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:
If you have any questions about this survey, please contact Emma Kirkpatrick at (512)458-7111 (Ext. 6731) or emma.kirkpatrick@dshs.state.tx.us.
Close
Close
Close