Dear Neighbor:

We are 9th graders at Charlestown High School. We are studying environmental health issues in Boston. We would like to know about the condition of the environment in your part of Boston.

Please help us by answering as many questions on this survey as you can. You are invited to our Community Health Fairs on May 24 and May 31. Please call our school at 635-9914 and ask for

Ms. Tuller for more information.

Thank you for your time!

1. What area of Boston do you live in? (please circle one)

Roxbury Dudley Codman Square/ Ashmont Fields Corner

Harbor Point Dorchester (other) South Boston Jamaica Plain

Roslindale West Roxbury Hyde Park Mattapan

Charlestown East Boston Allston Brighton

Back Bay Fenway/ Kenmore South End Chinatown

North End Other

4. Do you know of any toxic or contaminated areas in your neighborhood? Yes No

5. If yes, where is it and how is the area polluted?

6. Do you know anyone in your neighborhood that has health problems caused by pollution or something in the environment?

Yes No

7. If yes, what is it and what is it caused by?

8. How concerned are you about the following health problems that can be caused by the environment/ diet?

Not at all concerned Somewhat concerned Very concerned

Asthma 1 2 3

Lead poisoning 1 2 3

Cancer 1 2 3

Auto-immune diseases 1 2 3

(such as lupus or scleroderma)

Diabetes 1 2 3

Heart disease 1 2 3

9. Do you know anyone who has or has had one of these diseases? (please circle yes or no for each disease)

Asthma Yes No

Lead poisoning Yes No

Cancer Yes No

Auto-immune diseases Yes No

Diabetes Yes No

Heart disease Yes No

10. How much do you know about each of these diseases?

Iíve never heard of it I know a little bit I know a lot about it

Asthma 1 2 3

Lead poisoning 1 2 3

Cancer 1 2 3

Auto-immune diseases 1 2 3

(such as lupus or scleroderma)

Diabetes 1 2 3

Heart disease 1 2 3

11. Would you like more information on the causes and treatment of these diseases? (please circle yes or no for each disease)

Asthma Yes No

Lead poisoning Yes No

Cancer Yes No

Auto-immune diseases Yes No

Diabetes Yes No

Heart disease Yes No

12. Have you heard about the campaign to replace diesel buses with a trolley line on Washington Street?

Yes No

13. Would you be interested in learning about how different groups are trying to improve the environment in Boston?

Yes No

14. If yes, which of these are you interested in? (please circle one or more)

I would like more information on...

Reducing air pollution in Boston

Cleaning up contaminated areas in Boston

Replacing diesel buses with trolleys that give off less pollution

Removing lead paint from homes

Investigating high rates of lupus and scleroderma in some areas of Boston

Investigating high rates of cancer in some areas of Boston

Preventing diabetes

Preventing heart disease

Contacting city councilors and State House representatives about environmental issues

15. Have you been involved in any of the activities in #14? Yes No

16. If yes, which one, and how were you involved?

Thank you for filling out our survey. We will be holding Community Health Fairs on May 24 and 31. For more information, please call the school at 635-9914.

We hope you come to one of our health fairs. You may also write your name and address or phone number, and we will contact you.

OPTIONAL:

Name Address Phone #

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