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The Ten Toe Express Program User Account

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As the program continues, you will be able to use your username and password to log in to the Ten Toe Express system to record your walking and eating patterns and to track your progress in the program.

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Example: (555) 555-5555






Example: (555) 555-5555
KNOWLEDGE
Please select the answer you believe is most appropriate for each question.
1. What is the minimum amount of physical activity that a person should do each day? *

2. What is the minimum number of steps that a person should take each day? *
3. Which fruit or vegetable listed below is best for you? *

4. Biking or walking to the MetroLink instead of driving may help me achieve the daily recommended amount of physical activity. *
5. Raking leaves and shoveling snow are not types of physical activity. *
6. Taking the stairs instead of the elevator is a way to achieve more physical activity. *
7. Gardening for 30-40 minutes burns the same number of calories as jumping rope for 15 minutes. *
8. A good walking plan increases in duration, intensity, and frequency each week.  *
9. Taking 3-5 minutes to stretch before and after exercise will decrease injuries.  *
10. Walking may help maintain healthy bones, muscles, and joints.  *


BARRIERS and BELIEFS
Please select the answer you believe is most appropriate for each question.
1. I have a friend or family member with whom I can ride MetroLink or MetroBus. *
2. There are many places to walk in my community (walking trails, parks, community centers). *
3. I have a friend or family member with whom I can walk. *
4. It is safe to walk in my community. *
5. There is a MetroLink station or a MetroBus stop within walking distance of my home. *
6. I know how to use MetroLink or the MetroBus system. *
7. There are many places to take the MetroLink or MetroBus in my community. *
8. It is safe to ride MetroLink or MetroBus in my community. *
9. Which statement best describes you? *
10. Which statement best describes you? *
11. Which of the following statements best describes your readiness to eat more servings of fruit and vegetables each day? *


BEHAVIORS
Please select the answer you believe is most appropriate for each question.
1a.  During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or raking in the yard? Do not include walking.  Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal.  Think about only those physical activities that you did for at least 10 minutes at a time.
Days *


1b. How much time in total did you usually spend on one of those days doing moderate physical activity?
Hours * Minutes
Again, think only about those physical activities that you did for at least 10 minutes at a time.
2a.  During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, or fast bicycing? Vigorous physical activities refer to activities that take hard physical effort and make you breathe much harder than normal. 
Days *


2b. How much time in total did you usually spend on one of those days doing vigorous physical activity?
Hours * Minutes
3a.  During the last 7 days, on how many days did you walk for at least 10 minutes at a time? This includes walking at work and at home, walking to travel from place to place, and any other walking that you did solely for recreation, sport, exercise, or leisure.
Days *


3b. How much time in total did you usually spend walking on one of those days?
Hours * Minutes
The next question is about the time you spent sitting on weekdays while at work, at home, while doing course work and during leisure time. This includes time spend sitting at a desk, visiting friends, reading, traveling on a bus, or sitting or lying down to watch television.
4. During the last 7 days, how much time in total did you usually spend sitting on a week day?
Hours * Minutes
Now think about how you traveled from place to place, including places like work, stores, movies, and so on.
5a.  During the last 7 days, on how many days did you travel in a motor vehicle like a train, bus, car, or tram? 
Days *


5b. How much time in total did you usually spend on one of those days traveling in a car, bus, train, or other kind of motor vehicle?
Hours * Minutes
Now think only about the walking you did to travel to and from work. Only include walking that you did for at least 10 minutes at a time.
6a.  During the last 7 days, on how many days did you walk from your home to work? 
Days *


6b. How much time in total did you usually spend on one of those days walking from your home to work?
Hours * Minutes
7a.  During the last 7 days, on how many days did you use public transit (MetroLink or Metro Bus)? 
Days *


7b. How much time in total did you usually spend on one of those days taking public transit?
Hours * Minutes
DEMOGRAPHICS QUESTIONNAIRE
The following questions will be asking general questions about you. Remember that this information is strictly confidential. As with the other information in this interview, we will not use your name in association with this information. Please mark your answer choice with an X.
1. What is your gender?


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2. What is your age?


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3. What is your marital status?


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4. What is the highest level of education that you have completed?


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5. What is the race/ethnicity that best describe(s) you?


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6. What is your total household income, from all sources?


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7. Do you have access to reliable transportation (for example, a car, bus, friend, neighbor)?


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8. How do you rate your overall health?


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9. How satisfied are you with your current level of health?


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10. How did you hear about the Ten Toe Express program?


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Thank you for completing the Ten Toe Express survey.
We look forward to seeing you at upcoming Ten Toe Express Walks!