FY (Q4) Drought Questionnaire-California 2016

Drought Questionnaire_CA FINAL.docx

California Drought - Mariposa County, 2016 (Quarter 4)

FY (Q4) Drought Questionnaire-California 2016

OMB: 0920-1036

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Drought Community Assessment for Public Health Emergency Response – 2016

DK=Don’t Know Ref=Refused NA=Not applicable CATA= Check all that apply HH=Household

Form Approved

OMB No. 0920-1036

Exp Date: 12/17/2017

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Date: ____/______/2016 Cluster No.: _________________ Interview No.: _________________ Team name: _________

Demographics

Q1. Type of structure:

Single family Multiple unit Mobile home Other __________

Q3. Including yourself, how many people live in your HH? ___#___

Q4. Including yourself, how many people living in your HH are

Less than 2 years old? __#__ 2-17 years? __#__

18-64 years? __#__ 65+ years? __#__ DK Ref

Q2. Does your HH own or rent your place of residence?

Own Rent Other _________________ DK Ref

Communications

Q5. What is your HH’s primary source of information about the drought? (check ONE)

Newspaper TV Friends Family members

AM/FM radio Work Internet Place of worship

Other, _________________________ None DK Ref

Q7. What is the main language spoken in your HH?

English Spanish Other____________ DK Ref

Q8. Does anyone in your HH have any of the following that could be barriers to effective communication during an emergency? (CATA)

Impaired hearing

Impaired vision

Developmental/cognitive disability

Difficulty understanding written material

Difficulty understanding English

None DK Ref

Q6. What is your HHs most preferred method for receiving information about an emergency event? (check ONE)

TV Radio Text message Cell phone call Landline Internet NIXLE Word of mouth

Other _________________________________ DK Ref

Water Sources

Q9. Where did your HH water come from before the drought? (CATA)

Town, city, or county water system □ Small water system

Bottled water □ Private well (go to Q9a)

Cistern □ Surface water (river, lake, spring)

Other _______________________ □ DK □ Ref


Q9a. If well, in the last year, has your HH seen a decrease in water

production? Yes (go to Q9b) No DK Ref


Q9b. If yes, has your HH participated in the Mariposa County’s Dry

Well program? Yes No Unaware of program DK Ref

Q11. Does your HH use tap water for drinking and/or cooking?

Yes, drinking only Yes, cooking only Yes, drinking and cooking No □ NA, currently no running water DK Ref

Q12. Does your HH currently have reliable running water from a well or water system? Yes No (go to 12a) DK Ref


Q12a. What is the main barrier to getting running water in your

home? (check one)

Too expensive Well drillers are not available

Landlord needs to and has not Waiting for govt financial help

Waiting for govt to provide goods or services

Other ________________________ None/NA DK Ref

Q10. During the current drought, where does your HH water come from? (CATA)

Town, city, or county water system □ Small water system

Bottled water □ Private well

Cistern □ Surface water (river, lake, spring)

Other _______________________ □ DK □ Ref

Q13. Is your HH aware of any problems with the quality of your tap water? Yes No Does not use tap waterDK Ref

Q14. Has your HH noticed a change in the color, clarity, odor, or taste of your water? (CATA)

Color Clarity □ Odor □Taste □ None □ DK Ref

Drought Mitigation/Assistance Behavior

Q15. In response to water shortages, have you or members of your HH

Reduced water usage □ Yes □ No □ NA □ DK □ Ref

Created system to capture/reuse water □ Yes □ No □ NA □ DK □ Ref

Installed faucet aerators □ Yes □ No □ NA □ DK □ Ref

Repaired plumbing leaks □ Yes □ No □ NA □ DK □ Ref

Replaced appliances (washing machine) □ Yes □ No □ NA □ DK □ Ref

Replaced toilet with low-flush toilet □ Yes □ No □ NA □ DK □ Ref

Decreased washing HH laundry □ Yes □ No □ NA □ DK □ Ref

Reduced how often HH flushes toilet □ Yes □ No □ NA □ DK □ Ref

Reduced water use for lawn/landscaping □ Yes □ No □ NA □ DK □ Ref

Used your swamp cooler less □ Yes □ No □ NA □ DK □ Ref

Stopped gardening □ Yes □ No □ NA □ DK □ Ref

Quit farming or let land go fallow □ Yes □ No □ NA □ DK □ Ref

Shortened shower/bathing times □ Yes □ No □ NA □ DK □ Ref

Reduced how often shower/bathe □ Yes □ No □ NA □ DK □ Ref

Washed hands less or for shorter time □ Yes □ No □ NA □ DK □ Ref

Stopped washing hands with water □ Yes □ No □ NA □ DK □ Ref

Washed food less or for shorter time □ Yes □ No □ NA □ DK □ Ref

Drank less water □ Yes □ No □ NA □ DK □ Ref

Spent less time outdoors □ Yes □ No □ NA □ DK □ Ref

Reduced outdoor rec. time (skiing, boating) □ Yes □ No □ NA □DK □ Ref

Q17. If the drought continues, would your HH be able to further reduce water consumption? □ Yes (go to 17a) □ No □ DK □ Ref

Q17a. If yes, how so? ________________________________

Q18. Has anyone in your HH looked for assistance related to the drought? □ Yes (go to Q18a) □ No □ NA □ DK □ Ref


Q18a. If yes, what type of assistance did your HH need? (CATA)

Well drilling □ Drinking water □ Health Services

Utility or energy assistance □ Financial help

Food assistance □ Employment services

Other, specify _________________________ □ DK □ Ref


Q18b. If yes, Who provided the assistance? (CATA)

Other family members □ Neighbor □ Employer

Government agency □ Your faith community

Food Bank □ Fire, police, emergency agencies

Utility or water company □ Non-profit organization

Other ________________________________ □ DK □ Ref


Q18c. If yes, How difficult was it to get assistance?

Very difficult □ Difficult □ Easy □ Very Easy □ DK □ Ref


Q18d. What were the barriers to getting assistance?

___________________________­­­_______________________

No barriers □ DK □ Ref

Q16. Are there other actions your HH has taken to use less water? ___________________________________________ □ No □ DK □ Ref

Q19. Have you or members of your HH planted drought resistant…(CATA) □ Crops □ Edible Garden □ Landscaping plants □ None □ DK □ Ref

Q20. Are there any dead or dying trees on your property? □ Yes (go to Q20a) □ No □ NA □ DK □ Ref


Q20a. If yes, did your HH fell or have the trees felled? □ Yes (go to Q20b) □ No □ NA □ DK □ Ref


Q20b. If yes, approximately how much did it cost for your HH to fell or have someone else fell the trees? $_______ □ DK □ Ref


Q20c. If yes, approximately how many of each type of tree has your HH felled? □ Oak ____ □ Pine ____ □ Other ____ □ DK □ Ref

Drought Knowledge and Beliefs

California is in the fifth year of drought, I am going to read you a set of statements about drought. Please tell me whether you or your HH members believe the statement to be TRUE (T) or FALSE (F)

Q21. There is an increased demand for water □ T □ F □ DK □ Ref

Q25. Some people aren’t cutting water use enough □ T □ F □ DK □ Ref

Q22. There is poor water management by the govt.□ T □ F □ DK □ Ref

Q26. Droughts are caused by lack of rain/snow □ T □ F □ DK □ Ref

Q23. There is overuse of water by cities □ T □ F □ DK □ Ref

Q27. Droughts are caused by climate change □ T □ F □ DK □ Ref

Q24. Too much water is used to protect wildlife □ T □ F □ DK □ Ref

Q28. Droughts are caused by a “higher power” □ T □ F □ DK □ Ref

Health & Behavioral Health Impact of Drought

Q29. Has the drought negatively affected your HH’s… (CATA)

Property □ Finances □ Health □ Peace of Mind

Other, _______________________________ □ None □ DK □ Ref

Q36. Does everyone in your HH currently have health insurance?

Yes □ No □ DK □ Ref

Q37. Has anyone in your HH experienced any of the following more than usual in the last 30 days?

Difficulty concentrating □ Yes □ No □ NA □ DK □ Ref

Trouble sleeping/nightmares □ Yes □ No □ NA □ DK □ Ref

Loss of appetite □ Yes □ No □ NA □ DK □ Ref

Racing or pounding heartbeat □ Yes □ No □ NA □ DK □ Ref

Agitated behavior □ Yes □ No □ NA □ DK □ Ref

Witnessed firsthand violent behavior □ Yes □ No □ NA □ DK □ Ref Thoughts/attempts to harm self □ Yes □ No □ NA □ DK □ Ref

Increased alcohol consumption □ Yes □ No □ NA □ DK □ Ref

Increased illicit drug use □ Yes □ No □ NA □ DK □ Ref

Other _________________________ □ Yes □ No □ NA □ DK □ Ref

Q30. What is the general health of you and members of your HH?

Excellent □ Very Good □ Good □ Fair □ Poor □ DK □ Ref

Q31. Is anyone in your HH medically fragile, or been diagnosed with a chronic medical condition? □ Yes □ No □ DK □ Ref

Q32. Has a healthcare professional ever diagnosed you or any members of your HH with depression or any other emotional or mental health condition? □ Yes □ No □ DK □ Ref

Q33. Does anyone in your HH need any of the following special medical equipment or supplies? (CATA)

Oxygen □ Dialysis □ Breathing treatment machine □ Ventilator □ Feeding pump □ Insulin □ Other________ □ None □ DK □ Ref


Q33a. If yes, since the drought, has anyone in your HH experienced

any increase in difficulty using or maintaining their equipment or

supplies? □ Yes □ No □ NA □ DK □ Ref

Q38. Did you or anyone in your HH seek help for any of the items we’ve just covered using any of the following services? (CATA)

Counseling from religious leader or friend □ Emergency room

Pre-existing support group □ County mental health

Primary care provider or a clinic □ Social worker or case manager

Private mental health provider (i.e., psychologist)

Other, specify _________________________ □ DK □ Ref

Q34. Has the health of you or someone in your HH worsened because of the drought for the following conditions

Asthma □ Yes □ No □ NA □ DK □ Ref

COPD □ Yes □ No □ NA □ DK □ Ref

Emphysema □ Yes □ No □ NA □ DK □ Ref

Hypertension □ Yes □ No □ NA □ DK □ Ref

Heart disease □ Yes □ No □ NA □ DK □ Ref

Diabetes □ Yes □ No □ NA □ DK □ Ref

Mental health condition □ Yes □ No □ NA □ DK □ Ref

Other ___________­­­­­_________ □ Yes □ No □ NA □ DK □ Ref

Q39. Did you or a member of your HH have difficulty seeking mental health services? □ Yes (go to Q39a) □ No □ DK □ Ref


Q39a. If yes, what are the reasons? (CATA)

No transportation Services too far

Language barrier No child care

Unable to take time off work Not aware of resources

No health insurance Disabled/homebound

Too expensive Don’t trust healthcare system

Other__________________________________ □ DK □ Ref

Q35. Have you or a HH member sought additional medical attention outside of normal care because of the drought?

Yes □ No □ DK □ Ref

Other

Q40. Due to the drought, has anyone in your HH

Lost employment/Reduced work hrs □ Yes □ No □ NA □ DK □ Ref

Had to change jobs □ Yes □ No □ NA □ DK □ Ref

Traveled further to find work □ Yes □ No □ NA □ DK □ Ref

Had decreased income □ Yes □ No □ NA □ DK □ Ref Considered moving □ Yes □ No □ NA □ DK □ Ref Cut size or skip meals because of cost □ Yes □ No □ NA □ DK □ Ref

Q42. Did you or members of your HH hear about this survey prior to us talking to you today? □ Yes (go to Q42a) □ No □ DK □ Ref


Q42a. If yes, How did you or your HH members hear about it?

Social media Press release E-mail

Website Family/friends/neighbor

Other, __________________________ DK Ref

Q41. “The food that your HH bought just didn’t last, and we didn’t have money to get more” In the last 12 months, was that

Often True □ Sometimes True □ Never True □ DK □ Ref

Q43. What is your HH greatest need at this time?


Thank you!

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File TitleWest Virginia Community Assessment for Public Health Emergency Response – Elk River Chemical Spill, January 9th, 2014
AuthorBixler, Dee
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File Created2021-01-22

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