Melrose/Wakefield Community Food Assessment-Youth Food Survey
For Melrose & Wakefield 6th-12th graders
First we are going to ask you a few questions about what you eat at school.
In a typical week, where do you get the food you eat while you're at school?
Please let us know how much you agree or disagree with the following statements:
Strongly Agree
Agree
Disagree
Strongly Disagree
I eat healthy foods while I'm at my school
Healthy food is available to buy at my school
The food that is sold at my school cafeteria tastes good
I drink from water fountains/bubblers and/or use water bottle filling stations while I'm at my school
Clear selection
Now some questions about how you eat when you are not at school.
How often do the following things happen?
Often
Sometimes
Rarely
Never or almost never
You eat dinner with at least 1 adult family member
You eat food cooked by someone in your family
You eat breakfast
You eat in front of the television
You eat healthy food when you're at home
Clear selection
And some general questions about what and where you eat.
In the last 7 days, how many times did you:
0 times
1 time
2-3 times
4-6 times
7-10 times
More than 10 times
Drink sugar-sweetened drinks like soda (Coke, Sprite, Pepsi), diet sodas (Diet Coke, Diet Sprite, Diet Pepsi), fruit drinks (Kool-Aid, punch, lemonade), sports drinks (Gatorade, Powerade), sweet tea or coffee drinks (Snapple, Frappuchino), or energy drinks (Red Bull, Full Throttle)?
Drink or eat anything from a fast food restaurant? (for example, McDonald's etc)
Drink or eat antying from a convenience/corner store/drug store? (for example, 7-Eleven, CVS, etc)
Clear selection
If you and your friends buy snacks and/or meals at local restaurants or stores that sell food, which restaurants/stores do you typically go to? (If you don't typically buy food from local restaurants/stores, leave this question blank.)
Have you ever been hungry but didn't eat because your family didn't have enough food, or money to buy food?
Clear selection
Now some questions about your neighborhood.
Please let us know how much you agree or disagree with the following statements about the neighborhood where you live. (If you don't have any stores, parks, etc within walking or biking distance from where you live, please answer N/A.)
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
In my neighborhood it is easy to find a place to buy fruits or vegetables.
In my neighborhood it is easy to find a place to buy healthy snacks.
In my neighborhood it is easy to find a water fountain/bubbler.
In my neighborhood it is easy to find a place to buy candy and other sweets.
In my neighborhood it is easy to find a place to buy soda.
Clear selection
And finally, a few questions about you.
What grade are you in?
Clear selection
What school do you go to?
Clear selection
How do you describe your race/ethnicity?
How do you describe your gender?
Clear selection
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