalent) Q Associate's Degree or Vocational Training Q Other (please specify) 7. Are you a veteran or have you served in the military? Q Yes Q No 8. What type of health insurance do people in your home have? Q Government Insurance (Affordable Healthcare Act) Q Private Insurance Q Medicaid Q No Insurance Q Medicare o Military /VA 9. What most closely describes your income level? 0 Less than $10.000 0 $25,000 to $34,999 0 $75,000 to $99.999 0 $100.000 or more 0 $10,000 to $14,999 0 $35,000 to $49.999 0 Choose not to answer 0 $15.000 to $24,999 0 $50,000 to $74,999 Page 2 of 10 (Questions printed on both sides of page)

10. Do you feel your income or economic situation is negatively impacting your ability to access medical care or services? Q Yes Q No 11. Overall, how would you rate your physical health? Q Q Q Q QVery Poor Health Poor Health Neither Poor Nor Good Health Good Health Excellent Health 12. Overall, how would your rate your mental health? Q Q Q QVery Poor Mental Health Poor Mental Health Neither Poor Nor Good Mental Health Good Mental Health Q Excellent Mental Health 13. Listed below are health concerns. Please check three that MOST concern you regarding your own health. D Cancer D Vision issues D Unplanned Pregnancy D Diabetes D Hearing issues D Stroke / Heart Disease D High blood pressure D Caregiver Stress D Obesity D Respiratory Illness/ COPD D Drug Abuse/Overdose D Influenza/ Pneumonia D Alzheimer's Disease/Dementia D Dental health D Alcohol Abuse/ Use D Kidney Disease Other (please specify) 14. Listed below are mental health concerns. Please check three that MOST concern you. D Addiction D Bipolar Disorder D Suicide D Obsessive Compulsive Disorder D Intellectual Developmental Disability [J Anxiety D Schizophrenia D Attention Deficit Disorder/ Attention D Sleep Issues D Autism Deficit Hyperactivity Disorder D Depression D PTSD Other safety concern (please specify) Page 3 of 10 (Questions printed on both sides of page)

15. Listed below are behaviors that can cause poor health outcomes. Please check up to three most critical behaviors you feel keep people in Union County from being healthy. D Alcohol Use D Lack of Exercise D Not Getting Doctor Check Ups D Prescription or Illicit Drug Use D Caregiver Stress D Poor Eating Habits D Instability at Home D Reckless / Unsafe Driving [] Tobacco Use D Unsafe Sex/ Unprotected sex D Unsafe Living Conditions D Domestic Violence D Stress Other behaviors (please specify) 16. If you were in an abusive situation / relationship, would you know who to call, or how to report it? Q Yes Q No 17. In your opinion, which THREE issues or services most affects the quality of life in Union County? D Dropping out of school D Lack of literacy/Not be able to read D Homelessness D Lack of recreational facilities (parks, trails, community centers, D Hunger D Lack of affordable housing pools, etc.) D Lack of care to elderly who cannot leave their homes D Lack of child care D Lack of recreational programs for youth D Lack of educational opportunities D Lack of transportation D Low income/poverty Lack of healthy food choices or affordable healthy food D Pollution (of air, water, land) D Lack of job opportunities Poor housing conditions D Other (please specify) D Unemployment 18. How do you view your weight? Q Q Q Q QNormal Underweight overweight Obese Morbidly Obese 19. Do you feel your current weight is impacting your health status? Q Yes Q No 20. Do you have a medical doctor you see on a regular basis? Q Yes Q No Page 4 of 10 (Questions printed on both sides of page)

21. Was there a time that you needed to see a doctor during the last 12 months but did not? Q Yes 0 No 22. If yes, what was the main reason(s) you did not see a doctor? D Did not have the money to go D I do not trust doctors D No insurance D Did not know who to call or where to go D I had no transportation D Office was not open when I could get there D I was afraid / I don't like to go to the doctor D Language Barrier D Other reason: 23. Do you see a dentist on a regular basis? 0 No Q Yes 24. Was there a time during the last 12 months when you needed to see a dentist but did not? Q Yes 0 No 25. If yes, what was the main reason you did not see a dentist? D Did not have the money to go D I do not trust dentists D No insurance D Did not know who to call or where to go D I had no transportation D Office was not open when I Could get there D I was afraid/ I don't like to go to the dentist D Language Barrier Other reason: 26. Where do you go MOST OFTEN when you are sick and need medical care? Choose ONLY one. Q Doctor's office in Union County Q Urgent Care Facility in Union County Q Doctor's office outside Union County Q Minute Clinic in Union County Q QAtriumHealth Care Union Emergency Room (formerly CMC) Do not see a doctor� Use Naturopathic Remedies Q Emergency Department outside Union County Q Other: Page 5 of 10 (Questions printed on both sides of page)

27. Have you ever felt that you needed mental health services and did not get them? Q es Q No 28. If yes, why did you not go for mental health services? Check ALL that apply: D Did not have the money to go D I do not trust doctors D No insurance D Did not know who to call or where to go D Insurance does not pay for mental health services D Office was not open when I could get there D I had no transportation D Language Barrier D I was afraid / I don't like to go to the doctor D Embarrassed 29. Have you needed a prescription medication and did not get it? Q Yes Q No 30. If yes, why did you not get your medicine? D Insurance would not cover the medication D No transportation to Pharmacy D Did not have the money 0 Do not use medications (prefer alternative medicines I D No insurance D I had to pay other bills (food, gas, utilities) naturopathic) D Other (please specify) 31. Do you keep an emergency supply of your medications? Q Yes 0 No 0 NA 32. Have you changed the way you take your prescription medications without talking to a doctor? Q Yes Q No 33. If Yes, check all the reasons you changed the way you take your medicine: D Save money D Cut daily dosage to make prescription fast longer D Did not like the way the medicine made me feel D Shared prescription with someone else D Did not think the medicine was working [-] Did not understand how to take it D Took medicine every other day to make prescription last longer Page 6 of 10 (Questions printed on both sides of page)

34. Check ALL preventative health services you had during the past 12 months: D Physical Exam D Cholesterol Check D Pap Smear D Eye Exam (vision) D DBlood Glucose (Diabetes screening) Prostate Exam D Hearing Check D Colonoscopy D DHypertension (Blood Pressure check) Mammogram 35. If you did not receive any preventative services, please indicate why. Check ALL that apply. D No money D Only see a doctor for an urgent medical problem D No insurance D I do not have a medical doctor D No insurance coverage for prevention services D Use alternative medicine (naturopathic, holistic, etc.) D Do not feel prevention services are necessary D No time to go to a doctor 36. Did you receive a flu vaccine within the past year? Q Yes 0 No 37. If you did not receive a flu vaccine, please indicate why. CheckALLthat apply. D DNot sure where to get the flu vaccine or lack of transportation I do not believe that the flu vaccine is effective l1 Could not afford the flu vaccine D Concerned that I would have a serious reaction to the flu vaccine D DGenerally healthy, so I do not feel that I need the flu vaccine l have a chronic medical condition(s) and am afraid the flu D Concerned that I would get the flu from the vaccine vaccine will make me sick D Religious objection to vaccines D Other (please specify) 38. If you have a child or children age 6 or younger, is your child up to date on recommended immunizations? Q Yes Q No Q I do not have a child age 6 or younger Page 7 of 10 (Questions printed on both sides of page)

39. If you answered NO to the above question, please indicate why. Check ALL that apply. D My child does not have a primary doctor D I do not believe that vaccines are necessary because the diseases are not serious or are uncommon D I d!:!sire more information from my child's doctor D No money for vaccines and/or my child is uninsured D I am concerned that my child will have a serious reaction to the vaccine(s)/vaccines are unsafe D DI do not want my child to have multiple shots in one doctor's I am concerned that there is a link between vaccines and office visit autism D My child is not in daycare, so he/she is not exposed to D Religious objection to vaccines diseases D I believe that my child's immune system will be stronger if they contract a preventable disease D Other (please specify) 40. How do you normally get to your healthcare appointments? 0 Drive Myself� Personal Car 0 Family Member I Friend 0 Do not have transportation, so don't go to healthcare provider 0 Bicycle Union County Public Transportation 0 Walk 0 Taxi/ Uber/ LYFT 41. Where do you get most of your health information? Check ONLY one. Q My Doctor Q Internet Q Pharmacist Q Family / Friends Q TV Other (please specify) �--------------- 42.How many days a week do you normally get 30 minutes of exercise for fitness? Q Q Q Q Q QNone One Two Three Four Five or more 43. Are there enough opportunities for physical activity near your home? Q Yes Q No 44.How many servings of fruits and vegetables do you normally eat per day? Q Q Q Q Q QNone One Two Three Four Five or more 45. Do you purchase locally grown fruits/ vegetables at retail markets, farm stands or Farmers Markets? Q Yes Q No Page 8 of 10 (Questions printed on both sides of page)

46. Where do the majority of your meals come from? Q Home prepared / cooked meals Q Prepared Foods from Grocery Store Deli (Rotisserie chicken, Q Fast Food Restaurant Q Dine�in Restaurant sub sandwich, etc) Q Frozen Food / Microwave Meals Q Garden (home grown/ home canned) Other (please specify) 47. Please check if you do any of the following: D Smoke (cigarettes, cigars, pipe D Smoke Marijuana D Drink Alcohol tobacco) D Use Recreational Drugs D Use Opioids D Use smokeless tobacco (Chew/Dip/Snuff) D Vape/Juul/Smoke e�cigarettes 48. If you checked any of the above, do you feel this impacts your health negatively? Q Yes Q No 49. Listed below are safety hazards related to driving. Please check ALL that apply to you. D Texting/Snap Chatting/Use of Apps while driving D Driving under the influence (drugs or alcohol) D Talking on cell phone while I drive [] Reckless Driving / Speeding 50. Approximately how much time do you spend daily on social media? (Facebook, Instant Messaging, Snap Chatting, Texting) Q Q Q Q QNone 1 hours or less 2 hours 3 hours 4 hours or more 51. How much screen time do you spend daily? (TV, video games, computer, cell phone) Q Q Q Q1 hour or less 2 hours 3 hours 4 hours or more Page 9 of 10 (Questions printed on both sides of page)

52. Environmental Health (Check one answer per row) Outdoor Air Quality Great Concern Some Concern No Concern Indoor Air Quality (mold, 0 0 0 allergens, etc) 0 0 0 0 0 0 Stream Water Quality 0 0 0 0 0 0 Preserving Green Space 0 0 0 Vector Control 0 0 (mosquitoes) 0 0 Solid Waste Disposal 0 0 0 0 (appliances, mattresses, tires, etc.) Access to Convenience 0 Centers for Trash Disposal 0 0 Bioterrorism 0 Weather Disasters / Storm Debris Food Borne Illness 53. What type of drinking water do you have? D WellWater D Public Water Supply 54. Are you concerned about your drinking water? 0 No Q Yes 55. If yes, what is your primary concern? D Taste D Smell D Afraid of what is in the water c-----------other (pleasespecify) 56. Is there anything that could be done to improve the health of adults in Union County? Please explain. Thank you for taking the time to help us understand your perspective and identify key factors that impact the overall health of our local Union County residents. Please encourage your family and friends to provide their input as well. The Community Health Assessment survey can be completed on-line at UnionCountyNC.gov by clicking the survey link on the County's homepage.

Over the next six months, Union County Human Services, in collaboration with Novant Health and Atrium Health, will work together to develop the 2019 Community Health Assessment (CHA). The goal of CHA is to identify factors that affect the health of the population and determine the availability of resources within the county to address these factors. We need your input to help us identify health issues and concerns facing Union County seniors today, so we can help address them. Your voice and opinion matter to us. Please take about 10·15 minutes to complete the survey. The survey is anonymous. Your answers will not be connected to you in any way. Thank you for the gift of your time and for sharing your experiences and points of view. 1. What is your Zip Code? 0 28110 0 28173 0 28111 0 28174 0 28079 0 28112 0 28103 0 28113 0 28104 0 28105 2. In which Union County town or municipality do you reside? 0 Allan 0 Marvin Q Waxhaw 0 Fairview 0 Matthews 0 Weddington 0 Goose Creek 0 Mineral Springs 0 Wesley Chapel 0 Hemby Bridge 0 Monroe Q Wingate 0 Indian Trail 0 New Salem 0 Lake Park 0 Stallings 0 Out of County 0 Marshville 0 Unionville 0 Unincorporated Union County 3, What Is your Age? 4. What is your. Gender? Q Male Q r.;emale Q Transgender or Other Page 1 of 11 (Questions are printed on both sides of page)

5. Using the categories below, what do you consider yourself? Q Black/African American Q American Indian/ Alaska Native Q Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or other Asian) Q Hispanic / Latino (Including Mexican, MexicanAmerican, Chicano, Puerto Rican, Cuban, other Spanish) Q White I Caucasian/ European American Q Arab American I Mlddle Eastern Q Eastern European / Russian / Post Soviet States Q Other (please specify) 6. What Is your highest level of education? 0 Less than 9th grade 0 Assoclate's Degree or Vocational Q Graduate or professional degree 0 9·12 grade, no diploma Training 0 High School graduate (or some college (no degree) GED/equivalent) 0 Bachelor's degree 0 Other (please specify) 7. Are you a veteran or have you served in the military? Q Yes Q No 8. What type of health insurance do people in your home have? Q Government Insurance (Affordable Q Medicare Q No Insurance Q Private Insurance Q Military/VA Healthcare Act) Q Friend Q Medicaid 9. Do you live alone? 0 No Q Yes 10. If no, you do not live alone, who do you live with? Q Spouse Q Family Q other (please specify) Page 2 of 11 (Questions are printed on both sides of page)

11. What most closely describes your Income level? 0 less than $10,000 0 $25,000 to $34,999 0 $75,000 to $99,999 0 $10,000 to $14,999 0 $100,000 or more 0 $35,000 to $49,999 Q $15,000 to $24,999 0 Choose not to answer Q $50,000 to $74,999 12. Do you feel your income or economic situation Is negatively Impacting your ability to access medical care or services? Q Yes Q No 13. Overall, how would you rate your physical health? Q Q QVery Poor Health Q Good Health Q Excellent Health Poor Health Neither Poor Nor Good Health 14. Overall, how would you rate your mental health? Q Q Q QVery Poor Mental Health Poor Mental Health Neither Poor Nor Good Mental Health Good Mental Health Q Excellent Health 15. Listed below are health concerns. Please check three that concern you MOST. D Cancer D Dental Health D Alcohol Abuse/Use D Diabetes D Falling D High blood pressure D Hearing Issues D Kidney Disease D Respiratory Illness I COPD D Stroke/ Heart Disease D Vision Issues D Obesity D Alzhelme�s Disease / Dementia D Drug Abuse/Overdose D Influenza/ Pneumonia D Other (please specify) 16. Listed below are mental health concerns. Please check three that concern you MOST. 0 Addiction D Obsessive Compulsive Disorder D Intellectual Developmental Disability D Anxiety D Schizophrenia D Attention Deffcit Disorder I Attention D Autism D Sleep tssues Deficit Hyperactivity Disorder PTSD Depression D Suicide D Bipolar Disorder D caregiver Stress 0 other mental health concern (please specify) Page 3 of 11 (Questions are printed on both sides of page)

17.Listed below are behaviors that can cause poor health outcomes. Please check up to three behaviors you feel keep people In Union County from being healthy. D Alcohol Abuse D Unsafe Sex D Poor Eating Habits D Prescription or Illicit Drug Use D Domestic Violence D Not Getting Doctor Check Ups D Tobacco Use D Lack of J=xerclse D Reckless / Unsafe Driving Other behaviors (please specify) 18.Listed below are safety concerns that can impact your health. Please check three that concern you: D Instability at Home D Falling D Memory Problems/ Confusion D Unsafe Living Conditions D Neglect D Unable to Manage / Understand D Elder Abuse D Not Enough Food Medications Other safety concerns (please specify) 19. If you were in an abusive situation / relationship, would you know who to call, or how to report It? QYes QNo 20. In your opinion, which THREE issues or services most affects the quality of life In Union County? D Dropping out of school D Lack of job opportun\\tles D Homelessness D Lack of literacy/not be able to read D Hunger D Lack of recreational facilities {parks, tralls, community centersf D Lack of affordable housing pools, etc.) Lack of care to elderly who cannot leave their homes D Lack of transportation D Low Income/poverty Lack of child care D Pollution (of air, water, land) D Poor housing conditions D Lael< of educational opportunities D unemployment D Lack of heallhy food choices or affordable healthy food D Other (please specify) 21. How do you vlewyour weight? Q Obese Q Morbidly Obese Q Normal Q Underweight Q overweight Page 4 of 11 (Questions are printed on both sides of page)

22. Do you feel your current weight is impacting your health status? QYes QNo 23. Do you have a medical doctor you see on a regular basis? Qves QNo 24. Was there a time that you needed to see a doctor during the last 12 months but did not? Qves QNo 25. /fyes, what was the main reason you did not see a doctor? D Did not have the money to go D I do not trust doctors D No Insurance D Did not know who to call or where to go D I had no transportation D Office was not open when I could get there D I was afraid / I don't lll<e to go to the doctor D Language Barrier Other reason; 26. Do you see a dentist on a regular basis? Q No Q Yes 27. Was there a time during the last 12 months when you needed to see a dentist but did not? Qves QNo 28. /(yes, what was the main reason you did not see a dentist? D Did not have the money to go [] I do not trust dentists D No Insurance D Did not know who to call or where to go D I had no transportation D Office was not open when I could get there D I was afraid/ I don't like to go to the dentist D Language Barrier Other reason: Page 5 of 11 (Questions are printed on both sides of page)

29. Where do you go when you are sick and need medical care? Choose ONLY one. 0 Doctor's office In Union County Q Emergency Department outside Union County 0 Doctor's office oulslde Union County Q Urgent Care Facility in Union County 0 Atrium Health care Union Emergency Room (formerly CMG) Q Minute Clinic in Union County other: 30. Have you ever felt that you needed mental health services and did not get them? QYes QNo 31. Jfyes, why did you not go for mental health services? Check ALL that apply: D Did not have the money to go D Did not know who to call or where to go D No insurance D Office was not open when I could get there D I had no transportation D Language Barrier 0 I was afraid / I don't like to go to the tioctor D Embarrassed D I do not trust doctors 32. Have you needed a prescription medication and did not get it? QYes Q No 33. /fyes, why did you not get your medicine? D Insurance woufd not cover the medication D No transportation to Pharmacy D Did not have the money D Do not use medications (prefer alternative meellcines I D No insurance naturopathlc) [] I had to pay other bills (food, gas, utilities) Ether (please specify) __J 34. Does anyone help you take or manage your medications? ONA o� o� 35. Have you changed the way you take your prescription medications without talking to a doctor? QYes QNo Page 6 of 11 (Questions are printed on both sides of page)

36.lf Yes, check a.II the reasons you changed the way you tak,i your medicine: 'i D s�vemoney D cut dally dosage to make prescription last longer D Did not like the Way the medicine made me feel D Shared prescriptlon with someone else D bid not understand how to iake medicine D Did not think the medicine was working D !ook medicine ·every other day.to make prescrlptjon _last longer 37. Do you receive any home health services in your ho.me? QYes .QNo Q NA Q NA 38. Do you receive any non;medical iri home assistance? Q Yes Q No 39. Do you keep an emergency supply of your medications? QYes QNo Q NA 40.Check ALL preventative health services you had during the pasi 12 months: 0 Physical Exam O Cholesterol Check D PrOState EXam 0 Eye Exam {vision) 0 Blood Glucose (Diabe{e� screening) D None � Have not Seen 8. <;fodcir:111 ·1aSt D Hearing check O colonoscopy 12 months for preventativ� healtil 0 0Hypertension {Blood Pressure check) Mammogram 41, Ifyou did notreceive anypreventative seiv/ces, please indicate why. Check.ALL thatapply.. D No money D I only see a doctor /or an urgent medical problem D N_o tnsuranc� cov!,�ra. Qe .for pr'�\\l,enlion ser.,:lces. D I do not have a medical doctor ·. [] DO riot_.f�e\\ prevf!ntlo_rt Services ·are hecf!$Sary 42. Did you receive a flu vaccine within the pastyear? Q Yes Q·No Page 7 of 11 (Qllestions are printed ori b6th s·ides of f)afle)

43. lf you did not receive a nu vaccine, please indicate why. Check ALL that apply. D DNot sure where to get the flu vaccine or lack of transportation r do not belleve that the flu vaccine Is effective D Could not afford the flu vaccine D Concerned that I would have a serious reaction to the flu vaccine D Generally healthy, so I do not reel Iha! I need the nu vaccine D DConcerned that I would get the flu from the vaccine I have a chronic medical condltion(s) and am afraid the flu vaccine will make me sick D other (please specify) D Religious objection to vaccines 44, If you have a child or children age 6 or younger, is your child up to date on recommended immunizations? Q Yes 0 No Q I do not have a child age 6 or younger 45. ff you answered NO to the above question, please indicate why. Check ALL that apply. D My child does not have a primary doctor D I am concerned that my chlld will have a serious reaction to D I desire more information from my child's doctor the vaccine(s}/vaccines are unsafe D No money for vaccines a.nd/or my chlld is uninsured D I do not believethat vaccines are necessary because the diseases are not serious or are uncommon D DI do not want my child to have multiple shots in one doctor's I am concerned that there is a link between vaccines and office visit autism D My child Is not in daycare1 so he/she is not exposed to D Religious objection to vaccines diseases D I believe that my child's Immune system will be stronger Ir they contract a preventable disease D other (please specify) 46. How do you normally get to your healthcare appointments? 0 Drive Myself - Personal Car 0 Family Member/ Friend 0 Do not have transportation, s� don't go to healthcare provider 0 0Union County Public Transportation Bicycle 0 Taxi I Uber I LYFT 0 Walk Page 8 of 11 (Questions are printed on both sides of page)

47. Where do you get most of your health information? Check ONLY one. Q MyDoctor Q TV Q Family/ Friends Q Pharmacist Q Internet Other (please specify) [ ----- --� 48. How many days a week do you normally get 30 minutes of exercise? Q QQ Q Q QNone One TWo Three Four Five or more 49. Are there enough opportunities for physical activity near your home? Q No Q Yes 50. How many servings of fruits and vegetables do you normally eat per day? QQ None Q Q Q QOne 1\\Vo Three Four Five or more 51. Do you purchase locally grown fruits/ vegetables at retail markets, farm stands or Farmers Markets? Q Yes Q No 52. Where do the majority of your meals come from? D Home prepared / cooked meals D Frozen Food I Microwave Meals D Fast Food Restaurant D Garden (home grown/ home canned) D Dlnewln Restaurant D Meals on Wheels (County meals delivered to my home) D DPrepared Foolis from Grocery Store Deli (Rotisserie chlcl,en, Senior Nutrition Site sub sandwich, etc) Other (please specify) ___, _________[- 53. Please check if you do any of the following: D Smoke (cigarettes, cigars, pipe D Smoke Marijuana D Drink Alcohol tobacco) D Use Recreational Drugs [] Use smokeless tobacco D Use Oplolds (Chew/Dip/Snuff) D Vape/Juul/Smoke a-cigarettes 54. Ifyou checked anyofthe above, do you feel it impacts your health negatively? QYes QNo Page 9 of 11 (Questions are printed on both sides of page)

55.Listed below are safety hazards related to driving. Please check ALL that apply to you. D TexUng/Snap Chatting/ Use of Apps while I drive D Driving under the Influence (drugs or alcohol) D Talking on cell phone while I drive D Reckless Driving / speeding 56. Approximately how much time do you spend dally on social media? (Facebook, Instant Messaging, Snap Chatting, Texting) Q Q Q Q QNone 1 hours or less 2 hours 3 hours 4 hours or more 57.How much screen time do you spend daily? (TV, video games, computer, cell phone) Q Q Q Q QNone 1 hour or less 2 hours 3 hours 4 hours or more 58. Environmental Health (Check one answer per row) outdoor Air Quality Great concern Some Concern No Concern Indoor Air Quality (mold, 0 0 0 allergens, etc) 0 0 0 0 0 Stream Water Quality 0 0 0 0 0 0 Preserving Green Space 0 0 0 Vector Control 0 0 (mosquitoes) 0 0 SolidWaste Disposal 0 0 0 (appliances, mattresses, 0 0 tires, etc.) Access to convenience 0 Centers for Trash Disposal 0 0 Bloterrorism 0 Weather Disasters / Yard Debris Food Borne Illness 59. What type of drinking water do you have? D WellWater D Public Water Supply 60. Are you concerned about your drinking water? Q No Q Yes Page 10 of 11 (Questions are printed on both sides of page)

61./f Yes, what is your primary concern? 0 Taste/ smell L] Afraid of what Is In the water Other (please specify) 62.What specific things could be done to improve the health of Seniors in Union County? Please explain. Thank you for taking the time to help us understand your perspective and identify key factors that impact the overall health of our local Union County residents. Please encourage your family and friends to provide their input as well. The Community Health Assessment survey can be completed on-line at UnionCountyNC.gov by clicking the survey link on the County's homepage. Page 11 of 11 (Questions are printed on both sides of page)

Appendix C: 2019 Union County Community Health Survey Response Analysis Report 2019 Union County Community Health Assessment Appendix A-H

Union County Community Health Survey Response Analysis 2019 Adult, Senior and Teen Community Health Surveys Report Prepared by Annika Pfaender, Independent Consultant July 2019

Contents Introduction ..................................................................................................................................................................................... 3 Survey Distribution................................................................................................................................................................... 3 Methodology.............................................................................................................................................................................. 3 Data Limitations......................................................................................................................................................................... 4 Format ........................................................................................................................................................................................... 5 Suggestions for the Future.................................................................................................................................................... 6 Response Comparisons............................................................................................................................................................... 8 Rating Personal Health ........................................................................................................................................................... 9 Personal Health Concerns....................................................................................................................................................11 Quality of Life Issues..............................................................................................................................................................13 Access to Care ..........................................................................................................................................................................14 Weight, Physical Activity and Nutrition ..........................................................................................................................18 Risk Behaviors...........................................................................................................................................................................23 2019 Teen Survey Response Analysis ..................................................................................................................................25 Demographic Questions.......................................................................................................................................................26 Personal Health Questions ..................................................................................................................................................32 Community Health Questions............................................................................................................................................44 Access to Care Questions.....................................................................................................................................................47 At Risk Population: Teens Lacking Access to Medical Care................................................................................49 At Risk Population: Teens Lacking Access to Dental Care ..................................................................................54 At Risk Population: Teens Lacking Access to Mental Health Services............................................................58 Weight, Physical Activity and Nutrition Questions.....................................................................................................66 Risk Behaviors...........................................................................................................................................................................78 2019 Adult Survey Response Analysis .................................................................................................................................82 Demographic Questions.......................................................................................................................................................83 At Risk Population: Uninsured Adults.........................................................................................................................88 Personal Health Questions ..................................................................................................................................................91 Community Health Questions......................................................................................................................................... 101 2019 Community Health Survey Response Analysis Page 1

Access to Care Questions.................................................................................................................................................. 107 At Risk Population: Adults Lacking Access to Medical Care ........................................................................... 109 At Risk Population: Adults Lacking Access to Dental Care .............................................................................. 114 At Risk Population: Adults Lacking Access to Mental Health Services........................................................ 118 At Risk Population: Adults Lacking Access to Medications ............................................................................. 121 At Risk Population: Adults Unvaccinated Against Influenza ........................................................................... 131 Weight, Physical Activity, and Nutrition Questions................................................................................................. 136 At Risk Population: Adults Who Don’t Get Any Physical Activity.................................................................. 139 Risk Behaviors........................................................................................................................................................................ 148 Environmental Health Questions ................................................................................................................................... 153 2019 Senior Survey Response Analysis ............................................................................................................................ 157 Demographic Questions.................................................................................................................................................... 158 Personal Health Questions ............................................................................................................................................... 169 Community Health Questions......................................................................................................................................... 180 Access to Care Questions.................................................................................................................................................. 185 At Risk Population: Seniors Lacking Access to Medical Care ......................................................................... 187 At Risk Population: Seniors Lacking Access to Dental Care ............................................................................ 192 At Risk Population: Seniors Lacking Access to Mental Health Services...................................................... 197 At Risk Population: Seniors Lacking Access to Medications ........................................................................... 204 At Risk Population: Seniors Unvaccinated Against Influenza ......................................................................... 212 Weight, Physical Activity, and Nutrition Questions................................................................................................. 216 At Risk Population: Seniors Who Don’t Get Any Physical Activity ................................................................ 219 Environmental Health Questions ................................................................................................................................... 230 Appendices: Open-Ended Responses............................................................................................................................... 234 2019 Community Health Survey Response Analysis Page 2

Introduction The Community Health Survey is distributed as part of the Community Health Assessment process required of health departments in North Carolina and as part of the Community Health Needs Assessment process required of hospitals. In Union County, this process is a collaboration between Union County Human Services, NovantHealth and AtriumHealth. Survey Distribution The three survey instruments used in the Community Health Assessment process were built in Survey Monkey and distributed electronically throughout the Union County community following the convenience sampling model. Links to the survey were posted on the Union County Government and Human Services websites. Town and county officials, healthcare partners, and other community stakeholders shared links to the survey via email. Paper copies of the survey were available at the Union County Government Center, Union County Human Services, libraries, non-profit organizations, churches, and hospitals. Paper copies were collected by Human Services staff and entered manually into Survey Monkey. The surveys were distributed in May and June of 2019. Methodology A total of 4,343 surveys were collected via Survey Monkey and analyzed by the Consultant. • 2,408 Adult surveys, including 15 in Spanish • 1,086 Senior surveys, including 16 in Spanish • 849 Teen surveys, not including 1 in Spanish which was completed by an adult In order to ease the analysis process, the Spanish language surveys that were completed online were entered manually into the English version of the appropriate survey. Each of the three surveys were filtered within the Survey Monkey Analysis feature and exported via Excel files for use by the Consultant. All the data examined in the preparation of this report is compiled in three Data Workbooks, each of which contains both the overall responses for all questions as well as the responses for all of the stratified groups discussed in this report. The Union County 2019 Adult Survey Workbook, Union County 2019 Senior Survey Workbook, Union County 2019 Teen Survey Workbook are all available to the appropriate parties at Novant Health and Union County Health Department. Across the three surveys, there were almost 1,300 responses to the final open-ended question of the surveys (Q56. Is there anything that could be done to improve the health of adults in Union County? 2019 Community Health Survey Response Analysis Page 3

Please explain). It was beyond the scope of this project to complete the qualitative analysis of so many responses. They are all included in their entirety, sorted by question and alphabetically, in the three Appendices attached to this report. Appendix 1 includes all the open-ended responses from the Teen Survey, Appendix 2 includes such responses from the Adult Survey and Appendix 3 includes all open- ended responses from the Senior Survey. Stratified data is presented for some questions and falls within three categories: demographic groups (gender, race, education, and income), zip code groups, and town/municipality groups. In order to protect the identity of survey respondents, it is standard practice to suppress data that includes a small number of responses. Thus, if there were fewer than 50 respondents within a group (e.g. a specific race or zip code) they are not included in the data presented in this report. Data Limitations The data detailed in this report describes only the responses of the individuals who participated in the survey collection process. It does not reflect the views of the entire population of Union County. The table below compares the demographic representation of the three survey samples to the appropriate population data for Union County as a whole. Compared to their proportion in the total population of Union County, according to 2017 estimates from the American Community Survey/US Census Bureau: • The Teen Survey under-represents Black/African American and Hispanic/Latino residents. It adequately represents males and females. • The Adult Survey under-represents males, Hispanic/Latino residents, and the less well-educated. It over-represents females, Black/African American respondents, and those with a bachelor’s degree or higher. • The Senior Survey under-represents males, white residents, and the less well-educated. It over- represents females, Black/African American respondents, and those with a bachelor’s degree or higher. • While it is difficult to find comparable economic data, in the experience of the Consultant, community health surveys tend to under-represent those in lower-income brackets. 2019 Community Health Survey Response Analysis Page 4

Male Adult Total Senior Population Teen Population Female Survey Population Survey Over 60 Survey Under 18 White (2017) Black 23.3% (2017) 38.5% 45.6% 46.8% (2017) Hispanic 76.3% 49.3% 51.5% 51.3% HS or less 74.9% 50.7% 60.5% 54.4% 77.4% 48.7% Some college or 15.9% 81.5% 78.5% associate’s degree 11.5% 79.0% 86.6% 7.0% 11.6% 5.5% 10.9% 8.8% 15.7% BA or higher 13.5% 25.3% 16.4% 10.0% n/a Veteran 17.0% 30.5% n/a n/a 1.9% 3.3% n/a 21.3% 33.5% 34.3% 29.5% 53.2% 34.0% 43.2% 24.3% n/a n/a 5.3% 7.6% 21.1% 18.0% n/a n/a While the questions included in the survey are presumably well-tested and reliable, there is always a risk that individuals completing the survey (particularly teenagers) will not self-report their behavior honestly. Format The analysis provided in this report is not intended to be an exhaustive discussion of all nuances of the significant collection of data provided by the three survey samples. It is a summary with some additional details and highlights provided. This report presents in tables the response frequencies to all questions in each of the three surveys, with a basic narrative summary of the results below each table. Some data is also illustrated via charts. Select questions, as identified by the Consultant and where response rates allowed, are further explored via the presentation of stratified data in tables or charts. Stratified data is also summarized briefly in narrative form. Open-Ended Responses are handled according to the following protocol: If there were fewer than 30 responses in an open-ended text response category (e.g. Other, please specify:), they are briefly summarized below the data table presenting the responses for the question. If there were more than 30 responses, they are available in their entirety in the Appendices of this report. All charts are pasted into the document as image files and are thus easily copied, pasted and resized in other reports or documentation as needed by the end users. 2019 Community Health Survey Response Analysis Page 5

To help delineate the different surveys should portions of the report be excerpted for other uses, charts and tables pertaining to the Adult Survey are turquoise, charts and tables for the Senior Survey are dark blue, and charts and tables for the Teen Survey are aqua. The large tables presenting stratified data numerically are also copied and pasted as image files, because they are large and unwieldy to resize. The highest percentage in each COLUMN is highlighted in bold text in order to demonstrate how the top ranked choices varied in their importance (frequency) among the stratified groups. The highest percentage across each ROW is highlighted in YELLOW and the lowest percentage across each ROW is highlighted in GREEN in order to show the range of how the stratified groups felt about all answer choices. Pie charts are also subtly different among the three surveys, though green shades always indicate Yes and red shades always indicate No. Suggestions for the Future What follows are suggestions, albeit unsolicited, from the Consultant for future iterations of the survey process. • Make the age question a multiple-choice response question, where respondents can choose from a selection of age ranges (15-19, 20-24, 25-29, etc.). That will simplify the analysis and allow for age-based stratifications within the surveys (for instance, looking at what proportion of females over age 40 reported getting mammograms). It would also allow you to add a step in Survey Monkey where respondents who are not in the age group that should be taking in the survey (e.g. a 15 year old trying to take the Adult Survey), are bumped out of the survey and re- redirected to the appropriate one for their age group. • Given that many of the questions are aimed at the individual respondent and their personal concerns, shift the health insurance coverage question to be about the individual and not about the household. The wording of the question (and the fact that participants can only choose one answer) makes it a little problematic to understand what’s going on. • Make some select questions required: personal health concerns/mental health concerns/unhealthy behaviors, etc. They were more likely to be skipped than other questions and they’re not particularly invasive questions. Questions like the hazardous driving one or the substance use one also had high skip rates, but they are also more invasive and probably shouldn’t be required. • Make sure it’s very clear in the wording of the question when questions are about the individual and when they are about the broader community. • Consider adding a height and weight question so that BMIs can be calculated. Note that you have to be careful about how you format the open-ended response box so that the answers are 2019 Community Health Survey Response Analysis Page 6

all input as feet and inches, or you will get responses like 5.4 or five feet four inches, or typos. For it to be used to calculate a BMI, one field needs to be feet and another needs to be inches. I’m not sure now helpful it is to know how people view their own weight if there’s no understanding of what their actual weight is. • In the question asking Adults to report substance use, consider changing the alcohol option to measure excessive or binge drinking. Alcohol use by adults is not necessarily a risky behavior; in fact, consumers are often told that a glass of wine is beneficial. • Consider clarifying whether the question about screen time includes work-related activities. The YRBS asks about non-school screen use not general screen use. • Strive for consistency in answer choices where possible, to assure comparability across surveys. For instance, None was an answer choice for the preventive health services question on the Senior Survey and the Teen Survey but it was not an option on the Adult Survey. And None was an answer option on the screen time question on the Senior Survey but not the Adult Survey or the Teen Survey. These differences might have been simple oversights rather than intentional decisions. 2019 Community Health Survey Response Analysis Page 7

Response Comparisons (Note that not all survey questions were comparable across the three survey instruments. Only questions that were asked in the same way with the same answer choices are compared here.) 2019 Community Health Survey Response Analysis Page 8

Rating Personal Health • More than 70% of Union County respondents across all three surveys rated their physical health as good or excellent. • Teens were more likely than adults or seniors to rate their physical health as excellent. • Seniors were more likely than teens or adults to rate their physical health as poor. • A higher proportion of seniors felt their physical health was neither good nor bad compared to adults or teens. 2019 Community Health Survey Response Analysis Page 9

• More than 75% of respondents across all three surveys rated their mental health as good or excellent. • A higher proportion of seniors, compared to teens and adults, rated their mental health as excellent. • Teens were more likely than adults or seniors to rate their mental health as poor or very poor. • Teens were also more likely to rate their mental health as neither good nor bad compared to adults or seniors. 2019 Community Health Survey Response Analysis Page 10