Community Grocery Questionnaire Horizon Market Questionnaire This questionnaire will take 5 minutes to complete. Check all the places where you can get groceries within a 15-minute travel time (one way) of where you live: I cannot buy groceries within a 10-minute travel distance of my home. At a regular chain grocery store with fresh and packaged food (Martins, Weis, Aldi, Lidl). At a large retail store like Walmart or Target At a small local grocer, deli, or meat shop (Gordon's, Penn Ave Meats, etc) At a convenience store, gas station, or pharmacy with ONLY packaged items (no fresh food) At a Dollar Store At a farmer's market or farm/produce stand. At a food pantry If you buy groceries outside of a 10-minute traveling distance from the place where you live, how long are you traveling (one way)? 10-15min 16-30min 31-60min I don't buy groceries outside of a 15-minute traveling distance Please check all programs you've seen around your community that people participate in (check all that apply): Free or reduced-price school lunch or breakfast SNAP-Supplemental Nutrition Assistance Program WIC CSFP (Senior Food Box) Senior meal site Weekend food backpack program None of these How often do you buy groceries outside of Hagerstown, MD? Never Once per week 2-3 times per month Once per month How often do you buy groceries online? Never Once per week 2-3 times per month Once per month Thinking of the place where your household gets most of its groceries, how often are these foods available? Fresh Fruits and vegetables Never Sometimes Always Fresh meats Never Sometimes Always Frozen fruits and vegetables Never Sometimes Always Whole grains and breads Never Sometimes Always Frozen meats Never Sometimes Always Canned and boxed foods Never Sometimes Always Dairy and eggs Never Sometimes Always Other healthy food options Never Sometimes Always How important is it that the place where your household gets groceries has the features listed below? Accepts SNAP/LINK or WIC benefits Not at all important Somewhat important Very important Offers fresh produce Not at all important Somewhat important Very important Offers fresh meats, dairy, and eggs Not at all important Somewhat important Very important Is close to your home (within 10 minutes) Not at all important Somewhat important Very important Offers packaged foods Not at all important Somewhat important Very important Offers household items (cleaning supplies, kitchen essentials)kitchen Not at all important Somewhat important Very important Offers organic foods Not at all important Somewhat important Very important Has special dietary options (such as vegan, gluten-free, kosher, low-sodium, etc.) Not at all important Somewhat important Very important Offers locally produced foods Not at all important Somewhat important Very important Is open early Not at all important Somewhat important Very important Is open late Not at all important Somewhat important Very important Is a national chain or major retail store Not at all important Somewhat important Very important Has online ordering or store pickup/delivery Not at all important Somewhat important Very important In a normal month, how much money does your household spend on groceries? $1-$100 $101-$200 $201-$300 $301-$400 $401-$500 $500+ When you or someone in your household buys groceries, how do you usually get there? (Check all that apply) I drive my own car I ride in a friend or family member's vehicle I walk I ride the bus/public transit I ride my bike I pay for a ride service (Uber/Lyft/Taxi) OtherOther How likely is it that you or someone in your household would get groceries from a locally owned grocery store if it were available in your neighborhood? Not Likely Somewhat Likely Likely Very Likely Extremely Likely What makes it difficult for you to eat fruits, vegetables, or lean meats? (check all that apply) Not available in my community It is not a challenge for me to eat these foods Cost Available hours of food outlets Distance to store It takes too long to cook or prepare these foods Limited access to kitchen or kitchen supplies to prepare food Not sure how to prepare/cook meals with fruits, vegetables, or lean meats I don't like these foods OtherOther What is the zip code where you live/reside? What is your zip code where you work? Do you work remotely/telecommute? Yes No What is your age? Under 18 18-24 25-34 35-44 45-54 55-64 65+ What is your household's total annual income? Under $20,000 $20,001 - $40,000 $40,001 - $60,000 $60,001 - $80,000 $80,001 - $100,000 $100,001+ How many adults above the age 18 (including you) live in your household? How many children below the age of 5 live in your household? What is your gender? Male Female Transgender Male Transgender Female Non-Binary Not Listed:Not Listed: Prefer not to answer Please describe your race. Asian Black/African American Caucasian Hispanic/Latino/Latinx American Indian or Alaskan Native 2 or more races Other (please specify)Other (please specify) Prefer not to answer What is your ethnicity? Hispanic/Latino/Latinx Non-Hispanic/Non-Latino/Non-Latinx Prefer not to answer Submit If you are human, leave this field blank. Δ
