Nutrition Program

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
Nutrition Program

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