Two Bridges Community Resident Survey 2016
Thank you for your willingness to participate in this survey. As part of the Two Bridges/Lower East Side Healthy Neighborhood Initiative we are working alongside community partners to create a better and healthier neighborhood for all. We look to you, the residents, to provide us insights to your everyday life so that together we can build a healthier community.

The survey is voluntary and your answers are confidential. We will not share your individual responses to the questions with anyone. You can skip questions you do not want to answer.

Contact Information (optional)
Name:
Your answer
Email:
Your answer
Phone Number:
Your answer
Zip Code:
Your answer
Would you like to participate in a Healthy Neighborhood focus group?
Demographic Data
Age:
Your answer
Gender:
Your answer
Race/Ethnicity (Self-Identify):
Your answer
Preferred Language:
Your answer
How many people currently live in your household?
Please state how many adults and/or children, including yourself. For example: 2 Adults, 1 Child.
Your answer
Your Neighborhood
(Please check one box for the following questions)
1. How long have you lived in your neighborhood?
2. How proud are you to live in your neighborhood?
3. To what extent do you agree with this statement: "Residents in my neighborhood (Two Bridges/Lower East Side) care about our community."
4. To what extent do you agree with this statement: "I feel safe in the Two Bridges/Lower East Side neighborhood."
5. Do you feel safe walking in the Two Bridges/Lower East Side neighborhood at night?
(Please answer Yes or No.)
5a. Do you feel safe walking this neighborhood at night (continued)?
(Help us understand why you do or do not feel safe walking.)
Yes
No
No opinion
Is there...sufficient lighting?
Is there...adequate surveillance?
Is there...a low crime rate?
Is there...sufficient security patrol?
Are there...enough bystanders?
Other safety concerns?
Your answer
6. A person's health can be affected by their neighborhood environment. In the past year, have you been personally affected by:
(Check one response for each item.)
Yes
Maybe
No
No opinion
Crime
Lack of places to excercise
Difficulty accessing food
Housing insecurity
7. What method of transportation do you use most often when going to the following places?
(Check one for each location. Scroll to the right for more options.)
Walk
Bike
Public Transportation
Taxi
Drive
Pay someone
Other
N/A
Grocery store
Other shopping
Doctor
Church
Work
School/Classes
Social/Cultural Events
Your Health
Please check one box for each of the following questions
1. In general, how would you rate your health?
2. How often in the past week did you feel stressed?
3. In the past 30 days, what did you do for exercise?
(Check all that apply.)
4. Which one of the following best describes your level of physical activity in the past week?
5. In your opinion which FIVE neighborhood changes would make the most positive impact on your individual health.
(Check up to FIVE)
Food Access
Capital Improvements
Healthy Lifestyle
Access to Food & Grocery Shopping
1. On average, how much does your household spend on food per week?
(Total amount, including food stamps, cash, credit, etc.)
Your answer
2. How often do you prepare a full meal at home?
3. How often do you eat out (at a sit down restaurant, fast food restaurant, or other meals away from the home)?
4. How often do you purchase prepared food (hot or cold) from a supermarket or grocery store?
5. How often does your household buy food in the following places:
(Check one for each location)
Daily
3x/week
1x/week
Occasionally
Never
Bodega/Deli
Fast food restaurant
Sit down restaurant
Farmer's market
Supermarket
6. Where do you do most of your grocery shopping?
Name of store and address:
Your answer
7. On average, how many times per week do you visit this grocery store?
Your answer
8. Is it easy to find fresh fruits and vegetables within a 10 minute walking distance from your home?
9. Is it easy to find AFFORDABLE fruits and vegetables within a 10 minute walking distance from your home?
10. Can you find produce that is specific to your ethnic background?
11. Do you eat the recommended daily amount of fruit and vegetables (2 cups of fruit and 2.5 cups of vegetables) every day?
12. I have shopped closer to my home more than last year.
12a. If you checked "Yes", please check the boxes that apply to describe why you have shopped more locally:
(check all that apply)
12b. If you checked "No", please check the boxes that apply to describe why you have not shopped more locally:
(check all that apply)
13. Tell us how important the following items are to you when shopping for food.
(check one for each row)
Very Important
Important
Somewhat Important
Not Important
Cleanliness
Within walking distance
Affordability
Accept SNAP/EBT
Accept WIC
High quality food
Family-owned
Other comments?
Your answer
Household Income & Benefits
Registered for SNAP/EBT?
Registered for WIC?
Receive Medicaid?
Thank you for participating in our survey!
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