TTT IIe aes A Fresh Food Alternatives: Our Choice, Our Voice This survey asks questions about how you get fresh, unprocessed foods and will only take 10-15 minutes of your time, From now until is participating in a Community Food Assessment sponsored by ‘We're trying to learn how all residents and their families view their ability to buy, grow, store, prepare, and enjoy healthful food. This research will be used to help improve our community food resources. Above all its ‘main purpose is to listen. To hear from you, because you are the experts and your experiences and concerns are vital to finding out where we are strong and where we are weak food-wise — as families, as neighborhoods and as a community, Your comments will help improve our community food resources in order to better serve our collective food needs and will become a solution-oriented tool for the community. Please keep in mind that information on this form will be included in a report, but will remain confidential. No names or individual information will be used. You don’t have to answer any of these questions if you don’t want to, but we'd appreciate as much information as you can give us. Home Gardens: 1. Do you or anyone in your household: grow a vegetable garden? "Yes No (If No skip to question #4) hunt for meat for the house? (Yes (No harvest fruit trees or bushes, forage wild foods? [Yes [|No 2, How much of what you eat each year comes from your garden, hunting, foraging and/or someone else’s home garden, hunting, foraging? 0-25% (25-50% 50-75% 1175-100% 3. If you grow, hunt or forage for food and have extra, what do you do with that? Check all that apply. freeze, can, or dry give it away — to whom(ex. Neighbors, church): compost it feed it to animals Throw it in the woods ‘Throw it in the trash 4, Ido not grow a garden because: (Check all that apply) Does not apply, I do grow a garden lack of knowledge No space to garden Can't afford tools and seeds No time Unable, due to health/disability No interest Other: Health 5, What does it mean to you to ‘eat well"?6. How would you rate the nutritional quality of your diet? Excellent ||Good || Fair (Poor 7. Do you or someone in your household have one of these potentially diet-related conditions? (Check all that apply) Type I! Diabetes Heart Disease Obesity/Overweight Osteoporosis Cardiovascular Disease Other diet-related conditions: Hyper Tension/High Blood Pressure High Cholesterol 8. Please answer YES or NO for each item. Which of following options would help you eat more fruits and vegetables? Knowing that they can help prevent disease |) Yes [No If the food pantry had more || Yes ||No If they were cheaper |) Yes [No If Thad a way to cook them | Yes ||No. If I had refrigeration/storage |) Yes ||No Free or low cost shuttle to local stores / markets“) Yes [/No_ Better variety and quality where you shop “Yes No More fruit and veggie choices at restaurants / fast food places Yes (No Nearby Farmer's Market 7Yes No Food buying co-op where food is bought in bulk by a group of people for a discount “Yes CINo Having more time to prepare/eat more healthy, balanced meals Yes (No If T knew what choices are healthy or unhealthy "Yes (No Other: Affordability: 9, What issues, relative to cost-of-living, affect your ability to ‘eat well’ in Fairview? (Read each answer then choose your top 2, 1 being most important) _— inadequate personal income transportation __ high fuel/heating costs childcare costs/child related expenses __high rent/lack of affordable housing __ other: __high mortgage payment 10. Do you ever feel that fresh food is generally unaffordable in Fairview? (Yes No if yes, why? 11. Where do you go to find affordable fresh foods? (Please check all that apply) Local Farm Stand/StoreHunger/Use of Food Assistance: 12, Do you or anyone in your household regularly use any of the following food programs? (Check all that apply) None (Please skip to Question # 14) Food stamps/SNAP WIC © WIC Farmers Market Nutrition Program. © Food programs at churches © Commodities Programs (FDPIR) © Nutrition Services Incentives Program © Backpack Programs 13. What are the reasons that you use food a: ‘Unusual expense this month, Ran out of food stamps Recent job loss Continued unemployment © Separation from spouse stance at this time? Community gardens U Senior farmers market coupons i Meals on Wheels G Free or reduced school breakfast/lunch © Summer Food Program 3 Food for Fairview Food Pantry Other: Aid temporarily discontinued Delay in receiving aid/supply shortage Money/food stamps stolen New members in the household © Other: 14, People who qualify for free food programs do not use them for different reasons. Why do you NOT use free food programs? (Check all that apply) 1 Lknow that or don’t think I'm qualified Pm not aware of the food assistance programs available to me ‘The food available through these program: not what I typically eat © Teannot eat many of the food items available through these programs for health reasons © Teannot eat many of the food items available through these programs for religious reasons 5 Tdo not like the quality of the food available through these programs 5 Ido not like to accept charity I do not care for the people who work there Thave applied but been turned down I'S too much trouble to apply U Pmatraid to apply 1 Tdon’t have any transportation/gas money to apply/get to distribution locations © Tean’t find child care © A family member does not want me to © Embarrassment 1 Other reason: 15, Do you feel you are getting enough unprocessed foods, like fruits and vegetables, eggs, milk, whole _grains? (Please choose one) We always have enough to eat and the kinds of unprocessed foods we want. ‘We always have enough to eat, but do not choose to eat unprocessed foods often. We have enough to eat but not always the kinds of unprocessed foods we want, We sometimes do not have enough to eat. Often we do not have enough to eat. 16, Do you ever have a hard time stretching your food budget at the end of the month? [7 Yes [No If Yes, what do you do in those months?17. Here are some reasons why people don’t always have enough to eat. Which of the following, if anything, stops your family from buying the food you need? (Read each choice. Check all that apply.) Nothing. [can afford all the food I need. Don’t know how to cook well Income too low No working stove available Onadiet Prefer to eat out but can’t afford it Rent or other expenses too high Kinds of food we want are not available Not able to cook or eat due to health problems Need special food I can’t get Too hard to get to the store Medical bills / Prescription costs Too busy to shop Cost of child support Need help carrying groceries Cost of day care Too little time to cook Getting transportation to stores No refrigerator available Being treated poorly at stores What Influences your food choices? 18, Does transportation ever make it difficult for you to get your groceries? Yes/No If yes, what would make it easier for you to get your groceries?, 19, What influences the way you eat? (rank top three, I being most important) __ Family/culture __What family members will eat __ Price __ Seasonality __Availability __Taste Education —_Locally-grown __Friends —_ Nutritious __Advertising/trends Brand name —_ Special nutritional needs __ Certified organic __On a diet __Other: ___Convenience Food Prep and Cooking: 20. Where does your family eat the majority of their meals? (pick and rank 3, 1 being most important) __At home Church __ Sit down restaurant Workplace __At home of family __At school Convenience store __ Other: __Fast food 21. How many meals per week do you prepare at home? 10 "11-3 14-6 [17-10 “more than 11 22. Do you prepare these meals mostly from “scratch/with fresh foods Or !) with prepackaged goods? 23. Where did you learn how to get and prepare food? (Check all that apply) From a relative, From a dietitian/nutritionist In school Chureh, 4H From a book From an extension agent Other:The Future: 24, Which of the following do you think is useful or would be useful in improving your food resources? (Check all that, apply) Tips on getting the most for my money at the grocery store GiInformation on nutrition and healthful eating and cooking Help with reading, filling out or understanding free food program forms/applications GA “one-stop” application process forall food assistance programs Access to transportation Access to child care Help with budgeting Help gardening/Information on how to grow a garden Free cooking classes and recipes Community garden plots-affordable growing spaces for all community members Community kitchens ~ affordable kitchen space for all community members Food buying clubs GIA WICISNAP Farmer's market nutrition program — issuing food coupons specifically for fresh, farmers’ market produce GAffordable food purchasing & cooking classes QA Farmers’ Market nearby Subsidized Community Supported Agriculture/Fresh Food boxes direct from a local farm 25. What other ideas do you think would make it easier for people in our community to be able to buy, grow, prepare, eat, and enjoy fresh foods? Demograph To help us better understand the results of the survey, we'd like to ask a final few questions to know what kinds of people filled out the survey. 26. Are you: Male _ Female __ 27. About how old are you? +17 and under + 18-34 35-59-60 and over 28, What ethnicity do you most closely identify with? + White (non-Hispanic) + African American (non-Hispanic) + Latino/Hispani + American Indian/Alaskan Native + Asian of Pacific Islander + Moldavian + Albanian +Other (please describe)29. How would you describe your living situation? (check one box that best describes your situation) In house or apartment I can afford Ina place where I pay over 1/2 my income in rent Staying with family/friends Staying in a shelter (including domestic violence shelter) Staying in supported housing Living in a car, on the streets group home, halfway house Other: 30. Including yourself how many people live in your household? Total Children under 18 Adults 18 and over 31. What range includes your total household income, before taxes, for 20117 '$0-$20,000 | $20,001 to$30,000 $30,001 to $50,000 | $50,001 & over 32. What are your households sources of income? (check all that apply) Full time job 40 hrs.fwk Regular job less than 40 hrs/wk. Occasional work Supplemental Security Income (SSI) Social Security Help from family/friends ‘Unemployment payments Not currently employed AND not receiving unemployment payments Disability payments Other: 33. To give us some idea of your location in Fairview, please specify a STATE ROAD nearest to your residence: ‘We will be sharing the results of this survey in public meetings and in other ways next spring. If you would like a copy of ‘one page summary of our major results and key recommendations from this survey, and if you have an email address, it here: (Please print your email address carefully.) If you do not have an email address and would also like to be contacted please leave your preferred contact information (phone number or mailing address) Be assured that this contact information will in no way be connected with your survey comments. With this contact information we would be glad to invite you to the follow up meetings and provide you our major findings once the survey data have been analyzed. Thank you very much for your time and input