WSHC Community Baseline 2010 Please answer the following 16 questions. Question Title 1. About You: Demographic InformationAge Under 18 18-25 26-35 36-45 46-55 56+ Question Title 2. Location Gustine Newman Patterson Other Question Title 3. Gender Male Female Question Title 4. How often do you eat out? Daily 2-3 times week 2-3 times month Rarely Never Question Title 5. How often do you include fresh fruits and vegetables in your meals? Daily 2-3 times week Once per week Never Question Title 6. Do you consider healthy choices (nutrition) when you shop for groceries? Yes No Question Title 7. If no, is it because of... Cost I don't like these types of foods Lack of preparation ideas Question Title 8. Do you smoke? Yes No Question Title 9. How often do you think about your health? Daily One or more times a week Couple times a month Rarely Never Question Title 10. How often do you exercise? Daily 2-3 times week Once per week Rarely Never Question Title 11. If you exercise, how do you get your exercise? Walk At work Running Hobbies/Sports Other Other (please specify) Question Title 12. How healthy would you rate your present state of body? [1 = Not healthy / 5 = Very healthy) 1 2 3 4 5 Question Title 13. Do you or your family members regularly visit a doctor when you need to? Yes No Question Title 14. If no, why? No insurance Cost Can't get appointment No transportation Question Title 15. Have you heard about the Healthy Choices Campaign for the West Side? Yes No Question Title 16. If yes, how? Newspaper Article Newspaper Ad Newsletter Flier Word of Mouth Question Title 17. What are some ways in which messages about healthy life style choices could be shared with you and your community? Newspaper Internet letter Radio Billboard Direct mailing Done