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 $ ____._______ ________________________