Food Access Survey

Please answer the following questions about food access in the Newtown community. All surveys are anonymous.

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* 1. What is your zip code of primary residence?

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* 2. Do you shop for, or otherwise get food for your household? Household is defined as a single person getting food for themselves or a group of people who live together and share food on a regular basis.

Yes

Sometimes

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* 3. Where do you get most of your food?

	1 = All of the time	2 = Most of the time	3 = Some of the time	4 = Occasionally	5 = Never
Community gardens	Community gardens 1 = All of the time	Community gardens 2 = Most of the time	Community gardens 3 = Some of the time	Community gardens 4 = Occasionally	Community gardens 5 = Never
Convenience stores/gas stations	Convenience stores/gas stations 1 = All of the time	Convenience stores/gas stations 2 = Most of the time	Convenience stores/gas stations 3 = Some of the time	Convenience stores/gas stations 4 = Occasionally	Convenience stores/gas stations 5 = Never
Fast food restaurants	Fast food restaurants 1 = All of the time	Fast food restaurants 2 = Most of the time	Fast food restaurants 3 = Some of the time	Fast food restaurants 4 = Occasionally	Fast food restaurants 5 = Never
Food assistance (food banks, pantries, Salvation Army, etc.)	Food assistance (food banks, pantries, Salvation Army, etc.) 1 = All of the time	Food assistance (food banks, pantries, Salvation Army, etc.) 2 = Most of the time	Food assistance (food banks, pantries, Salvation Army, etc.) 3 = Some of the time	Food assistance (food banks, pantries, Salvation Army, etc.) 4 = Occasionally	Food assistance (food banks, pantries, Salvation Army, etc.) 5 = Never
Grocery stores (Safeway, Wal-Mart, etc.)	Grocery stores (Safeway, Wal-Mart, etc.) 1 = All of the time	Grocery stores (Safeway, Wal-Mart, etc.) 2 = Most of the time	Grocery stores (Safeway, Wal-Mart, etc.) 3 = Some of the time	Grocery stores (Safeway, Wal-Mart, etc.) 4 = Occasionally	Grocery stores (Safeway, Wal-Mart, etc.) 5 = Never
Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription)	Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription) 1 = All of the time	Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription) 2 = Most of the time	Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription) 3 = Some of the time	Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription) 4 = Occasionally	Local seasonal markets (Farmer’s Market, winter market, farm stands, CSA or veggie subscription) 5 = Never
Wholesale store (Sam’s Club, Costco)	Wholesale store (Sam’s Club, Costco) 1 = All of the time	Wholesale store (Sam’s Club, Costco) 2 = Most of the time	Wholesale store (Sam’s Club, Costco) 3 = Some of the time	Wholesale store (Sam’s Club, Costco) 4 = Occasionally	Wholesale store (Sam’s Club, Costco) 5 = Never

Other (ex. Friends/family, hunting, Co-ops, garbage cans, Dollar Tree):

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* 4. How do you usually travel to get your food?

	1 = All of the time	2 = Most of the time	3 = Some of the time	4 = Occasionally	5 = Never
My own car	My own car 1 = All of the time	My own car 2 = Most of the time	My own car 3 = Some of the time	My own car 4 = Occasionally	My own car 5 = Never
Walk	Walk 1 = All of the time	Walk 2 = Most of the time	Walk 3 = Some of the time	Walk 4 = Occasionally	Walk 5 = Never
Getting a ride with someone I know	Getting a ride with someone I know 1 = All of the time	Getting a ride with someone I know 2 = Most of the time	Getting a ride with someone I know 3 = Some of the time	Getting a ride with someone I know 4 = Occasionally	Getting a ride with someone I know 5 = Never
Public transportation	Public transportation 1 = All of the time	Public transportation 2 = Most of the time	Public transportation 3 = Some of the time	Public transportation 4 = Occasionally	Public transportation 5 = Never
Taxi or ride share (uber, Lift)	Taxi or ride share (uber, Lift) 1 = All of the time	Taxi or ride share (uber, Lift) 2 = Most of the time	Taxi or ride share (uber, Lift) 3 = Some of the time	Taxi or ride share (uber, Lift) 4 = Occasionally	Taxi or ride share (uber, Lift) 5 = Never
Bike	Bike 1 = All of the time	Bike 2 = Most of the time	Bike 3 = Some of the time	Bike 4 = Occasionally	Bike 5 = Never
Delivery	Delivery 1 = All of the time	Delivery 2 = Most of the time	Delivery 3 = Some of the time	Delivery 4 = Occasionally	Delivery 5 = Never

Other (please specify)

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* 5. Which of the following make it challenging for you to get and eat fruit, vegetables, and lean proteins? (Examples like chicken, fish).

	1 = All of the time	2 = Most of the time	3 = Some of the time	4 = Occasionally	5 = Never
Low wages	Low wages 1 = All of the time	Low wages 2 = Most of the time	Low wages 3 = Some of the time	Low wages 4 = Occasionally	Low wages 5 = Never
Prices of fruits, vegetables, and lean proteins	Prices of fruits, vegetables, and lean proteins 1 = All of the time	Prices of fruits, vegetables, and lean proteins 2 = Most of the time	Prices of fruits, vegetables, and lean proteins 3 = Some of the time	Prices of fruits, vegetables, and lean proteins 4 = Occasionally	Prices of fruits, vegetables, and lean proteins 5 = Never
Unemployment	Unemployment 1 = All of the time	Unemployment 2 = Most of the time	Unemployment 3 = Some of the time	Unemployment 4 = Occasionally	Unemployment 5 = Never
Limited transportation	Limited transportation 1 = All of the time	Limited transportation 2 = Most of the time	Limited transportation 3 = Some of the time	Limited transportation 4 = Occasionally	Limited transportation 5 = Never
Distance to store	Distance to store 1 = All of the time	Distance to store 2 = Most of the time	Distance to store 3 = Some of the time	Distance to store 4 = Occasionally	Distance to store 5 = Never
Lack of time available (cooking preparation)	Lack of time available (cooking preparation) 1 = All of the time	Lack of time available (cooking preparation) 2 = Most of the time	Lack of time available (cooking preparation) 3 = Some of the time	Lack of time available (cooking preparation) 4 = Occasionally	Lack of time available (cooking preparation) 5 = Never
Physical disabilities	Physical disabilities 1 = All of the time	Physical disabilities 2 = Most of the time	Physical disabilities 3 = Some of the time	Physical disabilities 4 = Occasionally	Physical disabilities 5 = Never
Limited access to or no available kitchen	Limited access to or no available kitchen 1 = All of the time	Limited access to or no available kitchen 2 = Most of the time	Limited access to or no available kitchen 3 = Some of the time	Limited access to or no available kitchen 4 = Occasionally	Limited access to or no available kitchen 5 = Never
Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins	Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins 1 = All of the time	Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins 2 = Most of the time	Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins 3 = Some of the time	Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins 4 = Occasionally	Uncertain of how to prepare and cook meals with fruits, vegetables, and lean proteins 5 = Never
Limited availability in community	Limited availability in community 1 = All of the time	Limited availability in community 2 = Most of the time	Limited availability in community 3 = Some of the time	Limited availability in community 4 = Occasionally	Limited availability in community 5 = Never
Other: Out of SNAP benefits, weather, emergencies	Other: Out of SNAP benefits, weather, emergencies 1 = All of the time	Other: Out of SNAP benefits, weather, emergencies 2 = Most of the time	Other: Out of SNAP benefits, weather, emergencies 3 = Some of the time	Other: Out of SNAP benefits, weather, emergencies 4 = Occasionally	Other: Out of SNAP benefits, weather, emergencies 5 = Never

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* 6. How many servings of fruits and vegetables do you estimate you eat daily?

0 Servings

1 Serving

2 Servings

3 Servings

4 Servings

More than 4 Servings

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* 7. How often does cost stop you from buying fruits, vegetables, and lean proteins?

Always

More than half of the time

Half of the time

Less than half of the time

These aren’t the foods I prefer to eat/shop for

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* 8. What would make it easier for you to consume more fruits, vegetables, and lean proteins?

	1 = All of the tiem	2 = Most of the time	3 = Some of the time	4 = Occasionally	5 = Never
Less expensive	Less expensive 1 = All of the tiem	Less expensive 2 = Most of the time	Less expensive 3 = Some of the time	Less expensive 4 = Occasionally	Less expensive 5 = Never
More of these items provided at my food bank/food pantry/delivery meal program	More of these items provided at my food bank/food pantry/delivery meal program 1 = All of the tiem	More of these items provided at my food bank/food pantry/delivery meal program 2 = Most of the time	More of these items provided at my food bank/food pantry/delivery meal program 3 = Some of the time	More of these items provided at my food bank/food pantry/delivery meal program 4 = Occasionally	More of these items provided at my food bank/food pantry/delivery meal program 5 = Never
A community garden in my neighborhood where I can learn to grow my own food	A community garden in my neighborhood where I can learn to grow my own food 1 = All of the tiem	A community garden in my neighborhood where I can learn to grow my own food 2 = Most of the time	A community garden in my neighborhood where I can learn to grow my own food 3 = Some of the time	A community garden in my neighborhood where I can learn to grow my own food 4 = Occasionally	A community garden in my neighborhood where I can learn to grow my own food 5 = Never
More farmers markets or farm stands	More farmers markets or farm stands 1 = All of the tiem	More farmers markets or farm stands 2 = Most of the time	More farmers markets or farm stands 3 = Some of the time	More farmers markets or farm stands 4 = Occasionally	More farmers markets or farm stands 5 = Never
Knowing how to grow my own food/having space to grow food	Knowing how to grow my own food/having space to grow food 1 = All of the tiem	Knowing how to grow my own food/having space to grow food 2 = Most of the time	Knowing how to grow my own food/having space to grow food 3 = Some of the time	Knowing how to grow my own food/having space to grow food 4 = Occasionally	Knowing how to grow my own food/having space to grow food 5 = Never
More time to prepare/cook meals	More time to prepare/cook meals 1 = All of the tiem	More time to prepare/cook meals 2 = Most of the time	More time to prepare/cook meals 3 = Some of the time	More time to prepare/cook meals 4 = Occasionally	More time to prepare/cook meals 5 = Never
More grocery stores near where I live/work	More grocery stores near where I live/work 1 = All of the tiem	More grocery stores near where I live/work 2 = Most of the time	More grocery stores near where I live/work 3 = Some of the time	More grocery stores near where I live/work 4 = Occasionally	More grocery stores near where I live/work 5 = Never
More convenience stores that sell fruits, vegetables, and lean proteins	More convenience stores that sell fruits, vegetables, and lean proteins 1 = All of the tiem	More convenience stores that sell fruits, vegetables, and lean proteins 2 = Most of the time	More convenience stores that sell fruits, vegetables, and lean proteins 3 = Some of the time	More convenience stores that sell fruits, vegetables, and lean proteins 4 = Occasionally	More convenience stores that sell fruits, vegetables, and lean proteins 5 = Never
Bus routes to places that sell fruits, vegetables, and lean proteins	Bus routes to places that sell fruits, vegetables, and lean proteins 1 = All of the tiem	Bus routes to places that sell fruits, vegetables, and lean proteins 2 = Most of the time	Bus routes to places that sell fruits, vegetables, and lean proteins 3 = Some of the time	Bus routes to places that sell fruits, vegetables, and lean proteins 4 = Occasionally	Bus routes to places that sell fruits, vegetables, and lean proteins 5 = Never
Knowing how to prepare fruits, vegetables, and lean proteins	Knowing how to prepare fruits, vegetables, and lean proteins 1 = All of the tiem	Knowing how to prepare fruits, vegetables, and lean proteins 2 = Most of the time	Knowing how to prepare fruits, vegetables, and lean proteins 3 = Some of the time	Knowing how to prepare fruits, vegetables, and lean proteins 4 = Occasionally	Knowing how to prepare fruits, vegetables, and lean proteins 5 = Never

Other (ex. cost of starting garden is high, rides to places):

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* 9. Are you currently using SNAP (food stamps), WIC or Senior Vouchers?

SNAP

WIC

Senior Vouchers

Not using SNAP, WIC or Senior Vouchers

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* 10. In the past year, was the following statement ever true for you?

“The food that I bought just didn’t last, and I didn’t have money to get more.”

Never true

Sometimes true

Often true

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* 11. In the last 12 months 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?

Only one or two months

Some months, but not every month

Almost every month

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* 12. In the past 12 months, how often have you or someone in your household used each of the following sources to get food?

	Never	A few times per year	Once every month or two	Once every two weeks	Once per week or more
Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi)	Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi) Never	Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi) A few times per year	Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi) Once every month or two	Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi) Once every two weeks	Superstore, Wholesaler, or Grocery Store (e.g., Wal-Mart, Costco, Aldi) Once per week or more
Small Independent Grocer	Small Independent Grocer Never	Small Independent Grocer A few times per year	Small Independent Grocer Once every month or two	Small Independent Grocer Once every two weeks	Small Independent Grocer Once per week or more
Partial Market (e.g., Walgreens, Dollar Store)	Partial Market (e.g., Walgreens, Dollar Store) Never	Partial Market (e.g., Walgreens, Dollar Store) A few times per year	Partial Market (e.g., Walgreens, Dollar Store) Once every month or two	Partial Market (e.g., Walgreens, Dollar Store) Once every two weeks	Partial Market (e.g., Walgreens, Dollar Store) Once per week or more
International Grocer (e.g. Asian market, Latino grocer)	International Grocer (e.g. Asian market, Latino grocer) Never	International Grocer (e.g. Asian market, Latino grocer) A few times per year	International Grocer (e.g. Asian market, Latino grocer) Once every month or two	International Grocer (e.g. Asian market, Latino grocer) Once every two weeks	International Grocer (e.g. Asian market, Latino grocer) Once per week or more
Specialty Grocer (e.g., River Valley Market, Trader Joe’s)	Specialty Grocer (e.g., River Valley Market, Trader Joe’s) Never	Specialty Grocer (e.g., River Valley Market, Trader Joe’s) A few times per year	Specialty Grocer (e.g., River Valley Market, Trader Joe’s) Once every month or two	Specialty Grocer (e.g., River Valley Market, Trader Joe’s) Once every two weeks	Specialty Grocer (e.g., River Valley Market, Trader Joe’s) Once per week or more
Discount Store (e.g., Big Lots)	Discount Store (e.g., Big Lots) Never	Discount Store (e.g., Big Lots) A few times per year	Discount Store (e.g., Big Lots) Once every month or two	Discount Store (e.g., Big Lots) Once every two weeks	Discount Store (e.g., Big Lots) Once per week or more
Convenience Store, Carryout, or Corner Store (e.g., gas station, general store)	Convenience Store, Carryout, or Corner Store (e.g., gas station, general store) Never	Convenience Store, Carryout, or Corner Store (e.g., gas station, general store) A few times per year	Convenience Store, Carryout, or Corner Store (e.g., gas station, general store) Once every month or two	Convenience Store, Carryout, or Corner Store (e.g., gas station, general store) Once every two weeks	Convenience Store, Carryout, or Corner Store (e.g., gas station, general store) Once per week or more
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) A few times per year	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Once every month or two	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Once every two weeks	Fast Food Restaurant (i.e., has many locations and, often, a drive-through window) Once per week or more
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) A few times per year	Sit-in Restaurant (i.e., has wait staff) Once every month or two	Sit-in Restaurant (i.e., has wait staff) Once every two weeks	Sit-in Restaurant (i.e., has wait staff) Once per week or more
Food Pantry	Food Pantry Never	Food Pantry A few times per year	Food Pantry Once every month or two	Food Pantry Once every two weeks	Food Pantry Once per week or more
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) A few times per year	Free Meal (e.g., Senior Center, church meal) Once every month or two	Free Meal (e.g., Senior Center, church meal) Once every two weeks	Free Meal (e.g., Senior Center, church meal) Once per week or more
WHEN IN SEASON: Farmers Market or Produce Stand	WHEN IN SEASON: Farmers Market or Produce Stand Never	WHEN IN SEASON: Farmers Market or Produce Stand A few times per year	WHEN IN SEASON: Farmers Market or Produce Stand Once every month or two	WHEN IN SEASON: Farmers Market or Produce Stand Once every two weeks	WHEN IN SEASON: Farmers Market or Produce Stand Once per week or more
WHEN IN SEASON: Community Supported Agriculture (CSA)	WHEN IN SEASON: Community Supported Agriculture (CSA) Never	WHEN IN SEASON: Community Supported Agriculture (CSA) A few times per year	WHEN IN SEASON: Community Supported Agriculture (CSA) Once every month or two	WHEN IN SEASON: Community Supported Agriculture (CSA) Once every two weeks	WHEN IN SEASON: Community Supported Agriculture (CSA) Once per week or more
WHEN IN SEASON: Personal, Community, or School Garden	WHEN IN SEASON: Personal, Community, or School Garden Never	WHEN IN SEASON: Personal, Community, or School Garden A few times per year	WHEN IN SEASON: Personal, Community, or School Garden Once every month or two	WHEN IN SEASON: Personal, Community, or School Garden Once every two weeks	WHEN IN SEASON: Personal, Community, or School Garden Once per week or more

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

Yes

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* 14. If you answered “no” to the question above what prevents you from getting the food you want to eat? Please check all that apply.

Cost/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 equpment

Other (please specify)

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

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

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* 16. What food related options would you prefer to have access to in your neighborhood? Rank in order of 1 (least like to have) to 5 for the (most like to have).

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* 17. How do you feel about the following statement(s)

	Agree	Disagree
The community of Newtown needs a grocery store.	The community of Newtown needs a grocery store. Agree	The community of Newtown needs a grocery store. Disagree
My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable instead of visiting a food pantry.	My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable instead of visiting a food pantry. Agree	My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable instead of visiting a food pantry. Disagree
My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable over shopping at a local convenience store.	My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable over shopping at a local convenience store. Agree	My preference is to be able to shop and pay cash for fresh foods at a grocery store if it was available, convenient, and affordable over shopping at a local convenience store. Disagree
If there was a grocery store in Newtown, I would still use the food pantry to supplement my groceries.	If there was a grocery store in Newtown, I would still use the food pantry to supplement my groceries. Agree	If there was a grocery store in Newtown, I would still use the food pantry to supplement my groceries. Disagree

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* 18. What types of food would you like to see at a grocery store? Check all that apply.

Milk, eggs, raw meat, and seafood

Fresh produce (fruits, vegetables)

Cultural foods like greens, black eyed peas, sweet potatoes, meats (ox tail)

Cultural foods like rice, beans, plantains

Foods to help prevent diabetes.

Spices for cooking

Healthy snacks for kids

Nutrition for older adults

Other (please specify)

Food Access Survey

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* 1. What is your zip code of primary residence?

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* 2. Do you shop for, or otherwise get food for your household? Household is defined as a single person getting food for themselves or a group of people who live together and share food on a regular basis.

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* 3. Where do you get most of your food?

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* 4. How do you usually travel to get your food?

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* 5. Which of the following make it challenging for you to get and eat fruit, vegetables, and lean proteins? (Examples like chicken, fish).

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* 6. How many servings of fruits and vegetables do you estimate you eat daily?

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* 7. How often does cost stop you from buying fruits, vegetables, and lean proteins?

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* 8. What would make it easier for you to consume more fruits, vegetables, and lean proteins?

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* 9. Are you currently using SNAP (food stamps), WIC or Senior Vouchers?

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* 10. In the past year, was the following statement ever true for you?“The food that I bought just didn’t last, and I didn’t have money to get more.”

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* 11. In the last 12 months 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?

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* 12. In the past 12 months, how often have you or someone in your household used each of the following sources to get food?

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

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* 14. If you answered “no” to the question above what prevents you from getting the food you want to eat? Please check all that apply.

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

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* 16. What food related options would you prefer to have access to in your neighborhood? Rank in order of 1 (least like to have) to 5 for the (most like to have).

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* 17. How do you feel about the following statement(s)

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* 18. What types of food would you like to see at a grocery store? Check all that apply.

* 10. In the past year, was the following statement ever true for you?

“The food that I bought just didn’t last, and I didn’t have money to get more.”