Nutrition Education Public Service Advertising Tracking Survey

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Telephone Survey

Nutrition Education Tracking Questionnaire

Good Morning/afternoon. My name is and I work for , a marketing research company in . We are conducting a study in your area and we would like to get your opinions. I can assure you that nobody will call you as a result of this telephone call to try to sell you something. All your answers will be kept confidential and will be use only for the purpose of our study. May I speak with the mother or caregiver responsible for preparing food in the household? Can I ask you some questions?

RECORD SEX: [ ] FEMALE – CONTINUE

[ ] MALE – TERMINATE

S1. For our discussion, we would like to include people who work in certain industries. Please tell me if you or anyone in your family work for any of the following types of companies or occupations: READ LIST

YES NO

Ad agency or public relations firm [ ] [ ]

Marketing research company [ ] [ ]

Marketing, Telemarketing or Promotions company [ ] [ ]

Medical field (doctor, nurse, etc.) [ ] [ ]

Nutritionist, dietitian [ ] [ ]

IF “YES” TO ANY OF THE ABOVE COMPANIES/OCCUPATIONS, TERMINATE

S2. What is your exact age? _________ (TERMINATE IF AGES < 18 or >50)

S3. I am going to read some income category levels. Which income category best represents your total annual household income? READ LIST AND CHECK ONE -

1. Less than $20,000

2. From 20,000 to less than $25,000

3. From $25,000 to $29,000

4. From 30,000 to $35,000

5. Over $35,000

6. Prefer not to state TERMINATE

S4. Are you the parent or guardian of any children under the age of 18 living in your household?

1. Yes

2. No TERMINATE

S5. How many children under the age of 18 are living in your household?

1. 1

2. 2

3. 3

4. 4

5. 5 or more

S6. How old are the children living in your household? (DO NOT READ LIST)

1. Younger than 2 years old

2. 2 -12 years old

3. 13-17 years old

TERMINATE IF RESPONDENTS ONLY HAVE CHILDREN IN CATEGORIES 1 AND/OR 3

Thank you for agreeing to take this survey. Your opinions are important to us! Please be honest when answering the survey.

Q1. How personally important to you is the issue of :

[RANDOMIZE LIST]	Extremely important	Very important	Somewhat important	Not too important	Not at all important	NOT SURE /NA
Making sure your child(ren) eats a healthy diet
Saving money for the future
Talking to your child(ren) about the consequences of drinking alcohol
Making sure your child(ren) knows the steps she or he needs to take in order to go to college
Monitoring the types of TV shows your child(ren) watches
Making sure your child(ren) is physically active everyday

Q2. How often would you say you typically do the following activities?

[RANDOMIZE LIST]	All the time	Often	Sometimes	Not very often	Not at all	NOT SURE /NA
Read nutrition facts on food labels
Feed your child(ren) 2 or more cups of vegetables a day?
Limit the amount of food your children consume
Feed your child(ren) 1 or more cups of fruit per day
Feed your child(ren) snacks such as potato chips, cheese doodles, nachos, etc.
Feed your child(ren) cookies, candy and other sweets
Encourage your child(ren) to be physically active at least one hour each day
Eat together as a family
Explain to your child(ren) the benefits of eating healthy

Q3. How much do you agree or disagree with the following statements?

[RANDOMIZE LIST]	Agree strongly	Agree Somewhat	Neither Agree Nor Disagree	Disagree Somewhat	Disagree Strongly
I am unclear about what foods are healthy for my child(ren)
I don’t worry too much about what my child(ren) eats or drinks. As long as they get some healthy food, I’m happy.
I know the appropriate amount of food to serve my child(ren) each day

Q4a. How much of a difference do you think you can make on your child(ren)’s overall health by encouraging them to make healthy food choices?

1. A lot of difference

2. Some

3. A little

4. Not much

5. No difference

Q4b. How much of a difference do you think you can make on your child(ren)’s overall health by encouraging them to be more physically active?

1. A lot of difference

2. Some

3. A little

4. Not much

5. No difference

Q5. For the action described below, please indicate which statement best describes you.

1. You have not thought about ways to improve your eating habits or your children’s eating habits

2. You occasionally think about ways to improve the eating habits of your children

3. You are planning to improve the eating habits of your children

4. You occasionally are doing things to improve the eating habits of your children

5. You regularly are doing things to improve the eating habits of your children

6. Your children already have healthy eating habits and therefore do not need to be improved

7. You have not thought about ways to improve your own eating habits

8. You are planning to improve your eating habits

9. You already do things to improve your eating habits

10. You already maintain good eating habits

Q6. In the past six months, have you:

RANDOMIZE LIST
Discussed ways to improve the eating habits of your children with friends and family	Yes	No
Visited a website to get more information about ways to improve the eating habits of your children	Yes	No
Discussed ways to improve the eating habits of your children with a doctor	Yes	No
Discussed ways to improve the eating habits of your children with your child’s teacher	Yes	No
Consciously acted as a positive role model for your child by eating healthy foods.	Yes	No

Q7. Have you recently heard, seen or read anything in advertising, publicity, the media, the Web or other places about making sure your child is physically active and/or receives a healthy diet?

1. Yes (SKIP to Q7a)

2. No (SKIP TO Q8)

Q7a. Which of the following places have you seen or heard those messages (ACCEPT MULTIPLE RESPONSES.)

TV program	Yes	No
TV ad	Yes	No
Radio program	Yes	No
Radio commercial	Yes	No
Magazine article	Yes	No
Magazine ad	Yes	No
Newspaper article	Yes	No
Newspaper ad	Yes	No
Website content	Yes	No
Web ad	Yes	No
Outdoor billboards or outdoor posters	Yes	No
From friends or family	Yes	No
From your child’s school	Yes	No
Some other place	Yes	No

Q8. Have you ever heard of a website called MyPyramid.gov?

1. Yes

2. No

3. Not sure

Q9a. Have you ever seen the U.S. Department of Agricultures MyPyramid which provides many options to help Americans make healthy food choices and to be active every day?

1. Yes (Skip to Q9b)

2. No (Skip to Q10)

3. Not sure

Q9b. Have you ever used ‘MyPyramid’ or ‘MyPyramid for Kids’ to help you or your child make healthier food choices and become physically active every day?

1. Yes

2. No

3. Not sure

Q9c. What are the five food groups illustrated on the food pyramid?

DO NOT READ LIST – PLEASE CHECK ALL RESPONSES OR INDICATE THAT RESPONDENT DID NOT KNOW

1. Grains

2. Vegetables

3. Fruits

4. Meat and Beans

5. Milk

6. Other

7. Do not know/Not sure

Q10. Have you seen a TV commercial where a girl is lying on her bed, staring at her bedroom ceiling and eating an apple? As she takes a bite of the apple she imagines that the cracks in the ceiling transform into a map of the world. The ad ends with some words on the screen that say “Good food nourishes the mind. For more on nutrition and a healthier lifestyle for your child go to MyPyrmaid.gov.” Have you seen this TV ad?

1. Yes

2. No

3. Not sure

Q11. Have you seen a TV commercial where a boy is sitting at a playground staring at a jungle gym and eating an orange? As he takes a bite of the orange, he imagines that the bars on the jungle gym move and transform into a scientific molecule structure like a DNA strand. The ad ends with some words on the screen that say “Good food nourishes the mind. For more on nutrition and a healthier lifestyle for your child go to MyPyramid.gov.” Have you seen this TV ad?

1. Yes

2. No

3. Not sure

Q12. Have you heard a public service ad on the radio that (read description of the radio ad).

Have you heard this public service ad on the radio?

1. Yes

2. No

3. Not sure

Now we would like to find out a little bit more about your background.

D1. What is your race and/or ethnicity? (DO NOT READ LIST)

1. White

2. Black or African-American

3. Hispanic or Latino

4. Asian

5. American Indian or Alaskan Native

6. Native Hawaiian or Other Pacific Islander

7. Prefer not to answer

D2. What was your last educational level that you completed? (DO NOT READ LIST)

1. Some elementary (5^th Grade or less)

2. Completed elementary (6^th Grade)

3. Some junior high/middle school

4. Completed junior high/middle school (8^th Grade)

5. Some high school

6. Completed high school

7. Some college

8. Completed college or more

D3a. Are you currently employed outside your house?

1. Yes (SKIP to D3b)

2. No (SKIP to D4)

D3b. Are you working…

1. Full time

2. Part time

D4. What is your marital status? READ LIST AND CHECK ONE

1. Never married (Single)

2. Living together but not married

3. Married

4. Separated

5. Divorced

6. Widowed

7. Prefer not to state

D5. Do you or your child(ren) currently participate in any of the following?

YES NO

1. WIC program [ ] [ ]

2. Supplemental Security Income (SSI) [ ] [ ]

3. Food Stamp Program [ ] [ ]

4. School Lunch Program [ ] [ ]

5. School Breakfast Program [ ] [ ]

6. Temporary Assistance to Needy Families (TANF) [ ] [ ]

D6. Do you live in the city, suburbs, or some other area?

1. City

2. Suburbs

3. Some other area

D7. What state do you live in?

CODE for STATE AND REGION