Public health, energy & climate change: A Maryland statewide survey, fall 2016

Abstract

Climate change jeopardizes public health both directly and indirectly, whether from extreme
weather events like extended periods of high heat, flooding, and storms, or as a result of
related environmental changes such as the transmission of disease and decreased air
quality. As climate change continues to reshape human environments around the world,
communities throughout Maryland may find themselves battling both intensified existing
health issues and new crises.
Continuing a research partnership that began during the 2015 study, George Mason
University (GMU) once again teamed up with the Johns Hopkins Bloomberg School of Public
Health to get Marylanders' opinions on climate change, public health and energy sources,
and their attitudes towards current or proposed policies that relate to these topics.

Full text

Public Health, Energy &
Climate Change
A Maryland Statewide Survey | Fall 2016

Investigators:
Karen Akerlof, PhD
George Mason University
Center for Climate Change Communication
4400 University Dr., MS 6A8
Fairfax, VA 22030
kakerlof@gmu.edu
Cindy Parker, MD, MPH
Peter Winch, MD, MPH
Johns Hopkins Bloomberg
School of Public Health
615 North Wolfe Street
Baltimore, MD 21205
Survey execution and report preparation:
With offices in both Washington, DC and Princeton, NJ, Princeton Survey Research
Associates International (PSRAI) is an independent firm dedicated to high-quality research
providing reliable, valid results for clients in the United States and around the world.
Acknowledgements:
This survey was funded by the Town Creek Foundation of Easton, MD. We thank the
Foundation and Executive Director Stuart Clarke for their support. We also thank members
of the Climate Communication Consortium of Maryland (climatemaryland.org), many of
whom assisted in the development of the survey, and Jennifer Su at PSRAI.
Credits, cover photo:
“Algae bloom” was made available by the U.S. EPA through a Creative Commons public
domain license.

Table of Contents
Executive Summary ...................................................................................................................................... i
Key Findings .............................................................................................................................................. i
Chapter 1: Many deal with chronic health issues and stress ................................................................... 1
Millennials experience the most prolonged stress ................................................................................ 2
Many tackle stress head-on, and some find solace in religion ............................................................. 2
Chapter 2: Common belief that climate change affects health ................................................................ 4
Exposure to chemicals, air pollution are the biggest threats ................................................................ 4
Most consider climate change a danger to their health ........................................................................ 4
Chapter 3: Pollen and heat are the top identified health scourges .......................................................... 7
Chronically ill are more likely to report health was harmed .................................................................. 8
Chapter 4: Residents say Marylanders’ health is at risk from climate change ....................................... 9
Ideological divide in perceptions of harm ........................................................................................... 10
Chapter 5: Marylanders consider fossil fuel to be harmful .................................................................... 11
Maryland should use less coal and petroleum ................................................................................... 11
Coal and petroleum viewed as biggest energy threat to public health ............................................. 12
Solar and wind energy are viewed as the safest energy choices for public health, while many are
uncertain about biomass options ........................................................................................................ 13
More residents today view coal, oil and wood fuel as harmful .......................................................... 13
Chapter 6: Most view gasoline and diesel vehicles as a public health threat ...................................... 14
Chapter 7: Majorities say reducing air pollution and respiratory illnesses should be important
priorities for the state ............................................................................................................................... 15
Chapter 8: Residents point to community social capital, but low trust in public officials .................... 17
Appendices ................................................................................................................................................ 19
Appendix 1: Topline Results ................................................................................................................. 21
Appendix 2: Methodology ..................................................................................................................... 41

i | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Executive Summary
Climate change jeopardizes public health both directly and indirectly, whether from extreme
weather events like extended periods of high heat, flooding, and storms, or as a result of
related environmental changes such as the transmission of disease and decreased air
quality. As climate change continues to reshape human environments around the world,
communities throughout Maryland may find themselves battling both intensified existing
health issues and new crises.
Continuing a research partnership that began during the 2015 study, George Mason
University (GMU) once again teamed up with the Johns Hopkins Bloomberg School of Public
Health to get Marylanders' opinions on climate change, public health and energy sources,
and their attitudes towards current or proposed policies that relate to these topics.
Below are some of the findings from the 2016 survey of Maryland residents, the fourth
installment of an annual study dating back to 2013.
Key Findings
1. Many residents currently deal with chronic health issues and periods of stress.
 Fifty-two percent of Maryland adults report having a chronic condition. Nearly one-
quarter, 24 percent, suffer from hypertension. Two in ten have arthritis. One in ten
have been medically diagnosed with asthma, diabetes or cancer.
 Six in ten report at least one prolonged period of stress in the last twelve months,
including 14 percent who describe being under constant stress during the last year.
 Millennials report being under the most stress of any generation. Thirty-six percent of
Millennials say they have experienced more than one period of prolonged stress and
20 percent were under constant stress over the last year.
2. Eight in ten say that climate change poses a risk to their personal health and well-being.
 A quarter say their health is at major risk because of climate change. Another third
(32%) rate it as a moderate risk and 23 percent a minor risk. Fourteen percent say
their health is at no risk due to climate change.
 Overwhelming majorities report that their personal health and wellness are at least at
minor risk because of other related effects from climate change: air pollution,
extreme heat, severe storms, polluted drinking water or local bodies of water, food- or
insect-borne illnesses, flooding and sea level rise.

ii | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
3. Marylanders are most likely to say their health was harmed by air pollution and extreme
heat in the past year.
 In the last twelve months, forty-eight percent have been at least slightly harmed by
poor outdoor air quality from air pollution, including almost two in ten who have been
moderately or severely harmed.
 Four in ten have been at least slightly harmed by extreme heat in the last year. Three
in ten report their health has been harmed by severe storms.
 Food and water supplies have also taken a hit for some residents. Three in ten have
been harmed by food-borne illnesses. Sixteen percent have suffered at least slightly
from water-borne illnesses.
4. Most Marylanders say others in the state are feeling the health effects of climate
change.
 Forty-four percent of Marylanders say they personally are currently moderately or
greatly harmed by climate change.
 Forty-seven percent say members of their community are being harmed by climate
change now. The largest share, 54 percent, say Marylanders statewide are feeling
the health effects of these environmental changes.
5. Seven in ten agree their home energy choices affect their health and environment, and
majorities want the state to use less fossil fuel energy in the future.
 More than half say Maryland should use less coal and petroleum to generate
electricity.
 Two-thirds or more say that coal and petroleum are harmful to people’s health.
 Solar and wind energy is rated the least harmful.
6. Most view gasoline and diesel vehicles as a public health threat.
 Thirty-seven percent strongly agree that pollution from these cars and trucks contain
chemicals that harm people's health, including toxins that cause cancer. Another 35
percent somewhat agree with that statement.
 Nearly two-thirds, 64 percent, disagree with the notion that living or working hear a
highway or major roadway has little to no effect on people's health.
7. Majorities say that reducing air pollution and rates of respiratory illnesses like asthma
should be a high priority for the General Assembly and Governor.

iii | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
 The state’s air quality is a concern. Seven in ten Marylanders want the government to
reduce air pollution.
 More than half consider lowering rates of asthma and respiratory disease a high or
very high priority.
8. Community social capital contributes to individual health and well-being. Residents
report that communities have the necessary services and resources to care for people
but many find some aspects of communication to be lacking. There is distrust of public
officials.
 Fifty-seven percent say people in their community are able to get the services they
need and nearly as many, 54 percent, agree that their community has the resources
to take care of its residents, including sufficient money and technology.
 However, fewer Marylanders, 41 percent, say they get information that helps with
their home or work lives from their communities.
 One-third say community members trust public officials, with just seven percent
strongly agreeing with that opinion.
These are just some of the findings from the 2016 survey, executed by Princeton Survey
Research Associates International (PSRAI). Results are based on mail interviews in English
with 907 adults ages 18 or older who live in the state of Maryland. Data collection,
administered by the Scantron Corporation, ran from May 21 to August 1, 2016.
The margin of sampling error for the complete set of weighted data is ±4.3 percentage
points. For more details on the design, execution and analysis of the survey, please see the
full methodological report, which can be found in Appendix 2 of this report.

iv | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey

1 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 1: Many deal with chronic health issues and stress
Many residents currently deal with chronic health issues. Fifty-two percent of Maryland adults
report having at least one chronic condition, including one-quarter who say they cope with two or
more chronic health problems.
Twenty-four percent suffer from hypertension. Two in ten have arthritis. One in ten have been
medically diagnosed with asthma, diabetes or cancer.
Five percent of Maryland’s adult population say they have heart disease or chronic obstructive
pulmonary disease (COPD). Two percent each have hepatitis, poor kidneys or stroke.
From family to work, personal finances to relationships, everyday life means responsibility and
with responsibility often comes stress. Stress can manifest itself in feelings of anxiety,
nervousness, fear, irritability, or tension or disrupt one’s ability to sleep. Stress can also
exacerbate symptoms related to chronic health conditions. Like millions of adults across the
country, a majority of Marylanders also find themselves dealing with prolonged stress.
Six in ten report at least one prolonged period of stress in the last twelve months, where a
prolonged period of stress is a duration of one month or longer. One quarter say they have had
more than one period of prolonged stress and 14 percent describe being under constant stress
during the last year.
46%
2%
2%
2%
5%
5%
9%
12%
12%
21%
24%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
None of the above
Stroke
Weak or failing kidneys
Hepatitis
COPD
Coronary heart disease
Cancer
Asthma
Diabetes
Arthritis
Hypertension
Figure 1: Have you ever been told by a doctor or health care
provider that you have one or more of these conditions?

2 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Millennials experience the most prolonged stress
Millennials (ages 18-35) have a lot of life yet to live and milestones yet to face. Many are still in
school, just entering the workforce or establishing their careers, and have younger children to
support. And despite being the least likely to suffer from chronic health problems, Millennials
report being under the most stress of any other generation.
Seventy-eight percent of Millennials say they have experienced at least one prolonged period of
stress in the last twelve months, an astonishing 50 percentage points more than the oldest
adults, or the Silent or Greatest Generations (ages 71 or older). Perhaps even more alarming is
that 36 percent of Millennials say they have experienced more than one period of stress and 20
percent were under constant stress over the last year.
Many tackle stress head-on, and some find solace in religion
How much control people feel like they have over their lives can affect how they respond to stress.
Most survey respondents report feeling in control of events. Eighty-seven percent of Marylanders
say they are responsible for their own successes, and seventy-seven percent hold themselves
accountable for their own failures.
People have different coping styles when problems occur — some may have more active styles,
while others may be more disengaged or fatalistic. When they experience stress, more than half of
residents say they concentrate a lot on doing something about it. Thirty-six percent say they focus
a medium amount of effort on addressing the causes of stress.
Similarly, more than half of adults say that a lot of the time, they try to come up with a strategy for
what to do about their stressful experiences. Thirty-six percent say they do this a medium amount.
28%
34%
67%
81%
78%
64%
55%
28%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Millennials Gen X Boomers Silent/G.I.
Figure 2: Chronic conditions and stress levels by
generation
Chronic condition Prolonged stress

3 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Many also turn to other activities as a distraction, talk to others to find out more about the
situation, or simply look for something good in what is happening.
A large percentage of Marylanders also turn to religion. Nearly half, 49 percent, express they put a
lot of trust in God during stressful times. Sixteen percent do this a medium amount.
Barely any residents say they just give up.
78%
57%
16%
7%
19%
10%
7%
1%
1%
18%
23%
36%
28%
17%
23%
24%
12%
9%
2%
12%
33%
37%
16%
38%
42%
36%
36%
2%
7%
16%
28%
49%
29%
28%
52%
53%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
I just give up.
I sleep more than usual.
I learn to live with it.
I look for something good
in what is happening.
I put my trust in God.
I turn to work or other activities
to take my mind off of it.
I talk to someone to find out
more about the situation.
I try to come up with a strategy
for what to do.
I concentrate my efforts on
doing something about it.
Figure 3: Typically, when you experience stress, what do you do?
Not at all A little bit A medium amount A lot

4 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 2: Common belief that climate change affects health
Stress from everyday life is just one of many health threats to Marylanders. With the exceptions of
flooding and sea level rise, half or more of state residents say their personal health is at moderate
or major risk from each of thirteen potential threats presented to them in this year’s survey.
Exposure to chemicals, air pollution are the biggest threats
Nearly all Marylanders say that air pollution and exposure to chemicals, including pesticides in
food or other products, put their health at least at minor risk. In fact, eight in ten say that air
pollution (81%) and chemicals (79%) pose a moderate or major risk to their well-being.
Since 2013, air pollution and chemicals are rated as the top threats to Marylanders’ health.
Though findings in this year’s study have remained steady since 2014, we have seen a dramatic
spike from 2013 in the amount of residents who consider these two potential risks as moderate
or major threats to their health.
Table 1: Moderate/Major risk to personal well-being
2016
2015
2014
2013
Air pollution
81%
82%
83%
70%
Exposure to chemicals
79%
80%
83%
67%
Most consider climate change a danger to their health
When asked about climate change overall, eight in ten say that climate change poses at least a
minor risk to their health and well-being. A quarter say their health is at major risk because of
climate change. Another third (32%) rate it as a moderate risk and 23 percent a minor risk.
Fourteen percent say their health is at no risk due to climate change.
Interestingly, overwhelming majorities report feeling their personal health and wellness are
threatened in at least a minor way because of other related effects from climate change. In
addition to air pollution, many feel their health is potentially affected by conditions like extreme
heat, severe storms, polluted drinking water or local bodies of water, or food- or insect-borne
illnesses.

5 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Residents are worried about the increased pollution of local bodies of water and what that means
for their own wellness. Three-quarters say water pollution puts their health at moderate or major
risk. Moreover, sixty-eight percent identify polluted drinking water as a moderate or major health
risk, including fully one-half who label contaminated drinking water as a major risk.
Exposure to chemicals like pesticides or polluted water are not the only potential risks, according
to respondents in this year’s study. Residents also take stock of how these issues affect their food
supplies. Two-thirds say that food-borne illnesses are a moderate or major risk, with over a third
saying ailments from tainted food is a major potential health threat.
As climate change continues to result in warmer weather, Marylanders find themselves faced with
more days of extreme heat than ever before. With extreme heat comes increased chance of heat
exhaustion, dehydration, wildfires and harsher droughts. Sixty-four percent of residents consider
extreme heat a moderate or major risk, up 11 percentage points since 2015.
21%
17%
14%
15%
11%
6%
9%
6%
8%
5%
3%
2%
1%
33%
16%
23%
35%
19%
19%
24%
23%
32%
19%
16%
13%
15%
23%
24%
32%
32%
28%
18%
38%
30%
36%
35%
30%
38%
25%
18%
39%
27%
16%
40%
50%
26%
35%
21%
35%
45%
43%
54%
4%
3%
4%
2%
2%
6%
3%
7%
3%
6%
6%
3%
5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Sea level rise
Obesity
Climate change
Flooding
Second-hand smoke from tobacco
Polluted drinking water
Extreme heat
Food-borne illnesses
Severe storms
Insect-borne diseases
Pollution of local water bodies
Air pollution
Exposure to chemicals
Figure 4: How much of a risk do you feel each of the following poses to
your health and well-being?
No risk at all Minor risk Moderate risk Major risk Don't know

6 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Table 2: Moderate/Major risk to personal well-being
2016
2015
2014
2013
Air pollution
81%
82%
83%
70%
Exposure to chemicals
79%
80%
83%
67%
Polluted drinking water
68%
71%
74%
53%
Second-hand smoke from tobacco
68%
64%
64%
51%
Extreme heat
64%
53%
56%
52%
Obesity
63%
61%
63%
56%
Climate change
59%
63%
62%
52%
Severe storms
57%
58%
64%
54%
Flooding
48%
48%
51%
32%
Sea level rise
41%
43%
n/a
n/a
Fluctuations in climate can also bring forth more severe storms and changes in the ranges and
prevalence of insect-borne diseases like Lyme disease or the West Nile virus. Fifty-seven percent
of Marylanders perceive severe storms to be a moderate or major risk to their health. An even
larger share, 70 percent, say their health is potentially threatened by insect-borne ailments.
Though just 15 percent report water damage to their home caused by heavy rains or flooding, just
under half (48%) consider flooding to pose a moderate or major risk to their health, an increase of
16 percentage points since 2013.

7 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 3: Pollen and heat are the top identified health scourges
The most commonly reported afflictions by survey respondents are respiratory ones, including
problems caused by pollen. Climate change is believed to affect respiratory health through
increased pollen counts, decreased air quality, and in even in some cases, heightened exposure
to indoor mold. Moreover, it can also affect a range of other environmental health concerns, from
flooding incidents to vector-borne disease, waterborne disease and food poisoning.
Seven in ten Maryland residents say their health was at least slightly harmed by pollen in the past
year, including 35 percent who were moderately or severely impaired.
In the last twelve months, forty-eight percent have been at least slightly harmed by poor outdoor
air quality from air pollution, including almost two in ten who have been moderately or severely
harmed.
Four in ten Marylanders say extreme heat has affected their health in the last year. Half of them,
18 percent, were moderately or severely impacted by extreme heat.
84%
83%
81%
80%
71%
67%
67%
57%
52%
31%
6%
9%
12%
7%
19%
22%
22%
25%
31%
35%
6%
4%
4%
7%
6%
8%
7%
13%
12%
25%
4%
3%
3%
5%
4%
3%
5%
5%
5%
10%
-5% 10% 25% 40% 55% 70% 85% 100%
Mosquito-borne diseases
Waterborne illness
Flooding
Tick-borne diseases
Food-borne illness
Severe storms
Poor indoor air quality from mold
Extreme heat
Poor outdoor air quality from air pollution
Pollen
Figure 5: In the last 12 months, how much as your health been harmed
by the following?
Not at all harmed Slightly harmed Moderately harmed Severely harmed

8 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Three in ten report their health has been harmed by severe storms, with 11 percent indicating
severe storms moderately or severely harmed their well-being in some way.
Food and water supplies have also taken a hit for some residents. Three in ten have been harmed
by food-borne illnesses. Sixteen percent have suffered at least slightly from water-borne illnesses,
with just a handful (7%) who were more aggressively harmed.
About equal shares of residents have come down with a tick- or mosquito-borne disease. The vast
majority, over eight in ten, have not.
Chronically ill are more likely to report health was harmed
Compared with healthier individuals, those who have a chronic health condition are more likely to
report their health has been harmed in various ways in the last twelve months. People who have
chronic medical conditions are more likely to be at risk from the health effects of climate change.
Table 3: Health severely/moderately/slightly harmed by…
Have a chronic
condition
No chronic
condition
Pollen
74%
63%
Poor outdoor air quality from air pollution
55%
40%
Extreme heat
52%
33%
Poor indoor air quality from mold
38%
27%
Severe storms
38%
25%
Flooding
23%
15%
Fifty-five percent of chronically-ill residents have been at least slightly harmed by poor outdoor air
quality, 15-percentage points higher than those without a chronic condition.
Fifty-two percent of chronically-ill residents have suffered from extreme heat, compared with one-
third of their healthier counterparts.

9 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 4: Residents say Marylanders’ health is at risk from
climate change
More than half of Marylanders say that the state’s residents are currently being harmed by
climate change. They are slightly less likely to say the same for themselves or their own
communities.
Forty-four percent of Marylanders say they personally are moderately or greatly harmed by climate
change. Just over a quarter, 27 percent, say they are only a little harmed and 20 percent feel they
are not at all harmed.
As residents think more broadly, slightly more, 47 percent say, members of their community are
being harmed by climate change now. Two in ten report that people in their community are
currently only a little hurt and 15 percent not at all hurt. Another 16 percent do not know enough
about the effects of climate change on other residents in their community to provide an opinion.
The largest share, 54 percent, think Marylanders statewide are feeling the effects of these
environmental changes, including almost two in ten who say Marylanders as a whole are being
greatly harmed by climate change.
These findings and patterns remain unchanged from one year ago.
20% 15% 12%
27%
23% 19%
30%
33% 36%
14% 14% 18%
8% 16% 16%
0%
20%
40%
60%
80%
100%
You personally People in your community People in Maryland
Figure 6: How much do you think climate change is
currently harming...?
Not at all Only a little Moderate amount Great deal Don't know

10 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Ideological divide in perceptions of harm
Greater numbers of liberals say that state residents are currently being harmed by climate change
than conservatives. In fact, a majority of liberals feel that residents -- themselves and across the
state -- face moderate or great harm from climate change.
Table 4: How much do you think climate change is currently
harming…?
Conservative
Moderate
Liberal
You personally
Moderate/Great harm
35%
47%
53%
Little/No harm
55%
44%
43%
People in your community
Moderate/Great harm
32%
50%
58%
Little/No harm
47%
34%
33%
People in Maryland
Moderate/Great harm
37%
56%
71%
Little/No harm
43%
27%
20%
In contrast, conservative Marylanders are more likely than moderates or liberals to say that little
or no harm has come to pass due to climate change.

11 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 5: Marylanders consider fossil fuel to be harmful
Seven in ten agree their home energy choices affect their health and environment. And because
residents understand that some energy sources are better for public consumption and have more
limited negative impact on the environment, they speak up about what they think would be best
for the Old Line State. Majorities want the state to use less fossil fuel energy and more
sustainable and renewable energy in the future.
Maryland should use less coal and petroleum
More than half of Marylanders think that the state should use less fossil fuel over the next several
years as electrical energy sources. Very few say the state should use more of these conventional
energy sources, such as coal, with a small handful saying much more should be used in Maryland.
As a side note, very little oil is currently used to fuel the state’s electricity; some households use
oil to heat their homes, however.
35%
26%
24%
25%
24%
10%
5%
5%
3%
3%
2%
19%
25%
19%
11%
10%
12%
6%
11%
5%
2%
1%
14%
20%
18%
10%
16%
16%
12%
14%
17%
6%
6%
4%
7%
7%
11%
10%
14%
20%
29%
20%
26%
20%
4%
2%
8%
8%
12%
19%
20%
17%
29%
46%
57%
24%
21%
25%
35%
28%
29%
36%
24%
26%
16%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Coal
Petroleum (oil)
Wood fuel
Fracking
Nuclear
Waste incineration
Gas from landfills
Other natural gas
Hydroelectric
Wind
Solar
Figure 7: Over the next several years, do you think Maryland should use
less, more or about the same amount of each of these sources of
electrical energy?
Much less Somewhat less Same amount Somewhat more Much more Don't know

12 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Fifty-four percent want to see the state use less coal for electrical energy, including more than
one-third (35%) who say much less coal should be used. One in seven are fine with the same
amount of coal being used and just eight percent say more coal should be used.
Petroleum, or oil, fares about the same as coal. Fifty-one percent say oil energy should be used
less in Maryland, with equal shares saying somewhat less or much less. One in five say about the
same amount of petroleum should be used as an electrical energy source in the years to come.
Nine percent would like to see more oil used to fuel their homes and Maryland overall.
Coal and petroleum viewed as biggest energy threat to public health
Conventional fossil fuels are considered the most hazardous to people's health. Seventy-three
percent say coal is harmful, including 41 percent rating it as very harmful and 32 percent
somewhat harmful. Oil energy receives poor marks from two-thirds of Marylanders, with the
largest share, 42 percent, saying it has a somewhat harmful impact on people's well-being.
A majority of residents also rate nuclear energy (57%) and wood fuel (50%) to be harmful. Another
two in ten are unable to provide an opinion.
2%
2%
6%
7%
6%
4%
9%
5%
35%
64%
67%
8%
14%
15%
22%
15%
13%
22%
31%
26%
17%
16%
32%
42%
24%
36%
35%
21%
23%
22%
13%
5%
3%
41%
23%
33%
14%
15%
24%
14%
7%
2%
2%
2%
16%
19%
21%
22%
30%
37%
33%
36%
24%
12%
12%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Coal
Petroleum (oil)
Nuclear
Wood fuel
Waste incineration
In-state fracking of natural gas
Gas from landfills
Other natural gas
Hydroelectric
Wind
Solar
Figure 8: Please rate each of the following sources of electrical energy in
terms of how harmful they are to people's health.
Not at all harmful Not very harmful Somewhat harmful Very harmful Don't know

13 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Solar and wind energy are viewed as the safest energy choices for public
health, while many are uncertain about biomass options
Solid majorities consider solar and wind to be the least hazardous to people's health. Eight in ten
residents say solar and wind energy are not harmful, including over six in ten who say they are not
at all harmful to people's health. Only a handful report solar- or wind- generated electricity is
unsafe for people, with a trivial two percent saying each is very harmful.
At least three in ten adults are also unsure about the health impacts that might arise from
electrical energy generated from landfill gases, fracking, other non-fracking natural gas sources
and incineration of waste, demonstrating an opportunity for elected officials and energy experts to
communicate with the public about potential energy alternatives.
More residents today view coal, oil and wood fuel as harmful
Compared with twelve months ago, more residents today say that electrical energy produced by
coal, petroleum and wood fuel negatively affect public health. In particular, wood fuel has seen a
more dramatic uptick in those who rate it as harmful to people's health: up four points since
2015, 19-points since 2014 and 16-points since 2013.
Table 5: Energy sources that are harmful to people's health
2016
2015
2014
2013
Coal
73%
69%
72%
68%
Petroleum
65%
62%
64%
59%
Nuclear
57%
57%
58%
58%
Wood fuel
50%
46%
31%
34%
In-state “fracking” of
natural gas
45%
44%
46%
44%
Other natural gas (not
in-state “fracking”)
29%
26%
29%
29%
Hydroelectric
15%
13%
10%
12%
Wind
7%
3%
4%
5%
Solar
5%
4%
4%
7%
Electrical energy generated from solar, wind and hydroelectric sources continue to be rated by
Marylanders as the least harmful to public health.

14 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 6: Most view gasoline and diesel vehicles as a public
health threat
Marylanders recognize the threat that gas and diesel vehicles pose to public health and the
environment. Thirty-seven percent strongly agree that pollution from these cars and trucks contain
chemicals that harm people's health, including toxins that cause cancer. Another 35 percent
somewhat agree with that statement. About one in ten disagree and 16 percent do not know.
Nearly two-thirds, 64 percent, disagree with the notion that living or working hear a highway or
major roadway has little to no effect on people's health. One in five agree that proximity to busy
roadways has minimal impact on people's health. One in seven are unsure.
27%
5%
37%
7%
16%
35%
6%
37%
14%
16%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Living or working near a highway or major
roadway has little to no effect on people’s health.
Pollution from these cars and trucks includes
toxic chemicals that harm people’s
health, including causing cancer.
Figure 9: How strongly do you disagree or agree with the following
statements?
Strongly disagree Somewhat disagree Somewhat agree Strongly agree Don't know

15 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 7: Majorities say reducing air pollution and respiratory
illnesses should be important priorities for the state
Seventy percent of Marylanders say that reducing air pollution should be a high or very high
priority for the state government, including nearly four in ten (38%) who rate it as a very high
priority. A majority of survey respondents, 55 percent, would like to see the General Assembly and
Governor work on lowering rates of asthma and respiratory disease, including 26 percent who say
the state should consider this topic a very high priority.
Reducing air pollution is rated as a high or very high priority by a majority of residents across key
demographics. However, some groups of Marylanders are more likely than others to consider this
topic to be an important priority, For instance, more women than men want the state government
to prioritize air pollution (74% women v. 64% men). Race is also a factor. Seventy-nine percent of
black Marylanders say reducing air pollution should be a high or very high priority, compared with
64 percent of whites. Income too plays a role: lower-income residents (less than $50,000 per
year) are more likely to rate this topic as a high or very high priority compared with higher-income
residents ($50,000 per year or more), by a 74 percent v. 66 percent margin.
52%
54%
55%
55%
57%
59%
70%
71%
79%
86%
86%
88%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Protecting coastal areas from storms and flooding
Making public transportation
more accessible and affordable
Lowering rates of asthma and respiratory disease
Addressing climate change
Expanding tax credits for renewable energy
Addressing racial inequalities
Reducing air pollution
Reducing home energy costs
Reducing water pollution
Improving schools
Creating jobs
Lowering crime
Figure 10: How much of a priority should these topics be for Maryland's
General Assembly and the Governor?
(Rated as a "High" or "Very high" Priority)

16 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Trends from the Centers for Disease Control and Prevention (CDC) indicate these groups (women,
blacks, lower-income) are also more prone to asthma.
1
When it comes to prioritizing reductions in
respiratory illnesses like asthma, the gap in opinions between women and men closes, while
racial and income differences remain. Three-quarters of blacks say that state government should
make it a high or very high priority to lower rates of asthma and other respiratory illnesses,
compared with less than half of whites (47%). In terms of income, 71 percent of those with annual
household incomes of under $50,000 consider this a high or very high priority, fully 25
percentage points higher than those with annual incomes of $50,000 or more (46%).
1
CDC, http://www.cdc.gov/nchs/products/databriefs/db94.htm

17 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Chapter 8: Residents point to community social capital, but low
trust in public officials
Changes in the environment often mean changes in the health and well-being of local
communities, who must negotiate providing the resources, services and information that
residents need to navigate both the exacerbation of current threats – like air pollution -- and the
emergence of new ones – such as vector-borne diseases.
Access to resources and communication within communities are two aspects that can contribute
to how resilient groups of people are likely to be in responding to hazards. Most residents
surveyed say that their community has the resources -- money, information, technology, tools, raw
materials and service -- it needs to take care of problems that the community may face. Two in ten
strongly agree with this statement and another 35 percent somewhat agree. About one-quarter
disagree that their community resources are sufficient. Twenty-one percent are neutral on the
subject.
And the good news continues: two-thirds agree that their community keeps people informed about
issues that are relevant to them, through media, phone or word of mouth. Fifty-seven percent also
say people in their community are able to get the services they need.
However, fewer Marylanders, 41 percent, say they get information that helps with their home or
work lives from their communities. About three in ten disagree with that notion and another three
in ten are agnostic.
Intercommunity involvement also has some room for improvement. Forty-seven percent say their
community works with organizations and agencies outside of their community to get things done.
Seventeen percent say that is not the case for their community, and 36 percent are unable to say
one way or the other.
The biggest issue seems to be split level of trust in the leaders elected or appointed to serve the
public. One-third say members of their community trust public officials, with just seven percent
strongly agreeing with that opinion. A similar share, 35 percent, disagree. Another third, 32
percent, neither agree nor disagree.

18 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey

19 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendices

20 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey

21 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 1: Topline Results
HEALTHY PEOPLE, HEALTHY PLACES:
A SURVEY OF MARYLANDERS ON PUBLIC HEALTH, ENERGY, AND THEIR ENVIRONMENT
PRINCETON SURVEY RESEARCH ASSOCIATES INTERNATIONAL FOR
GEORGE MASON UNIVERSITY AND
THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
TOPLINE RESULTS
AUGUST 31, 2016
Total N=907 Maryland adults ages 18 or older
Margins of Error: ± 4.3 percentage points for results based on Total [N=907]
Mail data collection dates: May 21-August 1, 2016
Questionnaire language: English only
Topline notes: Unless otherwise indicated, percentages are based on Total answering.
Because percentages are rounded, they may not total 100%.
An asterisk (*) indicates less than 0.5%.
INTRODUCTION
Dear Fellow Marylander,
The Johns Hopkins Bloomberg School of Public Health, in cooperation with George Mason University, welcomes a
select number of households in Maryland, yours among them, to take this 15-20 minute survey about our health,
environment and the energy we use.
Please have an adult in your household fill out the questionnaire. If there is more than one adult in your household we
ask that the person who has had the most recent birthday fill out the survey, if possible. This method will provide us
with a random sample of participants from the state of Maryland and each of its four regions. Answers to the
questionnaire will help organizations in the state, like non-profits and local and state government agencies, better
provide services to improve the health and well-being of our communities.
Thanks for taking the time to help us protect, and improve, our quality of life here in Maryland.
Sincerely,
Peter Winch, MD, MPH
Johns Hopkins Bloomberg School of Public Health

22 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
STUDY INFORMATION
Research procedures: This research is being conducted to inform the work of local and state government agencies,
universities, and non-profit organizations in promoting healthy people and places in Maryland. No state funds are
being used in this project; it is being funded by the Town Creek Foundation of Easton, Maryland. If you agree to
participate, this questionnaire will take about 15-20 minutes to complete.
Benefits: There are no benefits to you as a participant in completing this survey other than to further understanding of
Marylanders’ beliefs about public health, energy and the environment.
Confidentiality: Your information will be kept completely confidential. Only the George Mason University research
investigators will have access to the surveys; these will be kept in a locked cabinet on the university’s Fairfax campus.
Both Mason and Johns Hopkins researchers will have access to the final electronic database with the survey
information, in which all personal identifiers have been removed (such as addresses and contact information). Other
researchers may apply to the George Mason research team to obtain access to the information.
Participation: Your participation is voluntary. If you decide not to participate or if you withdraw from the study, there is
no penalty or loss of benefits to which you are otherwise entitled. There are no costs to you or any other party. A $2
thank you has been included with this survey.
Risks: There are no risks to you from participating in this research.
Contact: For more information, contact Karen Akerlof at (XXX) XXX-XXXX or XXXXXXXX@XXX.XXX. If you have questions
regarding your rights as a research participant, please contact the George Mason University Office of Research
Integrity & Assurance at (XXX) XXX-XXXX, or the Institutional Review Board for Johns Hopkins Bloomberg School of
Public Health at (XXX) XX-XXXX.
This research has been reviewed according to George Mason University procedures governing your
participation in this research.

23 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
1. How much of a priority should these topics be for Maryland’s General Assembly and the Governor?
Not a
priority
Low
Medium
High
Very high
Unwt. N2
a. Making public transportation
more accessible and
affordable
7
8
30
26
28
(896)
b. Lowering rates of asthma and
respiratory disease
5
13
26
29
26
(893)
c. Reducing home energy costs
1
6
23
31
40
(897)
d. Creating jobs
*
3
11
30
56
(899)
e. Improving schools
*
2
11
30
56
(897)
f. Lowering crime
*
1
11
26
62
(895)
g. Reducing water pollution
1
3
17
33
46
(895)
h. Addressing racial inequalities
8
12
22
26
33
(891)
i. Protecting coastal areas from
storms and flooding
3
15
30
29
23
(889)
j. Reducing air pollution
2
7
22
32
38
(897)
k. Addressing climate change
10
13
22
29
26
(892)
l. Expanding tax credits for
renewable energy
4
11
28
28
29
(892)
2. Below is a list of potential risks to people’s health and well-being. How much of a risk do you feel each of the
following poses to your health and well-being?
No risk at
all
Minor
risk
Moderate
risk
Major
risk
Don’t
know
Unwt. N
a. Second-hand smoke from
tobacco
11
19
28
40
2
(899)
b. Exposure to chemicals,
including pesticides, in food
and other products
1
15
25
54
5
(903)
c. Air pollution
2
13
38
43
3
(900)
d. Extreme heat
9
24
38
26
3
(901)
e. Severe storms
8
32
36
21
3
(898)
f. Obesity
17
16
24
39
3
(896)
g. Polluted drinking water
6
19
18
50
6
(901)
h. Food-borne illnesses
6
23
30
35
7
(899)
i. Climate change
14
23
32
27
4
(899)
j. Insect-borne diseases
5
19
35
35
6
(902)
k. Flooding
15
35
32
16
2
(899)
l. Sea level rise
21
33
23
18
4
(901)
m. Pollution of local streams,
rivers, and other water bodies
3
16
30
45
6
(900)
2
"Unwt. N" reflects the unweighted N, or the number of respondents who provided an answer.

24 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
3. In the last 12 months, how much has your health been harmed by the following?
Not at all
harmed
Slightly
harmed
Moderately
harmed
Severely
harmed
Unwt. N
a. Pollen
31
35
25
10
(896)
b. Extreme heat
57
25
13
5
(895)
c. Severe storm(s)
67
22
8
3
(892)
d. Tick-borne disease, such as Lyme
disease
80
7
7
5
(896)
e. Mosquito-borne disease, such as
West Nile virus
84
6
6
4
(894)
f. Flooding
81
12
4
3
(897)
g. Poor outdoor air quality from air
pollution
52
31
12
5
(895)
h. Waterborne illness
83
9
4
3
(896)
i. Food-borne illness
71
19
6
4
(895)
j. Poor indoor air quality from mold
67
22
7
5
(895)
4. In the last 12 months, have you experienced one or more of the following?
UNWEIGHTED N=907
% Yes
a. Water damage of your home caused by heavy rains or
flooding
15
b. Impassable roads due to flooding or storm damage
17
c. Sewage overflows after strong rains or storms
6
d. Septic system failure due to higher groundwater or flooding
3
e. A storm-related power outage
45
f. No household water
8
g. No household heat (when needed)
8
h. No household air conditioning (when needed)
11
i. Lack of access to transportation
10
j. Lack of access to medical care
6
k. Lack of access to high quality/nutritious food
7
l. Insufficient financial resources to cover bills if unable to
work for 1-2 weeks
21
m. None of the above
28
None selected
3

25 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
5. The following statements are possible descriptions of your community. How strongly do you disagree or
agree?
Strongly
disagree
Some-
what
disagree
Neither
disagree
nor
agree
Some-
what
agree
Strongly
agree
Unwt. N
a. My community has the resources
it needs to take care of community
problems (resources include
money, information, technology,
tools, raw materials, and services).
11
13
21
35
19
(894)
b. People in my community are able
to get the services they need.
9
15
20
37
20
(896)
c. My community works with
organizations and agencies
outside the community to get
things done.
9
8
36
31
16
(895)
6. The next statements are possible descriptions of communication in your community. How strongly do you
disagree or agree?
Strongly
disagree
Some-
what
disagree
Neither
disagree
nor
agree
Some-
what
agree
Strongly
agree
Unwt. N
a. My community keeps people
informed (for example, via
television, radio, newspaper,
Internet, phone, neighbors) about
issues that are relevant to them.
9
11
15
38
28
(895)
b. I get information/communication
through my community to help
with my home and work life.
16
13
29
28
13
(891)
c. People in my community trust
public officials.
17
18
32
26
7
(892)
People’s responses to life events may differ. Below are some statements that people have made.
7. For each of the following, how strongly do you disagree or agree?
Strongly
disagree
Some-
what
disagree
Neither
disagree
nor
agree
Some-
what
agree
Strongly
agree
Unwt. N
a. There is no sense in planning a
lot—if something good is going to
happen, it will.
41
25
17
13
3
(894)
b. I am responsible for my own
successes.
3
5
5
33
54
(894)
c. I have little control over the bad
things that happen to me.
18
32
21
23
6
(897)
d. I am responsible for my failures.
2
10
12
41
36
(895)

26 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
8. People deal with difficult events in different ways. Typically, when you experience stress, what do you do?
Not at
all
A little
bit
A
medium
amount
A lot
Unwt. N
a. I concentrate my efforts on doing something
about it.
1
9
36
53
(891)
b. I turn to work or other activities to take my
mind off of it.
10
23
38
29
(887)
c. I try to come up with a strategy for what to do.
1
12
36
52
(890)
d. I just give up.
78
18
2
2
(889)
e. I talk to someone to find out more about the
situation.
7
24
42
28
(892)
f. I sleep more than usual.
57
23
12
7
(889)
g. I look for something good in what is
happening.
7
28
37
28
(888)
h. I learn to live with it.
16
36
33
16
(887)
i. I put my trust in God.
19
17
16
49
(888)
The next questions address new options in Maryland for managing our generation and use of electricity.
9. Have you ever heard the term, “Smart Grid,” in referring to new ways to generate and manage electricity?
UNWEIGHTED N=894
No
39
Yes
48
Don't know
13
10. Do you have a Smart Meter installed at your home? Smart Meters digitally monitor energy usage, convey the
information wirelessly to your energy utility, and provide it to you online. They are installed for free by your
electric utility.
UNWEIGHTED N=893
No
42
Yes
42
Don't know
16

27 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
11. Smart Grids will mean some changes for consumers. How likely would you be to…
Very
unlikely
Some-
what
unlikely
Some-
what
likely
Very
likely
Already
done
Not
appli-
cable
Unwt. N
a. welcome installation of a Smart Meter.
10
9
18
22
33
8
(881)
b. change the timing of activities that use
a lot of electricity, like clothes drying,
to take advantage of lower electricity
costs at night.
9
11
25
36
16
3
(886)
c. buy “smart appliances” that
automatically reduce energy use
during high demand.
5
10
24
36
20
6
(888)
d. install solar panels either for your
home or within your community and
sell energy back to the utility.
27
17
19
21
4
12
(886)
e. volunteer to automatically lower
energy use during high demand in
return for lower bills.
9
11
27
31
17
4
(883)
12. How strongly do you disagree or agree with the following statements?
Strongly
disagree
Some-
what
disagree
Some-
what
agree
Strongly
agree
Don't
know
Unwt. N
a. My home energy choices affect our
health and environment.
8
10
42
31
10
(890)
b. I am worried that Smart Meters threaten
people’s privacy.
24
18
25
10
23
(882)
c. I am worried that Smart Meters may be
harmful.
35
20
11
7
28
(885)
d. Variable electricity rates at different
times of day will help me lower my
energy bills.
6
8
44
23
19
(887)
e. I can’t afford to install solar panels even
if I could sell the electricity back to the
utility.
11
11
20
37
21
(884)
f. Generating my own energy is appealing
to me.
9
8
31
37
16
(889)

28 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
The next questions address the choices about energy sources we make as a state and in our own homes.
13. Over the next several years, do you think Maryland should use less, more, or about the same amount of each
of these sources of electrical energy? (Please note, no hydraulic fracturing of natural gas is currently
occurring in Maryland.)
Much
less
Some-
what
less
Same
amount
Some-
what
more
Much
more
Don't
know
Unwt. N
a. Coal
35
19
14
4
4
24
(884)
b. Petroleum (oil)
26
25
20
7
2
21
(880)
c. Natural gas extracted by
hydraulic fracturing (“fracking”) in
Maryland
25
11
10
11
8
35
(872)
d. Other sources of natural gas
5
11
14
29
17
24
(868)
e. Wind
3
2
6
26
46
16
(884)
f. Nuclear
24
10
16
10
12
28
(879)
g. Solar
2
1
6
20
57
13
(882)
h. Hydroelectric (including dams)
3
5
17
20
29
26
(873)
i. Wood fuel
24
19
18
7
8
25
(878)
j. Incineration of waste
10
12
16
14
19
29
(880)
k. Gas from landfills
5
6
12
20
20
36
(885)
14. Please rate each of the following sources of electrical energy in terms of how harmful they are to people’s
health.
Not at all
harmful
Not very
harmful
Somewhat
harmful
Very
harmful
Don't
know
Unwt. N
a. Coal
2
8
32
41
16
(889)
b. Petroleum (oil)
2
14
42
23
19
(885)
c. Natural gas extracted by
hydraulic fracturing (“fracking”) in
Maryland
4
13
21
24
37
(880)
d. Other sources of natural gas
5
31
22
7
36
(876)
e. Wind
64
17
5
2
12
(888)
f. Nuclear
6
15
24
33
21
(879)
g. Solar
67
16
3
2
12
(887)
h. Hydroelectric (including dams)
35
26
13
2
24
(882)
i. Wood fuel
7
22
36
14
22
(885)
j. Incineration of waste
6
15
35
15
30
(887)
k. Gas from landfills
9
22
23
14
33
(885)
15. How much more would you be willing to pay each month on your electricity bill to purchase 100% of your
electricity from these fuel sources?
Not willing
to pay more
$1-5
$6-10
$11-15
$16-20
More than
$20 a
month
Unwt. N
a. Wind
50
17
14
7
7
6
(876)
b. Solar
48
17
14
8
8
6
(878)

29 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Maryland has the longest average commute time in the United States. The questions below ask about your driving
habits and transportation preferences.
16. How frequently do you use the following forms of transportation to get to work, school, or other primary daily
activity?
Never
Some-
times
Most of
the time
Almost
always
Not
applicabl
e
Unwt. N
a. Drive car or truck (single occupant)
5
11
10
67
6
(889)
b. Carpool with others
53
27
3
4
12
(881)
c. Take the Metro, subway, or light rail
55
24
2
6
12
(886)
d. Ride a bus
62
20
2
6
10
(888)
e. Bike
71
14
1
2
12
(887)
f. Walk
44
35
6
6
9
(887)
17. How long is your average daily commute to work, school, or other primary daily activity?
UNWEIGHTED N=880
10 minutes or less
14
11-20 minutes
21
21-30 minutes
15
31-40 minutes
10
41-50 minutes
10
51-60 minutes
7
More than 1 hour
7
Not applicable
15
18. Please answer two questions for each of the items below. Is it hard or easy for you to take the following
actions? And, are they actions you would dislike or like doing, whether or not they are feasible?
Is it hard or easy for you to take
this action?
Would you dislike or like doing
this?
Hard/No
t feasible
Easy
Unwt. N
Dislike
Like
Unwt. N
a. Working from home
57
43
(825)
26
74
(774)
b. Biking or walking instead of
driving for primary daily
activities (work, school, etc.)
81
19
(836)
48
52
(785)
c. Using public transportation
71
29
(830)
63
37
(783)
d. Purchasing or leasing a fuel-
efficient car or truck
55
45
(821)
27
73
(792)
e. Purchasing or leasing a plug-
in electric vehicle, such as
the Nissan Leaf or Chevy Volt
73
27
(819)
48
52
(792)

30 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
19. How strongly do you disagree or agree with the following statements?
Strongly
disagree
Some-
what
disagree
Some-
what
agree
Strongly
agree
Don't
know
Unwt. N
a. Driving gasoline- or diesel-fueled cars
and trucks is a minimal source of air
pollution.
25
28
28
12
7
(887)
b. The tailpipes of gasoline- or diesel-fueled
motor vehicles release pollution that
contributes to climate change.
5
9
31
43
13
(888)
c. Pollution from these cars and trucks end
up in our waterways, where they become
a significant source of pollutants in the
Chesapeake Bay.
5
13
32
34
16
(888)
d. Pollution from these cars and trucks
includes toxic chemicals that harm
people’s health, including causing
cancer.
5
7
35
37
16
(885)
e. Living or working near a highway or
major roadway has little to no effect on
people’s health.
27
37
16
6
14
(882)
f. Plug-in electric vehicles pollute the air
less than gasoline- or diesel-fueled
vehicles.
4
4
27
48
16
(886)
g. Over the lifetime of the car, it is cheaper
to own and operate a plug-in electric
vehicle than one powered by gasoline or
diesel fuel.
6
12
14
16
52
(887)
20. Maryland has begun implementing policies to alleviate road congestion on highways and improve air quality.
For each of the following policies, please answer two questions: Have you heard of this policy? How much do
you support or oppose this policy?
Heard of this policy
Your support for this policy
Yes
No
Unwt.
N
Strongl
y
oppose
Some-
what
oppose
Neither
Some-
what
support
Strongl
y
support
Unwt.
N
a. Requiring new cars and
other vehicles in Maryland
to be less polluting
51
49
(872)
3
6
17
31
43
(878)
b. Variable express lane fees
based on road congestion
52
48
(854)
18
13
28
24
17
(877)
c. Extending tax credits and
other incentives for
purchases or leases of
plug-in electric vehicles
and charging equipment
44
56
(843)
7
8
25
31
28
(878)
d. Making improvements to
bike and pedestrian road
access
58
42
(839)
3
3
17
27
50
(877)
e. Promotion of public
transportation
59
41
(829)
2
3
24
31
40
(877)

31 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
21. Maryland has begun implementing policies to promote new sources of energy and use energy more
efficiently. For each of the following policies, please answer two questions: Have you heard of this policy?
How much do you support or oppose this policy?
Heard of this policy
Your support for this policy
Yes
No
Unwt.
N
Strongl
y
oppose
Some-
what
oppose
Neither
Some-
what
support
Strongl
y
support
Unwt.
N
a. Expanding rebates to help
people purchase energy-
efficient lighting and
appliances
51
49
(867)
4
2
12
28
55
(873)
b. Updating state and local
building codes to increase
energy efficiency and
enable electric vehicle
charging
32
68
(863)
3
4
24
33
36
(871)
c. Encouraging the
development of more
homes with better access
to public transportation, as
a means to reduce sprawl,
and preserve forests and
farmland
29
71
(857)
4
7
22
23
44
(871)
d. Funding energy efficiency
and conservation projects
that serve low- to middle-
income Marylanders
32
68
(856)
4
5
19
25
48
(868)
e. Requiring that Maryland’s
electricity suppliers provide
a percentage of their total
electricity from renewable
energy sources
37
63
(851)
4
4
18
28
47
(869)
f. Continuing financial
incentives for the
generation of renewable
energy (such as solar and
wind)
49
51
(846)
4
3
15
27
51
(872)
g. Modernizing Maryland’s
electricity grid to better
integrate renewable energy
and incentivize efficiency
31
69
(847)
2
2
18
28
49
(870)

32 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
22. Maryland is required to evaluate the economic impacts, including to jobs and industry, of its energy and
greenhouse gas reduction policies that are collectively called the “Greenhouse Gas Reduction Plan.” How
likely do you think it is that these policies will accomplish the following?
Very
unlikely
Some-
what
unlikely
Some-
what
likely
Very
likely
Don't
know
Unwt. N
a. The policies will generate
between $2.5 billion and $3.5
billion in total economic benefits
by 2020.
13
17
21
5
44
(880)
b. The policies will create or
maintain 26,000 to 33,000 jobs
by 2020.
11
16
24
7
42
(880)
c. There will be no projected
impacts from these policies on
Maryland’s manufacturing
industries.
14
18
18
7
43
(881)
23. How much do you disagree or agree with the following? Stricter environmental laws in Maryland...
Strongly
disagree
Some-
what
disagree
Some-
what
agree
Strongly
agree
Don't
know
Unwt. N
a. cost jobs and hurt the economy.
20
21
22
12
25
(882)
b. are worth the cost because of
the public health benefits.
5
9
35
33
17
(882)
c. are worth the cost because of
the environmental benefits.
6
7
34
35
18
(883)
d. can fuel economic and jobs
growth.
7
11
33
21
28
(884)
We are interested in your opinion of how climate change may, or may not be, affecting your community.
24. Do you think that climate change is currently happening?
UNWEIGHTED N=895
Yes
77
No
10
Don't know
13
25. If you answered either yes or no, how sure are you?
UNWEIGHTED N=676 UNWEIGHTED N=107
Climate change is
happening
Climate change is not
happening
I’m not at all sure
2
14
I’m somewhat sure
27
40
I’m very sure
41
27
I’m extremely sure
30
19

33 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
26. If you think climate change is currently happening, what do you think is causing it?
UNWEIGHTED N=843
Caused entirely by human activities
14
Caused mostly by human activities
31
Caused about equally by human activities and natural changes in the
environment
30
Caused mostly by natural changes in the environment
9
Caused entirely by natural changes in the environment
2
I don’t think climate change is happening
5
Don't know
9
27. To the best of your knowledge, what percentage of the following people think climate change is happening?
0 to
20%
21 to
40%
41 to
60%
61 to
80%
81 to
100%
Don't
know
Unwt.
N
a. People in my region of Maryland
(Western, Central, Southern,
Eastern counties)
6
14
23
18
10
30
(888)
b. Maryland residents (statewide)
4
11
24
20
8
32
(886)
c. People in the United States
3
14
30
18
9
26
(885)
d. Climate scientists
3
4
6
12
53
22
(885)
28. How much do you think climate change is currently harming…?
Not at all
Only a
little
A
moderate
amount
A great
deal
Don't
know
Unwt. N
a. you personally
20
27
30
14
8
(888)
b. people in your community
15
23
33
14
16
(887)
c. people in Maryland
12
19
36
18
16
(893)
29. Which of the following do you think is likely to occur in your community as a result of climate change over the
next 10-20 years?
UNWEIGHTED N=907
% Yes
a. Hotter weather
72
b. Colder weather
46
c. Heavier rains
52
d. More frequent droughts
36
e. Wildfires
23
f. Increased air pollution
53
g. Warming of cold-water streams
35
h. Longer growing season
18
i. More severe storms
63
j. Rising coastal sea levels
47
k. Increased water pollution
46
l. Increased harmful bacteria and toxins with warmer waters
53
m. There are no likely effects from climate change
9
None selected
4

34 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
30. Which of the following resources in your community do you think may be harmed by climate change in the
next several years?
UNWEIGHTED N=907
% Yes
a. Public water supplies
53
b. Public sewer systems
33
c. People’s health
59
d. Transportation/roads/bridges
31
e. Historical sites
20
f. Coastlines
54
g. Wetlands
46
h. Forests
42
i. Wildlife
51
j. Chesapeake Bay
60
k. Aquatic life, such as fish and crabs
57
l. Agriculture
53
m. Fishing/seafood industry
57
n. Private wells/septic systems
33
o. Privately owned land/buildings
22
p. There are no local risks from climate
change
11
None selected
4
31. How much do you support or oppose state and local governments taking action to protect your community
against harm caused by climate change (if any)?
UNWEIGHTED N=856
Strongly oppose
7
Somewhat oppose
7
Somewhat support
28
Strongly support
47
Don't know
12

35 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
The information below will be used to ensure that the survey is representative of people in Maryland.
32. Are you:
UNWEIGHTED N=885
Male
44
Female
56
33. How old are you?
3
UNWEIGHTED N=790
18-29
15
30-49
36
50-64
29
65 or older
20
34. Do you rent or own your home?
UNWEIGHTED N=871
Rent
28
Own
68
Other (specify)
3
35. Are any children living in your household?
UNWEIGHTED N=892
Yes
35
No
60
Not applicable
5
36. What is the age of the youngest child?
UNWEIGHTED N=730
Less than 1 year
4
1-6 years
16
7-12 years
8
13-18 years
15
No children
57
3
Respondents were asked to write in their exact age. Ages have been grouped into categories in this topline.

36 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
37. What is the highest degree or level of school that you have completed?
UNWEIGHTED N=895
Less than high school
4
High school or GED
26
Some college, no degree
22
Associate’s degree
8
Bachelor’s degree
17
Advanced degree beyond a bachelor’s degree
22
38. Which of the following broad categories describes your household's total approximate annual income before
taxes?
UNWEIGHTED N=839
Less than $10,000
5
$10,000 — $14,999
5
$15,000 — $24,999
9
$25,000 — $34,999
7
$35,000 — $49,999
12
$50,000 — $74,999
18
$75,000 — $99,999
13
$100,000 — $149,999
18
$150,000 or more
13
39A/B. Think of this ladder as representing where people stand in their communities. People define community in
different ways, please define it in whatever way is most meaningful to you. Where would you place yourself
on this ladder, first for your community, and then for Maryland?
UNWEIGHTED N=846 UNWEIGHTED N=841
Q39A
Your standing in your community
Q39B
Your standing in Maryland
10 - Highest standing
6
5
9
6
5
8
14
12
7
18
15
6
13
15
5
19
18
4
7
8
3
9
6
2
4
8
1 - Lowest standing
4
7
40. Generally speaking, do you think of yourself as politically…
UNWEIGHTED N=888
Very conservative
11
Somewhat conservative
22
Moderate, middle of the road
39
Somewhat liberal
20
Very liberal
9

37 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
41. Do you happen to know where people who live in your neighborhood go to vote?
UNWEIGHTED N=896
No
6
Yes
80
Don't know
14
42. How often would you say you vote?
UNWEIGHTED N=898
Never
9
Seldom
6
Part of the time
10
Nearly always
25
Always
48
Don't know
2
43. What ethnicity do you consider yourself?
UNWEIGHTED N=858
Hispanic or Latino
7
Not Hispanic or Latino
93
44. What is your race?
4
UNWEIGHTED N=877
White
62
Black or African American
27
Asian
4
American Indian or Alaska Native
*
Native Hawaiian or other Pacific Islander
*
Other
5
Mixed race
2
Race/Ethnicity Summary table
43. What ethnicity do you consider yourself?
44. What is your race?
UNWEIGHTED N=878
White, non-Hispanic
59
Black or African American, non-Hispanic
26
Hispanic
7
Other/Mixed race, non-Hispanic
8
4
Respondents were allowed to select 1 or more races. Those who selected more than one are coded as “Mixed race.”

38 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
45. How would you describe your primary current occupation, or former occupation, if retired?
UNWEIGHTED N=886
Blue collar or service industry
22
Clerical
7
Managerial or professional
44
Student
4
Homemaker
7
Other/not applicable
15
46. In the last 12 months, have you personally experienced one or more prolonged periods of stress of 1 month
or longer in relation to circumstances in everyday life, such as work, health, or a family situation? (Stress
refers to feelings of irritability, tension, nervousness, fear, anxiety, or sleep disturbances.)
UNWEIGHTED N=885
I have not experienced a prolonged period of stress
41
One period of prolonged stress
20
More than one period of prolonged stress
26
Constant stress
14
47. Have you ever been told by a doctor or health care provider that you have one or more of these conditions?
UNWEIGHTED N=907
% Yes
a. Asthma
12
b. COPD
5
c. Hypertension
24
d. Coronary heart disease
5
e. Stroke
2
f. Diabetes
12
g. Cancer
9
h. Weak or failing kidneys
2
i. Arthritis
21
j. Hepatitis
2
k. None of the above
46
None selected
3
Please provide any additional comments for us below.
UNWEIGHTED N=907
Wrote comment
17
No comment
83

39 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
INFO1. Would you like any additional information about some of the topics in the survey? If so, please mark the
topics of interest…
UNWEIGHTED N=907
% Yes
a. Home energy efficiency
13
b. Flooding protection
5
c. Protection against heat waves
7
d. Energy bill assistance
12
e. Energy fuel choices and health
10
f. Home and community renewable energy generation
10
g. Smart grid
13
Thank you for completing the survey!
Please use the enclosed postage-paid envelope to return this survey.

40 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey

41 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2: Methodology
GEORGE MASON UNIVERSITY AND
THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC
HEALTH
HEALTHY PEOPLE, HEALTHY PLACES:
A SURVEY OF MARYLANDERS ON PUBLIC HEALTH,
ENERGY, AND THEIR ENVIRONMENT
METHODOLOGICAL REPORT
PREPARED BY:
PRINCETON SURVEY RESEARCH ASSOCIATES INTL.
Princeton Office
Washington Office
600 Alexander Road, Suite 3-2
1211 Connecticut Ave NW, Suite 305
Princeton, NJ 08540
Washington, DC 20036
(609) 924-9204
(202) 293-4710
August 2016

42 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
SUMMARY
The Healthy People, Healthy Places Survey, jointly sponsored by the Center For Climate Change
Communication at George Mason University (GMU) and the Johns Hopkins Bloomberg School of
Public Health, obtained interviews with a sample of 907 households in the state of Maryland. The
survey was conducted by Princeton Survey Research Associates International (PSRAI). Data were
collected by postal mail by the Scantron Corporation from May 21 to August 1, 2016.
Details on the design, execution and analysis of the survey are discussed below.
DESIGN AND DATA COLLECTION PROCEDURES
Sample and Questionnaire Design
A sample of 4,201 Maryland households were randomly selected from Survey Sampling
International's household address databases, based primarily on U.S. Postal Service delivery route
information. In contrast to the previous waves of this study where sampling took place at the
regional level, sampling for the 2016 study was a simple random selection of households at the
state level. Sample was provided to PSRAI by GMU.
In addition to sample design, George Mason University also developed all mailing materials
including the mail questionnaire. Prior to printing or mailing any materials, GMU submitted and
received approval for all mailing materials from Johns Hopkins' IRB. The Scantron Corporation,
with a location based out of Columbia, PA, supplied, printed and distributed all mailings,
developed the scannable questionnaire form, and processed and scanned all returned
questionnaires into an electronic data format in accordance with an approved data codebook.
PSRAI coordinated the mailings and data collection with Scantron, cleaned, processed and
weighted the survey data, and produced the reporting and analysis.
Contact Procedures
Data were collected by mail from May 21 to August 1, 2016. Requests for participation were sent
to a total of 4,201 Maryland households. Each household was sent up to four mailings. All
mailings were freighted to Maryland and distributed by a local Maryland post office. Progress was
monitored regularly throughout the data collection period.
On April 20, 2016, advanced letters on Johns Hopkins letterhead were mailed to all 4,201
sampled households. The letter was signed by Dr. Peter Winch, a Professor in the Social and
Behavioral Interventions Program in the Department of International Health at the Johns Hopkins
Bloomberg School of Public Health. The letter explained that a survey about public health, energy
and Maryland’s environment would be arriving soon and encouraged the household's
participation. (All letters can be found in the Appendix.)

43 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
On May 21, 2016, the initial survey mailings on Johns Hopkins letterhead were mailed to 4,200
sampled households.
5
Each packet contained a questionnaire booklet, a postage paid return
envelope, a $2 bill, and a cover letter signed by Dr. Peter Winch. This cover letter explained the
survey and encouraged participation by an adult member of the household, age 18 or older. If
there was more than one adult in the household, instructions indicated that the person in the
household who has had the most recent birthday should complete the enclosed questionnaire.
On June 16, 2016, postcard reminders to non-responders were mailed to 3,626 households.
Excluded from the postcard mailing were households that had already completed the survey,
refused to participate, or had both previous mailings returned as undeliverable.
On June 29, 2016, a follow-up survey mailing on Johns Hopkins letterhead was mailed to 3,589
households. Excluded from the follow-up survey mailing were households that had already
completed the survey, refused to participate, or had the first two mailings returned as
undeliverable. Each packet contained a questionnaire booklet, a postage paid return envelope,
and a cover letter signed by Dr. Peter Winch. Affixed to each cover letter was a sticky note
indicating a study deadline of July 15 and offering participants a chance to be entered into a raffle
for a gift card.
WEIGHTING AND ANALYSIS
Weighting is generally used in survey analysis to compensate for sample designs and patterns of
non-response that might bias results. The sample was weighted to match Maryland adult general
population parameters.
The weighting adjusted sample demographics to known population parameters. The sample was
balanced to match parameters for sex, age, education, race/ethnicity, region and population
density. The basic weighting parameters came from and analysis of the U.S. Census Bureau’s
2014 American Community Survey data. The population density parameter was derived from
Census 2010 data at the county level.
Weighting was accomplished using SPSSINC RAKE, an SPSS extension module that
simultaneously balances the distributions of all variables using the GENLOG procedure. Weights
were trimmed to prevent individual interviews from having too much influence on the final results.
The use of these weights in statistical analysis ensures that the demographic characteristics of
the sample closely approximate the demographic characteristics of the national population. Table
1 compares weighted and unweighted sample distributions to population parameters.
5
Upon receiving the advance letter, one household indicated they are part-time residents and were removed from
further mailings for this study.

44 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Table 1: Sample Demographics
Parameter
Unweighted
Weighted
Gender
Male
47.4
32.9
42.8
Female
52.6
64.7
54.5
missing
2.4
2.7
Age
18-34
30.1
11.4
22.4
35-44
16.8
9.9
13.8
45-54
19.0
12.7
16.8
55-64
16.7
20.7
15.7
65+
17.4
32.4
17.1
missing
12.9
14.3
Education
HS Grad or less
36.2
16.0
29.5
Some College/Assoc Degree
28.4
26.1
29.9
College Graduate
35.4
56.6
39.1
missing
1.3
1.5
Race/Ethnicity
White/not Hispanic
55.0
69.8
56.7
Black/not Hispanic
28.4
15.4
25.2
Hispanic
8.2
3.9
6.4
Other/not Hispanic
8.4
7.7
8.2
missing
3.2
3.6
Region
Capital
35.9
31.9
33.6
Central
46.2
51.6
47.4
Southern
5.7
4.2
6.2
Eastern shore
7.8
7.2
7.8
Western
4.4
5.2
5.0
County Pop. Density
1 - Lowest
2.5
2.8
2.8
2
14.0
12.6
14.7
3
12.7
16.3
13.8
4
60.0
57.3
57.4
5 - Highest
10.8
11.0
11.3

45 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Effects of Sample Design on Statistical Inference
Post-data collection statistical adjustments require analysis procedures that reflect departures
from simple random sampling. PSRAI calculates the effects of these design features so that an
appropriate adjustment can be incorporated into tests of statistical significance when using these
data. The so-called "design effect" or deff represents the loss in statistical efficiency that results
from unequal weights. The total sample design effect for this survey is 1.71.
PSRAI calculates the composite design effect for a sample of size n, with each case having a
weight, wi as:
In a wide range of situations, the adjusted standard error of a statistic should be calculated by
multiplying the usual formula by the square root of the design effect (√deff ). Thus, the formula for
computing the 95% confidence interval around a percentage is:
where
p
ˆ
is the sample estimate and n is the unweighted number of sample cases in the group
being considered.
The survey’s margin of error is the largest 95% confidence interval for any estimated proportion
based on the total sample— the one around 50%. For example, the margin of error for the entire
sample is ± 4.3 percentage points. This means that in 95 out every 100 samples drawn using the
same methodology, estimated proportions based on the entire sample will be no more than 4.3
percentage points away from their true values in the population. It is important to remember that
sampling fluctuations are only one possible source of error in a survey estimate. Other sources,
such as respondent selection bias, questionnaire wording and reporting inaccuracy, may
contribute additional error of greater or lesser magnitude.
2
1
1
2











n
ii
n
ii
w
wn
deff
formula 1








 npp
deffp )
ˆ
1(
ˆ
96.1
ˆ
formula 2

46 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Response rate
Table 2 reports the disposition of all sample records released. The response rate estimates the
fraction of all eligible sample that was ultimately interviewed. The response rate is based on
AAPOR response rate #3 as set forth by the American Association for Public Opinion Research.
Thus the response rate for the sample was 24 percent.
Table 2: Sample Disposition
Total Sample Released
4201
Non-response, unknown eligibility U
3178
Refused R
23
Ineligible IN
93
Completed I
907
e= estimated eligibility (I+R)/(I+R+IN)
90.9%
Response Rate I/[I+R+(e*U)]
23.7%

47 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
CODING AND EDITING
The completed questionnaires were returned to Scantron and scanned into an electronic data file.
All handwritten open-end question responses were recorded verbatim by Scantron coders and
entered into the electronic data file. PSRAI thoroughly examined completed questionnaires to
ensure proper completion and checked to ensure the data responses matched the responses in
the questionnaire booklets. Any notes from respondents, problems or inconsistencies were dealt
with by PSRAI staff. Problems were reconciled whenever possible and cleaned in the data file.
 If there are multiple response to a question that should only have one response and that
question has no ‘other specify’ option, the question was recoded as 'No answer' in the data
if there is not some indication of which answer is right (e.g. one crossed out and the
second circled multiple times).
 If there are multiple response to a question that should only have one response and that
question has an ‘other specify’ option, the question was recoded as ‘other’ and the
responses entered into the specify field in the data.
 If applicable, 'other specify' responses were back-edited if they fit into the existing answer
categories/codes.
In addition to open-end response categories for specific questions, respondents also had the
opportunity to make any additional comments at the end of the survey.
DATA ENTRY AND VERIFICATION
The data were entered, verified, and cleaned to correct for any scanning entry errors, appropriate
question sequence (i.e., skip patterns), valid response ranges, and other logical consistencies.

48 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2a: Advance letter
[DATE]
[Name of city] Resident
[Address1], [Address2]
[City], [State] [Zip]-[Zip4]
Dear [Name of city] Resident:
The Johns Hopkins Bloomberg School of Public Health, as part of a research project with George
Mason University, is requesting your help with an important study being conducted about public
health, energy and Maryland’s environment. Your household was selected at random from among
all residents in Maryland. In the next few days you will receive an envelope containing our
questionnaire. We hope you will participate.
We would like to make it as easy and enjoyable as possible for you to participate in the study. I am writing in
advance because sometimes people like to know ahead of time that they will be asked to fill out a
questionnaire. The success of this study will rely on the generous help of people like you who are willing to
take about 15-20 minutes of their time to answer our questions.
As a token of our appreciation, we will be sending you $2 in the envelope containing the questionnaire.
Please keep your eyes open for that envelope in the mail; it should arrive in the next several days. This project
is funded by the Town Creek Foundation of Easton, Maryland; no state funds are being used. You are not
under any obligation to participate, but I hope you will be willing to help us. Most of all, I hope that you enjoy
taking the survey and the opportunity to tell us about your views on the health of Maryland’s people and
environment.
Best wishes,
Peter Winch, MD, MPH
Johns Hopkins Bloomberg School of Public Health
Princeton Survey Research Associates International (PSRAI), a national polling firm, will conduct this survey
for us, with data collection provided by Scantron. If you have any questions, you may contact XXXXXXXXXXX
of PSRAI at XXXXXXXXXXXXXXX@psrai.com. You may also contact Project Director XXXXXXXXXXXXX at (703)
XXX-XXXX or XXXXXXXX@gmu.edu at George Mason University.

49 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2b: Cover letter for initial survey mailing
[DATE]
[Name of city] Resident
[Address1], [Address2]
[City], [State] [Zip]-[Zip4]
Dear [Name of city] Resident:
I am writing to request your help with an important study being conducted about public health, energy and
Maryland’s environment. One important way for us to learn about these issues is to ask people who live in
the state to share their thoughts with us. Your household is one of 4,200 homes that have been randomly
selected for this study being conducted by the Johns Hopkins Bloomberg School of Public Health and George
Mason University, and funded by the Town Creek Foundation in Easton, Maryland.
Please have an adult (age 18 or over) fill out the survey. If there is more than one adult in your household,
please have the person in your household who has had the most recent birthday complete the enclosed
questionnaire if possible. This ensures we hear from a random sample of people who live in the state.
The questions should only take about 15-20 minutes to answer. By taking this time to share your thoughts,
you will help us understand how to better develop future public health services for Marylanders, such as
programs that assist communities during heat waves and other extreme weather events. As a way of saying
thank you for participating, we have enclosed a small token of appreciation. No state funds are being used
in this project. You are not under any obligation to participate, but I hope that you will consider participating,
and will enjoy taking the survey.
I look forward to hearing your thoughts. Thanks for taking this time to help us better protect our quality of life
here in Maryland.
Best wishes,
Peter Winch, MD, MPH
Johns Hopkins Bloomberg School of Public Health
Princeton Survey Research Associates International (PSRAI), a national polling firm, will conduct this survey
for us, with data collection provided by Scantron. If you have any questions, you may contact XXXXXXXXXXX
of PSRAI at XXXXXXXXXXXXXXX@psrai.com. You may also contact Project Director XXXXXXXXXXXXX at (703)
XXX-XXXX or XXXXXXXX@gmu.edu at George Mason University.

50 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2c: Postcard reminder

51 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2d: Cover letter for follow-up survey mailing
[DATE]
[Name of city] Resident
[Address1], [Address2]
[City], [State] [Zip]-[Zip4]
Dear [Name of city] Resident:
In April we sent a letter inviting you to complete a questionnaire on the health and wellbeing of Maryland’s
people and environment. While you are not under any obligation to participate, to the best of our knowledge,
we have not received it yet, and wanted to be sure that it had not been lost in the mail.
We are writing again because of the importance that your questionnaire has in helping us to get accurate
results that truly represent the state’s residents. Therefore, we hope that the adult in your household who
has had the most recent birthday will fill out the questionnaire (another copy of which is enclosed) and return
it to us soon. This will help ensure that we hear from a random sample of adults in every household.
The questions should only take about 15-20 minutes to complete. We hope that you enjoy answering the
questions and sharing your thoughts with us. We look forward to hearing your opinion on these important
issues.
Best wishes,
Peter Winch, MD, MPH
Johns Hopkins Bloomberg School of Public Health
Princeton Survey Research Associates International (PSRAI), a national polling firm, will conduct this survey
for us, with data collection provided by Scantron. If you have any questions, you may contact XXXXXXXXXXX
of PSRAI at XXXXXXXXXXXXXXX@psrai.com. You may also contact Project Director XXXXXXXXXXXXX at (703)
XXX-XXXX or XXXXXXXX@gmu.edu at George Mason University.

52 | Public Health, Energy & Climate, 2016 | A Maryland Statewide Survey
Appendix 2e: Sticky note affixed to cover letter for follow-up survey mailing