For Me For Us Video Feedback Question Title * 1. Gender Male Female Question Title * 2. Age Under 18 18-45 46-64 65 and older Question Title * 3. Race/Ethnicity (You may check more than one.) Native Hawaiian Tongan Samoan Other Pacific Islander American Indian/Alaskan Native Asian Black/African American Hispanic/Latino White/Caucasian Question Title * 4. Where do you live? Utah Other (please specify) Question Title * 5. Which versions of the “For Me, For Us” video have you seen? (Check all that apply.) Samoan Language Version Spanish Language Version Tongan Language Version English Language Version for African Americans English Language Version for Hispanics/Latinos English Language Version for Pacific Islanders English Language Version for General Population Question Title * 6. How did you find out about this video? Church Community-Based Organization Friend or Relative Health Department or Public Health Worker Hospital or Clinic Internet Search Utah Department of Health website YouTube Other (please specify) Question Title * 7. Do you feel that the information in the video was useful? Yes No Question Title * 8. Was the video easy to understand? Yes No Question Title * 9. Was the video enjoyable to watch? Yes No Question Title * 10. Did you learn any new information by watching this video? Yes No Question Title * 11. Were you motivated to change any health behaviors because of watching this video? Yes No Question Title * 12. Would you recommend this video to a friend or relative? Yes No Question Title * 13. Overall, how do you rate the video? Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 14. Do you have any comments about the video? Done