Environmental Health Concerns & Community Impact Survey

Thanks for taking a few minutes to share how environmental conditions in your area affect your health. Your responses are completely confidential and anonymized. There are no wrong answers — this takes about 8 minutes and helps shape local health guidance.

Which environmental issues are you most concerned about when it comes to your own health or your family's?

• Air quality / pollution
• Extreme heat
• Water quality
• Wildfire smoke
• Flooding or extreme weather
• Pesticides or chemical exposure
• Mold or indoor air quality
• Climate change generally

Overall, how concerned are you that environmental conditions where you live could harm your health?

In the last 3 months, how often have you experienced the following?

In the last 30 days, which of these have you done to protect your health from environmental conditions?

• Checked an air quality or pollen index before going outside
• Stayed indoors on a high-pollution or extreme-heat day
• Worn a mask outdoors for air quality reasons
• Used an air purifier or filter at home
• Avoided tap water or used a filter/bottled water
• Rescheduled outdoor exercise due to conditions
• None of these

Rank these environmental health risks by how urgently you think your local health department should address them, most urgent first.

1. Air pollution
2. Extreme heat
3. Water contamination
4. Wildfire smoke
5. Chemical or pesticide exposure
6. Mental health impacts of climate anxiety

For each set, choose the intervention that would most and least improve your household's environmental health.

• Free air quality monitors for homes
• Cooling centers during heat waves
• Clearer public alerts about pollution or smoke days
• Free water quality testing
• Subsidized air filters or purifiers
• More neighborhood green space and tree cover
• Health provider guidance on environmental risks
• Public transit incentives to reduce emissions

How well do healthcare providers you've seen address environmental factors as part of your health, if at all?

How much do you trust local health authorities to give you accurate, timely information about environmental health risks?

Focus on the environmental health issue the respondent rated as most concerning or ranked highest. Ask them to describe a specific recent moment when it affected their health, mood, or daily plans, what symptoms or reactions they noticed, and what (if anything) would make them feel meaningfully safer. If they say they're not concerned about any environmental issue, probe why — indifference, lack of awareness, or genuine low local risk.

Is there anything else about environmental conditions and your health that you wish someone would ask or act on?

Which age range are you in?

• Under 18
• 18-24
• 25-34
• 35-44
• 45-54
• 55-64
• 65+
• Prefer not to say

What ZIP code or neighborhood do you primarily live in? (Prefer not to say is fine.)

Thank you for sharing your experience! Your answers feed directly into a report that helps health teams prioritize environmental health outreach and resources in your community.