The Make Healthy Choices Easy committee wants to find out how screens/devices are used and their impact on our community. Screens/devices are defined as a: television, computer, laptop, game console, cell phone, iPad, tablet, or DVD player. This survey should only take 4 - 5 minutes to complete. Thank you for taking part in this survey!


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* 1. Research shows too much screen time impacts many areas of our lives. Which of the following are you aware of and which impact you, if any? (MARK ALL THAT APPLY)

  AWARE OF AFFECTED BY
Bullying 
Obesity
Myopia, Dry Eye, Vision-Retinal Cells
Anxiety, Loneliness, Depression, Suicide
Sleep Deprivation
Decreased Vocabulary
Lower Interaction with Parents
Behavioral and Cognitive Issues
Addictions: i.e. gaming, gambling, shopping, stock trading, increased compulsivity

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* 2. How many hours do you estimate you spend a day (on average) in front of a   screen?

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* 3. Do you think you spend too much time using screens?

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* 4. Are there any restrictions on the AMOUNT of time you are allowed to be in front of a screen at home?

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* 5. How soon after waking up do you interact with a device?

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* 6. When with family and friends, how often do you put down or turn off screen   devices?

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* 7. When with family and friends, do you participate in the following? (MARK ALL THAT APPLY)

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* 8. Have you ever used an app to see how much time you spend on: (MARK ALL THAT APPLY)

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* 9. Which of the following have you ever done? (MARK ALL THAT APPLY)

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* 10. Do you use any of the following strategies to limit screen time? (MARK ALL THAT APPLY)

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* 11. Do you think organizations (worksites/schools) should have policies to help reduce screen time?

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* 12. Which of the following environmental approaches would you support at work/school, if any? (MARK ALL THAT APPLY)

OPTIONAL:  The following demographic data is helpful but not required.

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* 13. My gender is:

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* 14. What is your age:

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