Indian River County PACE-EH 2022 Survey

The Department of Health in Indian River would like to identify the needs of communities within the county. Your input is important because it is the basis for assessing which environmental health problems exist in your community. Please assist us by completing this survey and returning it to the Health Department or Dasie Hope Center. Questions? Contact Molly or Julianne at 772-794-7410. Thank you for your participation!

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* 1. Where do you live?

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* 2. What is your zip code?

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* 3. How many people currently live in your household?

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* 4. What is your age?

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* 5. How many of the members of your household are under the age of 18?

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* 6. Does your community need assistance and/or information on the following? (mark all that apply)

Affordable childcare

Affordable elder care services

Parenting classes

Family Planning

Mental health / counseling

Substance abuse / addiction recovery

Domestic violence / sexual assault services

Women's health

Sexual health

Free health screenings

Disability services

Health Insurance/Medicare/ Medicaid information & enrollment

Legal assistance (immigration, foreclosure, marital, etc.)

Job training & application assistance

Affordable housing

Unemployment benefits application assistance

Transportation services

English language classes

Nutrition / cooking classes

Physical activity opportunities / classes

Other (please specify)

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* 7. In the past month did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?

One time

More than one time

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* 8. Are you usually able to get the food that you want to eat?

Yes

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* 9. If you answered "no" to the question above, what prevents you from getting the food you want to eat?

Price

Lack of transportation

Don't know where to find it

Travel time

Personal safety

Not available where I regularly shop

Lack of free time

Lack of cooking equipment

Other (please specify)

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* 10. How many days in the past month did poor physical health interfere with daily activities?'

1-5

6-10

11+

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* 11. How many days in the past month did poor mental health interfere with daily activities?

1-5

6-10

11+

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* 12. Are you aware of Community Supported Agriculture (CSA) or a food co-op in our county?

Yes

	Never	Once	A few times	Often
Grocery Store	Grocery Store Never	Grocery Store Once	Grocery Store A few times	Grocery Store Often
Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store)	Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Never	Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Once	Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) A few times	Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Often
Fast Food Restaurant (i.e., has many locations and, often, a drive-through window)	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Never	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Once	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) A few times	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Often
Sit-in Restaurant (i.e., has wait staff)	Sit-in Restaurant (i.e., has wait staff) Never	Sit-in Restaurant (i.e., has wait staff) Once	Sit-in Restaurant (i.e., has wait staff) A few times	Sit-in Restaurant (i.e., has wait staff) Often
Food Pantry	Food Pantry Never	Food Pantry Once	Food Pantry A few times	Food Pantry Often
Free Meal (e.g., Senior Center, church meal)	Free Meal (e.g., Senior Center, church meal) Never	Free Meal (e.g., Senior Center, church meal) Once	Free Meal (e.g., Senior Center, church meal) A few times	Free Meal (e.g., Senior Center, church meal) Often
Farmers’ Market or Produce Stand (when in season)	Farmers’ Market or Produce Stand (when in season) Never	Farmers’ Market or Produce Stand (when in season) Once	Farmers’ Market or Produce Stand (when in season) A few times	Farmers’ Market or Produce Stand (when in season) Often
Your own garden (when in season)	Your own garden (when in season) Never	Your own garden (when in season) Once	Your own garden (when in season) A few times	Your own garden (when in season) Often

Never

Once

A few times

Often

Grocery Store

Grocery Store Never

Grocery Store Once

Grocery Store A few times

Grocery Store Often

Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store)

Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Never

Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Once

Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) A few times

Convenience store, carryout or corner store (eg., gas station, pharmacy, discount store) Often

Fast Food Restaurant (i.e., has many locations and, often, a drive-through window)

Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Never

Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Once

Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) A few times

Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Often

Sit-in Restaurant (i.e., has wait staff)

Sit-in Restaurant (i.e., has wait staff) Never

Sit-in Restaurant (i.e., has wait staff) Once

Sit-in Restaurant (i.e., has wait staff) A few times

Sit-in Restaurant (i.e., has wait staff) Often

Food Pantry

Food Pantry Never

Food Pantry Once

Food Pantry A few times

Food Pantry Often

Free Meal (e.g., Senior Center, church meal)

Free Meal (e.g., Senior Center, church meal) Never

Free Meal (e.g., Senior Center, church meal) Once

Free Meal (e.g., Senior Center, church meal) A few times

Free Meal (e.g., Senior Center, church meal) Often

Farmers’ Market or Produce Stand (when in season)

Farmers’ Market or Produce Stand (when in season) Never

Farmers’ Market or Produce Stand (when in season) Once

Farmers’ Market or Produce Stand (when in season) A few times

Farmers’ Market or Produce Stand (when in season) Often

Your own garden (when in season)

Your own garden (when in season) Never

Your own garden (when in season) Once

Your own garden (when in season) A few times

Your own garden (when in season) Often

	Not important	Important	Very Important
Taste	Taste Not important	Taste Important	Taste Very Important
Nutritional value	Nutritional value Not important	Nutritional value Important	Nutritional value Very Important
Appearance	Appearance Not important	Appearance Important	Appearance Very Important
Price	Price Not important	Price Important	Price Very Important
Locally grown	Locally grown Not important	Locally grown Important	Locally grown Very Important
Organically grown or grown without the use of pesticides	Organically grown or grown without the use of pesticides Not important	Organically grown or grown without the use of pesticides Important	Organically grown or grown without the use of pesticides Very Important

Not important

Important

Very Important

Taste

Taste Not important

Taste Important

Taste Very Important

Nutritional value

Nutritional value Not important

Nutritional value Important

Nutritional value Very Important

Appearance

Appearance Not important

Appearance Important

Appearance Very Important

Price

Price Not important

Price Important

Price Very Important

Locally grown

Locally grown Not important

Locally grown Important

Locally grown Very Important

Organically grown or grown without the use of pesticides

Organically grown or grown without the use of pesticides Not important

Organically grown or grown without the use of pesticides Important

Organically grown or grown without the use of pesticides Very Important

	Yes	No	Yes but needs improvement
Sidewalks or walking / biking paths	Sidewalks or walking / biking paths Yes	Sidewalks or walking / biking paths No	Sidewalks or walking / biking paths Yes but needs improvement
Parks or playgrounds	Parks or playgrounds Yes	Parks or playgrounds No	Parks or playgrounds Yes but needs improvement
Recreation or community center	Recreation or community center Yes	Recreation or community center No	Recreation or community center Yes but needs improvement
Fresh foods / market	Fresh foods / market Yes	Fresh foods / market No	Fresh foods / market Yes but needs improvement
Public transportation / bus stops	Public transportation / bus stops Yes	Public transportation / bus stops No	Public transportation / bus stops Yes but needs improvement

Yes

Yes but needs improvement

Sidewalks or walking / biking paths

Sidewalks or walking / biking paths Yes

Sidewalks or walking / biking paths No

Sidewalks or walking / biking paths Yes but needs improvement

Parks or playgrounds

Parks or playgrounds Yes

Parks or playgrounds No

Parks or playgrounds Yes but needs improvement

Recreation or community center

Recreation or community center Yes

Recreation or community center No

Recreation or community center Yes but needs improvement

Fresh foods / market

Fresh foods / market Yes

Fresh foods / market No

Fresh foods / market Yes but needs improvement

Public transportation / bus stops

Public transportation / bus stops Yes

Public transportation / bus stops No

Public transportation / bus stops Yes but needs improvement

Indian River County PACE-EH 2022 Survey

WHAT DO YOU THINK?

Question Title

* 1. Where do you live?

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* 2. What is your zip code?

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* 3. How many people currently live in your household?

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* 4. What is your age?

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* 5. How many of the members of your household are under the age of 18?

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* 6. Does your community need assistance and/or information on the following? (mark all that apply)

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* 7. In the past month did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?

Question Title

* 8. Are you usually able to get the food that you want to eat?

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* 9. If you answered "no" to the question above, what prevents you from getting the food you want to eat?

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* 10. How many days in the past month did poor physical health interfere with daily activities?'

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* 11. How many days in the past month did poor mental health interfere with daily activities?

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* 12. Are you aware of Community Supported Agriculture (CSA) or a food co-op in our county?

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* 13. In the past month, how often have you or someone in your household used each of the following sources to get food?

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* 14. Please rate how important the following are in your decision about what food to buy

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* 15. In your neighborhood is there one of the following?

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* 16. What would make it easier for you to consume more fruits, vegetables and lean proteins? Please check the items that would make it easier.