Health Equity Survey - Angelina County & Cities Health District

We’re collecting information to continue working toward a healthier tomorrow for Angelina County.

NOTE: This survey is intended for residents of Angelina County. If you do not live in Angelina County, please do not complete this survey. This information is important and to help us gather accurate information, please complete this survey only one time.

Encuesta de Equidad En Salud - En Español

1. What is your home zip code?

2. What neighborhood or community do you live in?

3. How many years have you lived in your community?

4. What are the greatest strengths or best things in the community where you live? (list up to 3)

5. Do you have health insurance?

Yes

6. What do you think are the three most important health concerns in your community? (choose 3)

7. What do you think are the three most important things necessary for a “Healthy Community”? (Choose 3)

8. What is one thing that you would like to see improved in your community?

9. What (if any) barriers have you encountered getting tested for COVID-19 or accessing the COVID vaccine?

10. What is your age?

11. What is your gender identity?

Female

Male

Non-Binary, Genderqueer

Gender Neutral

Transwoman

Transman

Other

12. What is your sexual orientation?

Straight

Gay or Lesbian

Bisexual

Prefer not to answer

Other

13. With which racial and/or ethnic group(s)* do you identify? (check all that apply)

14. What is the highest level of education you have completed?

Some or no high school

High school graduate or GED

Vocational or technical school

Some college

College graduate or higher

15. How many people live in your household?

16. Are children living in your household? (check all that apply)

Yes, aged 0-4

Yes, aged 5-12

Yes, aged 13-17

No children in my household

17. Do you or does anyone in your household have a disability?

Yes

18. What is your annual household income?

*Race and ethnicity categories reflect definitions used in Census and health care data sets and are not an attempt to define race and ethnicity biologically, anthropologically, or genetically. We recognize that the race and ethnicity categories include racial, ethnic, and national origins and sociocultural groups.