Environmental Scan Strategy: Defining Healthy Communities using CHESS

Transcription

1 Environmental Scan Strategy: Defining Healthy Communities using CHESS To learn more about CHESS contact: Fiona Wong at CHESS is a copyright Public Health Solutions, Inc o

2 Introduction to the Environmental Scan Community Health Environment Scan Survey (CHESS) is an empirical assessment tool which measures the availability, accessibility and affordability of healthy lifestyle options 1. CHESS reveals existing community assets as well as opportunities for change, shaping community intervention planning efforts by focusing on community-relevant opportunities to address three key risk factors for chronic disease (i.e. unhealthy diet, physical inactivity, and tobacco use). The CHESS tool was developed following a review of existing auditing tools and in consultation with experts. It is based on the social-ecological model and is adaptable to diverse settings in developed and developing countries throughout the world. The version of CHESS described here was used for the Oxford Health Alliance Community Interventions for Health Programme (CIH) 2. CHESS Is a tool for the systematic assessment of built environment related health behaviours It combines GIS mapping with description of the built environment It involves both qualitative and quantitative data collection It can serve as an important process in the planning of community interventions Methodology For the CIH programme, the neighbourhood level environmental scans were conducted by the Evaluation Team 3 using CHESS. In order to gather sufficient data to generate a context for each CIH community, the Evaluation Team conducted environmental scans of the neighbourhoods around a minimum of 50% of all sampled schools (or at least ten schools in the intervention area and in the control area) and a maximum of 100% of all sampled schools (maximum of 20 schools in the intervention area and in the control area) in the intervention and control areas. In terms of an overview, Figure 1 below depicts the overall strategy for the environmental scans that included the schools as the focal point of interest in each community setting/neighbourhood and how the various components of the scan dovetail in any given community. The environmental scans occur within a 0.25 mile (400 meter) radius around each of the schools (0.5 mile or 800 meter radius for rural settings) and include the assessment of the community neighbourhood in terms of its physical attributes/facilitators and barriers. The 0.25 mile radius is based on urban planning literature that defines communities as developing within this size range and that schools, parks, shopping facilities, etc should fall within this range. 1 More information can be found in the article by Fiona Wong, Denise Stevens, Kathleen O Connor-Duffany, Karen Siegel and Yue Gao (2011). Community Health Environment Scan Survey (CHESS): a novel tool that captures the impact of the built environment on lifestyle factors. Global Health Action 2011, 4: DOI: /gha.v4i The mobile technology platform and software used for CHESS was updated in The Evaluation Team were asked to build country level research capacity using the methods proposed herein and worked with each site to train a core set of researchers on CHESS. Quality assurance/control measures were built into the systematic trainings for those utilising the environmental scan methods. MATRIX Public Health Solutions 2008 Page 2 of 31

3 Figure 1: Schematic of Neighbourhood Assessment Below in Figure 2 is a flowchart of the environmental scan method that considers the following questions: 1) Where are you in the community? 2) Where do you see something of interest? 3) What is it that you see? 4) What environmental scan are you using to gather the information? MATRIX Public Health Solutions 2008 Page 3 of 31

4 Figure 2: Environmental Scan Flowchart MATRIX Public Health Solutions 2008 Page 4 of 31

5 As illustrated in Figure 1 the scans include assessments of selected food stores, restaurants/bars, street vendors, streets (for media and overall street design), recreational facilities, and parks around the schools. Digital photographs that map GIS coordinates of specific locations of interest (e.g., parks, stores, billboards/posters, kiosks, etc.) are taken during the physical walk through each of the neighbourhoods. Each individual scan includes a summary score and the scores will be tallied to reflect an overall Environmental Scan summary score by risk factor. Stores, restaurants (including bars/pubs), food carts/vendors, vending machines, parks/green spaces, recreational facilities, farmers markets, community gardens, fruit and vegetable carts, streets, public transportation hubs (stations), and bike paths, lanes and walking paths in both the intervention and control communities are scanned as follows (refer to Table 1 as a summary): Stores: Every store within the school radii is GPS coded. For each site, 1 store of each type (supermarket, chain convenience store, local store) and every store around the perimeter of or across the street from the schools is scanned. Restaurants/bars/pubs: Every restaurant, bar, and pub within the school radii is to be GPS coded and categorised. Four restaurants and one fast food restaurant in each of the school neighbourhoods is scanned in detail for diet and tobacco environments. Food carts/vendors: Every food cart/vendor within the school radii is GPS coded. The first street vendor encountered, and every subsequent third food cart/vendor, in the school neighbourhood scans and every cart/vendor around the perimeter of or across the street from the schools is assessed for the diet environment. Vending machines: Every vending machine within the school radii is GPS coded and assessed for availability of healthy versus unhealthy foods and beverages and tobacco products. Recreational facilities: All recreational facilities in the school radii is GPS coded and scanned for physical activity, tobacco, and food availability environments. Farmers markets/community gardens/fruit and vegetable carts: All in the school radii will be GPS coded and scanned for diet/food availability. Streets: A street summary scan assessing all streets within the school radii will be completed at the end of each walk around each school radius. Additionally, all streets will be scanned for the information environment. This assessment will look at advertisements (food, tobacco, other unhealthy lifestyle choices), signs (community resources), health promotion flyers and/or brochures, and point-ofdecision prompts. Bike lanes will be noted. Information environment: All advertisement, signs, health promotion flyers and/or brochures, and point-of-decision prompts within the school radii will be GPS coded and scanned. MATRIX Public Health Solutions 2008 Page 5 of 31

6 Table 1: Summary of Scan Activities What Setting will be Scanned? What will be Scanned? How Many Will be Scanned? Neighbourhood Stores (large & small) 1 of each type in school radius and every store around the perimeter of or across the street from each school Neighbourhood Restaurants (including bars and pubs) chain and nonchain 4 restaurants and 1 fast food restaurant and every restaurant around the perimeter of or across the street from each school Neighbourhood Food carts/ vendors Every 3 rd cart/vendor and every cart/vendor around the perimeter of or across the street from each school Neighbourhood Vending machines All observed in school radius Neighbourhood Parks/green spaces All observed in school radius Neighbourhood Recreational facilities All observed in school radius Neighbourhood Neighbourhood Farmers markets, community gardens, fruit and vegetable carts Streets (information environment) All observed in school radius All observed in school radius Neighbourhood Public transportation hubs All observed in school radius Neighbourhood Bike paths, lanes, walking paths All observed in school radius MATRIX Public Health Solutions 2008 Page 6 of 31

7 APPENDIX: STEP BY STEP Guide Technology Requirements: Maps of the areas to be scanned can be created where possible in advance using Google Earth Pro, and the 400m radii can be created using a circular ruler program. CHESS data is collected using a personal digital device (PDA) with integrated GPS and camera (Magellan Mobile Mapper 6). CHESS was programmed using electronic survey software (Snap version 9). Field Preparations Check list: Charged mobile device Additional batteries Printed maps Tracking log form or place to make notes about Back-up digital camera List of foods and brands of foods that will be tracked for the detailed store scans. It is important to know the community context and select the foods that are the most commonly consumed both in type, size and brand. This should be determined prior to going out to do the scan and the same items should be tracked in all the stores. Procedures while conducting the scans If you are conducting the scan with 2 people, it is useful to have one person marking on the map which route and road has been covered and also track which store, restaurant, street vendor, park and recreational facility number have been used. This can be done by creating a simple 5 column form and after each entry on the PDA that person marks with a tick or count which number has just been used. Please see example below of one of these forms which can be manually drawn on the back of the map. MATRIX Public Health Solutions 2008 Page 7 of 31

8 Figure 1: Example of tracking sheet Store Street Vendors Restaurant Park Recreational IIII IIII IIII IIII IIII III III II I IIII IIII I From this example it can been seen that the next store will be number 22, the next street vendor will be number 14, the next restaurant will be number 4, the next part will be number 3 and the recreational will be number 2 If the scan is being completed by 1 person, please ensure the same methods are used in tracking the location covered on the map and the numbering of the facilities scanned. Table 1: Summary of Items To Be GPS Coded and Scanned at Each Site Attribute GPS coordinates Scan Information Gathered Intervention Community Schools All sampled/intervened in All sampled/intervened in Restaurants (including bars and pubs) Food carts/vendors All in school radii (and note type of restaurant as defined in scans) All in school radii 4 restaurants/local chains and 1 fast food restaurant in each of the 6 school radius (diet, PA, tobacco) MATRIX Public Health Solutions 2008 Page 8 of 31 AND Every restaurant around the perimeter of or across the street from the schools Every 3 rd cart/vendor AND Every cart/vendor around the perimeter of or across the street from the schools Stores (food) All in school radii 1 store of each type (supermarket, chain convenience store, local store) (diet and tobacco) (diet) (diet and tobacco sales)

9 Attribute GPS coordinates Scan Information Gathered Vending machines Parks/green space Recreational facilities Farmers markets Community gardens Fruit and vegetable carts All in school radii AND Every store around the perimeter of or across the street from the schools All in school radii (ask 1 question re what they sell) (diet and tobacco sales) All in school radii All in school radii (PA, tobacco smokefree, diet/food availability) All in school radii All in school radii (PA, diet food availability, tobacco smoke-free and sales) All in school radii All in school radii (diet/food availability) All in school radii ne All in school radii All in school radii (diet/food availability) Streets N/A Overall summary scan (PA) Information environment (eg, billboards, posters, flyers, ads) Transportation hubs Bike paths, lanes, walking paths All in school radii All seen All in school radii All in school radii (information environment only) All in school radii Overall summary scan (street scan, PA) MATRIX Public Health Solutions 2008 Page 9 of 31

10 Conducting the Neighbourhood Walk This step by-step guide is intended to assist sites in understanding the mobile electronic versions of the environmental scan. In order to improve time as well as usability for field data collection, a sophisticated skip pattern has been programmed into the survey. It is important to familiarize yourself with the scan questions prior to field data collection. The scans in the electronic versions are the same as the paper versions in the Appendix. Please keep in mind that the formatting of the paper version and electronic version is slightly different. STEPS in starting the Neighbourhood Walk 1. Start at the entrance of the school, and begin walking along the main access either in a northward, southward, eastward or westward direction. Begin your scanning and take care to observe all stores, restaurants, street vendors and physical activity opportunities along your path. Go until you reach the limits of your perimeter which you can determine by using the printed map you have as reference. Mark on your map the path you have taken and ensure you cover most of the streets as shown on the map. IMPORTANT NOTE: You must cover at least 75% of each radius. It is preferable that you walk all streets in your radii but if there are major physical barriers in accessing some streets those areas can be skipped. 2. When you see your first facility of interest turn on your PDA, open the FAST program login with the preset login information IMPORTANT: DO NOT CHANGE THE LOGIN INFORMATION THAT IS PRESET TO THE PDA. 3. Select appropriate survey: if you see a store select Store Quick Scan survey, if you see a street vendor select Street vendor survey, if you see a restaurant select the Restaurant Scan, if you see anything else select the Pre-survey. IMPORTANT NOTE: Street vendors/food stall are those vendors that sell foods, which require some preparation (i.e. packaging, cutting, juicing etc); whereas a kiosk/fixed stall, which is assessed under the store scan are vendors selling foods that require no preparation because the foods are all manufactured pre-packaged (i.e. chips, cookies etc.) or sold as whole as in fruits or vegetables. For example a vendor selling fresh orange juices will be assessed as a street vendor but a person selling fresh oranges in a cart will be assessed as a fixed/mobile stall/kiosk in the store scan. The outline of the survey is provided below. 4. Once you ve completed the survey in FAST open the SNAP program. 5. Select the survey options that apply to what you are scanning. If you are scanning a store select the Store scan If you are scanning a restaurant select the Neighbourhood Walk Scan MATRIX Public Health Solutions 2008 Page 10 of 31

11 If you are scanning any other facilities in the neighbourhood select the Neighbourhood Walk Scan IMPORTANT NOTE: You only need to collect the detailed information for one store type and one restaurant type in each radii if it is available therefore it is not required that you complete the SNAP survey for each store and restaurant you see. However the FAST surveys must be completed for every store and restaurant you see. 6. Once you complete your surveys continue your walk and repeat steps 2-5 for each facility of interest you encounter. MATRIX Public Health Solutions 2008 Page 11 of 31

12 Survey Questions Reading the chart The left column indicates the screen number you see on the mobile device. The centre column represents the questions you will see on the mobile device screen. The text in red explains the questions as well as the choices of options. The right column indicates the proceeding screen number which is dependent on the response you select. FAST Surveys Pre-Survey Scan Screen # Questions and Response option Next Screen # 1 Please enter the date 2 Select the date in which you are doing the scan 2 Enter time ##:## 3 Enter the time you are entering the data using 24 hours format 3 Select country 4 1,China 2, India 3, Mexico 4,Uk Select the country you are working in. 4 Where are you? 5 1, Neighbourhood 2, School 3, Health care facility 4, Workplace Select which location you are currently scanning. Please NOTE: if you are scanning a restaurant, store or street vendor you should open the restaurant, store or street vendor survey rather than the Pre_survey. For all other attributes in the neighbourhood, parks, poster, recreational facilities etc... select the neighbourhood option. 5 Please take GPS coordinates 6 Once you begin seeing coordinates in the longitude and Latitude fields press the capture pts button and click next. Please NOTE: if you have just started the machine it will take some time to capture GPS points 6 Please take a picture of the facility 7 Take a picture of the facility you are scanning it is important to get an image of the location in order to have complete data If you selected Neighbourhood in Screen 4 7 Please enter the school code 8 8 Where are you in the neighbourhood 9 1,On the street 2, In front of a store 3, In front of a restaurant 4, In front of a street vendor 5, In front of a park 6, In front of a recreational facility 7, In front of a vending machine 8, In front of public transportation 9, In front of information 10, Others Select the most appropriate response for where you are in the neighbourhood. Please NOTE: if you are scanning a restaurant, store or street vendor you should open the restaurant, store or street vendor survey rather than the Pre_survey.If you selected other you will be prompted to specify in the next screen. If you selected School in screen 4 MATRIX Public Health Solutions 2008 Page 12 of 31

13 7 Please enter the school code 8 If you selected Health care facility in screen 4 7 Please enter the health care facility code 8 If you selected Workplace 7 Please enter the workplace code 8 Restaurant Quick Scan 1 Please enter the date 2 Select the date in which you are doing the scan 2 Enter time ##:## 3 Enter the time you are entering the data using 24 hour format 3 Select country 4 1,China 2, India 3, Mexico 4,Uk Select the country you are working in. 4 Enter the school code 5 5 Enter the restaurant/food services code 6 Start numbering at 1 and go as high as you need 6 Please take GPS coordinates 7 Once you begin seeing coordinates in the longitude and Latitude fields press the capture pts button and click next. Please NOTE: if you have just started the machine it will take some time to capture GPS points 7 Please take a picture of the facility 8 Take a picture of the facility you are scanning it is important to get image of the location in order to have complete data 8 The food service is a , Fast food chain (global) Fast food chains (global) are referring to restaurants like McDonalds, Pizza Hut, and Kentucky Fried Chicken etc. They are available in many countries around the world. 2, Fast food chain (country) Fast food chains (country) are food establishments specific to the country setting available nationwide. 3, Fast food chain (local) Fast food chains (local) are food establishments that are specific to the intervention area city and there might be several of the same shop distributed around the city or district 4, n-chained fast food n-chain fast food are food establishments with only one 5, Mixed (fast food and fresh) 6, Restaurant chain (global) 7, Restaurant chain (country) 8, Restaurant chain (local) 9, n-chained restaurant Restaurants are sit-down facilities which typically have food served to you at the table. Fast food establishments sell prepared foods or foods that are prepared quickly and the types of foods sold are high in fat/sugar or salt and frying or deep frying is the primary methods used in food preparation. Please apply the same definitions for global, country, local and non-chain fast foods to the restaurant options. 9 Please enter additional comments te if there are no smoking signs or people smoking inside the restaurants 10 Street Vendor Scan 1 Please enter the date Select the date in which you are doing the scan 2 Enter time ##:## Enter the time you are entering the data using 24 hours format 2 3 MATRIX Public Health Solutions 2008 Page 13 of 31

14 3 Select country 4 1,China 2, India 3, Mexico 4,Uk Select the country you are working in. 4 Enter the school code 5 5 Enter the street/food vendor code 6 Start at 1 and go as high as you need 6 Please take GPS coordinates 7 Once you begin seeing coordinates in the longitude and Latitude fields press the capture pts button and click next. Please NOTE: if you have just started the machine it will take some time to capture GPS points 7 Please take a picture of the facility 8 Take a picture of the facility you are scanning it is important to get image of the location in order to have complete data. 8 How many street vendor do you see, including the current one you are assessing 9 Walk down the street block and count the number of street vendors along one side of the street. 9 Please add any additional comments. Get the hours which street vendor is at the location and which days. 10 Store Quick Scan 1 Please enter the date 2 Select the date in which you are doing the scan 2 Enter time ##:## 3 Enter the time you are entering the data using 24 hours format 3 Select country 4 1,China 2, India 3, Mexico 4,Uk Select the country you are working in. 4 Enter the school code 5 5 Enter the store code 6 Start at 1 and go as high as you need 6 Please take GPS coordinates 7 Once you begin seeing coordinates in the longitude and Latitude fields press the capture pts button and click next. Please NOTE: if you have just started the machine it will take some time to capture GPS points 7 Please take a picture of the facility Take a picture of the facility you are scanning it is important to get image of the location in order to have complete data. 8 MATRIX Public Health Solutions 2008 Page 14 of 31

15 8 What type of store is this? 1,Mega supermarket/ te chain name 9 Very large grocery store where one can do their weekly food shopping and other household items Mega supermarkets have more than one level and have a large selection of all types of foods. They are often part of a global chain (i.e. Carrefour, Wal-Mart, or others). They also sell a range of products that are not food related. If you selected Mega supermarket you will be prompted in next screen to enter the name of the supermarket 2,Small chain grocery Typically people use this to do their weekly food shopping. Chain grocery stores have multiple locations with the same name and layout They have a smaller selection of food options compared to a mega supermarket. Small grocery stores will sell fresh produce, packaged foods and some house hold essential products. 4,Small non-chain grocery Typically people use this to do their weekly food shopping. Chain grocery stores have multiple locations with the same name and layout 5,Chain convenience store A convenience store is where people go to purchase foods and other items on a needed base. Chainconvenience stores have multiple locations with the same name and layout. The stores typically carry a variety of packaged food products and normally do not have a large selection of fresh produce. 6,n-chain convenience A convenience store is where people go to purchase foods and other items on an as needed basis. They typically carry a variety of packaged food products and normally do not have a large selection of fresh produce. 7,Local store A local store is similar to the n-convenience store but will carry specialized items for the community or a greater variety of specific items. 8, Market Market refers to areas where food producers (i.e. farmers) sell their products in a central location. Typically the products sold here are fresh foods (i.e. fruits, vegetables, meats etc.). 9,Kiosk / fixed stall / mobile stall Kiosk / fixed stall / mobile stall are small stores, carts or stands where food is sold. It could be a fruit or vegetable cart. If the vendor is selling snacks and other goods please complete the street vendor scan. 10,Bakery A bakery carries baked items either prepared on premises or off. 9 What does this store MOSTLY sell? 1,Fresh fruits and vegetables 2,High fat/salt/sugar options (such as sweet, chips and sugar-sweetened drinks) 3,Low fat/salt/sugar options 4,Variety of package high fat/salt/sugar options and low /salt/sugar options 5,Tobacco products Packaged high-fat, high-salt, high-sugar options (such as candy, chips and sugar-sweetened drinks) OR Packaged lowfat, low-salt, low-sugar options, which means the store did not sell fresh foods. Wide variety of food items includes both package foods and fresh foods 10 Does this store sell FRESH fruits and/or vegetables 1, 2, 11 Does this store sell tobacco products? 1, 2, 12 Please enter additional comments Please note if there are signs indicating there are no sales of tobacco products to minors SNAP SURVEYS Screen # Questions and Response option Next Screen # MATRIX Public Health Solutions 2008 Page 15 of 31

16 1 GENERAL INFORMATION Please enter the time and date of the environmental scan. Enter FAST time (24 Hours): Enter FAST date (mm/22/yyyy): Enter the time when you are starting to fill out this present scan. Enter in the following format hh:mm (hours:minutes). Please use a 24 hour clock when entering the time. Enter the same time as was entered in the FAST survey Please note: There is a specific format in which the date needs to be entered. Enter the month, enter the date and then the year. 2 2 Please enter the country code. (1=China, 2=India, 3=Mexico, 4=UK) Enter country code: Enter the specific country code for your setting - you may only enter 1, 2, 3 or 4 3 Which scan would you like to complete? Neighbourhood walk 3 4 If you selected Neighbourhood Walk 4 Please enter the school code. Enter school code: Enter the school code for the neighbourhood. SI should be prefix for intervention area and SC should be the prefix for the control area. If you have more than one intervention area use SI_ (the blank should be the first letter of the district name). The number following your prefix should correspond with the list you used to enumerate the schools. 5 NEIGHBOURHOOD WALK Where are you now? On street In front of restaurant/food service In front of street vendor/food stall At entrance to park In front of recreational facility In front of vending machine On public transportation In front of information Select the option of location of where you are for the neighbourhood scan. Street scan should be completed at the end of each NW. It is a summary impression of the streets in the NW radius. If you selected On the street 5 6 MATRIX Public Health Solutions 2008 Page 16 of 31

17 6 Over all summary (rank 1 being very poor 5 being excellent) Cycling paths and trails?? 1=There are no cycling paths or trails 2=There are minimal trails but poorly maintained or very difficult to reach 3=There are a moderate number of trails and they are in working condition 4=There are several trails and they are in working condition with good accessibility (connected to major roads, etc) 5=There are many trails and they are well maintained with signage promoting their use and they are very accessible Sidewalks 1=There aren t any sidewalks on major and minor roads 2=There are sidewalks on few major roads and they are in poor condition (uneven, cracked with holes and gaps) 3=There are sidewalks on some major roads and they are in fair condition (few cracks, holes, gaps and somewhat uneven) 4=There are sidewalks on all major roads and some minor roads and they are in fair condition (few cracks, holes, gaps and somewhat uneven) 5=There are sidewalks on all major and minor roads and they are in excellent condition Cycling Lanes 1=There aren t any bike lanes on any major and minor roads 2=There are a few bike lanes on major roads but they are not fully delineated from the rest of the traffic 3=There are some bike lanes on major roads and a few minor roads but they are not fully delineated from the rest of the traffic 4=There are bike lanes on major and minor roads and they are somewhat delineated from the rest of the traffic 5=There are bike lanes on major and minor roads and they are fully delineated from the rest of the traffic 7 7 Summary of safety and pollution (rank 1 being very poor 5 being excellent) Safety? 1=There is no rule (i.e. traffic lights or street signs) in regulating motor vehicle movement on major and minor roads 2=There are minimal traffic regulations on major and minor roads 3=Major roads have well regulated traffic but minor roads do not have well regulated traffic 4=Most major and minor roads have good traffic regulation 5=All major and minor roads have good traffic regulation (pedestrian crosswalks, traffic lights, etc) Pollution 1=It is very difficult to breathe walking on the streets 2=There is always the smell of exhaust fumes on the streets 3=There is some smell of exhaust fumes on the streets 4=There is no noticeable smell of exhaust fumes on the streets 5=The air quality is excellent 8 8 Summary of overall appearance (rank 1 being very poor 3 being excellent). Are there trees along the streets? Trees along the streets 1=There are no trees or greenery 2=There are trees along some streets 3=There are lots of trees along all the streets Is the neighbourhood generally free from litter? 1=There is litter on most streets Rank MATRIX Public Health Solutions 2008 Page 17 of 31

18 2=There is litter on some streets 3=There is no litter on any streets 9 Please enter any comments Would you like to access the information environment? Select yes or no if you want to assess the information environment if you select the survey is completed. 11 If you selected at the end of the street scan OR On Public Transportation OR In front of Information for where you are. 10 i. What do you see? Message ["Says something"] Advertisement ["Sells something"] Point of decision prompt ["Says Do something] Regulation [ Indicates a rule/law ] 11 ENVIRONMENTAL SCAN: INFORMATION ENVIRONMENT For which risk factor? Diet Physical activity Tobacco use Check all risks discussed in the message 12 Is it positive or negative? Positive Negative Positive messages are those that encourage a healthy diet, increase physical activity and reduce tobacco use. Negative messages are those that encourage an unhealthy diet, reduce physical activity and promote tobacco use. If information that is provided is incorrect or conflicts with our messaging, please note this in the description section i.e. eat more meat for a healthy diet. If you selected Message ["Says something"] OR Advertisement ["Sells something"] OR Point of decision prompt ["Says Do something] 13 ii. What kind of message or advertisement is it? Message Billboard/Hoardings Billboards are large outdoor display structures that have images and/or messages and /or promotions for companies and/or products Poster Posters are large displays typically placed on walls and flat surfaces Flyer Flyers are typically one paper sheet distributed to the public. It may include images, messages, and/or promotions for companies, products and/or events Brochure Brochures are similar to flyers but often used to promote companies and/or products and/or ideas. They may be in booklet format or tri-folds. (They typically look more polished and provide more information than flyers.) Smoke-free or no-smoking sign sale to minors sign (for tobacco option only) Print advertisement Free samples Free-samples are typically distributed in or around stores. In order to promote a product the company will set up a booth and distribute their product to the public. Tobacco products for sale in establishments (for tobacco option only) Coupons / special prices --> What is the price per unit Please indicate the cost for the purchase of the product for what unit. Logos (on clothing) This can include T-Shirt, hats or bags Sponsorship: which company Others, please specify 14 Is a brand mentioned? : If yes, please enter brand name MATRIX Public Health Solutions 2008 Page 18 of 31

19 If you selected yes, you will be prompted to enter the brand name in the next screen. 15 Please describe the information (message / advertisement / point of decision prompt) or image details below. Please describe placement and size of the message you saw and any relevant messages and/or organizations involved in creating the message. If you selected In front of a STORE in screen 5 6 Please enter the FAST store code. (Start at 1 and go as high as needed, this should be automatic.) Enter store code: Use the code you used in the FAST entry 7 Are the following types of foods available? [Check all that apply] Fresh fruits n fresh fruits Fresh vegetables n fresh vegetables Nuts (packaged or fresh)/ Whole grain foods/ Legumes (beans, canned or dried) High fat foods (convenient noodles, fried meats, etc.) Oils Sweets (desserts, cookies, etc.) Salty snacks (chips, others, etc.) Low-fat, low-sugar, and/or low-salt options Tobacco products Sugar-sweetened beverages Low Calorie drinks Water Prepared foods Staple items Eggs, Other PLEASE NOTE: pickled vegetables and fruits should be categorised as salty snacks rather than non fresh vegetable or fruits. Dried, frozen or canned fruits and vegetable with no additional ingredients added (i.e. salt, sugar or fat) should be categorised under non fresh fruit or vegetables. If you selected oil or prepared foods please also complete the oil and prepared food scan when you do the detailed questions. If you selected tobacco product please note in the comment section whether single cigarettes are sold. If you selected other, you will be ask to specify the item category in the next screen If you select Fresh fruits Please note: the following section will not include the screen number as there are multiple configurations and it is dependent on the items that were selected in Screen 7. However keep in mind that each row indicates a new screen on the PDA. Please list the 2 most common fresh fruits in the community (1) Fresh fruit #1 (2) Fresh fruits#2 Pick the two most common fruits for your setting. Enter the name of the fruit you have chosen to assess. For the 2 most common fruits selected, please enter the range of price per unit. (1) Fresh fruit #1 (2) Fresh fruit #2 Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which of unit the product is sold by). For the 2 most common fruits selected, please rate the overall quality. Rate from 1-3 (1 being very poor and 3 being excellent) Fresh fruit #1 Fresh fruit #2 1= The overall quality is very poor (lots of bruises, insects bites or other damages). 2= There is a mixture in the quality; some fruits are in excellent condition (no bruises, insects bites or other damages) and other fruits are in poor condition (lots of bruises, insects bites or other damages) OR the fruits offered are in moderate condition (some bruises, insects bites or other damages). 7 8 MATRIX Public Health Solutions 2008 Page 19 of 31

20 3= All fruits offered are in excellent condition (no bruises, insects bites or other damages) For the selected fresh fruits selected, is there a point of decision prompt or sale? Fresh fruit #1 Fresh fruit #2 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill out the information environment scan. If you select Fresh vegetables Please list the 2 most common fresh vegetables in the community. (1) Fresh veg #1 (2) Fresh veg #2 Pick the two most common vegetables for your settling. Enter the name of the vegetables you have chosen to assess. For the 2 most common vegetables selected, please enter the range of price per unit. (1) Fresh veg #1 (2) Fresh veg #2 Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the 2 most common vegetables selected, please rate the overall quality. Rate from 1-3 (1 being very poor and 3 being the excellent) Fresh veg#1 Fresh veg #2 1= The overall quality is very poor (lots of bruises, insects bites or other damages). 2= There is a mixture in the quality of vegetables; some vegetables are in excellent condition (no bruises, insects bites or other damages) and other vegetables are in poor condition (lots of bruises, insects bites or other damages) OR the vegetables offered are in moderate condition (some bruises, insects bites or other damages). 3= All vegetables offered are in excellent condition (no bruises, insects bites or other damages) For the selected fresh vegetables selected, is there a point of decision prompt or sale? Fresh vegetable #1 Fresh vegetable #2 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill out the information environment scan. If you select NON Fresh fruits Please list the 2 most common non-fresh fruits in the community (1) n fresh fruit #1 (2) n fresh fruit #2 Pick the two most common non fresh fruits for your settling. Enter the name of the fruit you have chosen to assess. For the 2 most common fruits selected, please enter the price per unit (1) n fresh fruit #1 (2) n fresh fruit #2 Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the selected non-fresh fruits selected, is there a point of decision prompt or sale? n-fresh fruit #1 n-fresh fruit #2 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill out the information environment scan. For the selected non-fresh fruits selected, i is there a nutritional label on the package? n-fresh fruit #1 n-fresh fruit #2 Nutritional labelling must include caloric information. If the label only lists the ingredients of the items, then this is not a nutritional label. MATRIX Public Health Solutions 2008 Page 20 of 31

21 If you select NON Fresh vegetables Please select the 2 most common non-fresh vegetables in the community (1) n fresh veg #1 (2) n fresh veg#2 Pick the two most common non fresh vegetables for your settling. Enter the name of the fruit you have chosen to assess. For the 2 most common fruits selected, please enter the price per unit (1) n fresh veg #1 (2) n fresh veg #2 Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the selected non-fresh vegetables selected, is there a point of decision prompt or sale? n-fresh veg #1 n-fresh veg #2 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill out the information environment scan. For the selected non-fresh vegetables selected, i is there a nutritional label on the package? n-fresh veg #1 n-fresh veg #2 Nutritional labelling must include caloric information. If the label only lists the ingredients of the items, then this is not a nutritional label. If you selected Legumes (cans or dried)/ Nuts/Whole grain foods Please list the most common nut, legume and whole grain item available in the community and enter the type below Nut Legume Whole Grain For the selected nut, legume and whole grain item, please enter the price per unit below Nut Legume Whole Grain Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the selected nut, legume and whole grain item, is there are point of decision prompt or sale? NA Nut Legume Whole grain If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill the information environment scan. If there are not any items for any of the categories, check NA. For the selected nut, legume and whole grain item, is there are nutritional labels on the package? NA Nut Legume Whole grain Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label. If there are not any items for this category, check NA. If you selected High fat food item Please select the most common high fat dairy product [i.e. butter / regular cheese / cream / half & half or other high-fat dairy], animal fat product [i.e. high salt sausages / fried meats / hot dog] and fried food product [e.g. fried convenient noodles/crisps] available in the community. Indicate the type and brand below High fat dairy item Animal fat item Fried food item Other MATRIX Public Health Solutions 2008 Page 21 of 31

22 For the selected high fat items please indicate the unit price. High fat dairy item Animal fat item Fried food item Other Enter the price / unit or price/ package quantity i.e. ($/ 1kg or which unit the product is sold by). For the selected high fat foods, is there a point of decision prompt or sale? NA High fat dairy item Animal fat item Fried food item Other If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill the information environment scan. If there are not any items for any of the categories, check NA. For the selected high fat foods, is there are nutritional labels on the package? NA High fat dairy item Animal fat item Fried food item Other Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label. If there are not any items for this category, check NA. If you selected High salt foods Please list the most common high-salt foods for each category. Enter the type and brand in the space provided. High-salt low fat (eg. pretzels / baked chips/pickled fruits or other similar snacks ) High-salt high-fat (eg. Potato chips ) Other Other For the selected high salt foods, please enter the unit price High-salt low-fat (eg. pretzels / baked chips/pickled fruits or other similar snacks ) High-salt high-fat (eg. Potato chips ) Other Other Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the selected high salt foods, is there a point of decision prompt or sale? NA High salt low-fat High salt high fat Other Other If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill the information environment scan. If there are not any items for any of the categories, check NA. For the selected high salt foods, is there are nutritional labels on the package? NA High salt low-fat High salt high fat Other Other Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label. If there are not any items for this category, check NA. MATRIX Public Health Solutions 2008 Page 22 of 31

23 If you selected Sweets Please list the most common sweets available in the community. Enter the type and brand in the space provided. Sweets #1 Sweets#2 Sweets #3 For the selected sweets please enter the price per unit. Sweets #1 Sweets#2 Sweets #3 Enter the price / unit or price/ package quantity (i.e. $/ 1kg or which unit the product is sold by). For the selected sweet items, is there a point of decision prompt or sale? NA Sweets #1 Sweets #2 Sweets #3 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill the information environment scan. If there are not any items for any of the categories, check NA. For the selected sweet items, is there are nutritional labels on the package? NA Sweets #1 Sweets #2 Sweets #3 Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label. If there are not any items for this category, check NA. If you selected Sugar-sweetened beverages OR Low calorie drinks OR Water Please indicate what types of beverages are available. Plain water Sports drinks / vitamin water n-100% juice 100% juice Sugar-sweetened beverages (e.g., regular soda) Diet sweetened beverages (e.g., diet soda) Whole milk 2% reduced-fat milk 1% low-fat / skim milk Soybean milk List the most common item and brand for each of the categories. For the selected beverage item, please enter the unit price. Unit price Plain water Sports drinks / vitamin water n-100% juice 100% juice Sugar-sweetened beverages (e.g., regular soda) Diet sweetened beverages (e.g., diet soda) Whole milk 2% reduced-fat milk 1% low-fat / skim milk Soybean milk Only those items you selected as being available will appear on this screen. Therefore it is dependent on the MATRIX Public Health Solutions 2008 Page 23 of 31

24 type of beverages available. Enter the price / unit or price/ package quantity (i.e. $/ 1L or which unit the product is sold by). For the selected beverage item, is there a point of decision prompt or sale? Plain water Sports drinks / vitamin water n-100% juice 100% juice Sugar-sweetened beverages (e.g., regular soda) Diet sweetened beverages (e.g., diet soda) Whole milk 2% reduced-fat milk 1% low-fat / skim milk Soybean milk Only those items you selected as being available will appear on this screen. Therefore it is dependent on the type of beverages available. If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill the information environment scan For the selected beverage item, is there nutritional labels on the package? Plain water Sports drinks / vitamin water n-100% juice 100% juice Sugar-sweetened beverages (e.g., regular soda) Diet sweetened beverages (e.g., diet soda) Whole milk 2% reduced-fat milk 1% low-fat / skim milk Soybean milk Only those items you selected as being available will appear on this screen. Therefore it is dependent on the type of beverages available. Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label If you selected Low fat/salt/ sugar options Please check all the healthy items available in this location. [Check all that apply] Low fat items Low salt items, Low sugar items, Low fat, salt and sugar items Check which types of low fat/salt/sugar items are available. For those items you check you will be prompted to enter the name and type of product in the next screen If you selected Oil Which oils do they sell? [Check all that apply] Butter/Ghee Hard margarine Soft margarine Lard/suet Palm oil MATRIX Public Health Solutions 2008 Page 24 of 31

25 Canola oil Coconut oil Olive oil Soybean oil Sunflower oil Safflower oil Rapeseed oil Corn oil Sesame oil Peanut oil Grapeseed oil Avocado oil Others Check all the types of oils available in the store Please select the most common oils used in the community. Enter the type and brand in the space provided. Vegetable oil #1 Vegetable oil #2 Animal base fat #1 Animal base fat #2 List the 2 most common vegetable oil and animal based fats used in the community and enter the brand in the space provided. For the selected oils please enter the price per unit. Vegetable oil#1 Vegetable oil #2 Animal base fat #1 Animal base fat#2 Enter the price / unit or price/ package quantity (i.e. $/ 1L or which unit the product is sold by). For the selected oils, is there a point of decision prompt or sale? NA Vegetable oil#1 Vegetable oil#2 Animal base fat #1 Animal base fat # 2 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging you to buy the product please also fill out the information environment scan. If there are no items for this category then check NA For the selected oils, is there a point of decision prompt or sale? NA Vegetable oil#1 Vegetable oil#2 Animal base fat #1 Animal base fat # 2 Nutritional labelling must include caloric information. If the label only lists the ingredients of the item, then this is not a nutritional label. If there are not any items for this category, check NA. If you selected Tobacco products Please check all the types of tobacco products that are available in this location. [Check all that apply] Beedis Single cigarettes Packaged cigarettes Pan Masala Gutkha Mouth Freshener Khaini Betelnut Snuff Other If you selected other you will be asked to clarify in the next screen. Please select the 3 most common tobacco brands. Enter the type and brand in the spaced provided. MATRIX Public Health Solutions 2008 Page 25 of 31

26 Brand #1 Brand#2 Brand#3 For the selected brands, please enter the unit price. Brand #1 Brand#2 Brand#3 Enter the price / unit or price/ package quantity (i.e. $/ 20 cigarettes or which unit the product is sold by). For brands selected, is there a point of decision prompt or sale? NA Brand #1 Brand #2 Brand #3 If the product has been reduced because of a sale please select yes. If there are messages or postings encouraging/discouraging you to buy the product please also fill the information environment scan. If there are no items for this category, check NA. For brands selected, is there a warning label? NA Brand #1 Brand #2 Brand #3 A warning label must include a clear message of the harm of the tobacco product not just the ingredients in the product. If applicable, what kinds of foods are at the register? Please enter any additional notes about the store. (Please note range of price per unit of tobacco products.) Would you like to assess the information environment? If you selected In front of a restaurant/food service 6 Please enter the restaurant/food service code. (Start at 1 and go as high as needed, this should be automatic.) Code 7 Is there a tobacco vendor in or in front of the restaurant/food service?, in the restaurant/food service, in front of the restaurant/food service 8 Is the restaurant/food service designated as smoke-free? 9 Is part of the restaurant/food vendor smoke-free with restricted areas for smoking indoors? 10 Are there any smoke-free or no-smoking signs visible? If there a message or posting indicating no-smoking, please also fill out the Information Environment Scan. 11 Are there any people smoking inside? MATRIX Public Health Solutions 2008 Page 26 of 31