Telephone Contacting Scripts

Form Approved

OMB No.: XXXX-XXXX

Expiration Date: xx/xx/xxxx

Community Based Survey of Supports for Healthy Eating and Active Living

Computer-Assisted Telephone Interview (CATI) Questionnaire Specifications

Public Reporting burden of this collection of information is estimated to average 30 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/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; ATTN: PRA 0920-xxxx). Do not return the completed form to this address.

CATI Introduction Scripts

INTRO_1 SCRIPTS

CATI ONLY

ONLY SHOW IF CONTACT IS CONFIRMED

Select appropriate introduction script to be read by the TI

OUTBOUND CALL

Hello, my name is [NAME] and I'm calling from NORC at the University of Chicago. We are conducting an important survey on behalf of the U.S. Centers for Disease Control and Prevention (CDC) about policies implemented by local governments. This call may be recorded or monitored for quality assurance.

INBOUND CALL

Thank you for calling the CBS HEAL Survey! This is [NAME]. How may I help you?

PAUSE AND WAIT FOR RESPONSE.

IF RESPONDENT IS OPEN TO CONTINUE, READ: I'm speaking to you on behalf of NORC at the University of Chicago. We are an independent research organization that is conducting an important study to inform the CDC about municipality’s policies and programs related to healthy and active living for residents. [NAME OF RESPONDENT] has been selected to represent [MUNICIPALITY] and complete a short survey. The survey will take approximately 30 minutes to complete.

For quality assurance, this call may be recorded or monitored. May I continue?

PARTIAL COMPLETE / GENERAL CALLBACK

Hello, my name is [NAME] and I'm calling from NORC at the University of Chicago. We are conducting the CBS HEAL study on behalf of the U.S. Centers for Disease Control and Prevention (CDC). We previously spoke with [NAME OF RESPONDENT]. Is [NAME OF RESPONDENT] available to continue?

REFER TO CALL NOTES TO IDENTIFY THE RESPONDENT. IF NAME WAS GIVEN FOR APPOINTMENT, ASK FOR THAT PERSON.

This call may be recorded or monitored.

INTRO_1

CATI ONLY

We are conducting an important study for CDC about policies implemented by local governments that promote more healthful eating and physical activity for residents. [NAME OF RESPONDENT] has been selected to represent [MUNICIPALITY] and complete a short survey. Is [NAME OF RESPONDENT AVAILABLE]?

CELLSAFE

CATI ONLY

If you are not in a place where you can safely talk on the phone and answer my questions, I could call you back at a later time.

01 CONTINUE

02 R UNABLE TO CONTINUE

S1

CATI ONLY

Am I speaking with [NAME OF RESPONDENT]?

IF THE RESPONDENT SAYS NO, ASK TO SPEAK WITH [NAME OF RESPONDENT].

01 I AM THAT PERSON [Go to CONSENT]

03 NEW PERSON COMES TO PHONE [Go back to INTRO_1]

04 CONTACT NOT AVAILABLE – CALL BACK LATER [Set Call Back]

05 WRONG PHONE NUMBER [Go to Interviewer notes]

99 REFUSED

CONSENT

CATI ONLY

This should be displayed AFTER screener questions have been completed and the respondent has NOT been terminated.

On behalf of the Centers of Disease Control and Prevention (CDC), NORC at the University of Chicago (NORC) is conducting Community-Based Survey for Healthy Eating and Active Living (CBS HEAL). The national study seeks to gather information on the existence of certain policies, standards, and practices enacted or implemented by local governments that promote more healthful eating and physical activity for residents.

Your municipality was selected randomly to participate and you were identified as the person best able to address questions about the policies enacted by your local government. The survey includes questions on the communitywide planning documents of local governments; policies that improve the built environment to support physical activity, and policies that support increasing access to healthful foods.

The survey will take approximately 30 minutes to complete. Your participation is voluntary. You may choose not to answer any of the questions or you may choose to participate without penalty. There are no expected risks to participating in the survey.

CDC will use this information to evaluate the extent to which local communities have in place policy and environmental supports for healthy eating and active living consistent with recommendations from expert groups. In addition, communities, such as yours, may use the data collected to see how they compare with other communities nationally or with communities of a similar geography, population size, and urban status.

I'd like to continue now unless you have any questions.

01 CONTINUE [Go to Definitions]

02 R DOES NOT WANT TO CONTINUE AT THE MOMENT. CB NEEDED [Set Call back]

99 REFUSED TO PARTICIPATE WITH THE INTERVIEW [Code as Refusal]

CATI Voicemail Scripts

s_am answering machine scripts

CATI ONLY

ONLY SHOWN WHEN LEAVING AM MESSAGE

NO CONTACT

Hello, I am calling from NORC at the University of Chicago. We are conducting an important survey on behalf of the U.S. Centers for Disease Control and Prevention (CDC) about the existence of certain policies, standards, and practices enacted or implemented by local governments that promote more healthful eating and physical activity for residents. [NAME OF RESPONDENT] has been selected to represent [MUNICIPALITY] and complete a short survey. Would you please call us toll-free at 1-xxx-xxx-xxxx? Again, that number is 1-xxx-xxx-xxxx. Thank you.

MISSED GENERAL CALLBACK

Hello, I am calling from NORC at the University of Chicago. We are conducting an important survey on behalf of the U.S. Centers for Disease Control and Prevention (CDC) about policies implemented by local governments that promote more healthful eating and physical activity for residents. [NAME OF RESPONDENT] has been selected to represent [MUNICIPALITY] and complete a short survey. I'm calling back to complete the survey. Please call us back at 1-xxx-xxx-xxxx. Again, our toll-free number is 1-xxx-xxx-xxxx. Thank you.

MISSED APPOINTMENT

Hello, I am calling from NORC at the University of Chicago. We spoke previously regarding the CDC study related to healthy eating and increased activities and you requested that we call you back at this time. I'm sorry that we've missed you. We'll try to contact you again soon but please feel free to return our call any time at 1-xxx-xx-xxxx. That number again is 1-xxx-xxx-xxxx. Thank you.

CATI Email Script

ALTE

FUNCTIONALITY ENABLED TO SEND EMAIL WITH THE FOLLOWING CONTENT VIA “SEND EMAIL” BUTTON:

Sender email: CBSHEAL@norc.org

Subject: CBS HEAL Survey

Body:

Dear <Respondent Name>,

Thank you for participating in the CBS HEAL Survey!

To complete the survey online, go to this link: http://www.CBSSURVEYWEBSITE HERE.com

Please enter your PIN to access the survey: <P_PIN>

This survey is being conducted by NORC at the University of Chicago. If you experience technical issues, please call [TOLL-FREE NUMBER] or email cbsheal@norc.org for assistance.

Begin main questionnaire.

Survey Instructions

Thank you for agreeing to participate in this study. The survey is divided into 7 sections. All questions are non-mandatory, so feel free to skip any question you are not comfortable answering.

If you have difficulties answering a section completely, you have the option of nominating another person to complete that section. If we reach a section someone else should answer, let me know and we can collect that individual’s business information and contact them later.

01 CONTINUE

DEFINITIONS

For the purposes of this survey, we refer to these definitions below for the following terms:

Jurisdiction: The geographic territory that is subject to a municipal government.

Local government: The administrative and legal body that oversee a particular jurisdiction.

Community: The people who live within a particular jurisdiction.

01 CONTINUE

Section 1: Structure of Your Local Government

Timestamp (TS_SEC1) at INTRO1.

intro1

The first question asks about the structure of your local government.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

GOVSTRUCT_a

Does your local government have a Department, Office, Division, or other similar entity that is responsible for…

Transportation?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GOVSTRUCT_B

(Does your local government have a Department, Office, Division, or other similar entity that is responsible for…)

Planning?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GOVSTRUCT_C

(Does your local government have a Department, Office, Division, or other similar entity that is responsible for…)

Housing?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GOVSTRUCT_D

(Does your local government have a Department, Office, Division, or other similar entity that is responsible for…)

Parks and Recreation?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GOVSTRUCT_E

(Does your local government have a Department, Office, Division, or other similar entity that is responsible for…)

Health or Public Health?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GOVSTRUCT_F

(Does your local government have a Department, Office, Division, or other similar entity that is responsible for…)

Health Equity?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

Section 2: Communitywide Planning Efforts for Healthy Eating and Active Living

Timestamp (TS_SEC2) at INTRO2.

intro2

These questions ask about communitywide planning documents that local governments may have created or adopted that promote healthy eating and active living. These may include Comprehensive, General, or Master Plans, or other plans, such as a transportation plan, a parks and recreation plan, or a bicycle and pedestrian plan.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

GENPLAN

Does your local government have a Comprehensive, General, or Master Plan?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a comprehensive/general plan GENPLAN = 2 or GENPLAN =3, go to OTHPLAN_A. Else go to GENMANDATE.

GENMANDATE

Was the development of your Comprehensive, General, or Master Plan mandated by the state?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

GENPLANYR

When was your Comprehensive, General, or Master Plan first adopted?

01 Less than 5 years ago

02 5 years to less than 10 years ago

03 10 years to less than 15 years ago

04 15 years to less than 20 years ago

05 More than 20 years ago

77 DON’T KNOW

99 REFUSED

GENPLANUP

When was your Comprehensive, General, or Master Plan last revised or updated?

01 Less than 5 years ago

02 5 years to less than 10 years ago

03 More than 10 years ago

04 Currently being revised or updated

05 It has not been revised or updated

77 DON’T KNOW

99 REFUSED

OTHPLAN_A

Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive, General, or Master Plan?

A land use plan for new development and growth management?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OTHPLAN_B

(Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive, General, or Master Plan?

A transportation plan?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OTHPLAN_C

(Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive, General, or Master Plan?)

A parks and recreation plan?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OTHPLAN_D

(Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive, General, or Master Plan?)

A bicycle or pedestrian plan?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OTHPLAN_E

(Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive, General, or Master Plan?)

A health equity plan?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a comprehensive/general plan GENPLAN = 2 or GENPLAN =77, AND not having sub-plans OTHPLAN_A through OTHPLAN_E = 02 or 77, go to ADAPLAN. Else go to OBPLAN_A.

OBPLAN_A

Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.

Implementing a Complete Streets policy, as defined by the National Complete Streets Coalition, for new and retrofit projects?

[INTERVIEWER, READ IF NECESSARY: A Complete Streets policy, as defined by the National Complete Streets Coalition, is a policy ensuring that transportation planners and engineers consider the needs of all users during the design of major road projects, including bicyclists, pedestrians of all ages and abilities, public transit vehicles and riders, and motorists.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_B

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Developing regulations that promote street connectivity, for example, shorter block lengths or adding pedestrian routes between blocks

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_C

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Establishing new parks, green spaces, or recreational walking and bicycling paths

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_D

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Encouraging mixed-use development that combines residential land use with one or more commercial, institutional, or other public land uses

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_E

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Supporting farmers markets or community gardens

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_F

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Preserving land for agricultural use

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OBPLAN_G

(Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.)

Providing free safe or clean drinking water in outdoor public places such as parks

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ADAPLAN

Has your local government developed or updated an Americans with Disabilities Act (ADA) Transition Plan since 2010?

[INTERVIEWER, READ IF NECESSARY: An ADA Transition Plan is a plan local governments develop to ensure equal access to facilities, public rights-of-way, and services with people with disabilities.]

01 Yes

02 No, but planning to develop or update

03 No, and not planning to develop or update

77 DON’T KNOW

99 REFUSED

EQPLAN

Does your local government have a plan for the allocation of resources to low income or traditionally under-resourced areas?

01 Yes, we have a stand-alone plan

02 Yes, it is incorporated into other plans

03 No, but we are planning to develop one or incorporate it into other plans

04 No, and we are not planning to develop one or incorporate into other plans

77 DON’T KNOW

99 REFUSED

Section 3: The Built Environment and Policies That Support Physical Activity

Timestamp (TS_SEC3) at INTRO3.

Intro3

The next questions ask about policies or standards that support the physical activity of your community’s residents, even if the policy or standard was passed by another level of government, such as a regional transportation planning authority. You may find it helpful to consult with a representative in either the parks and recreation department or transportation department if you cannot answer a question.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

PAGOV_A

Does your local government have design standards, guidelines, or policies that require installation of dedicated bicycle infrastructure for roadway expansion projects or when retrofitting streets?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PAGOV_B

Does your local government have design standards, guidelines, or policies that require developers to reserve space for use by the local jurisdiction for development of bicycle infrastructure?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PAGOV_C

Does your local government have design standards, guidelines, or policies that require traffic-calming features, such as speed bumps, reduced speed zones, or signal modifications that increase roadway safety in areas with high pedestrian and bicycle volume? This does not include school zones.

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

STREETCOMP

Does your local government have a formal Complete Streets policy, as defined by the National Complete Streets Coalition, for designing and operating streets with safe access for all users?

[INTERVIEWER NOTE, READ IF NECESSARY: A Complete Streets policy, as defined by the National Complete Streets Coalition, is a policy ensuring that transportation planners and engineers consider the needs of all users during the design of major road projects, including bicyclists, pedestrians of all ages and abilities, public transit vehicles and riders, and motorists.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a Complete Streets policy STREETCOMP = 2 or STREETCOMP =77, go to STREETZERO. Else go to STREETGOV.

STREETGOV

What level of government adopted the Complete Streets policy?

01 Municipality

02 Metropolitan area (e.g. MPO)

03 County

04 Region (e.g. regional transportation planning authority)

05 Other

77 DON’T KNOW

99 REFUSED

STREETADOPT

When was your Complete Streets policy first adopted?

01 Less than 5 years ago

02 5 years to less than 10 years ago

03 10 years to less than 15 years ago

04 15 years to less than 20 years ago

05 More than 20 years ago

77 DON’T KNOW

99 REFUSED

STREETREVISE

When was your Complete Streets policy last revised or updated?

01 Less than 5 years ago

02 5 years to less than 10 years ago

03 More than 10 years ago

04 Currently being revised or updated

05 It has not been revised or updated

77 DON’T KNOW

99 REFUSED

STREETMEAS

Does the Complete Streets policy establish specific performance measures that will be used to monitor success?

[INTERVIEWER, READ IF NECESSARY: These measures assess the impact of the policy. Examples include miles of sidewalks or bike lanes completed, pedestrian or cyclist counts, or pedestrian or cyclist injuries.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

STREETZERO

Does your local government have a Vision Zero Action Plan or Strategy in place, as defined by the Vision Zero Network?

[INTERVIEWER, READ IF NECESSARY: A Vision Zero Action Plan or Strategy, as defined by the Vision Zero Network, is a plan or strategy to eliminate all traffic fatalities and severe injuries, while increasing safe, healthy, equitable mobility for all. Include a plan or strategy even if it was adopted by another level of government, such as a regional transportation planning authority.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

STREETFORM

Does your local government have Form-Based Code regulations in place, as defined by the Form-Based Codes Institute?

[INTERVIEWER, READ IF NECESSARY: A Form-Based Code, as defined by the Form-Based Codes Institute, is a land development regulation that fosters predictable built results and a high-quality public realm by using physical form (rather than separation of uses) as the organizing principle for the code. A form-based code is a regulation, not a mere guideline, adopted into city, town, or county law.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

BIKERACK

Does your local government have a written requirement or official objective to install bicycle racks at public facilities, such as public parks, government buildings, or transit stations?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

intro3a

The next questions ask about parks and outdoor recreation areas and policies supporting recreation.

PARKPOL_a

Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…

Lighting in parks or outdoor recreation areas?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PARKPOL_B

(Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…)

Patrols by police or security in parks or outdoor recreation areas?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PARKPOL_C

(Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…)

Maintenance of green space and equipment?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PARKPOL_D

(Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…)

Prohibition of unleashed or unrestrained dogs in parks and outdoor recreation areas, excluding dog parks?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PARKPOL_E

(Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…)

Provision of safe or clean drinking water fountains or water bottle filling stations in parks or outdoor recreation areas?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PARKPOL_F

(Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…)

Maintenance of drinking water fountains in parks or outdoor recreation areas?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

SCHREC

Has your local government adopted a joint or shared use agreement or memorandum of understanding with any school that allows the public to use school recreational facilities, for example, gymnasiums, athletic fields, or playgrounds, during non-school hours?

01 Yes

02 No

03 Our municipality does not have schools in our jurisdiction.

77 DON’T KNOW

99 REFUSED

If the respondent reports not having shared use agreement with any school, SCHREC=02 or SCHREC =03 or SCHREC=77, go to LOCALTAC. Else go to SCHJOINT.

SCHJOINT

Who is your joint use or shared use agreement with?

01 Local school district or board

02 Individual school

03 Other

77 DON’T KNOW

99 REFUSED

SCHDOOR

What school recreational facilities are covered by the joint or shared use agreement or memorandum of understanding?

01 Outdoor facilities only

02 Indoor facilities only

03 Outdoor and indoor facilities

77 DON’T KNOW

99 REFUSED

LOCALTAC

Does your local government have a pedestrian, bicycle, or active transportation advisory committee?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having pedestrian, bicycle, or active transport advisory committee, LOCALTAC=02 or LOCALTAC =77, go to INTRO4. Else go to REPTAC.

REPTAC _A

Is there a designated health/public health representative on the pedestrian, bicycle, or active transportation advisory committee?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

REPTAC _B

Is there a designated community representative on the pedestrian, bicycle, or active transportation advisory committee?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

Section 4: Zoning That Supports Healthy Eating and Active Living

Timestamp (TS_SEC4) at ZONELOC.

INTRO4

These next questions ask about zoning and design or development codes that support healthy eating and active living.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

ZONELOC

Does your local government have a planning and/or zoning commission?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a planning and/or zoning commission, ZONELOC =02 or ZONELOC =77, go to ZONECODE_A. Else go to ZONEREP.

ZONEREP_A

Is there a designated health/public health representative on the planning and/or zoning commission?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONEREP_B

Is there a designated community representative on the planning and/or zoning commission?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_A

Does your local government include the following features in policies for development, including zoning codes design or development guidelines?

Require short- to medium pedestrian-scale block sizes

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_B

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Require continuous sidewalk coverage

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_C

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Require minimum sidewalk widths of 5 feet

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_D

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Require buildings are oriented to pedestrian scale (for example, require entrances or windows face the street or reduced front setbacks)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_E

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Require pedestrian amenities such as trees or furniture along the street

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_F

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Allow mixed land uses (for example, zoning that combines residential land use with one or more commercial, institutional, or public land uses)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONECODE_G

(Does your local government include the following features in policies for development, including zoning codes design or development guidelines?)

Require or incentive accessibility of safe or clean drinking water in outdoor public places

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

ZONErem

Does your local government have policies that remove zoning barriers, such as lot size requirements, or provide other zoning incentives to encourage supermarkets to open in underserved areas or food deserts?

01 Yes

02 No

03 My community does not have underserved areas or food deserts

77 DON’T KNOW

99 REFUSED

ZONEPOL

Does your local government have specific zoning policies to address recurring non-permanent farmers markets?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

Section 5: Public Transportation Policies That Support Healthy Eating and Active Living

Timestamp (TS_SEC5) at INTRO5.

intro5

The next questions ask about public transportation and related policies and processes that support healthy eating and active living in your community, even if the policy or process was passed by another level of government, such as a regional transportation planning authority.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

PUBAUTH

Is transportation planning for your community performed in part or completely by a regional or metropolitan authority or organization?

1. Yes, in part

2. Yes, completely

03 No

77 DON’T KNOW

99 REFUSED

PUBTRANS

Does your local government have a defined process or set of criteria for prioritizing or selecting transportation projects?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a planning and/or zoning commission, PUBTRANS =02 or PUBTRANS =77, go to PUBCURRENT. Else go to PUBMODES.

PUBMODES

Does this process include criteria that prioritizes providing multiple transportation choices, including non-motorized modes and transit, for people to access homes, jobs, schools, food, or other retail?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBCURRENT

Is the community currently served by public transit, for example, buses, light rails, or subway commuter rail?

01 Yes

02 No, but planning for transit

03 No, and not planning for transit

77 DON’T KNOW

99 REFUSED

If the respondent reports not having public transit, PUBCURRENT =03 or PUBCURRENT =77, go to PUBDEMAND. Or if PUBCURRENT =02 go to PUBSPECS. Else go to PUBCOMM_A.

PUBCOMM_A

Does your community have the following types of public transit available?

Bus (for example, fixed-route)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBCOMM_B

(Does your community have the following types of public transit available?)

Light rail

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBCOMM_C

(Does your community have the following types of public transit available?)

Subway or commuter rail

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBCOMM_D

(Does your community have the following types of public transit available?)

Paratransit (for example, county or regional van service)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBCOMM_E

(Does your community have the following types of public transit available?)

Other

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBSPECS

Are requirements for public transit facilities specified (for example, access, lighting, shelter) in community policies and plans?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBMULTI

Are there multimodal use requirements near transit stops, for example, provision of bicycle lanes and sidewalks present within a certain radius of a transit stop?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBTOD

Are there incentives offered to promote transit-oriented development, for example, increased density, different parking requirements?

[INTERVIEWER, READ IF NECESSARY: Transit-oriented development, or TOD, is a type of urban development that maximizes the amount of residential, business, and leisure space within walking distance of public transportation.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PUBLOC_A

When planning public transit, does your local government consider locating near the following destinations? Include planning done by your local government or another level of government, such as the regional transportation planning authority.

Community health clinics, health hubs, or medical offices

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

PUBLOC_B

(When planning public transit do you consider locating near the following destinations?)

Farmers markets

[INTERVIEWER, READ IF NECESSARY: Include planning done by your local government or another level of government, such as the regional transportation planning authority.]

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

PUBLOC_C

(When planning public transit do you consider locating near the following destinations?)

Supermarkets or other full-service grocery stores

[INTERVIEWER, READ IF NECESSARY: Include planning done by your local government or another level of government, such as the regional transportation planning authority.]

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

PUBLOC_D

(When planning public transit do you consider locating near the following destinations?)

Parks or recreation facilities

[INTERVIEWER, READ IF NECESSARY: Include planning done by your local government or another level of government, such as the regional transportation planning authority.]

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

PUBLOC_E

(When planning public transit do you consider locating near the following destinations?)

Schools, including colleges or universities

[INTERVIEWER, READ IF NECESSARY: Include planning done by your local government or another level of government, such as the regional transportation planning authority.]

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

PUBDEMAND

Even if your community is not served by mass transit, does your local government operate paratransit community vans or shuttle buses that operate on as-needed or on-demand basis?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having paratransit community vans or shuttle buses, PUBDEMAND =02 or PUBDEMAND =77, go to INTRO6. Else go to DESTINAT_A.

DESTINAT _A

Do these vans or shuttle buses provide transportation to any of the following destinations?

Community health clinics, health hubs, or medical offices

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

DESTINAT _B

(Do these vans or shuttle buses provide transportation to any of the following destinations?)

Farmers markets

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

DESTINAT _C

(Do these vans or shuttle buses provide transportation to any of the following destinations?)

Supermarkets or other full-service grocery stores

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

DESTINAT _D

(Do these vans or shuttle buses provide transportation to any of the following destinations?)

Parks or recreation facilities

01 Yes

02 No

03 We do not have this destination in our community

77 DON’T KNOW

99 REFUSED

Section 6: Other Policies and Practices That Support Access to Healthy Food and Healthy Eating

Timestamp (TS_SEC6) at INTRO6.

INTRO6

The next questions are about policies that may affect access to healthy food options in your community, even if the policy or standard was passed by another level of government. If you feel you cannot provide the best answer, you may find it helpful to nominate another representatives within your local government, such as a public health official, a representative in the tax assessor’s office, or a purchasing or procurement representative.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

OTHFOOD

Not including schools, does your local government or a subcontractor sell foods or beverages to employees or visitors on local government-owned or operated properties? This could include cafeterias, vending machines, park concession stands, or other food venues.

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not selling foods or beverages on gov-owned properties, OTHFOOD =02 or OTHFOOD =77, go to OTHSERVE. Else go to OTHGOV.

OTHGOV

Not including schools, does your local government have written nutrition standards for foods and beverages sold to employees or visitors in or on government-owned or operated properties?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having written nutrition standards for food sold in gov-owned properties, OTHGOV =02 or OTHGOV =77, go to OTHSERVE. Else go to OTHCONTRACT.

OTHCONTRACT

Are any of these nutrition standards included in food purchasing agreements and/or food service contracts?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

OTHSERVE

Not including schools, does your local government or a subcontractor serve food, at little or no cost, to facility residents or program participants in facilities or programs owned or operated by the local government? This could include correctional facilities, senior centers/programs, recreation programs, or other settings that serves congregate meals.

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having written nutrition standards for food sold in gov-owned properties, OTHSERVE =02 or OTHSERVE =77, go to INTRO6A. Else go to OTHOWN.

OTHOWN

Not including schools, does your local government have written nutrition standards for foods served to facility residents or program participants in facilities or programs it owns or operates?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having written nutrition standards for food sold in gov-owned properties, OTHOWN =02 or OTHOWN =77, go to INTRO6A. Else go to OTHAGREE.

OTHAGREE

Are these nutrition standards included in food purchasing agreements and/or food service contracts?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

intro6a

The next questions ask you about policies that support increasing access to healthful foods. Supermarkets and full-service grocery stores typically stock a higher proportion of healthier foods than smaller stores, including convenience and corner stores. Supermarkets and full-service grocery stores sell a general line of foods, including canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry.

STOREOPEN_A

Does your local government currently use any of the following approaches to encourage supermarkets and other full-service grocery stores to open stores?

Tax incentives (for example, tax abatement, tax credit, or property tax exemption)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

STOREOPEN_B

(Does your local government currently use any of the following approaches to encourage supermarkets and other full-service grocery stores to open stores?)

Grant or loan programs

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

STOREOPEN_C

(Does your local government currently use any of the following approaches to encourage supermarkets and other full-service grocery stores to open stores?)

Programs to link store openings to broader neighborhood revitalization projects (for example, improvements to lighting, signage, safety, or walkability in the surrounding commercial corridor)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not using any programs to encourage supermarkets or grocery stores, STOREOPEN_A =02 or 77 and STOREOPEN_B =02 or 77, and STOREOPEN_C= 02 or 77, go to INTRO6B. Else go to LOWINCOME.

LOWINCOME

Do any of these policies or programs used by your community to encourage supermarkets and other full-service grocery stores to open stores explicitly prioritize low-income or under-resourced areas?

01 Yes

02 No

03 Our community does not have any low-income or under-resourced areas

77 DON’T KNOW

99 REFUSED

intro6b

In addition to supermarkets and full-service grocery stores, food can be sold in smaller venues such as convenience or corner stores. Some local governments use incentives, training, or grants to help convenience or corner stores sell healthier foods.

HEALTHFOOD_A

Does your local government provide any of the following to help convenience or corner stores sell healthier foods…?

Grant or low-interest loan programs to purchase equipment for storage or sales of healthful foods? (for example, refrigeration or a point of sales system)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

HEALTHFOOD_B

(Does your local government provide any of the following to help convenience or corner stores sell healthier foods…?)

Technical assistance or training programs to increase the ability to sell healthier foods (for example, support for new point of sales systems, marketing assistance, produce handling training, product placement)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

HEALTHFOOD_C

(Does your local government provide any of the following to help convenience or corner stores sell healthier foods…?)

Programs to link convenience or corner store improvements to broader neighborhood revitalization projects (improvements to lighting, signage, safety, walkability)

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not using any programs to encourage supermarkets or grocery stores, HEALTHFOOD _A =02 or 77 and HEALTHFOOD _B =02 or 77, and HEALTHFOOD _C= 02 or 77, go to INTRO6C. Else go to HLTHFOODLOW.

HLTHFOODLOW

Do any of these policies or programs used to help convenience or corner stores sell healthier foods explicitly prioritize low-income or under-resourced areas?

01 Yes

02 No

03 Our community does not have any low-income or under-resourced areas

77 DON’T KNOW

99 REFUSED

INTRO6C

These next questions ask about policies and standards that your community may use to support access to farmers markets operated by the local government or other entities within the community. Please answer the questions, even if you don’t currently have farmers markets in your community.

FARMPOLICY _A

Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that…

Allow vendors to sell fresh produce on city-owned property?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FARMPOLICY _B

(Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that….)

Streamline processes for obtaining health and food safety permits and licenses?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FARMPOLICY _C

(Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that…)

Extend waivers of required business permits or retail licensing fees or taxes?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FARMPOLICY _D

(Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that...)

Provide funds or in-kind services for personnel, signage, or advertising?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FARMPOLICY _E

(Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that…)

Encourage opening in lower income neighborhoods lacking supermarkets or full-service grocery stores?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FARMMRKT

Does your community have a farmers’ market, farm stand, or green/produce cart?

01 Yes, we currently have one

02 No, but we are working on getting one

03 No, but we had one or more in the past

04 No, we have never had one

77 DON’T KNOW

99 REFUSED

FARMEBT

Does your local government provide funding for Electronic Benefits Transfer (EBT) machines or provide technical assistance on how to obtain or use EBT machines at local farmers markets, farm stands, or green/produce carts?

[INTERVIEWER, READ IF NECESSARY: Electronic Benefit Transfer (EBT) is an electronic system that allows the government to provide assistance benefits. Assistance benefits include the Supplemental Nutrition Assistance Program [SNAP], formerly known as Food Stamps, or the Temporary Assistance for Needy Families [TANF]) via a plastic debit card to eligible constituents.]

01 Yes

02 No

03 Our community does not have a farmers’ market, farm stand, or green/produce cart

77 DON’T KNOW

99 REFUSED

FOODSEC

Does your community have a local, county, or regional food policy council, food security coalition, or other community group working to increase access to healthy food?

[INTERVIEWER, READ IF NECESSARY: A food policy council is a council that brings together stakeholders from diverse food-related sectors in a specific geographical area to examine how the food system is operating in that area and to develop recommendations for improvement.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having a food policy council, FOODSEC=02 or FOODSEC =77, go to SNAP. Else go to FOODCOUN.

FOODCOUN

Is a local government employee or elected official a member of the food policy council, food security coalition, or other community groups working to increase access to healthy food?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PHCOUNC_A

Is there a designated health/public health representative on the food policy council, food security coalition, or other community groups working to increase access to healthy food?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

PHCOUNC_B

Is there a designated community representative on the food policy council, food security coalition, or other community groups working to increase access to healthy food?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

SNAP

Does your local government offer incentive programs that allow Supplemental Nutrition Assistance Program (SNAP) recipients to purchase healthier foods at a subsidized or discounted rate beyond standard SNAP benefits?

[INTERVIEWER, READ IF NECESSARY: For example, programs that provide extra SNAP funds for the purchase of healthy foods in places such as farmers markets, corner stores, or grocery stores?]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

LEADTEST

Not including schools, does your local government require testing for lead in tap water in buildings owned or operated by local government?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

Section 7: Policies That Support Employee Breastfeeding

Timestamp (TS_SEC7) at INTRO7.

INTRO7

These next questions ask about policies that support employee breastfeeding.

1. CONTINUE

2. COLLECT NOMINEE INFORMATION

FEMWORK

Federal law requires employers to provide breast-feeding employees with break time and a private space other than a bathroom to pump breast milk. The law applies only to women who work for hourly wages. Does your local government have a policy that allows ALL salaried and hourly local government employees break time and space to pump breast milk?

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

FEMMAT

Does your local government provide paid maternity leave for its employees?

[INTERVIEWER, READ IF NECESSARY: Paid maternity leave is paid leave that does not use already accrued leave such as vacation or sick leave. It also does not include leave allowed under the Family Medical Leave Act (FMLA). A human resources department representative may be helpful in answering this question.]

01 Yes

02 No

77 DON’T KNOW

99 REFUSED

If the respondent reports not having paid maternity leave, FEMMAT =02 or FEMMAT =77, go to THANK YOU SCREEN. Else go to FEMWEEK.

FEMWEEK

How long is this maternity leave?

01 Less than 4 weeks

02 4-7 weeks

03 8-12 weeks

04 More than 12 weeks

77 DON’T KNOW

99 REFUSED

THANKYOU

Thank you for your participation in the CBS HEAL study. We appreciate your time and efforts. A summary report will be sent to you when all data has been collected and summarized.

If you have any questions, please contact our study partner, NORC at the University of Chicago, at cbsheal@norc.org or 800-239-5036.

CATI Delegation Specifications

Throughout administration of the questionnaire, respondents will have the opportunity to nominate another individual to complete specific questions or sections within the questionnaire. Once this option is selected, the telephone interviewer will be taken to a screen to collect new contact information.

Delegation Screen (to appear when “NOMINATE” button is selected)

Please provide the name, telephone number, and email address for the individual you would like to complete this section.

[INTERVIEWER, READ IF NECESSARY: After we have completed the interview with you, we will call this individual to complete any remaining items.]

[INTERVIEWER, READ IF WANTS TO EMAIL: Yes, we can also send the individual an email to complete the survey.]

TITLE: ______________________

NAME: ______________________

PHONE: ______________________

EMAIL: _______________________

Email text sent to nominated individuals, if email preferred over phone call:

Greetings [NOMINEE],

NORC at the University of Chicago is conducting the Community Based Survey of Supports for Healthy Eating and Active Living (CBS HEAL), a national study sponsored by the CDC. [NAME] started the survey, but was not able to answer some of the questions posted to them in the survey and has nominated you as someone who might be able to answer these questions instead.

In order to access the survey, please use the unique link below.

Survey Link

If you have any questions, please contact NORC at cbsheal@norc.org or XXX-XXX-XXXX.

Sincerely,

The CBS HEAL team
NORC at the University of Chicago