Neighborhood Resident Survey

Subject ID: ________

Appendix I

Health Bucks Neighborhood Resident

Survey Instrument

Form Approved

OMB No.: 0920-xxxx

Exp. Date: xx/xx/xxxx

NYC HEALTH BUCKS EVALUATION

NEIGHBORHOOD RESIDENT SURVEY

Interviewer Name: ________________________

Date of Interview: ____________

INSTRUCTIONS TO INTERVIEWER:

[READ TO RECRUIT] “Hello, My name is _________, and I am calling on behalf of the Centers for Disease Control and Prevention, from Abt-SRBI. We’re conducting an important study to improve the health of New Yorkers. Your household has been randomly chosen to participate in a brief survey about your habits surrounding the purchase and consumption of fruits and vegetables. Do you have 5 to 10 minutes to answer some questions, or is there a better time to contact you?”

[IF YES, ASK TO DETERMINE ELIGIBILITY:] “Before we begin, I’m going to ask you a few questions to make sure you are eligible to participate.”

S1. “May I ask if you are over 18? “

[IF NO:] “Thank you for your time, but I cannot administer the survey to anyone under 18. Sorry, and have a great day!”

[IF YES, CONTINUE TO S2.]

S2. “What is your zip code of residence?”

[DPHO ZIP CODES WILL BE CODED INTO CATI SURVEY SYSTEM & VERIFIED.]

[IF OUTSIDE OF DPHO ZIP CODE:] “Thank you for your time, but I cannot administer the survey to households in your zip code. Sorry, and have a great day!”

[IF INSIDE OF DPHO ZIP CODE, CONTINUE TO S3.]

Public reporting burden of this collection of information is estimated to average 9 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx). Do not send the completed form to this address.

S3. “Do you do most of the food shopping for your household?”

[IF NO:] “I can only administer the survey to individuals who do most of the food shopping for their households. Is the person who buys most of the food for your household at home?”

[IF YES:] “May I speak with this person?”

[IF YES, READ AND OBTAIN CONSENT, THEN BEGIN SURVEY.]

[IF NO:] “Thank you for your time, and have a great day!”

[CONSENT: READ TO PARTICIPANT]

Congratulations! You qualify for our study. I’d like to explain what the study is about before I ask you any other questions. The purpose of this study is to learn about the effects of a farmers’ market coupon program, called NYC Health Bucks, on fruit and vegetable consumption in certain neighborhoods in New York. As part of our study, we are talking to residents in your neighborhood to learn about residents’ fruit and vegetable consumption habits and awareness of the Health Bucks program. The Public Health Service Act gives CDC the authority to conduct studies like this, which collect information that’s used to improve disease prevention and health promotion programs.

Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law, and your answers to our questions will not be linked in any way to your name or phone number. Your individual responses will be reported only in combination with responses from about 1,000 other households asked to complete the survey. There are no costs for participating in this survey. You will not be given money or other rewards for participating, and your participation is voluntary. Even if you agree to participate, you are not required to answer all the questions. You may stop this survey at any time without penalty.

Do you have any questions about this study, or may I begin now?

[IF YES, REFER TO “FREQUENTLY ASKED QUESTIONS” AND ASK AGAIN]

[IF NO, BEGIN SURVEY]

“First, I have a few questions about farmers’ markets. A farmers’ market is an outdoor market where local farmers come together to sell fresh fruits & vegetables to the public.”

Q1. During the farmers’ market season (July 1 through November 15), how often do you shop at a farmers’ market? (INTERVIEWER: READ CHOICES.)

____ More than Once a Week

____ About Once a Week

____ Once or Twice a Month

____ About Once a Month

____ Less Than Once a Month

____ Never

Q2. Is there a farmers’ market located in your neighborhood?

____ Yes

____ No

____ Don’t Know/Not Sure

Q3. IF YES or NO: If you were to walk from your home to the closest farmers’ market, how long would it take you to get there?

____ Less than 5 Minutes

____ 5 to 10 Minutes

____ More than 10 Minutes

____ (VOL) Not Sure/Refused

Q4. Think about the closest location to your home where you can purchase fresh fruits and vegetables that is not a farmers’ market. What type of location is this?

(INTERVIEWER: READ LIST, AS NEEDED.)

____ Supermarket or Grocery Store

____ Convenience/Corner Store

____ Bodega

____ Fresh Fruit & Vegetable Stand or Cart

____ Other

____ (VOL) Not Sure/Refused

Q5. If you were to walk from your home to that location, how long would it take you to get there?

____ Less than 5 Minutes

____ 5 to 10 Minutes

____ More than 10 Minutes

____ (VOL) Not Sure/Refused

“Health Bucks are $2 coupons provided for the purchase of fresh fruits and vegetables at certain farmers’ markets in New York City. The next questions are about Health Bucks.”

Q6. Have you ever seen or heard about Health Bucks?

____ Yes

____ No

____ (VOL) Not Sure

____ (VOL) Refused

Q7. IF YES: How did you first hear about Health Bucks?

(INTERVIEWER: READ CHOICES.)

____ Flyer, Brochure, or Other Promotional Handout

____ Poster at the Farmers’ Market

____ Subway/Bus Advertisement

_____ Newspaper

_____ Web

____ Mailing Received at Home

____ From Other People (Family, Friends, etc.)

____ From a Local Community Organization

(i.e. health/community center, church, food pantry, etc.)

____ Saw Them Being Used By Shoppers at the Market

____ Other

____ (VOL) Not Sure/Refused

Q8. When did you first hear about Health Bucks?

(INTERVIEWER: READ CHOICES.)

____ This Farmers’ Market Season (2010)

____ Last Farmers’ Market Season (2009)

____ Before Last Farmers’ Market Season (2005 → 2008)

____ (VOL) Not Sure/Refused

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

[INTERVIEWER: ONLY ASK Q10 → 15 IF AWARE OF HEALTH BUCKS.]

Q9. Have you ever used Health Bucks?

____ Yes

____ No

____ (VOL) Not Sure

____ (VOL) Refused

Q10. IF YES: Did you use Health Bucks this farmers’ market season?

____ Yes

____ No

____ (VOL) Not Sure

____ (VOL) Refused

Q11. Where did you get the Health Bucks you used this farmers’ market season?

(INTERVIEWER: READ LIST AND CHECK ALL THAT APPLY.)

____ At the Farmers’ Market (w/ SNAP or EBT Benefits)

____ At the Farmers’ Market (as part of a promotion)

____ From a Local Community Organization

(i.e. health/community center, church, food pantry, etc.)

____ From a Friend or Relative

____ Other

____ (VOL) Not Sure/Refused

Q12. Thinking about the last time you used Health Bucks at a farmers’ market, what did you buy with them?

(INTERVIEWER: READ LIST AND CHECK ALL THAT APPLY.)

____ Fruits

____ Vegetables

____ Jams/Juices

____ Bread

____ Cheese

____ Meats/Fish

____ Baked Goods

____ Other

____ (VOL) Not Sure/Refused

Q13. IF NO: Why didn’t you use Health Bucks this farmers’ market season?

(INTERVIEWER: READ LIST AND CHECK ALL THAT APPLY.)

____ I don’t think I’m eligible for Health Bucks.

____ I didn’t know where to get them.

____ I didn’t know how to use them.

____ I tried to use them, but the vendor(s) wouldn’t accept them.

____ I have some, but I forgot to use them.

____ I didn’t know where to find a farmers’ market.

____ I don’t like fruits and vegetables.

____ Other

____ (VOL) Not Sure/Refused

Q14. How much do you agree with these statements about the Health Bucks program?

"I shop at farmers' markets more often because of Health Bucks."

(INTERVIEWER: READ CHOICES.)

____ Strongly Agree

____ Somewhat Agree

____ Neutral

____ Somewhat Disagree

____ Strongly Disagree

____ (VOL) Not Sure/Refused

"I buy more at farmers' markets because of Health Bucks."

(INTERVIEWER: READ CHOICES.)

____ Strongly Agree

____ Somewhat Agree

____ Neutral

____ Somewhat Disagree

____ Strongly Disagree

____ (VOL) Not Sure/Refused

"I spend more in Food Stamps (a.k.a. SNAP or EBT benefits) at farmers' markets because of Health Bucks."

(INTERVIEWER: READ CHOICES.)

____ Strongly Agree

____ Somewhat Agree

____ Neutral

____ Somewhat Disagree

____ Strongly Disagree

____ (VOL) Not Sure/Refused

"Health Bucks help me to eat more fresh fruits & vegetables."

(INTERVIEWER: READ CHOICES.)

____ Strongly Agree

____ Somewhat Agree

____ Neutral

____ Somewhat Disagree

____ Strongly Disagree

____ (VOL) Not Sure/Refused

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

“Next, I have some questions about your consumption of fruits and vegetables.”

Q15. Thinking about nutrition . . . How many total servings of fruit and/or vegetables did you eat yesterday? A serving would equal one medium apple, a handful of broccoli, or a cup of carrots.

(INTERVIEWER: DO NOT READ CHOICES ALOUD.)

____ None ____ 6

____ 1 ____ 7

____ 2 ____ 8

____ 3 ____ 9

____ 4 ____ 10+

____ 5 ____ (VOL) Not Sure/Refused

Q16. Was the amount of fruit and vegetables that you ate yesterday much more than usual, about the same as usual, or much less than usual?

____ Much More Than Usual

____ About the Same As Usual

____ Much Less Than Usual

____ (VOL) Not Sure/Refused

Q17. Compared to one year ago, would you say you are now eating more, less, or the same amount of fruits and vegetables?

____ More ____ Less ____ Same

____ (VOL) Not Sure/Refused

Q18. Now I am going to read you several statements that people have made about their food situation at home. Please tell me whether each statement was often true, sometimes true, or never true for your household in the last 12 months, that is since (CURRENT MONTH AND LAST YEAR).

“In my household, we worried about whether our food would run out before we got money to buy more.”

____ Often True ____ Sometimes True ____ Never True

“The food that we bought just didn’t last, and we didn’t have enough money to get more food.”

____ Often True ____ Sometimes True ____ Never True

“We couldn’t afford to eat balanced meals.”

____ Often True ____ Sometimes True ____ Never True

*Upon completion of the survey, please ask the respondent the following questions:

“And lastly, I have a few questions for statistical purposes only.”

Q19. What is your age? ____ years

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

Q20. Are you male or female? ____ Male

____ Female

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

Q21. Are you Hispanic or Latino?

____ Yes

____ No

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

[IF HISPANIC: Some people, aside from being Hispanic, also consider themselves to be a member of a racial group.] Which one of these groups would you say best represents your race?

(INTERVIEWER: READ CHOICES; MULTIPLE RESPONSE.)

____ White

____ Black or African American

____ Asian

____ Native Hawaiian or Other Pacific Islander

____ American Indian or Alaska Native

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

Q22. Including yourself, how many people live in your household?

____ total # of people

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

Q23. How many children under the age of 18 live in your household?

____ # of children

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

Q24 The next question is about your combined household income. By household income we mean the combined income from everyone living in the household including even roommates or those on disability income. Is your household’s annual income from all sources:

02 Less than (100-199%) IF “NO,” ASK 05; IF “YES,” ASK 01

01 Less than (<100%) IF “NO,” CODE 02 (100-199%); IF “YES,” CODE 01 (< 100%)

05 Less than (400-499%) IF “NO,” ASK 06 (500-599%); IF “YES,” ASK 04 (300-399%)

06 Less than (500-599%) IF “NO,” CODE 07 (>600%); IF “YES,” CODE 06 (500-599%)

04 Less than (300-399%) IF “NO,” CODE 05; IF “YES,” ASK 03 (200-299%)

07 (>600%)

03 Less than (200-299%) IF “NO,” CODE 04; IF “YES,” CODE 03

77 DON’T KNOW/NOT SURE

99 REFUSED

ASK IF 77 OR 99

Q Can you just tell me if your annual household income is less than $PVTYLVL?

1 YES

2 NO

7 DON’T KNOW/NOT SURE

9 REFUSED

Q25. Please indicate which of the following programs you or someone in your household currently participates in.

(INTERVIEWER: READ LIST AND CHECK ALL THAT APPLY.)

____ Food Stamps (a.k.a. SNAP or EBT Benefits)

____ WIC

____ WIC Farmers’ Market Nutrition Program (FMNP)

____ Senior Farmers’ Market Nutrition Program (SFMNP)

____ None of the Above

____ (VOL) Don’t Know/Not Sure

____ (VOL) Refused

[THANK PARTICIPANT FOR TAKING THE SURVEY.]

10