FDA HEALTH AND DIET SURVEY
CORE QUESTIONS
(Note: Question numbering will be customized at each iteration when needed.)
D1. First, I am going to read two statements about health and food. As I read each statement, please tell me how much you agree or disagree with it. The first statement is… Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it? …
The next statement is “…”
The next statement is…
(INTERVIEWER: REPEAT RESPONSE OPTIONS WHEN NECESSARY)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[PROG: D1: RANDOMIZE LIST/RANDOMIZE ITEMS]
If I eat a healthy diet I can greatly reduce my chance of getting heart disease.
If I eat a healthy diet I can greatly reduce my chance of getting cancer.
I am confident that I know how to choose healthy foods.
I generally know which menu items in a restaurant have more calories and which have fewer calories.
A5. Have you heard anything about heart disease or heart attacks being related to things people eat or drink?
Yes
No
[DON’T READ] Don’t know/Not sure (DK/NS)
[DON’T READ] Refused (RF)
A7. Have you heard anything about cancer being related to things people eat or drink?
Yes
No
DK/NS
RF
A9. Have you heard anything about high blood pressure being related to things people eat or drink?
Yes
No
DK/NS
RF
DBA700. Now, think about your eating habits. In general, how healthy is your overall diet? Would you say?
Excellent
Very good
Good
Fair, or
Poor
CBQ645. About how many calories do you think a [IF SPEAKING TO A MALE INSERT ‘man’; IF SPEAKING TO A FEMALE INSERT ‘woman’] of your age and physical activity needs to consume a day to maintain your current weight?
(INTERVIEW, READ LIST AS NECESSARY)
Less than 500 calories
500-1000 calories
1001-1500 calories
1501-2000 calories
2001-2500 calories
2501-3000 calories
More than 3000 calories
DBQ750. Think about the Nutrition Facts label on many food products that list the amounts of things like calories, fat, cholesterol, vitamins and minerals in the product. How often do you use the Nutrition Facts label when deciding to buy a food product? Would you say always, most of the time, sometimes, rarely, or never?
(INTERVIEWER: DO NOT READ “DK/NS/RF/ NEVER SEEN THE LABEL”)
Always
Most of the time
Sometimes
Rarely
Never
NEVER SEEN THE LABEL
DK/NS
RF
[PROG: IF DBQ750= Rarely, Never, SKIP TO CBQ698]
[PROG: IF DBQ750=DK/NS/RF OR Never seen the label, SKIP TO xx]
CBQ710. Now think about the types of food products you buy using the Nutrition Facts label. How often do you look for nutrition information on the Nutrition Facts label when you buy each of the following types of foods? Would you say always, most of the time, sometimes, rarely, or never?
[PROG: ALL SKIP TO xx]
[PROG: CBQ710. RANDOMIZE LIST]
(Interviewer – do not read “I’ve never seen the label” or “I never/don’t buy these products”)
(Note: food types may be varied at each iteration as needed.)
Snacks like chips, popcorn, or pretzels
Breakfast cereals
Salad dressings
Raw meat, poultry, or fish
Processed meat products like hot dogs or bologna
Bread
Always
Most of the time
Sometimes
Rarely
Never
I’ve never seen the label
I never/don’t buy these products
DK/NS
RF
CBQ698. People rarely or never check the Nutrition Facts label for various reasons. Which of the following three reasons is the primary reason that you rarely or never check the Nutrition Facts label when deciding to buy a food product?
I don't have the time
It is difficult to use the label
I don’t feel I need to use the label
DK/NS
RF
[PROG: CBQ698. RANDOMIZE LIST
IF CBQ698= “I don't have the time”, or “DK/NS” OR “RF” SKIP TO xx
IF CBQ698= “It is difficult to use the label” GO TO CBQ698x
IF CBQ698= “I don’t feel I need to use the label” GO TO CBQ698y]
CBQ698x. You said it is difficult for you to use the Nutrition Facts label. Is it:
Because the print on the label is too small,
Because you cannot read English that well, or
Because you don’t know what to look for even if you read the label?
You can choose more than one answer.
[PROG: CBQ698x. RANDOMIZE LIST]
The print is too small
I cannot read English that well
I don’t know what to look for even if I read the label
DK/NS
RF
[ALL SKIP TO xx]
CBQ698y. You said you don’t feel you need to use the Nutrition Facts label. Is it:
Because you usually buy foods that you are used to,
because you buy what you or your family likes,
because you are satisfied with your diet or health, or
because you get product information from other sources
because you don’t think food labels are important to you
You can choose more than one answer.
[PROG: CBQ698y. RANDOMIZE LIST]
I usually buy foods that I'm used to
I buy what I or my family like
I am satisfied with my diet or health
I get product information from sources other than the Nutrition Facts label
I don’t think food labels are important
DK/NS
RF
J1. Are you on a reduced-calorie or weight-loss diet?
Yes
No
DK/NS
RF
[PROG: IF J1=NO OR DK/NS OR RF, SKIP TO J3, OTHERWISE CONTINUE TO J2]
J2. Did a doctor or other health professional recommend that you be on a reduced-calorie or weight-loss diet?
Yes
No
DK/NS
RF
J3. There are some food products specially made to have less fat; they’re often labeled “low fat” or “fat free” or something like that. Have you ever seen any of these products or seen them in advertising?
Yes
No
DK/NS
RF
[PROG: IF J3=NO OR DK/NS OR RF, SKIP TO xx, OTHERWISE CONTINUE TO J3a]
J3a. Do you buy “low fat” or “fat free” foods regularly, only sometimes, hardly ever, or do you never buy these products?
Regularly
Only Sometimes
Hardly ever
Never
DK/NS
RF
J4. To the best of your knowledge, does the government set standards about which products are qualified to use statements like “low fat” or “fat free”?
Yes
No
DK/NS
RF
A10r. As far as you know, do all adults face the same chance of getting high blood pressure?
Yes
No
DK/NS
RF
A10s. Do adults and children face the same chance of getting high blood pressure?
Yes
No
DK/NS
RF
A10t. Now, let’s talk about how much salt or sodium we eat in our diet. In your opinion, do American adults …..
?
[PROG: A10t. RANDOMIZE LIST, IN LEADING SENTENCE ALSO PLEASE]
[PROG: RANDOMIZE LIST]
eat more salt than they should,
eat as much salt they should, or
eat less salt than they should
A10v. Some people say that we as a nation should eat less salt or sodium. Whose actions do you think can be most effective in reducing the amount of salt or sodium we eat ….
We the consumer,
Food manufacturers and retailers,
the restaurant industry,
or the government?
[PROG: A10v. RANDOMIZE LIST; RECORD ONE ANSWER ONLY]
(INTERVIEWER –READ LIST, DON’T READ “no one”/” everyone/all of them equally”/all of the above/DK/NS OR RF)
We the consumer
Food manufacturers and retailers
The restaurant industry
The government
No one
Everyone/all of them equally/all of the above
DK/NS
RF
SLT1. Now, think about the sources of salt or sodium in your own diet. How much of the salt or sodium you eat comes from each of the following six sources, none, a little, some, or a lot?
[PROG: SLT1 READ AND RANDOMIZE LIST]
The salt I add at the table
The salt added when meals are prepared or cooked at my home
The salt added to packaged or processed foods such as bread, canned soups, chips, sausages
The salt in foods prepared by fast-food or other types of restaurants
The salt that naturally exists in foods
None
A little
Some
A lot
DK/NS
RF
SLT2. How concerned are you about the amount of salt or sodium you eat?
(INTERVIEWER: READ LIST)
Very concerned
Somewhat concerned
Somewhat unconcerned
Not concerned at all
DK/NS
RF
SLT3. If you wanted to eat less salt or sodium, how easy or difficult would it be for you to actually do it?
(INTERVIEWER: READ LIST)
Very easy
Somewhat easy
Somewhat difficult
Very difficult
DK/NS
RF
SLT4. Are you currently watching or reducing your salt or sodium intake?
Yes
No
DK/NS
RF
[PROG: SLT4.if SLT4=NO, DK/NS, OR RF SKIP TO STL6]
SLT5. Has a doctor or other health professional ever advised you to watch or reduce your salt or sodium intake?
Yes
No
DK/NS
RF
SLT6. There are some food products specially made to have less salt or sodium; they’re often labeled “low salt,” “reduced salt,” “low sodium,” “reduced sodium” or something like that. Have you ever seen any of these products in the store or in advertising?
Yes
No
DK/NS
RF
[PROG: SLT6.if SLT6=NO, DK/NS, OR RF SKIP TO STL8]
SLT7. Do you buy “low sodium,” “reduced sodium,” “low salt,” or “reduced salt” foods regularly, only sometimes, hardly ever, or do you never buy these products?
Regularly
Sometimes
Hardly ever
Never
DK/NS
RF
SLT8. I am going to read six statements about reduced or low sodium or salt products. Please tell me how strongly you agree or disagree with each statement.
[PROG: SLT8. RANDOMIZE LIST]
Reduced or low sodium products generally don’t taste as good as regular products
Reduced or low sodium products usually cost more than regular products
Reduced or low sodium products are not always available in the store
Reduced or low sodium products are good for me
I know which products are low in sodium or have reduced amount of sodium
I should eat reduced or low sodium products
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
DK/NS
RF
E1. I'd like you to think about the labels on many food products that list ingredients and provide nutrition and other information. When you buy a product for the first time, how often do you read this information? Would you say often, sometimes, rarely, or never?
Often
Sometimes
Rarely or
Never
DK/NS
RF
[IF E1=NEVER, SKIP TO E5, IF E1= DK/NS OR RF SKIP TO E10]
E2. People tell us they use food product labels in many different ways. When you look at food labels, either in the store or at home, how often, if at all, do you use the labels in the following ways? Would you say you often, sometimes, rarely or never use the label
[PROG: E2. RANDOMIZE LIST]
[PROG: E2. ALL IN E2 SKIP TO E6]
To help you decide which brand of a particular food item to buy
To figure out how much of the food product you or your family should eat
To compare different food items with each other
To see if something said in advertising or on the package is actually true
To get a general idea of the nutritional content of the food
To see how high or low the food is in things like calories, salt, vitamins, or fat
To help you in meal planning
To see if there is an ingredient that you or someone in your family should avoid
Often
Sometimes
Rarely
Never
DK/NS
RF
E5. People have different reasons for not using the nutrition information on the food label. Please say whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with each of the following reasons for not using the food label:
[PROG: E5. RANDOMIZE LIST]
[PROG: E5. ALL IN E5 SKIP TO E10]
I’m just not that interested
The information is hard to understand
It takes too much time
I prefer getting nutrition information from other sources
I don’t need to use the food label since I already know what foods to eat
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
DK/NS
RF
E6. Now, I would like for you to think about information about serving sizes which is also found on the food label. Would you say you often, sometimes, rarely or never use serving size information?
Often
Sometimes
Rarely
Never
DK/NS
RF
[IF E6=NEVER, OR IF E6= DK/NS OR RF SKIP TO E10]
E7. What does serving size mean to you? You can choose more than one answer.
[PROG: E7. RANDOMIZE LIST]
The amount of a food that people should eat
The amount of a food that people usually eat
Something that makes it easier to compare foods
[DON”T READ] Other [Specify]
DK/NS
RF
[PROG: E7. ALL RESPONDENTS SKIP TO E10]
E10. Food packages sometimes have statements on the front of the package that describe the product as “low sodium” or “rich in antioxidants.” When it is available, how often do you use this information when deciding to buy a product? Would you say often, sometimes, rarely, or never?
(Note: The types of claim asked at each iteration may vary depending on needs.)
(INTERVIEWER, DON’T READ “I’ve never seen these products”/DK/NS OR RF)
Often
Sometimes
Rarely
Never
I’ve never seen these products
DK/NS
RF
[PROG: E10. IF E10= “I’ve never seen these products”/DK/NS OR RF SKIP TO E20]
NF1. Have you tried to limit any of the following things in your diet in the past 30 days? Have you tried to limit the amount of ….. in your diet, yes or no? …. What about ….?
[PROG: NF1. RANDOMIZE LIST]
Saturated fat
Trans fat or trans fatty acid
Calories
Cholesterol
Carbohydrates
Sodium
Sugar
(INTERVIEWER - READ LIST; REPEAT “YES OR NO” WHEN NECESSARY)
Yes
No
DK/NS
RF
NF2. Have you tried to eat enough of any of the following things in your diet in the past 30 days? Have you tried to eat enough of … in your diet, yes or no? …. What about ….? .
[PROG: NF2. RANDOMIZE LIST]
Calcium
Iron
Vitamin A
Vitamin C
Potassium
Fiber
Vitamin D
(INTERVIEWER - READ LIST; REPEAT “YES OR NO” WHEN NECESSARY)
Yes
No
DK/NS
RF
V3. How many adults, age 18 and older, including yourself live in your household?
NUMBER: ____________ (RANGE: 1-15)
DK/NS
RF
V5. What is the last grade or year of school that you have completed?
(INTERVIEWER – – READ LIST IF NECESSAIRY)
0-11years
12 years or high school graduate
1-3 years of college
4 years of college or college graduate
Postgraduate/Masters/doctorate/law degree/MD
DK/NS
RF
V6. Are you of Hispanic or Latino origin?
Yes
No
DK/NS
RF
V7. What is your race? Please select one or more categories.
[PROG: V7. READ LIST]
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaskan Native
Yes
No
DK/NS
RF
V8. What year were you born?
19 ________ (RANGE: 19xx-19yy)
DK/NS
RF
[RESPONDENT AGE = 201x – V8.]
“The next few questions may seem a bit personal. But we need this information because this survey is about nutrition and health.”
V9. How tall are you without shoes?
(INTERVIEWER WHEN THE RESPONDENT REPORTS FRACTIONS, ROUND UP TO THE NEXT WHOLE NUMBER. FOR EXAMPLE, 3.5 INCHES SHOULD BE CODED AS 4 INCHES. DON’T PROBE.)
( ) feet and ( ) inches
OR
( ) meter(s) and/or ( ) centimeters
DK/NS [ENTER 88 FEET 0 INCH]
RF [ENTER 99 FEET 0 INCH]
V10. How much do you weigh without shoes?
(INTERVIEWER WHEN THE RESPONDENT REPORTS FRACTIONS ROUND UP TO THE NEXT WHOLE NUMBER. FOR EXAMPLE, 122.5 POUNDS SHOULD BE CODED AS 123 POUNDS. DON’T PROBE.)
( ) pounds
OR
( ) kilograms
DK/NS [ENTER 8888 POUNDS]
RF [ENTER 9999 POURNDS]
V11. How do you describe your health? In general, would you say your health is…?
(INTERVIEWER - READ LIST)
Excellent
Very good
Good
Fair, or
Poor
DK/NS
RF
V12a. Have you ever been told by a doctor or other healthcare professional that you have any of the following health conditions? I don’t need to know which condition, just whether you have any of them.
(INTERVIEWER - READ: “high blood pressure, diabetes, high cholesterol, heart disease, obesity, overweight, or cancer.”)
Yes
No
RF
V13. I am going to read you a list of categories of income. Please stop me when I read the category that includes your total household income before taxes for year 201x.
Less than $25,000
From $25,000 to less than $50,000
$50,000 to less than $75,000
$75,000 to less than $100,000
$100,000 or more
DK/NS
RF
| File Type | application/msword |
| Author | clin |
| Last Modified By | Lin, Chung-Tung |
| File Modified | 2014-11-24 |
| File Created | 2014-11-24 |