Your opinions about health related needs are important, so we are asking for your help. Specifically, we are seeking to better understand your experiences related to 1) access to healthy food, 2) physical activity opportunities, and 3) tobacco-free environments within your community. This will help our efforts to prevent heart disease and cancer, the top two leading causes of death in Oklahoma.  You must be at least 18 years old to complete this survey. It is voluntary and your answers will be kept confidential.

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* 1. Where do you live?

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* 2. Below are several health issues facing people in Oklahoma. How serious of a problem is each of these issues for people in your community?

  Not serious Only a little serious Somewhat serious Very serious
Heart disease
Cancer
Diabetes
Overweight and obesity
Smoking, vaping and other tobacco use
Lack of exercise
Unhealthy eating and poor nutrition
The next set of questions will help us learn more about what you need to make it easier to get and eat healthy foods.

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* 3. In a typical month, how often do you buy or get groceries from these types of places?

  Never 1 time 2 to 3 times 4+ times
Wholesale store (ex: Costco, Sam’s Club)
Grocery store
Big-box store or supercenter (ex: Walmart, Target)
Convenience store or gas station
Dollar stores (ex: Dollar Store, Family Dollar, Dollar General)
Farmers markets, produce stands, etc.
Gardens (community, neighborhood, personal)
Food bank or pantry
Other (please specify below)

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* 4. Please tell us how much you agree or disagree with the following statements.

  Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
I can easily get to a store near my home that sells healthy foods and beverages.
I am currently able to buy or receive all the healthy food I need for me or my family.
It is easy to find a variety of high-quality, fresh fruits and vegetables near my home.
It is easy to identify which items are healthy when I am shopping for food and beverages.
I know how to prepare and cook healthy foods.
My community leaders work to make sure that healthy foods are easy to get and are affordable for all community members.

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* 5. If any of the following changes were made, would they help you eat more fruits and vegetables? Select yes or no for each potential change.

  Yes No
Better variety and quality of fruits and vegetables where I shop
Better prices for fruits and vegetables where I shop
More stores that accept SNAP / WIC vouchers
In-store signs that highlight fruits and vegetables and remind me to include them as I shop
Increased safety at stores near me (lighting, quality sidewalks, etc.)
Free or low-cost ride to local grocery stores
More fruit and vegetables offered at food banks or pantries
More fruit and vegetable choices at convenience stores or gas stations
More fruit and vegetable choices at locally-owned restaurants
More fruit and vegetable choices at my worksite
More farmers markets or produce stands (ex: more locations or days, year-round markets)
A community garden that is near my home

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* 6. Are you a parent or caregiver for a child enrolled in any of the following: school (K-12), an after-school program, or a childcare program?

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