Please circle your response.
- How important is nutrition to your overall health?
Not Important Somewhat Important Very Important Don’t Know
- How important is nutrition to your appearance?
Not Important Somewhat Important Very Important Don’t Know
- How important are your food choices to your social life?
Not Important Somewhat Important Very Important Don’t Know
- What level of importance do your friends give to healthy food choices?
Not Important Somewhat Important Very Important Don’t Know
- What level of importance do your family members give to healthy food choices?
Not Important Somewhat Important Very Important Don’t Know
- In the last month, how often did you make healthy food choices?
Never Once in a while 2-3 Days/Week 4-5 Days/Week Every Day
- In the last month, how often did your friends and others around you make healthy food choices?
Never Once in a while 2-3 Days/Week 4-5 Days/Week Every Day
- In the last month, how often was time a barrier to making healthy food choices?
Never Once in a while 2-3 Days/Week 4-5 Days/Week Every Day
- In the last month, how often was access to healthy food a barrier to your healthy food choices?
Never Once in a while 2-3 Days/Week 4-5 Days/Week Every Day
- What is your age? _________________
- What is your gender? ______________
- What is your race/ethnicity? _________
Sample Solution
