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Measure Complete

By Joseph Wilson,2014-08-09 10:22
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Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    SouthWest Baltimore Food Access Study

    Cover Sheet

    Rater ID: | |

    O Grocery Store 10

    O Supermarket 20

    O Convenience Store 30

    O Liquor Store 40 Hours of Operation

     Monday Friday ____ : ____ to ____ : ____

     Store ID: | - - | - | | | Saturday ____ : ____ to ____ : ____ Sunday ____ : ____ to ____ : ____ Date: ____/____/____ Month Day Year GIS Start Time: _____ : _____ Latitude: _______ Longitude: _______ O AM O PM MISC. End Time: _____ : _____ O AM WIC Accepted? ? Yes ? No O PM Food Stamps Accepted? ? Yes ? No Number of cash registers: ____|____ Refusal ? Yes ? No

Comments: ____________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #1: MILK

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

A. Reference Brand

    1. Store brand (preferred) O yes O no

    2. Alternate Brand Name _______________________________________________________

    Comments: _____________________________________________________________

     _____________________________________________________________

B. Availability Comments:

    1. a. Is soy milk available? O Yes O No ____________________________

    b. Is low-fat (skim or 1%) available? O Yes O No ____________________________

     c. If not, is 2% available? O Yes O No ____________________________

    2. Shelf Space: (measure only if soy OR low fat milk is available; “shelf space” = # of facings)

     Type Pint Quart Half gallon Gallon

    a. Skim & 1% ___|___ ___|___ ___|___ ___|___

    b. 2% ___|___ ___|___ ___|___ ___|___

    c. Whole ___|___ ___|___ ___|___ ___|___

    d. Soy Milk 64 oz ___|___

C. Pricing: Milk items should be same brand (Store or Alternate) Comments:

     1. Whole milk, quart $ ____._______ ________________________________________

     2. Whole milk, half-gallon $ ____._______ ________________________________________

     3. Whole milk, one gallon $ ____._______ ________________________________________

     3. Lowest-fat milk, quart $ ____._______ ________________________________________

     3. Lowest-fat milk, half-gallon $ ____._______ ________________________________________

     4 Lowest-fat milk, one gallon $ ____._______ ________________________________________

     5. Soy milk, 64 oz. $ ____._______ ________________________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #2: FRUITS

Rater ID: | Store ID: | - - | - | | |

    Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

1. Total Varieties O None O 1-10 O 11-25 O 26-50 O >50

     Available Price Unit Quality Comments

    Produce Item Yes No # pc lb A UA

    2. Bananas O O $ ____._______ ___O O O O _________________________

     __________________________

    3. Apples O Red delicious O O $ ____._______ ___O O O O _________________________

     O ___________ __________________________ 4. Oranges O Navel O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________ 5. Grapes O Red Seedless O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________ 6. Cantaloupe O O $ ____._______ ___O O O O _________________________

     ___________________________ 7. Peaches O O $ ____._______ ___O O O O _________________________

     ___________________________ 8. Strawberries O O $ ____._______ ___O O O O _________________________

     ___________________________ 9. Honeydew Melon O O $ ____._______ ___O O O O _________________________

     ___________________________ 10. Watermelon O Seedless O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________ 11. Pears O Anjou O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #3: VEGETABLES

Rater ID: | Store ID: | - - | - | | |

    Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

1. Total Varieties O None O 1-10 O 11-25 O 26-50 O >50

     Available Price Unit Quality Comments

    Produce Item Yes No # pc lb A UA

    2. Carrots O 1 lb bag O O $ ____._______ ___O O O O ______________________

     O __________ _______________________ 3. Tomatoes O Loose O O $ ____._______ ___O O O O ______________________

     O __________ _______________________ 4. Sweet Peppers O Green bell O O $ ____._______ ___O O O O ______________________

     O __________ _______________________ 5. Broccoli O Bunch O O $ ____._______ ___O O O O ______________________

     O __________ _______________________ 6. Lettuce O Green leaf O O $ ____._______ ___O O O O ______________________

     _______________________ 7. Corn O O $ ____._______ ___O O O O ______________________

     ________________________ 8. Celery O O $ ____._______ ___O O O O ______________________

     ________________________ 9. Cucumbers O Regular O O $ ____._______ ___O O O O ______________________

     O __________ ________________________ 10. Cabbage O Head O O $ ____._______ ___O O O O ______________________

     O ___________ _______________________ 11. Cauliflower O O $ ____._______ ___O O O O ______________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #4: GROUND BEEF

Rater ID: | Store ID: | - - | - | | |

    Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

     Item Available Comments

     Yes No Price/lb.

     Healthier Option:

    1. Lean ground beef, 90% lean, O O $ ____._______ _____________________

     10% fat (Ground Sirloin) _____________________

Alternate Item (if #1 not available) Yes No

    2. Lean ground beef (<10% fat) O O $ ____._______ _____________________

    ____|____ % fat _____________________ OR

    3. Ground Turkey (< 10% fat) O O $ ____._______ _____________________

    ____|____ % fat _____________________

    4. # of varieties of lean ground beef (< 10% fat): O 0 O 1 O 2 O 3 O 4 O 5 O 6+

Regular option:

    5. Standard ground beef, 80% lean, O O $ ____._______ _____________________

     20% fat _____________________

Alternate Items (if #5 not available) Yes No

    6. Standard alternate ground beef, if O O $ ____._______ _____________________

     above is not available

    ____|____ % fat _____________________

    7. # varieties of standard ground beef (?20% fat): O 0 O 1 O 2 O 3 O 4 O 5 O 6+

    Measure Complete |

    Nutrition Environment Measures Survey (NEMS)

    Measure #5: HOT DOGS

Rater ID: | Store ID: | - - | - | | |

    Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

     Item Available Price/pkg. Comments

     Yes No

     Healthier Option:

    1. Oscar Mayer Fat-free Wieners O O $ ____._______ _______ ______________________

     (turkey/beef) 0g fat

If Item #1 is not available Note: Complete only one item (proceed in numerical order)

    Alternate Items: (? 9 g Fat) Yes No

    2. Fat-free other brand 0g fat O O $ ____._______ ____________________________

    _________________________ __________

     Brand name Kcal/svg 3. Light Wieners (turkey/pork) O O $ ____._______ ____________________________

    4. Light beef Franks, O O $ ____._______ _______ _____________________

     (about 1/3 less calories 50% less fat)

    5. Turkey Wieners O O $ ____._______ ____________________________

     (about 1/3 less fat)

    6. Other Complete below for item found (in #2-6) ________________________ O O $ ____._______ ___|___ oz pkg ___|___ Svgs/pkg

     ___|___ g fat ___|___ kcal/svg

     _______ ______________________

Regular option:

     7. Oscar Mayer Wieners O O $ ____._______

     (turkey/pork/chicken)-regular 12g fat

If item #7 is not available Note: Complete only one item (proceed in numerical order)

    Alternate Items: (> 10g fat)

     8. Beef Franks (regular) 13 g fat O O $ ____._______

     9. Other Complete below for item found (8 or 9) ________________________O O $ ____._______ ___|___ oz pkg ___|___ Hot dogs/pkg

     ___|___ g fat ___|___ kcal/svg

    Measure Complete |

    Nutrition Environment Measures Survey (NEMS)

    Measure #6: CHICKEN

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

     Item Available Comments

     Yes No Price/lb.

Healthier Option:

    1. Skinless Breast O O $ ____._______ _______________________________

2. # Varieties of Skinless Chicken O 0 O 1 O 2 O 3 O 4 O 5 O 6+

Regular Option:

    3. Thighs with Skin O O $ ____._______ _______________________________

4. # Varieties of Chicken with Skin O 0 O 1 O 2 O 3 O 4 O 5 O 6+

    Measure Complete |

    Nutrition Environment Measures Survey (NEMS)

    Measure #7: FROZEN DINNERS

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

A. Reference Brand

    1, Stouffer’s brand (preferred) O Yes O No

    2. Alternate brand if #1 is not available (Note: the Alternate Brand must also offer a reduced-fat variety) Reduced-fat Frozen Dinner Brand Name: ______________________________________________________________________

    Comments: _______________________________________________________________________________________

     ________________________________________________________________________________________

B. Availability

    1. Are reduced-fat frozen dinners

     available? (< 9 g fat/8-11 oz.) O Yes O No

    Shelf Space: (measure only if reduced-fat frozen dinners are available) 2. Reduced-fat dinners : regular dinners ? Proportion O <=10% O 11-33% O 34-50% O 51%+

C. Pricing (All items must be same brand)

    Reduced Fat Dinner Price/Pkg Regular Dinner Price/Pkg

    1. Lean Cuisine Lasagna $ ____._______ Stouffer’s Lasagna $ ____._______

     ____|____ oz. ____|____ g fat ____|____ oz. ____|____ g fat

    Comments: ____________________________________________________________________________________

    If both brands under #1 are not available:

    Reduced-Fat Alternate (? 9g fat) Regular Alternate (> 10 g fat)

    Brand/item: _______________________________ Brand/item: _______________________________

     $ ____._______ $ ____._______

     ____|____ oz. ____|____ g fat ____|____ oz. ____|____ g fat

    Nutrition Environment Measures Survey (NEMS)

    Measure #8: FROZEN DINNERS

    Space Units in Frozen Section (fill in all that apply): Chests ___|___ Open Freezers ___|___ Freezer doors ___|___

1. Total # of space units (chests and/or open freezers and/or freezer doors) in store ___|___

    2. Total # of space units dedicated to fruits and vegetables ___|___

    3. Total # of space units dedicated to ice cream ___|___

    Measure Complete |

    Nutrition Environment Measures Survey (NEMS)

    Measure #9: BAKED GOODS

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability & Price

Low-fat baked goods <3g fat/serving

     Item Available Amt. per g fat/ kcal/ Price

     Yes No package per item per item

Healthier option:

    1. Bagel

    Single O O ___|___ _______ $ ____._______

    If single unavailable Yes No

    Package O O ___|___ ___|___ _______ $ ____._______

    Comments: ____________________________________________________________________________________

Alternate Items: Yes No (Complete only if neither option in #1, above, is available)

     2. English muffin O O ___|___ ___|___ _______ $ ____._______

     3. Low-fat muffin O O ___|___ ___|___ _______ $ ____._______

    Comments: ____________________________________________________________________________________

Regular option (>4g fat/serving or 400 Kcal/serving):

4. Regular muffin O O ___|___ ___|___ _______ $ ____._______

    Alternate Items Yes No (Complete only if #4, above, is not available) 5. Regular Danish O O ___|___ ___|___ _______ $ ____._______

    6. Other O O ___|___ ___|___ _______ $ ____._______

    Brand/item: _______________________________________________________ Comments: ____________________________________________________________________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #10: BEVERAGES - CS

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability & Price

     Healthier option: Available Price Comments

     Yes No

    1. Diet Coke 12 oz. O O $ ____._______ ________________________

     20 oz. O O $ ____._______ ________________________ 2. Alternate brand of diet soda Yes No

     (If #1, above, is not available)

    _______________________ 12 oz. O O $ ____._______ ________________________ _______________________ 20 oz. O O $ ____._______ ________________________ Regular option: Yes No

    3. Coke 12 oz. O O $ ____._______ ________________________

     20 oz. O O $ ____._______ ________________________ 4. Alternate brand of diet soda Yes No

     (If #3, above, is not available)

    _______________________ 12 oz. O O $ ____._______ ________________________ _______________________ 20 oz. O O $ ____._______ ________________________ Healthier option:

    5. 100% juice, 15.2 oz. Yes No

    O Minute Maid O Tropicana O Other O O $ ____._______ ________________________

Alternate items Yes No

     (If #5, above, is not available)

    6. 100% juice, 14 oz.

    O Minute Maid O Tropicana O Other O O $ ____._______ ________________________ 7. 100% juice, _____ oz.

     O Minute Maid O Tropicana O Other O O $ ____._______ ________________________ Regular option: Yes No

    8. Juice Drink, 15.2 oz

     O Minute Maid O Tropicana O Other O O $ ____._______ ________________________ Alternate items Yes No

     (If #8, above, is not available)

    9. Juice Drink, 14 oz.

     O Minute Maid O Tropicana O Other O O $ ____._______ ________________________

10. Juice Drink, ____ oz.

     O Minute Maid O Tropicana O Other O O $ ____._______ ________________________

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