H
OMB#: 0925-0584
Exp. xx/xx/xxxx
Public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0584). Do not return the completed form to this address.
ID NUMBER: |
|
|
|
|
|
|
|
|
|
FORM CODE: FPE VERSION: B |
Contact Occasion |
|
|
SEQ # |
|
|
|
0a. Completion Date: // 0b. Staff ID:
Month Day Year
Instructions: Enter the answer given by the participant for each response.
1. Over the past 12 months, how often did you drink orange juice or grapefruit juice?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
2. How often did you drink apple juice?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
3. How often did you drink grape juice?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
4. How often did you drink other 100% fruit juice/nectar or 100% fruit juice/nectar mixtures (such as pineapple, pear, apricot, or others)?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
Over the past 12 months…
5. How often did you drink other fruit drinks (such as cranberry cocktail, Hi-C, lemonade, or Kool-Aid, diet or regular)?
NEVER (GO TO QUESTION 6)
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
5a. How often were your fruit drinks diet or sugar-free drinks?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
6. How often did you drink milk as a beverage (NOT in coffee, NOT in cereal)? (Please include chocolate milk and hot chocolate)
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
7. How often did you drink meal replacement, energy, or high-protein beverages such as Instant Breakfast, Ensure, Slimfast, Sustacal or others?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
8. How often did you drink soft drinks, sodas, or pop?
NEVER (GO TO QUESTION 9)
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
Over the past 12 months…
8a. How often were these soft drinks, soda, or pop diet or sugar-free?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
9. How often did you drink beer?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
10. How often did you drink wine or wine coolers?
NEVER
1 time per month or less 1 time per day
2-3 times per month 2-3 times per day
1-2 times per week 4-5 times per day
3-4 times per week 6 or more times per day
5-6 times per week
11. How often did you eat oatmeal, grits, or other cooked cereals?
NEVER (GO TO QUESTION 12)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
11a. How often was the cooked cereal you ate oatmeal?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
Over the past 12 months…
12. How often did you eat cold cereal (box cereal such as Corn Flakes)?
NEVER (GO TO QUESTION 13)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
12a. How often was the cold cereal you ate a whole grain type (such as shredded wheat, Wheaties, Cheerios, Raisin Bran or other bran, oat, or whole wheat cereal)?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
13. How often did you eat applesauce?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
14. How often did you eat apples?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
15. How often did you eat pears (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
16. How often did you eat bananas? (NOT plantains-we will ask about plantains later)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
17. How often did you eat pineapple?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
18. How often did you eat dried fruit, such as prunes or raisins?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
19. How often did you eat peaches, nectarines, or plums?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
20. How often did you eat grapes?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
21. How often did you eat melons (such as cantaloupe, watermelon, or honeydew)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
22. How often did you eat strawberries?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
23. How often did you eat oranges, tangerines, clementines, or tangelos?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
24. How often did you eat grapefruit?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
25. How often did you eat mango (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
26. How often did you eat papaya, lechosa or fruta bomba (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
27. How often did you eat other kinds of fruit?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
28. How often did you eat COOKED greens (such as spinach, turnip, collard, mustard, chard, or kale)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
29. How often did you eat RAW greens (such as spinach, turnip, collard, mustard, chard, or kale)? (We will ask about lettuce later.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
30. How often did you eat carrots (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
31. How often did you eat string beans or green beans (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
32. How often did you eat peas (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
33. How often did you eat corn (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
34. How often did you eat broccoli (fresh or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
35. How often did you eat mixed vegetables (fresh, canned, or frozen)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
36. How often did you eat fresh tomatoes (including those in salads)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
37. How often did you eat summer squash (include yellow and green squash)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
38. How often did you eat lettuce salads (with or without other vegetables)?
NEVER (GO TO QUESTION 39)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
38a. How often were the lettuce salads you ate made with dark green leaves? (such as spinach or romaine)
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
39. How often did you eat sweet potatoes or yams?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
40. How often did you eat French fries, home fries, hash browned potatoes, or tater tots?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
41. How often did you eat potato salad?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
42. How often did you eat baked, boiled, or mashed potatoes?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
43. How often did you eat salsa or pico de gallo?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
44. How often did you eat ketchup?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
45. How often did you eat chili (chili con carne or with beans)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
46. How often did you eat tortillas or tacos?
NEVER (GO TO QUESTION 47)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
46a. How often were your tortillas or tacos corn tortillas or tacos?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
47. How often did you eat cooked dried beans (such as baked beans, pintos, kidney, blackeyed peas, lima, lentils, soybeans, or refried beans)? (Please don’t include bean soups or chili.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
48. How often did you eat winter squash (including pumpkin, acorn, and butternut squash)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
49. How often did you eat avocado?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
50. How often did you eat nopal?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
51. How often did you eat plantain?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
52. How often did you eat other kinds of vegetables?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
53. How often did you eat rice or other cooked grains (such as bulgur, cracked wheat, or millet)?
NEVER (GO TO QUESTION 54)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
53a. How often was the rice or other cooked grains you ate brown rice, cracked wheat, or millet?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
Over the past 12 months…
54. How often did you eat pancakes, waffles, or French toast?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
55. How often did you eat bagels or English muffins?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
The next questions ask about your intake of breads other than bagels or English muffins. First, we will ask about bread you ate as part of sandwiches only. Then we will ask about all other bread you ate.
56. How often did you eat breads or rolls AS PART OF SANDWICHES (including burger and hot dog rolls)?
NEVER (GO TO QUESTION 57)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
56a. How often were the breads or rolls that you used for sandwiches white bread (including burger and hot dog rolls)?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
57. How often did you eat breads or dinner rolls, NOT AS PART OF SANDWICHES?
NEVER (GO TO QUESTION 58)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
57a. How often were the breads or rolls you ate white bread?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
58. How often did you eat jam, jelly, guava paste or honey on bagels, muffins, bread, rolls, or crackers?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
59. How often did you eat roast beef or steak IN SANDWICHES?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
60. How often did you eat turkey or chicken COLD CUTS (such as loaf, luncheon meat, turkey ham, turkey salami, or turkey pastrami)? (We will ask about other turkey or chicken later.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
61. How often did you eat luncheon or deli-style ham? (We will ask about other ham later.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
62. How often did you eat other cold cuts or luncheon meats (such as bologna, salami, corned beef, pastrami, or others, including low-fat)? (Please do not include ham, turkey, or chicken cold cuts.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
63. How often did you eat canned tuna (including in salads, sandwiches, or casseroles)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
64. How often did you eat beef hamburgers or cheeseburgers?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
65. How often did you eat ground beef in mixtures (such as meatballs, casseroles, or meatloaf)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
66. How often did you eat hot dogs or frankfurters? (Please do not include sausages or vegetarian hot dogs.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
67. How often did you eat beef mixtures such as beef stew, beef pot pie, beef and noodles, or beef and vegetables?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
68. How often did you eat roast beef or pot roast? (Please do not include roast beef or pot roast in sandwiches.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
69. How often did you eat steak (beef)? (Do not include steak in sandwiches)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
70. How often did you eat ribs (pork or beef)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
71. How often did you eat roast turkey, turkey cutlets, or turkey nuggets (including in sandwiches)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
72. How often did you eat chicken as part of salads, sandwiches, casseroles, stews, or other mixtures?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
73. How often did you eat baked, broiled, roasted, stewed, or fried chicken (including nuggets)? (Please do not include chicken in mixtures.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
74. How often did you eat baked ham or ham steak?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
75. How often did you eat pork (including chops, roasts, and in mixed dishes)? (Please do not include ham, ham steak, or sausage.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
76. How often did you eat bacon (including low-fat)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
77. How often did you eat sausage (including chorizo, breakfast, Polish, Italian and including low-fat)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
78. How often did you eat smoked fish or seafood (such as smoked salmon, lox, or others)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
79. How often did you eat all other fish or seafood (including shellfish) that was NOT SMOKED?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
80. How often did you eat soups?
NEVER (GO TO QUESTION 81)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
80a. How often were the soups you ate bean soups?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
80b. How often were the soups you ate cream soups (including chowders)?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
Over the past 12 months…
80c. How often were the soups you ate tomato or vegetable soups?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
81. How often did you eat pizza?
NEVER (GO TO QUESTION 82)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
81a. How often did you eat pizza with pepperoni, sausage, or other meat?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
82. How often did you eat crackers?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
83. How often did you eat corn bread or corn muffins?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
84. How often did you eat biscuits?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
85. How often did you eat tortilla chips or corn chips (including low-fat, fat-free, or low-salt)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
86. How often did you eat popcorn (including low-fat)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
87. How often did you eat peanuts, walnuts, seeds, or other nuts?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
88. How often did you eat yogurt (NOT including frozen yogurt)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
89. How often did you eat cottage cheese (including low-fat)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
90. How often did you eat cheese (including low-fat; including on cheeseburgers or in sandwiches or subs)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
91. How often did you eat frozen yogurt, sorbet, or ices (including low-fat or fat-free)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
92. How often did you eat ice cream, ice cream bars, or sherbet (including low-fat or fat-free)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
93. How often did you eat pudding or custard?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
94. How often did you eat cake (including low-fat or fat-free)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
95. How often did you eat cookies or brownies (including low-fat or fat-free)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
96. How often did you eat doughnuts, sweet rolls, Danish, or pop-tarts?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
97. How often did you eat sweet muffins or dessert breads (including low-fat or fat-free)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
98. How often did you eat fruit crisp, cobbler, or strudel?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
99. How often did you eat pie?
NEVER (GO TO QUESTION 100)
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
99a. How often was the pie you ate fruit pie (such as apple, cherry, peach, blueberry, or others)?
Almost never or never
About ¼ of the time
About ½ of the time
About ¾ of the time
Almost always or always
Over the past 12 months…
100. How often did you eat chocolate candy?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
101. How often did you eat other candy?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
102. How often did you eat eggs, egg whites, or egg substitutes (NOT counting eggs in baked good and desserts)? (Please include eggs in salads, quiche, and soufflés.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
103. How many cups of coffee, caffeinated or decaffeinated, did you drink?
NONE
Less than 1 cup per month 1 cup per day
1-3 cups per month 2-3 cups per day
1 cup per week 4-5 cups per day
2-4 cups per week 6 or more cups per day
5-6 cups per week
104. How many glasses of ICED tea, caffeinated or decaffeinated, did you drink?
NONE
Less than 1 cup per month 1 cup per day
1-3 cups per month 2-3 cups per day
1 cup per week 4-5 cups per day
2-4 cups per week 6 or more cups per day
5-6 cups per week
Over the past 12 months…
105. How many cups of HOT tea, caffeinated or decaffeinated, did you drink?
NONE
Less than 1 cup per month 1 cup per day
1-3 cups per month 2-3 cups per day
1 cup per week 4-5 cups per day
2-4 cups per week 6 or more cups per day
5-6 cups per week
106. How often did you add sugar or honey to your coffee or tea?
NEVER
Less than 1 time per month 1 time per day
1-3 times per month 2-3 times per day
1 time per week 4-5 times per day
2-4 times per week 6 or more times per day
5-6 times per week
107. How often did you add artificial sweetener to your coffee or tea?
NEVER
Less than 1 time per month 1 time per day
1-3 times per month 2-3 times per day
1 time per week 4-5 times per day
2-4 times per week 6 or more times per day
5-6 times per week
108. How often was non-dairy creamer added to your coffee or tea?
NEVER
Less than 1 time per month 1 time per day
1-3 times per month 2-3 times per day
1 time per week 4-5 times per day
2-4 times per week 6 or more times per day
5-6 times per week
109. How often was cream or half and half added to your coffee or tea?
NEVER
Less than 1 time per month 1 time per day
1-3 times per month 2-3 times per day
1 time per week 4-5 times per day
2-4 times per week 6 or more times per day
5-6 times per week
Over the past 12 months…
110. How often was milk added to your coffee or tea?
NEVER
Less than 1 time per month 1 time per day
1-3 times per month 2-3 times per day
1 time per week 4-5 times per day
2-4 times per week 6 or more times per day
5-6 times per week
111. How often was sugar or honey added to foods you ate? (Please do not include sugar in coffee, tea, other beverages, or baked goods.)
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
112. How often did you eat sour cream?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
113. How often did you eat fresh cream?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
114. How often did you eat foods with oils added or with oils used in cooking (do not include baked goods or salads)?
NEVER
1-6 times per year 2 times per week
7-11 times per year 3-4 times per week
1 time per month 5-6 times per week
2-3 times per month 1 time per day
1 time per week 2 or more times per day
Over the past 12 months…
115. What kind of oils did you usually eat? (Mark all that apply.)
Olive
Corn
Canola/rapeseed
Other
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |