CookShop for Families Survey
Classroom Info
Site Name
Classroom Name
Classroom ID
Thank you for joining us today. Please tell us a little bit about yourself
Gender
Female
Male
Prefer not to answer
Age
5-17 years
18-59 years
60 or older
Prefer not to answer
Ethnicity
Hispanic/Latino
Non-Hispanic/Latino
Prefer not to answer
Race (check all the apply)
White
Black or African America
Asian
American Indian/Native Alaskan
Hawaiian Native or Pacific Islander
Prefer not to answer
Since attending these nutrition classes:
Since attending these nutrition classes:
Since attending these nutrition classes:
I eat more fruit now than I did before.
I eat the same amount of fruit now as I did before.
I eat more vegetables now than I did before.
I eat the same amount of vegetables now as I did before.
I eat more whole grain foods now than I did before.
I eat the same amount of
whole grain foods
now as I did before.
I eat more low-fat dairy products now than I did before.
I eat the same amount of low-fat dairy products now as I did before.
I choose more lean proteins now than I did before.
I choose the same amount of lean proteins now as I did before.
I drink fewer sugary beverages now, than I did before.
I drink the same amount of sugary beverages now as I did before.
I get more physical activity now than I did before.
I get the same amount of physical activity now as I did before.
I compare prices more often now than I did before.
I compare prices the same amount now as I did before.
I plan and prepare more meals at home now than I did before.
I plan and prepare the same amount of meals at home now as I did before.
I am able to get more healthy foods now than I did before.
I get the same amount of healthy foods now as I did before.
The following questions ask you about your current health behaviors and how they have changed since you started attending nutrition classes.
Mark one answer for each statement.
Never
Rarely
(1-3 times a month)
1-3 days each week
4-6 days each week
Once each day
2 or more times each day
How often do you usually eat
fruit
? (e.g., fresh, dried, frozen or canned)
How often do you usually eat
vegetables
? (e.g., fresh, dried, frozen or canned)
How often do you usually eat
whole grain foods
? (e.g., whole wheat bread, oatmeal, whole grain pasta, brown rice)
How often do you eat or drink
low-fat dairy
products? (e.g., milk, yogurt, cheese, soy milk)
How often do you choose
lean proteins
? (e.g., chicken, fish, beans, lentils)
How often are you
physically active for at least 30 minutes a day
? (e.g., brisk walking, dancing, playing actively)
How often do you
plan and prepare
meals at home?
Based on what you learned today, will you compare prices before you buy food?
Yes, I plan to compare prices
No, I am not planning to compare prices
I might compare prices in the future, but not right now
I already compare prices
Based on what you learned today, do you intend to plan and cook more meals at home?
Yes, I plan to plan and cook meals at home
No, I am not planning to plan and cook meals at home
I might plan and cook meals at home, but not right now
I already plan and cook most meals at home
How sure are you that you can get (access) healthy foods for your family on a budget?
I am not at all sure that I can get healthy foods on a budget
I am not very sure that I can get healthy foods on a budget
I am somewhat sure that I can get healthy foods on a budget
I am very sure that I can get healthy foods on a budget
Contact Information