OMB No: 0910-0345 Expiration Date: xx/xx/2028
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To start off, here are some questions about your diet.
1. Thinking about your eating habits, in general, how healthy is your overall diet?
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
2. How strongly do you disagree or agree with each of the following statements?
2a. Look at the list of foods below. For each food mark if it is generally high in Salt/sodium, Saturated fat, or Added Sugars. You may mark one or more nutrient per food.
|
Generally high in Salt/sodium |
Generally high in Saturated fat |
Generally high in Added sugar |
Generally, not high in any of these nutrients |
a. Deli meat |
Q2_a_1 |
Q2_a_2 |
Q2_a_3 |
Q2_a_4 |
b. Fish |
Q2_b_1 |
Q2_b_2 |
Q2_b_3 |
Q2_b_4 |
c. Beef |
Q2_c_1 |
Q2_c_2 |
Q2_c_3 |
Q2_c_4 |
e. Cheese |
Q2_e_1 |
Q2_e_2 |
Q2_e_3 |
Q2_e_4 |
f. Ice cream |
Q2_f_1 |
Q2_f_2 |
Q2_f_3 |
Q2_f_4 |
h. Fresh vegetables |
Q2_h_1 |
Q2_h_2 |
Q2_h_3 |
Q2_h_4 |
i. Fruit drink/fruit punch |
Q2_i_1 |
Q2_i_2 |
Q2_i_3 |
Q2_i_4 |
l. Canned soup |
Q2_l_1 |
Q2_l_2 |
Q2_l_3 |
Q2_l_4 |
m. Potato chips |
Q2_m_1 |
Q2_m_2 |
Q2_m_3 |
Q2_m_4 |
3. During the past 7 days, how many times did you eat "sweets" such as soda, cake, cookies, pastries, donuts, muffins, chocolate, candies or ice cream? Do not count diet soda or items made with sugar alternatives or sugar substitutes.
1 3 or more times per day
2 1 – 2 times per day
3 4 – 6 times in the past 7 days
4 1 – 3 times in the past 7 days
5 I did not eat sweets in the past 7 days
6 Don't know
3a. Just thinking about yourself, are you currently trying to reduce your added sugars intake?
1 Yes
2 No
3b. During the past 7 days, how many times did you consume foods or drinks sweetened with sugar alternatives or sugar substitutes? These include foods or drinks with things like, saccharin (Sweet 'N Low), aspartame (Equal), and sucralose (Splenda).
1 3 or more times per day
2 1 – 2 times per day
3 4 – 6 times in the past 7 days
4 1 – 3 times in the past 7 days
5 I did not consume foods or drinks sweetened with sugar alternatives in the past 7 days
6 Don't know
4. Just thinking about yourself, are you currently trying to reduce your salt or sodium intake?
1 Yes
2 No [Go to 7]
SKIP-START SB_115
{slt4} != 2
5. Why did you decide to reduce your salt or sodium intake? Select all that apply.
A doctor or other health professional advised me to
To control a health condition
Talked with family members or friends
Heard or saw something in the news about salt or sodium
Looked up information on my own
Other, please specify
6. How are you reducing your salt or sodium intake? Select all that apply.
Checking the Nutrition Facts label
Checking restaurant nutrition information for sodium
Not adding salt to food at the table.
Using less salt while cooking or eating
Buying or choosing products lower in sodium
Avoiding or limiting foods high in sodium
Eating more fresh foods
Eating more at home
Replacing salt with other herbs or seasonings
Using substitute shakable salt
Reducing use of condiments such as soy sauce, ketchup, relish, salad dressing
Other, please specify
SKIP-END SB_115
7. How confident are you that you know how much salt or sodium you should eat each day?
1 Not at all confident
2 Not very confident
3 Somewhat confident
4 Very confident
5 Extremely confident
8. How confident are you that you know how many calories you should eat each day?
1 Not at all confident
2 Not very confident
3 Somewhat confident
4 Very confident
5 Extremely confident
9. How confident are you that you know how many calories are in the foods you eat?
1 Not at all confident
2 Not very confident
3 Somewhat confident
4 Very confident
5 Extremely confident
The next questions are about how you shop for food and look at packages and labels.
10. How much of your household's food shopping do you do?
1 All of the food shopping
2 Most of it
3 About half of it
4 Only a little of it
5 None of it
6 Don't know
11. About how often do you shop for your household groceries in the following ways?
[Programmer Note: If 11c (online delivery question) is NEVER or Don’t know, GO TO 13, ELSE GO TO 12]
SKIP-START SB_187
{Q11c} != 5 and {Q11c} != 6
12. When having groceries delivered to you, did you ever notice any of the following: Select all that apply.
Raw meat or seafood products that were leaking
Food was not cold when it should have been
Food packaging was tampered with or damaged
Food was left sitting outside your home longer than expected
Food was spoiled or moldy
Food was past the sell by or use by date
Produce was wilted
Other problems. Please specify:
None of the above
SKIP-END SB_187
Please
refer to the image of frozen m
ixed
vegetables ...
13. When shopping for groceries in-person, how often do you look for the following information on food packages?
|
Never |
Rarely |
Sometimes |
Most of the time |
Always |
|
a. |
1 |
2 |
3 |
4 |
5 |
|
b. |
1 |
2 |
3 |
4 |
5 |
|
c. |
1 |
2 |
3 |
4 |
5 |
|
d. |
1 |
2 |
3 |
4 |
5 |
|
e. |
1 |
2 |
3 |
4 |
5 |
|
f. |
1 |
2 |
3 |
4 |
[If 13= never for any item then then skip 13b for that item]
13b. How hard or easy is it to find the information you are looking for?
|
VERY HARD TO FIND |
SOMEWHAT HARD TO FIND |
NEITHER HARD NOR EASY TO FIND |
SOMEWHAT EASY TO FINE |
VERY EASY TO FIND |
|
a. |
Q13aIngredient information |
1 |
2 |
3 |
4 |
5 |
b. |
Q13bAllergen information |
1 |
2 |
3 |
4 |
5 |
c. |
Q13cNutrition Facts label |
1 |
2 |
3 |
4 |
5 |
d. |
Q13dLabel statements on front of packages |
1 |
2 |
3 |
4 |
5 |
e. |
Q13eStorage information |
1 |
2 |
3 |
4 |
5 |
f. |
Q13fCooking or preparation instructions |
1 |
2 |
3 |
4 |
5 |
[If 11b and 11c =never then skip 14 and 15]
SKIP-START SB_221
not({Q11b} = 5 and {Q11c} = 5)
14. When shopping for groceries online, how often do you look for the following information on food packages?
|
Never |
Rarely |
Sometimes |
Most of the time |
Always |
|
a. |
1 |
2 |
3 |
4 |
5 |
|
b. |
1 |
2 |
3 |
4 |
5 |
|
c. |
1 |
2 |
3 |
4 |
5 |
|
d. |
1 |
2 |
3 |
4 |
5 |
|
e. |
1 |
2 |
3 |
4 |
5 |
|
f. |
1 |
2 |
3 |
4 |
5 |
[If 14 =never for any item then skip 14b]
14b. How hard or easy is it to find the information you are looking for?
|
VERY HARD TO FIND |
SOMEWHAT HARD TO FIND |
NEITHER HARD NOR EASY TO FIND |
SOMEWHAT EASY TO FINE |
VERY EASY TO FIND |
|
a. |
Q13aIngredient information |
1 |
2 |
3 |
4 |
5 |
b. |
Q13bAllergen information |
1 |
2 |
3 |
4 |
5 |
c. |
Q13cNutrition Facts label |
1 |
2 |
3 |
4 |
5 |
d. |
Q13dLabel statements on front of packages |
1 |
2 |
3 |
4 |
5 |
e. |
Q13eStorage information |
1 |
2 |
3 |
4 |
5 |
f. |
Q13fCooking or preparation instructions |
1 |
2 |
3 |
4 |
5 |
SKIP-END SB_221
16. Which of the following statements, if you saw it on the front of a food package, would make you more likely to purchase that product compared to a similar product without that statement? Select all that apply.
Sugar free
No added sugar
Low calorie
Low fat
Low saturated fat
Low salt or low sodium
No artificial ingredients
No artificial colors
Non-GMO
Raised without antibiotics
Gluten-free
Whole grain
High fiber
Natural
Organic
Healthy
Sustainably produced (using farming or production methods that protect the environment and support long-term agricultural viability)
Minimally processed
None of these
[Programmer Note: For 17 online version, only show items selected in 16.]
SKIP-START SB_274
{Claim16_noneb} != 1 and {TotalNoCB} > 2
17. Which two of the statements that you selected in the previous question are most important to you? Select the two most important.
SKIP-START SB_281
{Claim16_lowsugarb} = 1
Sugar free
SKIP-END SB_281 SKIP-START SB_284
{Claim16_noaddedsugarb} = 1
No added sugar
SKIP-END SB_284 SKIP-START SB_287
{Claim16_lowcalb} = 1
Low calorie
SKIP-END SB_287 SKIP-START SB_290
{Claim16_lowfatb} = 1
Low fat
SKIP-END SB_290 SKIP-START SB_293
{Claim16_lowsatfatb} = 1
Low saturated fat
SKIP-END SB_293 SKIP-START SB_296
{Claim16_lowsodiumb} = 1
Low salt or low sodium
SKIP-END SB_296 SKIP-START SB_299
{Claim16_noartingb} = 1
No artificial ingredients
SKIP-END SB_299 SKIP-START SB_302
{Claim16_noartcolorb} = 1
No artificial colors
SKIP-END SB_302 SKIP-START SB_305
{Claim16_nongmob} = 1
Non-GMO
SKIP-END SB_305 SKIP-START SB_308
{Claim16_noantib} = 1
Raised without antibiotics
SKIP-END SB_308 SKIP-START SB_311
{Claim16_glutenfreeb} = 1
Gluten-free
SKIP-END SB_311 SKIP-START SB_314
{Claim16_wholegrainb} = 1
Whole grain
SKIP-END SB_314 SKIP-START SB_317
{Claim16_highfiberb} = 1
High fiber
SKIP-END SB_317 SKIP-START SB_320
{Claim16_naturalb} = 1
Natural
SKIP-END SB_320 SKIP-START SB_323
{Claim16_organicb} = 1
Organic
SKIP-END SB_323 SKIP-START SB_326
{Claim16_healthyb} = 1
Healthy
SKIP-END SB_326 SKIP-START SB_329
{Claim16_sustainb} = 1
Sustainably raised
SKIP-END SB_329 SKIP-START SB_332
{Claim16_miniprocess} = 1
Minimally processed
SKIP-END SB_332
SKIP-END SB_274
18.
Do you ever
look at the Nutrition Facts label on food packages?
lookNF
1 Yes
2 No [Go to 21]
3 Don't know [Go to 21]
SKIP-START SB_349
{lookNF} != 2 and {lookNF} != 3
19. When buying a food product for the first time, how often do you use the Nutrition Facts label?
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Never seen the label [Go to 21]
SKIP-START SB_358
{dbq750} != 6
20. When you look at Nutrition Facts labels, either in the store, online, or at home, how often do you use the labels in the following ways? Select one for each row.
SKIP-END SB_358
SKIP-END SB_349
21.
What does serving size mean to you? Select all that apply.
e71
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
Something else. Please specify:
Don't know
22. How much do you disagree or agree with the following statements? Select one for each row.
23. Which of the following nutrients do you usually look for when looking at a Nutrition Facts label? Select all that apply.
Calories
Total fat
Saturated fat
Trans fat
Cholesterol
Sodium
Total carbohydrate
Dietary fiber
Total sugars
Added sugars
Protein
Vitamin D
Potassium
Calcium
Iron
None of the above
24. When you look at the Nutrition Facts label, which of the following do you look at? Select all that apply.
Serving size
Number of servings
The amount of nutrients (such as grams or milligrams)
The percent Daily Value amounts (%DV)
None of the above
25.
The Nutrition Facts label (below) shows that the product contains 10%
Daily Value for Saturated Fat in a serving of the product. What does
the 10% Daily Value mean to you?
1
10% of the calories in one serving of the product come from
Saturated Fat
2
One serving of the product contains 10% Saturated Fat
by weight
3
One serving of the product contains 10% of the Saturated Fat
that
an average person should eat in an entire day
4 Don't know
26.
The Nutrition Facts label (below) shows that one serving of the food
contains 20% of the Daily Value (DV) of Sodium. Based on the
information, would you consider a serving of this product to have a
low, medium, or high amount of Sodium?
1 Low
2 Medium
3 High
4 Don't know
The next questions are about restaurant food.
27. How often do you get food and drink for yourself or others from each of the following places? Include breakfast, lunch, dinner, and snacks. Include eat-in, take-out, and delivery. Select one for each row.
28. In general, when you order at chain restaurants, how often do you see calorie information listed on menus or menu boards? Select one for each row.
|
Always |
Most of the Time |
Sometimes |
Rarely |
Never |
Do Not Order Food This Way |
|
a. |
1 |
2 |
3 |
4 |
5 |
6 |
|
b. |
1 |
2 |
3 |
4 |
5 |
6 |
|
c. |
1 |
2 |
3 |
4 |
5 |
6 |
|
d. |
1 |
2 |
3 |
4 |
5 |
6 |
29. Do you ever use the calorie information on menus or menu boards to decide what to order?
1 Yes
2 No [Go to 31]
SKIP-START SB_506
{restcal_use} != 2
30. How do you use the calorie information when deciding what to order? Select all that apply.
To help select lower calorie items
To help select higher calorie items
Decide on a smaller portion size
Decide on a larger portion size
Order fewer items
Order more items
Share the meal with someone else
Save part of the meal for later
Something else. Please specify
SKIP-END SB_506
31. When having restaurant food delivered to you, did you ever notice any of the following: Select all that apply.
Food was not hot when it should have been
Food was not cold when it should have been
The food packaging was NOT secure and sturdy
Was left sitting outside your home longer than expected
Food was spoiled or moldy
Produce was wilted
Other problems. Please specify:
Q31_specify[__________]Q31_none
I have never had restaurant food delivered
32. How often do you look at date labeling (e.g., “BEST if used by” or “USE by”) on the food and drink products that you buy?
1 Always
2 Most of the time
3 About half of the time
4 Occasionally
5 Never
6 It varies too much to say
7 None of the food or drinks I buy have date labels
8 Don't know
33. What do you think the phrase, "BEST if used by" means on food packages?
1 A. The date you need to use the food for safety for perishable foods
2 B. The date manufacturers suggest using the food for best taste or nutritional quality
3 Both A. and B.
4 Something else. Please specify
Please specifyQ33_other[__________]
5 Don't know
34. What do you think the phrase, "USE by" means on food packages?
1 A. The date you need to use the food for safety for perishable foods
2 B. The date manufacturers suggest using the food for best taste or nutritional quality
3 Both A. and B.
4 Something else. Please specify
Please specifyQ34_other[__________]
5 Don't know
35. Who do you think determines date labeling for packaged foods?
1 The food manufacturer
2 The State or Federal government
3 Something else. Please specify
Please specifyQ35_other[__________]
4 Don't know
The next questions are for statistical purposes.
36. When eating food cooked at home, how often are you the one who cooks or prepares the food?
1 All or nearly all of the time
2 Only some of the time
3 Never
37. Have you ever worked in any of the following industries? Select one for each row.
|
Yes |
No |
|
a. |
1 |
2 |
|
b. |
1 |
2 |
|
c. |
1 |
2 |
|
d. |
1 |
2 |
|
e. |
1 |
2 |
38. Would you say your health in general is…
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
6 Don't know
39. Thinking about yourself, about how many calories do you need to consume in a day to maintain your current weight?
1 Less than 500 calories
2 500-1000 calories
3 1001-1500 calories
4 1501-2000 calories
5 2001-2500 calories
6 2501-3000 calories
7 More than 3000 calories
8 Don't know
40. Are you currently following any of these diets? Select all that apply.
Low sodium diet
Low fat diet
Low carb diet
Low calorie diet
Low sugar diet
None of the above
41. Are you currently on a GLP-1 drug such as Ozempic, Zepbound, Wegovy, or Mounjaro?
1 Yes
2 No
3 Don't know
42. Has a medical doctor or health care professional ever diagnosed you as having any of the following: hypertension or high blood pressure, diabetes, heart disease, respiratory diseases, kidney disease, autoimmune disorder, cancer, or another condition that could compromise your immune system?
1 Yes
2 No
3 Don't know
43. Have you ever been told by a doctor or other healthcare professional that you are overweight or obese?
1 Yes
2 No
3 Don't know
44. How tall are you without shoes?
[__________]
ft
[__________]
inch
OR
[__________]
m
[__________]
cm
Don't know
45. How much do you weigh without clothes or shoes?
[__________]
lbs
OR
Enter weight in kilogramsV10_KG
[__________]
kg
Don't know
46. About how many days per week do you engage in moderate or vigorous physical activity (such as brisk walking, jogging, biking, aerobics, or yard work)?
1 0 days per week
2 1 day per week
3 2 days per week
4 3 days per week
5 4 days per week
6 5 days per week
7 6 days per week
8 7 days per week
47. Do you have any current food allergies, or do you suspect you have a food allergy?
1 Yes
2 No [Go to 49]
SKIP-START SB_688
{M1} != 2
48. Has a medical doctor diagnosed your condition as a food allergy?
1 Yes
2 No
SKIP-END SB_688
49.
How many total people, including yourself, currently live in your
household at least 50% of the time?
Please include
unrelated individuals (such as roommates), and also include those now
away traveling, away at school, or in a hospital.
[__________]
Total people
[Programmer NOTE: If the answer to 49 is 1, Go to 51]
SKIP-START SB_704
{P3} > 1
49a. Including yourself, how many of the people are:
|
Number of people |
Children 2 years and younger |
Q49a_numppl[__________] |
Children 3 to 5 years old |
Q49b_numppl[__________] |
Children 6 to 17 years old |
Q49c_numppl[__________] |
Adults 18 to 59 years old |
Q49d_numppl[__________] |
Adults 60 years or older |
Q49e_numppl[__________] |
[Programmer Note: If there are no children (17 and younger) living in the household, Go to 51]
SKIP-START SB_720
{Q49a_numppl} > 0 or {Q49b_numppl} > 0 or {Q49c_numppl} > 0
50. Are you the parent or primary caregiver to any of the children under the age of 18 in your household?
1 Yes
2 No
50a. In the past 12 months, have you or anyone living in your household received benefits from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program?
1 Yes
2 No
3 Don't know
SKIP-END SB_720
SKIP-END SB_704
51. In the past 12 months, have you or anyone living in your household received Supplemental Nutrition Assistance Program (SNAP) or food stamp benefits?
1 Yes
2 No
3 Don't know
52. Are you:
1 Female
2 Male
53. In what year were you born?
54. Do you...
1 Own your home,
2 Rent your home, or
3 Have some other arrangement?
55. What language or languages do you usually speak at home? Select all that apply.
English
Spanish
Other language(s)? Please specify
56.
What is your race and/or ethnicity?
Select
all that apply and enter additional details in the spaces below.
American Indian or Alaska Native
Other, please specify.
Asian – Provide details below.
Chinese
Asian Indian
Filipino
Vietnamese
Korean
Japanese
Other, please specify.
Black or African American – Provide details below.
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Other, please specify.
Hispanic or Latino – Provide details below.
Mexican
Puerto Rican
Salvadoran
Cuban
Dominican
Guatemalan
Other, please specify.
Middle Eastern or North African – Provide details below.
Lebanese
Iranian
Egyptian
Syrian
Iraqi
Israeli
Other, please specify.
Native Hawaiian or Pacific Islander – Provide details below.
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Other, please specify.
White – Provide details below.
English
German
Irish
Italian
Polish
Scottish
Other, please specify.
57. What is the last grade or year of school that you have completed?
1 Less than high school degree
2 High school graduate or GED
3 1 – 3 years college/some college
4 College graduate – Bachelors’ degree or equivalent
5 Postgraduate, master’s degree, doctorate, law degree, other professional degree
58. What was your total household income before taxes during the past 12 months?
Include ALL income sources for everyone living in your household:
• Employment income: Wages, salary, tips, bonuses, commissions • Business income: Self-employment earnings, partnerships, S-Corporation distributions • Retirement income: Traditional pensions, 401(k)/403(b)/457 withdrawals, IRA distributions • Government benefits: Social Security, unemployment benefits, disability payments • Investment income: Interest, dividends, capital gains, rental property income • Other income: Alimony, child support, gifts, or any other regular income
1 Less than $25,000
2 $25,000 to 34,999
3 $35,000 to $49,999
4 $50,000 to $74,999
5 $75,000 to $99,999
6 $100,000 to $149,999
7 $150,000 to $199,999
8 $200,000 or more
9 Don’t know
10 Prefer not to answer
59. We appreciate your taking the time to participate in our study. Is there anything you’d like to add?
Thank you for completing our survey.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | 2025 FSANS Nutrition Version |
Author | Andrew Heller |
File Modified | 0000-00-00 |
File Created | 2025-10-01 |