Homeless Veteran Food Insecurity Questionnaire

Thank you for taking the time to answer this brief questionnaire as part of my practicum for the University of South Carolina Public Health Program. 

Please answer the following 20 questions as accurately as possible. If you have any related comments, please include them in box 21. 

By completing this survey, you agree to the publication and analysis of all survey responses. Names will not be used in the report. Interviews will use first name only. 

If you have any questions, would like to set up an interview, or would like a copy of the final results, please email: HVFI2015@gmail.com

Thank You. 
Brenna B. 

Please answer the questions keeping in mind the time when you were homeless, not just your current situation. 

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* 1. In what City and State do you currently reside? (City, State)

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* 2. Please specify your ethnicity

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* 3. What is your gender

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* 4. What is your age

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* 5. What is your marital status?

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* 6. In what branch of the military did you serve? 

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* 7. How many years did you serve? 

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* 8. Are you using Food Stamp Benefits?

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* 9. Do you believe you are food insecure? 
The USDA defines Food Insecurity as: the state of being without reliable access to a sufficient quantity of affordable, nutritious food.

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* 10. Which of the following are reasons you do not have enough to eat. Select all that apply.

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* 11. Please rank your barriers to obtaining food. Where 1 is the greatest barrier to food and 4 is the least.

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* 12. In the past 12 months: Have you been to your local food bank for assistance?  

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* 13. In the past 12 months: Did you run out of food and not have enough money to buy more?

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* 14. In the past 12 months: Have you skipped meals or cut the size of your meals because you did not have enough food

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* 15. If you answered Yes to question 14: How often have you skipped meals in the past 12 months?

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* 16. In a typical day, how many full meals do you eat?
For this purpose, a full meal is considered a protein (meat, beans, etc), fruit or vegetable, plus carbohydrates (bread, pasta, rice, etc.)

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* 17. Have you ever gone a full day without eating because you didn't have enough money or didn't have access to food? 

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* 18. In the past month: How many times have you not known when your next meal would be or where it would come from?

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* 19. Please Describe the Availability of specific types of food vs. your preference for the food. 

  Availability Preference
Fresh Fruits 
Fresh Vegetables 
Canned or Frozen Vegetables 
Canned or Frozen Fruits 
Proteins (Meats, beans, etc.)
Dairy (Cheese, milk, yogurt, etc.)
Carbohydrates and Starches (Potatoes, Rice, Bread, etc.) 
Sweets/Snacks (Cookies, Crackers, Chips, etc.) 

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* 20. Do you have any known medical conditions that you feel could be linked to Food Insecurity?

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* 21. Please include any comments, thoughts, or ideas you have on Homeless Veteran Food Insecurity. If you would be interested in participating in a brief interview, please include your email address or phone number for follow up. 

Thank you.

T