GAVA COHORT ADULT SURVEY best for you. Thank you! version_10... · How often do you have sugary drinks like regular (not diet) sodas, sports drinks (Gatorade, Powerade, etc.), fruit

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GAVA COHORT ADULT SURVEY

The following questions are about your neigborhood and your access to certain types of food and physical activity. We will not share your answers with anyone. This survey is completely anonymous and confidential. Please answer the questions to the best of your ability by checking the one answer that is

best for you. Thank you!

First, a few questions about you and your family…. 1. What is your home zip code? ______________ 2. What is your age? __________ years old 3. What is your gender?

Female Male

4. How many adults (older than 18) including yourself live in your household _________ Adults (18+ years)

5. How many children less than 18 years old live in your household? ____________ Number of children

6. How old are each of your children and what school do they attend? _____ years ______________ School

_____ years ______________ School _____ years ______________ School _____ years ______________ School _____ years ______________ School

7. If you have children who are of preschool age (ages 4 or 5), are they in preschool? No – If no, why not? ___________________________________________________ Yes, in public pre-school Yes, in private pre-school

8. What is your ethnicity? (Check all that apply).

African-American or Black

Hispanic or Latino Caucasian or White Other (write):_________________

9. What language do you normally speak at home? Only or Mostly English (skip the next question) Only or Mostly Spanish Both English and Spanish about the same amount Mostly other language (please specify):_________________

IRB NUMBER: HSC-SPH-13-0108

IRB APPROVAL DATE: 10/08/2013

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10. If not a native English speaker, how comfortable are you speaking English? Very beginner (you can speak a few words) Beginner (you can make a few sentences)

Somewhat proficient (you can discuss but still have trouble in a conversation) Very proficient (you have no problem getting your ideas across)

11. In what country were you born? United States Another country

12. How many years have you lived in the United States? ____________ Years 13. For how long have you lived in the Dove Springs Community? ______________Years/Months

14. Are you currently…?: Married or living with a partner Divorced, separated, or widowed

Never married 15. What was your annual household gross income for 2012? (the responses to these questions are for descriptive

purposes ONLY and are CONFIDENTIAL and will NOT be connected to your name). Under $10,000 $10,001-$15,000 $15,001-20,000

$20,001-$25,000

$25,001-$35,000 $35,001-$50,000 $50,001-or greater

16. What is the highest degree or level of school that the person who earns most of the income in the family

has completed? (Check ONE box.) Never atended school Grades Kinder through 8 (Elementary/primary) Grades 9 through 11 (Some high school/secondary)

Grades 12 or GED (High School Graduate) College 1 year to 3 years (some college or technical school)

College 4 years or more (College graduate) 17. Do you have any type of healthcare coverage, including private health insurance or government plans such

as Medicare or CHIP?

No Yes

18. Has a doctor ever told you that you have any of these medical conditions? (Check all that apply) High blood pressure Obesity/Overweight

High Cholesterol Asthma Depression

Diabetes Arthritis

Other- Please specifiy: ___________________________________

None



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19. Do you have a medical condition that requires you to be on a special diet or limits your physical activity? No Yes

20. How do you usually get around for your daily activities? (one or more may apply) My own car A friend or relative’s car I walk

I take the bus I ride a bike I ride a motorcycle/scooter

ACCESS TO FOOD

21. Do you use a grocery store in your community? Yes, regularly Rarely or never, because it is too far for me Rarely or never, because it is too expensive for me

Rarely or never, because it does not stock the food I like to buy

Rarely or never, because the food is of poor quality Never, because there is no grocery store in my community I don’t know if there is a grocery store in my community

22. Where do you obtain fruits and vegetables for your family? (Check all that apply) Supermarket (i.e. Target, Walmart, HEB, Randalls, Fiesta)

Smaller grocery store (La Micheaoacan, Wheatsville, El Rancho) Convenience store (7-11, gas station) Farmers’ market, mobile vending, farm stand Own garden or community garden

23. Do you use a farmers’ market or farm stand in your community? Yes, regularly – (where?):______________________ Yes, sometimes – (where?):_______________________ Rarely or never

24. If you answered “rarely or never” to question 23, can you tell us why?

It is too far for me It is too expensive for me The produce for sale is poor quality There is no farmers’ market/farm stand in my community

I don’t know if there is a farmers’ market/ farm stand in my community 25. Do you use a “mobile vegetable market” in your community? Yes, regularly Yes, sometimes Rarely or never, because it is too far for me

Rarely or never, because it is too expensive for me Rarely or never, because the produce for sale is poor quality Never, because there is no mobile vegetable market in my community I don’t know if there is a mobile vegetable market in my community



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26. Do you use a community garden in your community? Yes, regularly Yes, sometimes

Rarely or never, because it is too far for me Rarely or never, because I don’t have time to do gardening Rarely or never, because it is easier to buy fruits and vegetables from a market Rarely or never, because it is hard to grow vegetables and fruits Never, because there is no community garden in my community

I don’t know if there is a community garden in my community No, but I would like to know how to grow food No, but I garden in my home garden

27. Have you had any of the following issues when you buy fruits and vegetables for your family? The fruits and vegetables are of low quality

Poor selection of fruits and vegetables The fruits and vegetables are expensive Not available in stores where I buy food

Other reason: (Please write here)___________________________________________________ 28. Have you ever attended a class that teaches you how to grow your own fruits and vegetables? No Yes (write which one):__________________________________

29. Have you ever attended a class that teaches you how to cook and prepare fruits and vegetables?

No

Yes (write which one):__________________________________ 30. Which of the following type of assistance does your family receive? (Check all that apply) None Free and Reduced Lunch program at school

Food stamps/SNAP (Supplemental Nutrition Assistance) TANF (Temporary Assistance for Needy Families) WIC (Women, Infants & Children) Veteran Benefits

31. Do you run out of food at the end of the month because you can’t afford to buy more? Almost always or always

Sometimes Almost never or never

ATTITUDES

32. How important is it to you that your family eats healthy? Not at all A little

Somewhat A lot



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33. In your neighborhood, how many people do you know that think healthy eating is important? None A few (1-2)

Several (3-4)

A lot (5 or more) I don’t know

34. In your neighborhood, how many people do you know that purchase fresh fruits and vegetables at a

farmers market or farm stand? None A few (1-2) Several (3-4)

A lot (5 or more) I don’t know

35. In your neighborhood, how many people do you know that purchase fresh fruits and vegetables through a

CSA (Community Supported Agriculture) program? None

A few (1-2) Several (3-4)

A lot (5 or more)

I don’t know

36. At community events in your neighborhood, such as church events or block parties or school events, what

kind of items are usually available? (Check all that apply) Fresh fruit and vegetables Sodas Fruit juice

Pizza Chips and other fried snacks Baked sweets (brownies, churros, cupcakes, cakes)

Candies Ice creams

Other food/drink (write here): ______________________________________________________ 37. If you wanted to eat healthier foods (i.e. more fruits and vegetables, more whole grains, less fat and sugar,

less packaged foods), which of the factors below would make it easier for you to do so (Check all that apply): If there were more locations where I could buy healthy foods in my neighborhood. If the distance to locations I could buy healthy foods was closer to me.

If there was a greater variety of healthy food options at locations in my neighborhood that sell them. If healthy foods were easier to find at locations that sell them in my neighborhood. If the price of healthy foods was lower in my neighborhood.

If unhealthy foods in my neighborhood were more expensive.

If unhealthy foods in my neighborhood were harder to find. If I had more information about what food is healthy and what food is unhealthy If there were coupons or discounts for healthy foods in my neighborhood. If there were rewards, prizes or incentives for buying healthy foods in my neighborhood.

If I knew more about how to make healthy foods If I knew more about how to store healthy foods If I had more space in my kitchen for healthy foods.



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FOOD AROUND THE HOUSE

38. How often do you have fresh fruits or vegetables available in your home?

Never

Rarely

Sometimes

Often

Always

39. How often do you have frozen, dried, or canned fruits or vegetables available in your home?

Never

Rarely

Sometimes

Often

Always

40. How often do you have sweets like candy, cookies, cake, ice cream available in your home?

Never

Rarely

Sometimes

Often

Always

41. How often do you have sugary drinks like regular (not diet) sodas, sports drinks (Gatorade, Powerade,

etc.), fruit drinks (Capri Sun, Kool-Aid, etc) available in your home?

Never

Rarely

Sometimes

Often

Always

42. How often do you have regular potato chips, corn chips, and cheese puffs like Lays, Doritos, Cheetos, etc.

available in your home?

Never

Rarely

Sometimes

Often

Always



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EATING HABITS

43. Do you eat fruits and/or vegetables as snacks?

No Yes, sometimes

Yes, often Yes, everyday

44. Do you eat more than one variety of fruit each day? No Yes, sometimes

Yes, often Yes, everyday

45. What is the total amount of fruit you eat each day? (1/2 cup equals approximately one handful) 0 cups

½ cup 1 cup

1 ½ cups

2 cups or more

46. Do you eat more than one variety of vegetable each day (i.e. spinach and tomatoes)? No

Yes, sometimes Yes, often Yes, everyday

47. What is the total amount of vegetables that you eat each day? (1/2 cup equals approximately one

handful) 0 cups

½ cup

1 cup

1 ½ cups

2 cups or more

48. Do you eat 2 or more vegetables at your main meal each day? No

Yes, sometimes Yes, often Yes, everyday

49. During the past week, how many times did you eat a meal from a sit-down or fast food restaurant? Never

A few times (1-2) Sometimes (3-4)

Many times (5 or more)

50. During the past week, how many times did you eat a homecooked dinner at home. Never

A few times (1-2) Sometimes (3-4) Many times (5 or more)



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51. How often did YOU eat or drink these foods or drinks in the PAST WEEK? (mark one box in each row) FOOD/DRINK ITEM Less than

once per week

About 1 time a week

2-3 times a week

4-6 times a week

Once a day 2 or more times a

day

Eggs

Whole milk or flavored milk

(not low fat or skimmed)

Flour tortillas (not corn)

Hamburgers or cheeseburgers

Tacos, burritos, or enchiladas

Other mixed dishes with meat

Roast pork or chops, roast beef, or steak

Fried chicken

Cheese or cheese spreads

Pizza

Refried beans

French fries or fried potatoes

Potato chips, corn chips, or peanuts

Cake, sweet rolls, doughnuts, or Mexican sweet bread

How often do you use fat or oil to fry, cook, or season?

Salad dressing

Regular sodas (not diet)

PHYSICAL ACTIVITY

52. During the past 7 days, how many times did you exercise or take part in any VIGOROUS physical activity (any activity that makes you breathe fast such as basketball, soccer, running, swimming, fast bicycling) for AT LEAST 20 MINUTES? Never

1-2 times 3-4 times

5-6 times

7 times More than 7 times



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53. Please check the box of all activities that you have done during the past 7 days. For each activity that was

checked , write down the total # of minutes that you spent doing the activity per day.

Activity Total # Minutes per Day

SUN

MO

N

TUE

WED

THU

R

FRI

SAT

Aerobic Dance/Step Aerobics/Zumba

Basketball

Bicycling (indoor, outdoor)

Bowling

Calisthenics/Toning Exercises

Canoeing/Rowing/Kayaking

Dancing (square, line, ballroom)

Elliptical Trainer

Fishing

Football/Soccer

Gardening or Yardwork

Golf

Hiking

Hunting

Jogging (outdoor, indoor)

Jumping Rope

Martial Arts (karate, judo)

Pilates

Raquetball/Handball/Squash

Skating (roller, ice, blading)

Softball/Baseball

Stairmaster



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Activity Total # Minutes per Day

SUN

MO

N

TUE

WED

THU

R

FRI

SAT

Strength/Weight Training

Swimming (laps, snorkeling)

Tai Chi

Tennis

Volleyball

Walking for Exercise (outdoor, indoor, treadmill)

Water Aerobics

Yoga

Other _____________________

I did none of these activities over the past 7 days.

54. Was this week reflective of your usual activity levels? YES NO

55. Excluding time at work, in general how many HOURS per DAY do you usually spend watching television or

working on a computer? __________ hours.

56. Over this past week, have you spent more than one day confined to a bed or chair as a result of an injury, illness,

or surgery? YES NO

If yes, how many days over the past week were you confined to a bed or chair?__________ days.

57. Do you have difficulty doing any of the following activities?

a. Getting in or out of a bed or chair? YES NO

b. Walking across a small room without resting? YES NO

c. Walking for 10 minutes without resting? YES NO

PHYSICAL ACTIVITY OPPORTUNITY

58. In general, how safe is it for teens/adults to bike or walk in the neighborhood? Not safe at all If you checked NOT SAFE AT ALL, can you tell us why?: ____________________________________

Mostly safe Very safe



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59. In general, how safe is it for children to walk or bike to school from your house? Not safe at all If you checked NOT SAFE AT ALL, can you tell us why?: ____________________________________

Mostly safe

Very safe 60. Is there a place to get drinking water in your neighborhood when you are outside being active? No Yes

I don’t know

61. Does your neighborhood have free or low cost public recreation facilities (such as swimming pools, parks, walking trails, bike paths, etc) FOR ADULTS?

No Yes

I don’t know

62. Does your neighborhood have free or low cost public recreation facilities (such as swimming pools, parks, walking trails, bike paths, etc) open to CHILDREN? No Yes I don’t know

63. In general, how would you rate the condition of your neighborhood public recreational facilities?

Poor Fair Good Excellent

I did not know there were facilities in my neighborhood I am aware of the facilities in my neighborhood, but have never used them (Please tell us why

here):___________________________________________________________________________________________________________________________________________________________________

64. Does your neighborhood have playgrounds that are of good quality and safe, for children to use? No

Yes

I don’t know

65. Does your neighborhood have enough free or low cost programs for physical activity for adults? No

Yes I don’t know



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66. Does your neighborhood have enough free or low cost programs for physical activity for children? No Yes

I don’t know 67. If you said NO to question 65 or 66, what free or low-cost programs do you wish your neighborhood had:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

68. In general, how would you rate the quality of the free or low cost programs in your neighborhood? Poor

Fair Good

Excellent I did not know there were programs in my neighborhood

I am aware of the programs in my neighborhood, but have never attended them (Please tell us why here):___________________________________________________________________________________________________________________________________________________________________

69. What is the general quality of your neighborhood’s sidewalks, streets, and open spaces? Poor Fair Good

Excellent 70. In the past 6 months, how often have you used the recreation center in your neighborhood for physical

activity? 3 or more times a week 1-2 times a week

1-2 times a month Less than once month

If you did, please indicate which one(s): _________________________________________________________________________________

71. In the past 6 months, how often have you used the neighborhood trails or streets for walking? 3 or more times a week 1-2 times a week


72. In the past 6 months, how often have you used the parks in your neighborhood for physical activity? 3 or more times a week 1-2 times a week


If you did, please indicate which one(s): ☐ Franklin park ☐ Dove Springs District Park ☐ Ponciana Park ☐ Others (please specify): _____________________________________________________________



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73. In the past 6 months, how often have you used the playgrounds in neighborhood? 3 or more times a week 1-2 times a week


ATTITUDES

74. I get as much physical activity as I would like. (Please answer for yourself) No, I disagree completely I disagree somewhat

I agree somewhat Yes

75. If you disagree somewhat or completely with the question above, why? (Check all that apply)

The physical activity facilities (trails, parks or recreation centers) in my neighborhood are too far There is too much traffic to walk in my neighborhood

There is too much crime to walk in my neighborhood I don’t have enough time to do enough physical activity

The physical activity facilities (trails, parks or recreation centers) are of poor quality

The physical activity facilities (trails, parks or recreation centers) are not safe I prefer doing sedentary activity like watching TV I don’t have anybody who will do physical activity with me

76. I feel it is important for my family to be physically active.

Not at all A little

Somewhat A lot

77. In my neighborhood, a lot of people walk. Strongly disagree Somewhat disagree

Neither agree nor disagree

Somewhat agree Strongly agree

78. In my neighborhood, a lot of people ride their bikes. Strongly disagree Somewhat disagree Neither agree nor disagree

Somewhat agree Strongly agree

79. In general, do you feel like your neighborhood is a safe place for your child to play outside? Strongly disagree

Somewhat disagree Neither agree nor disagree

Somewhat agree

Strongly agree



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80. Around your child’s school, how much of a problem are the following?

Not a problem Minor problem Moderate problem Serious problem

Theft

Assault

Gangs

Trash and litter

Traffic

Drugs

Other:________________

COMMUNITY PARTICIPATION

81. Please check the appropriate box, to show how strongly you agree with the following statements about

people in your neighborhood:

Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

People around here are willing to help their neighbors

This is a close-knit neighborhood

People in this neighborhood can be trusted

People in this neighborhood generally don’t get on with each other

People in this neighborhood do not share the same values

82. In the past 12 months have you:

No Yes

Voted in an election (local, state, or national)?

Written or called a local, state, or federal government official about the issue in your community?

Volunteered at your child’s school (e.g. PTA, PTO, SHAC, library, cafetería monitor, classroom assistant)?

Attended a meeting of a school board, city council, or other official government body?

Volunteered for any community organization?

83. Have you heard or seen anything about the Go Austin! Vamos Austin Project before this survey (GAVA)?

(Please check all that apply) No, I haven’t

Yes, from a neighbor Yes, from a flyer Yes, on the radio Yes, at a meeting

Yes, at the recreation center

Yes, at my child’s school Yes, other place (specify):

____________________________



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QUESTIONS ABOUT YOUR KINDERGARTEN CHILD

Finally, we’d like to ask you some questions about your kindergarden-aged child…

84. How many days per week is your child physically active at least 30 minutes? Less than 1 day per week 2-3 days per week 4-5 days per week

More than 5 days per week 85. Does your child walk or bike to school? No Yes

Why not: ______________________________________________________ 86. How many days per week does your child eat 5 servings of fruits and vegetables (not counting french fries

as a vegetable) Less than 1 day per week 2-3 days per week 4-5 days per week

More than 5 days per week 87. How often do you cook your main meal with at least one vegetable for your child? All of the time Most of the time

Some of the time Never

88. In the last week, how many times did your child eat home-cooked dinner at home with the family? Never 1-2 times

3-4 times 5-7 times

89. In the last week, how many times did your child eat fast food for dinner? Never

1-2 times

3-4 times 5-7 times

90. Do you limit the number of sodas or sugar-sweetened beverages (including flavored milk) that your child

can drink? No, never

Yes, sometimes Yes, most of the time Always



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91. Does your child usually get enough sleep every night? The recommended number of hours of sleep for 4 and 5 year old children is 10-12 hours. No, my child never gets 10-12 hours of sleep

Some nights (1-3 nights per week) my child gets 10-12 hours of sleep

Most nights (4-6 nights per week) my child gets 10-12 hours of sleep My child always gets 10-12 hours of sleep

92. My child’s school has opportunities for:

No Yes

My child to learn about eating healthy.

Me to learn about eating healthy

My child to learn about being active.

Me to learn about being active.

93. Does your child go to an organized after-school program (for example, YMCA)? No Yes

94. How often did YOUR CHILD consume these items YESTERDAY? (mark one box in each row)

FOOD/DRINK ITEM 0 times 1 time 2 times 3 or more

times

Orange vegetables (like carrots, squash, or sweet potatoes)

Salad (made with lettuce or any other Green vegetables like spinach, broccoli, swiss chard)

Beans (like pinto, garbanzo, black or kidney)

Any other vegetables (like tomatoes, asparagus, cucumbers, mushrooms, bell peppers, celery)

Fruit (fresh, frozen, canned or dried)

Punch, Kool-Aid, Sports drinks or any other fruit-flavored drink (DO NOT COUNT 100% Juice)

100% Fruit Juice (like apple, orange, grape)

Regular sodas or soft drinks

A cup or bottle of water



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GAVA COHORT ADULT SURVEY best for you. Thank you! version_10... · How often do you have sugary drinks like regular (not diet) sodas, sports drinks (Gatorade, Powerade, etc.), fruit