PESTICIDES ON FOOD SURVEY How much do you agree with each of the following statements? (circle your response) 1 = strongly disagree2 = disagree3 = neutral4 = agree5 = strongly agree With respect to pesticides on food: 12345This is an important issue to me 12345I'd like to know more 12345The government should do more to inform me 12345Grocery stores should provide more information 12345I can't do much about my exposure 12345Children are at higher risk than adults 12345I am not concerned about how they may affect my family 12345I consider myself well-informed 12345A grocery store is a useful place to distribute information How often do you do the following? (circle your response) 1 = never 2 = rarely 3 = sometimes 4 = most of the time5 = always 12345Wash fruits and vegetables 12345Peel fruits and vegetables that have a skin that you can eat 12345Purchase organic food 12345Ask your grocer about food that is grown using fewer or no pesticides Where have you gotten information about pesticides on food in the past? (check all that apply) ___Radio ___Public Library ___Television News ___Newspaper ___Magazine ___Friends/Family ___Grocery Store ___Internet ___Medical Doctor ___School ___Have not gotten information, until now   ___Other____________________________________     If you could recommend where to distribute information about pesticides on food, where would you suggest? (circle your selection(s) from the above list) From the following list choose the five issues that are most important to you and rank them on a scale of 1 to 5: 1 = most important issue and 5 = least important issue ___Loss of natural and scenic areas ___Endangered species ___Depletion of the ozone layer ___Air pollution ___Pesticide use on foods ___Disposal of hazardous waste ___Acid rain ___Drinking water contamination Please check the appropriate response: Gender: ___M ___F Age: ___18-19 ___20-24 ___25-29 ___30-34 ___35-39 ___40-44 ___45-49 ___50-54   ___55-59 ___60-64 ___65 & over           Schooling Completed: ___Some High School ___High School Diploma or GED ___Some College   ___4-year College Degree ___Post-Graduate Degree   Yearly Household Income: ___Under $15,000 ___$15,001 - $18,000 ___$18,001 - $21,000 ___$21,001 - $24,000 ___$24,001 - $27,000 ___$27,001 - $30,000 ___$30,001 - $35,000 ___$35,001 - $40,000 ___$40,001 - $50,000 ___$50,001 - $60,000 ___$60,001 - $70,000 ___$70,001 - $80,000 ___$80,001 - $90,000 ___$90,001 - $100,000 ___$100,001 and Over I consider myself: ___Asian American ___Latino/Hispanic ___Black/African American   ___Native American ___White/Caucasian ___Other Number of children in household (under age 18):_____ Number of adults in household (age 18 & over):_____ Please add any other comments.   Please return your completed survey to: Pesticides on Food Survey School of Natural Resources & Environment University of Michigan Dana Building 430 E. University Ann Arbor, MI 48109-1115 Return to top