QuestionPro Survey - Obesity

Help us track the positive impact and reach of the Growing Community DVD series around the state by completing the following:

Name:

Email Address:

Date of Screening:

City/County:

Location venue of screening:

Number of attendees:

Which DVD segments were viewed (pick all that apply):

Increase Breastfeeding

Increase Physical Activity

Increase Consumption of Fruit and Vegetables

Decrease Consumption of High-Energy Dense Foods

Decrease Consumption of Sugar-Sweetened Beverages

Decrease Television Viewing

Target Audience: (Pick all that apply)

Members of a community-based, faith-based or other non-profit organization

Member of the news media

Government officials or representatives

Hospital/healthcare representatives

Academic/research organizations representatives

Advocates for the public or segment of the public

Members of a for-profit organization

Members of the general public

Youth

Parents

School representatives

After watching the DVD, participants… (Pick all that apply):

Went home without discussion

Discussed issues in the community

Decided to address one or more of the issues mentioned in the video

Scheduled a meeting to plan a program/project to prevent obesity through policy and environmental change

Other

If you selected "Other," please specify:

If you would like to leave additional comments, your feedback is always welcome:

You will be redirected to the Growing Community homepage upon successful submission of this survey.
Thank you! Your feedback is very important to us.