Health Disparities Survey Statistics at Survelum Public Data Bank |
| Data collected: 155 survey responses Click on underlined response options to use corellation filters |
Personal Background |
What is your age? | ||
| Under 21 | ||
| 21-30 | ||
| 31-40 | ||
| 41-50 | ||
| 51-60 | ||
| Above 60+ | ||
| Not Checked | ||
What is your race/ethnicity? | ||
| Caucasian | ||
| Asian | ||
| African American | ||
| Hispanic | ||
| Native American | ||
| Middle Eastern | ||
| Other | ||
| Do not know | ||
| Not Checked | ||
What is your highest level of education? | ||
| No formal education | ||
| Elementary school | ||
| Junior high school | ||
| High school | ||
| G.E.D | ||
| Home school | ||
| Associate degree | ||
| Bachelor's degree | ||
| Master's | ||
| Ph.D. | ||
| Not Checked | ||
What is your occupation? | ||
| Part-Time | ||
| Full-Time | ||
| Student | ||
| Healthcare | ||
| Military | ||
| Agriculture | ||
| Professional | ||
| Managerial | ||
| Retail | ||
| Sales | ||
| Education | ||
| Service | ||
| Other | ||
What area of the United States do you currently reside in? (As defined by the US Census) | ||
| Northeast | ||
| Midwest | ||
| South | ||
| West | ||
| Do not know | ||
| I live outside the United States | ||
| Not Checked | ||
Do you currently have health insurance? If no skip next three questions | ||
| Yes | ||
| No | ||
| Not Checked | ||
If "Yes" to the previous question, then what kind of insurance? | ||
| Managed Care | ||
| Fee for Service | ||
| Health Maintenance Organization (HMO) | ||
| Point of Service Plans (POS) | ||
| Preferred Provider Organization (PPO) | ||
| Medicare | ||
| Medicaid | ||
| Do not Know | ||
| Not Checked | ||
What types of services does your insurance cover? | ||
| Physical exams | ||
| Care by specialists | ||
| Hospitalization and emergency care | ||
| Prescription drugs | ||
| Vision care | ||
| Dental services | ||
| Care and counseling for mental health | ||
| Services for drug and alcohol abuse | ||
| Obstetrical-gynecological care and family planning services | ||
| Ongoing care for chronic (long-term) diseases, conditions, or disabilities | ||
| Physical therapy and other rehabilitative care | ||
| Home health, nursing home, hospice care, long-term care | ||
| Chiropractic or alternative health care, such as acupuncture | ||
| Experimental treatments | ||
| Other | ||
Are you satisfied with your medical coverage? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
If "No" to health insurance, has it ever hindered you from seeking medical attention? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
Which of the following health conditions have you had or currently suffer from? | ||
| Cancer, breast | ||
| Cancer, Colon | ||
| Cancer, lung | ||
| Cancer, Prostrate | ||
| Cancer, other | ||
| Heart disease | ||
| AID/HIV | ||
| Stroke | ||
| Mental Illness | ||
| Pneumonia/influenza | ||
| Asthma | ||
| Diabetes | ||
| Sexual transmitted disease | ||
| Do not know | ||
| Other | ||
Have you smoked more than 20 cigarettes? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
Do you exercise 3 or more times a week? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
On average do you consume more than 10 drinks in a week? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
How would you rate your health status? | ||
| Excellent | ||
| Good | ||
| Fair | ||
| Poor | ||
| Extremely poor | ||
| Do not know | ||
| Not Checked | ||
Do you believe health disparities have a direct relationship with health status? | ||
| Definitely | ||
| Somewhat | ||
| Possibly | ||
| Not at all | ||
| Do not know | ||
| Not Checked | ||
Have you ever been mistreated by a medical professional? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
If yes to previous question, do you believe it was because of your race? | ||
| Yes | ||
| No | ||
| Do not know | ||
| Not Checked | ||
The United States should have a universal healthcare plan. | ||
| Strongly Agree | ||
| Agree | ||
| Neutral | ||
| Disagree | ||
| Strong Disagree | ||
| Do not know | ||
| Not Checked | ||
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