Diet History Questionnaire II - Dfzljdn9uc3pi.cloudfront
This is a sample form. Do not use for scanning.NATIONAL INSTITUTES OF HEALTHDiet History Questionnaire IIGENERAL INSTRUCTIONSAnswer each question as best you can. Estimate if you are not sure. A guess isbetter than leaving a blank.Use only a black ball-point pen. Do not use a pencil or felt-tip pen. Do not fold,staple, or tear the pages.Put an X in the box next to your answer.If you make any changes, cross out the incorrect answer and put an X in the boxnext to the correct answer. Also draw a circle around the correct answer.If you mark NEVER, NO, or DON’T KNOW for a question, please follow anyarrows or instructions that direct you to the next question.BEFORE TURNING THE PAGE, PLEASE COMPLETE THE FOLLOWING QUESTIONS.Today's date:MONTHJanFebMarAprMayJunJulAugSepOctNovDecIn what month wereyou born?DAYYEAR 23456789In what year wereyou born?19 456789Are you male orfemale?MaleFemaleBAR CODE LABEL OR SUBJECT IDHERE DHQ II PastMonth1
This is a sample form. Do not use for scanning.1. Over the past month, how often did you drinkcarrot juice?3b.NEVER (GO TO QUESTION 2)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always1 time per day2–3 times per day4–5 times per day6 or more times per day4.1a.Each time you drank carrot juice, howmuch did you usually drink?Over the past month, how often did you drinkother 100% fruit juice or 100% fruit juicemixtures (such as apple, grape, pineapple, orothers)?Less than ½ cup (4 ounces)½ to 1¼ cups (4 to 10 ounces)More than 1¼ cups (10 ounces)2.NEVER (GO TO QUESTION 5)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekOver the past month, how often did you drinktomato juice or other vegetable juice?(Please do not include carrot juice.)NEVER (GO TO QUESTION 3)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week2a.4a.1 time per day2–3 times per day4–5 times per day6 or more times per dayEach time you drank tomato juice or othervegetable juice, how much did you usuallydrink?4b.5.NEVER (GO TO QUESTION 4)3a.Each time you drank other 100% fruit juiceor 100% fruit juice mixtures, how much didyou usually drink?How often were the other 100% fruit juice or100% fruit juice mixtures you drankcalcium-fortified?Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or alwaysOver the past month, how often did you drinkorange juice or grapefruit juice?1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week1 time per day2–3 times per day4–5 times per day6 or more times per dayEach time you drank orange juice orgrapefruit juice, how much did you usuallydrink?How often did you drink other fruit drinks (suchas cranberry cocktail, Hi-C, lemonade, or KoolAid, diet or regular)?NEVER (GO TO QUESTION 6)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekLess than ¾ cup (6 ounces)¾ to 1¼ cups (6 to 10 ounces)More than 1¼ cups (10 ounces)Question 4 appears in the next column1 time per day2–3 times per day4–5 times per day6 or more times per dayLess than ¾ cup (6 ounces)¾ to 1½ cups (6 to 12 ounces)More than 1½ cups (12 ounces)Less than ¾ cup (6 ounces)¾ to 1¼ cups (6 to 10 ounces)More than 1¼ cups (10 ounces)3.How often was the orange juice or grapefruitjuice you drank calcium-fortified?2Question 6 appears on the next page1 time per day2–3 times per day4–5 times per day6 or more times per day
This is a sample form. Do not use for scanning.Over the past month 5a.7a.Each time you drank fruit drinks, how muchdid you usually drink?Less than 1 cup (8 ounces)1 to 1½ cups (8 to 12 ounces)More than 1½ cups (12 ounces)Less than 1 cup (8 ounces)1 to 2 cups (8 to 16 ounces)More than 2 cups (16 ounces)5b.7b.How often were your fruit drinks diet orsugar-free?8.How often did you drink milk as a beverage(NOT in coffee, NOT in cereal)? (Please do notinclude chocolate milk and hot chocolate.)How often did you drink meal replacement orhigh-protein beverages (such as InstantBreakfast, Ensure, Slimfast, Sustacal or others)?NEVER (GO TO QUESTION 9)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekNEVER (GO TO QUESTION 7)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week6a.1 time per day2–3 times per day4–5 times per day6 or more times per day8a.Each time you drank milk as a beverage,how much did you usually drink?9.What kind of milk did you usually drink?NEVER (GO TO QUESTION 10)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week9a.How often did you drink chocolate milk(including hot chocolate)?Question 8 appears in the next column1 time per day2–3 times per day4–5 times per day6 or more times per dayEach time you drank soda or pop, howmuch did you usually drink?Less than 12 ounces or less than 1 can or bottle12 to 16 ounces or 1 can or bottleMore than 16 ounces or more than 1 can or bottleNEVER (GO TO QUESTION 8)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekEach time you drank meal replacement orhigh-protein beverages, how much did youusually drink?How often did you drink soda or pop?Whole milk2% fat milk1 % fat milkSkim, nonfat, or ½% fat milkSoy milkRice milkOther7.1 time per day2–3 times per day4–5 times per day6 or more times per dayLess than 1 cup (8 ounces)1 to 1½ cups (8 to 12 ounces)More than 1½ cups (12 ounces)Less than 1 cup (8 ounces)1 to 1½ cups (8 to 12 ounces)More than 1½ cups (12 ounces)6b.How often was the chocolate milk reducedfat or fat-free?Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or alwaysAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always6.Each time you drank chocolate milk, howmuch did you usually drink?1 time per day2–3 times per day4–5 times per day6 or more times per day3Question 10 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 9b.12. How often did you drink beer?NEVER (GO TO QUESTION 13)How often were these sodas or pop diet orsugar-free?1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always9c.1 time per day2–3 times per day4–5 times per day6 or more times per day12a. Each time you drank beer, how much didyou usually drink?How often were these sodas or popcaffeine-free?Less than a 12-ounce can or bottle1 to 3 12-ounce cans or bottlesMore than 3 12-ounce cans or bottlesAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always10. How often did you drink sports drinks (such asPropel, PowerAde, or Gatorade)?13. How often did you drink water (including tap,bottled, and carbonated water)?NEVER (GO TO QUESTION 11)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week1 time per day2–3 times per day4–5 times per day6 or more times per day10a. Each time you drank sports drinks, howmuch did you usually drink?1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekLess than 12 ounces or less than 1 bottle12 to 24 ounces or 1 to 2 bottlesMore than 24 ounces or more than 2 bottles11. How often did you drink energy drinks (such asRed Bull or Jolt)?13b. How often was the water you drank tapwater?NEVER (GO TO QUESTION 12)1 time per day2–3 times per day4–5 times per day6 or more times per dayAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always11a. Each time you drank energy drinks, howmuch did you usually drink?Less than 8 ounces or less than 1 cup8 to 16 ounces or 1 to 2 cupsMore than 16 ounces or more than 2 cupsQuestion 12 appears in the next column1 time per day2–3 times per day4–5 times per day6 or more times per day13a. Each time you drank water, how much didyou usually drink?Less than 12 ounces or less than 1 bottle12 to 24 ounces or 1 to 2 bottlesMore than 24 ounces or more than 2 bottles1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per weekNEVER (GO TO QUESTION 14)4Question 14 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 16. How often did you eat oatmeal, grits, or othercooked cereal?13c. How often was the water you drank bottled,sweetened water (with low or no-caloriesweetener, including carbonated water)?NEVER (GO TO QUESTION 17)1 time in past month2–3 times in past month1 time per week2 times per weekAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always16a. Each time you ate oatmeal, grits, or othercooked cereal, how much did you usuallyeat?13d. How often was the water you drank bottled,unsweetened water (including carbonatedwater)?Less than ¾ cup¾ to 1¼ cupsMore than 1¼ cupsAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always16b. How often was butter or margarine addedto your oatmeal, grits or other cookedcereal?14. How often did you drink wine or wine coolers?NEVER (GO TO QUESTION 15)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day1 time per day2–3 times per day4–5 times per day6 or more times per dayAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always17. How often did you eat cold cereal?NEVER (GO TO QUESTION 18)1 time in past month2–3 times in past month1 time per week2 times per week14a. Each time you drank wine or wine coolers,how much did you usually drink?Less than 5 ounces or less than 1 glass5 to 12 ounces or 1 to 2 glassesMore than 12 ounces or more than 2 glasses3–4 times per week5–6 times per week1 time per day2 or more times per day17a. Each time you ate cold cereal, how muchdid you usually eat?15. How often did you drink liquor or mixeddrinks?Less than 1 cup1 to 2½ cupsMore than 2½ cupsNEVER (GO TO QUESTION 16)1 time in past month2–3 times in past month1–2 times per week3–4 times per week5–6 times per week1 time per day2–3 times per day4–5 times per day6 or more times per day15a. Each time you drank liquor or mixeddrinks, how much did you usually drink?17b. How often was the cold cereal you ate TotalRaisin Bran, Total Cereal, or Product 19?Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or alwaysLess than 1 shot of liquor1 to 3 shots of liquorMore than 3 shots of liquorQuestion 16 appears in the next column5Question 18 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 18. How often did you eat applesauce?NEVER (GO TO QUESTION 19)17c. How often was the cold cereal you ate AllBran, Fiber One, 100% Bran, or All-BranBran Buds?1 time in past month2–3 times in past month1 time per week2 times per weekAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always18a. Each time you ate applesauce, how muchdid you usually eat?Less than ½ cup½ to 1 cupMore than 1 cup17d. How often was the cold cereal you ate someother bran or fiber cereal (such as Cheerios,Shredded Wheat, Raisin Bran, Bran Flakes,Grape-Nuts, Granola, Wheaties, or HealthyChoice)?19. How often did you eat apples?NEVER (GO TO QUESTION 20)Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always1 time in past month2–3 times in past month1 time per week2 times per week17e. How often was the cold cereal you ate anyother type of cold cereal (such as CornFlakes, Rice Krispies, Frosted Flakes, SpecialK, Froot Loops, Cap'n Crunch, or others)?3–4 times per week5–6 times per week1 time per day2 or more times per day19a. Each time you ate apples, how many didyou usually eat?Less than 1 apple1 appleMore than 1 appleAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always17f.3–4 times per week5–6 times per week1 time per day2 or more times per day20. How often did you eat pears (fresh, canned, orfrozen)?Was milk added to your cold cereal?NEVER (GO TO QUESTION 21)NO (GO TO QUESTION 18)1 time in past month2–3 times in past month1 time per week2 times per weekYES17g. What kind of milk was usually added?3–4 times per week5–6 times per week1 time per day2 or more times per day20a. Each time you ate pears, how many did youusually eat?Whole milk2% fat milk1% fat milkSkim, nonfat, or ½% fat milkSoy milkRice milkOtherLess than 1 pear1 pearMore than 1 pear21. How often did you eat bananas?17h. Each time milk was added to your coldcereal, how much was usually added?NEVER (GO TO QUESTION 22)1 time in past month2–3 times in past month1 time per week2 times per weekLess than ½ cup½ to 1 cupMore than 1 cupQuestion 18 appears in the next column6Question 22 appears on the next page3–4 times per week5–6 times per week1 time per day2 or more times per day
This is a sample form. Do not use for scanning.Over the past month 24. How often did you eat grapes?NEVER (GO TO QUESTION 25)21a. Each time you ate bananas, how many didyou usually eat?1 time in past month2–3 times in past month1 time per week2 times per weekLess than 1 banana1 bananaMore than 1 banana3–4 times per week5–6 times per week1 time per day2 or more times per day24a. Each time you ate grapes, how much didyou usually eat?Less than ½ cup or less than 10 grapes½ to 1 cup or 10 to 30 grapesMore than 1 cup or more than 30 grapes25. How often did you eat cantaloupe?22. How often did you eat dried fruit (such asprunes or raisins)? (Please do not include driedapricots.)NEVER (GO TO QUESTION 26)1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 23)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day25a. Each time you ate cantaloupe, how muchdid you usually eat?Less than ¼ melon or less than ½ cup¼ melon or ½ to 1 cupMore than ¼ melon or more than 1 cup22a. Each time you ate dried fruit, how much didyou usually eat?Less than 2 tablespoons2 to 5 tablespoonsMore than 5 tablespoons26. How often did you eat melon, other thancantaloupe (such as watermelon orhoneydew)?23. How often did you eat peaches, nectarines, orplums?NEVER (GO TO QUESTION 27)1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 24)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day26a. Each time you ate melon other thancantaloupe, how much did you usually eat?23a. Each time you ate peaches, nectarines, orplums, how much did you usually eat?Less than ½ cup or 1 small wedge½ to 2 cups or 1 medium wedgeMore than 2 cups or 1 large wedgeLess than 1 fruit or less than ½ cup1 to 2 fruits or ½ to ¾ cupMore than 2 fruits or more than ¾ cupQuestion 24 appears in the next column3–4 times per week5–6 times per week1 time per day2 or more times per day7Question 27 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 30. How often did you eat pineapple?NEVER (GO TO QUESTION 31)27. How often did you eat strawberries?1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 28)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day30a. Each time you ate pineapple, how much didyou usually eat?27a. Each time you ate strawberries, how muchdid you usually eat?Less than ¼ cup or less than 1 medium slice¼ to ¾ cup or 1 medium sliceMore than ¾ cup or more than 1 medium sliceLess than ¼ cup or less than 3 berries¼ to ¾ cup or 3 to 8 berriesMore than ¾ cup or more than 8 berries31. How often did you eat other kinds of fruit?NEVER (GO TO QUESTION 32)28. How often did you eat oranges, tangerines, orclementines?1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 29)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day31a. Each time you ate other kinds of fruit, howmuch did you usually eat?Less than ¼ cup¼ to ¾ cupMore than ¾ cup28a. Each time you ate oranges, tangerines, orclementines, how many did you usuallyeat?Less than 1 fruit1 fruitMore than 1 fruit32. How often did you eat COOKED greens (suchas spinach, turnip, collard, mustard, chard, orkale)?NEVER (GO TO QUESTION 33)29. How often did you eat grapefruit?1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 30)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day32a. Each time you ate COOKED greens, howmuch did you usually eat?29a. Each time you ate grapefruit, how much didyou usually eat?Less than ½ cup½ to 1 cupMore than 1 cupLess than ½ grapefruit½ grapefruitMore than ½ grapefruit33. How often did you eat RAW greens (such asspinach, turnip, collard, mustard, chard, orkale)? (We will ask about lettuce later.)NEVER (GO TO QUESTION 34)1 time in past month2–3 times in past month1 time per week2 times per weekQuestion 30 appears in the next column8Question 34 appears on the next page3–4 times per week5–6 times per week1 time per day2 or more times per day
This is a sample form. Do not use for scanning.Over the past month 37. How often did you eat string beans or greenbeans (fresh, canned, or frozen)?33a. Each time you ate RAW greens, how muchdid you usually eat?NEVER (GO TO QUESTION 38)1 time in past month2–3 times in past month1 time per week2 times per weekLess than ½ cup½ to 1 cupMore than 1 cup34. How often did you eat coleslaw?37a. Each time you ate string beans or greenbeans, how much did you usually eat?NEVER (GO TO QUESTION 35)1 time in past month2–3 times in past month1 time per week2 times per weekLess than ½ cup½ to 1 cupMore than 1 cup3–4 times per week5–6 times per week1 time per day2 or more times per day38. How often did you eat peas (fresh, canned, orfrozen)?34a. Each time you ate coleslaw, how much didyou usually eat?NEVER (GO TO QUESTION 39)Less than ¼ cup¼ to ¾ cupMore than ¾ cup1 time in past month2–3 times in past month1 time per week2 times per week35. How often did you eat sauerkraut or cabbage(other than coleslaw)?3–4 times per week5–6 times per week1 time per day2 or more times per day38a. Each time you ate peas, how much did youusually eat?NEVER (GO TO QUESTION 36)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per dayLess than ¼ cup¼ to ¾ cupMore than ¾ cup3–4 times per week5–6 times per week1 time per day2 or more times per day39. How often did you eat corn?35a. Each time you ate sauerkraut or cabbage,how much did you usually eat?NEVER (GO TO QUESTION 40)1 time in past month2–3 times in past month1 time per week2 times per weekLess than ¼ cup¼ to 1 cupMore than 1 cup36. How often did you eat carrots (fresh, canned, orfrozen)?39a. Each time you ate corn, how much did youusually eat?NEVER (GO TO QUESTION 37)1 time in past month2–3 times in past month1 time per week2 times per weekLess than 1 ear or less than ½ cup1 ear or ½ to 1 cupMore than 1 ear or more than 1 cup3–4 times per week5–6 times per week1 time per day2 or more times per day36a. Each time you ate carrots, how much didyou usually eat?Less than ¼ cup or less than 2 baby carrots¼ to ½ cup or 2 to 5 baby carrotsMore than ½ cup or more than 5 baby carrotsQuestion 37 appears in the next column3–4 times per week5–6 times per week1 time per day2 or more times per day9Question 40 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 43. How often did you eat winter squash (such aspumpkin, butternut, or acorn)?40. How often did you eat broccoli (fresh orfrozen)?NEVER (GO TO QUESTION 44)1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 41)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day43a. Each time you ate winter squash, howmuch did you usually eat?40a. Each time you ate broccoli, how much didyou usually eat?Less than ½ cup½ to ¾ cupMore than ¾ cupLess than ¼ cup¼ to 1 cupMore than 1 cup44. How often did you eat mixed vegetables?NEVER (GO TO QUESTION 45)41. How often did you eat cauliflower or Brusselssprouts (fresh or frozen)?1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 42)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day3–4 times per week5–6 times per week1 time per day2 or more times per day44a. Each time you ate mixed vegetables, howmuch did you usually eat?Less than ½ cup½ to 1 cupMore than 1 cup41a. Each time you ate cauliflower or Brusselssprouts, how much did you usually eat?Less than ¼ cup¼ to ½ cupMore than ½ cup45. How often did you eat onions?NEVER (GO TO QUESTION 46)42. How often did you eat asparagus (fresh orfrozen)?1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 43)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day45a. Each time you ate onions, how much didyou usually eat?Less than 1 slice or less than 1 tablespoon1 slice or 1 to 4 tablespoonsMore than 1 slice or more than 4 tablespoons42a. Each time you ate asparagus, how muchdid you usually eat?Less than ⅓ cup or less than 4 spears⅓ to ⅔ cup or 4 to 7 spearsMore than ⅔ cup or more than 7 spearsQuestion 43 appears in the next column3–4 times per week5–6 times per week1 time per day2 or more times per day10Question 46 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 47a. Which fats, sauces, or dressings wereusually added AFTER COOKING OR ATTHE TABLE? (Please do not includepotatoes. Mark all that apply.)46. Now think about all the cooked vegetables youate in the past month and how they wereprepared. How often were your vegetablesCOOKED WITH some sort of fat, including oilspray? (Please do not include potatoes.)Margarine(including low-fat)Butter (includinglow-fat)Lard, fatback, orbacon fatNEVER (GO TO QUESTION 47)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per daySalad dressingCheese sauceWhite sauceOther47b. If margarine, butter, lard, fatback, or baconfat was added to your cooked vegetablesAFTER COOKING OR AT THE TABLE,how much did you usually add?Did not usually add theseLess than 1 teaspoon1 to 3 teaspoonsMore than 3 teaspoons47c. If salad dressing, cheese sauce, or whitesauce was added to your cooked vegetablesAFTER COOKING OR AT THE TABLE,how much did you usually add?Did not usually add theseLess than 1 tablespoon1 to 3 tablespoonsMore than 3 tablespoons46a. Which fats were usually added to yourvegetables DURING COOKING? (Pleasedo not include potatoes. Mark all thatapply.)Margarine(including low-fat)Butter (includinglow-fat)Lard, fatback, orbacon fatOlive oilCorn oilCanola or rapeseed oilOil spray, such as Pamor othersOther kinds of oilsNone of the above48. How often did you eat sweet peppers (green,red, or yellow)?NEVER (GO TO QUESTION 49)1 time in past month2–3 times in past month1 time per week2 times per week47. Now, thinking again about all the cookedvegetables you ate in the past month, how oftenwas some sort of fat, sauce, or dressing addedAFTER COOKING OR AT THE TABLE?(Please do not include potatoes.)48a. Each time you ate sweet peppers, howmuch did you usually eat?Less than ⅛ pepper⅛ to ¼ pepperMore than ¼ pepperNEVER (GO TO QUESTION 48)1 time in past month2–3 times in past month1–2 times per week3–4 times per weekQuestion 48 appears in the next column3–4 times per week5–6 times per week1 time per day2 or more times per day5–6 times per week1 time per day2 times per day3 or more times per day11Question 49 appears on the next page
This is a sample form. Do not use for scanning.Over the past month 52. How often did you eat sweet potatoes oryams?49. How often did you eat fresh tomatoes(including those in salads)?NEVER (GO TO QUESTION 53)1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 50)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day52a. Each time you ate sweet potatoes or yams,how much did you usually eat?49a. Each time you ate fresh tomatoes, howmuch did you usually eat?1 small potato or less than ¼ cup1 medium potato or ¼ to ¾ cup1 large potato or more than ¾ cupLess than ¼ tomato¼ to ½ tomatoMore than ½ tomato53. How often did you eat French fries, home fries,hash browned potatoes, or tater tots?50. How often did you eat lettuce salads (with orwithout other vegetables)?NEVER (GO TO QUESTION 54)1 time in past month2–3 times in past month1 time per week2 times per weekNEVER (GO TO QUESTION 51)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per dayLess than 10 fries or less than ½ cup10 to 25 fries or ½ to 1 cupMore than 25 fries or more than 1 cupLess than ¼ cup¼ to 1¼ cupsMore than 1¼ cups54. How often did you eat potato salad?50b. How often did the lettuce salads you ateinclude dark green lettuce?NEVER (GO TO QUESTION 55)Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day54a. Each time you ate potato salad, how muchdid you usually eat?51. How often did you eat salad dressing (includinglow-fat) on salads?Less than ½ cup½ to 1 cupMore than 1 cupNEVER (GO TO QUESTION 52)3–4 times per week5–6 times per week1 time per day2 or more times per day55. How often did you eat baked, boiled, ormashed potatoes?NEVER (GO TO QUESTION 56)51a. Each time you ate salad dressing onsalads, how much did you usually eat?1 time in past month2–3 times in past month1 time per week2 times per weekLess than 2 tablespoons2 to 4 tablespoonsMore than 4 tablespoonsQuestion 52 appears in the next column3–4 times per week5–6 times per week1 time per day2 or more times per day53a. Each time you ate French fries, homefries, hash browned potatoes, or tatertots how much did you usually eat?50a. Each time you ate lettuce salads, howmuch did you usually eat?1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day12Question 56 appears on the next page3–4 times per week5–6 times per week1 time per day2 or more times per day
This is a sample form. Do not use for scanning.Over the past month 55g. How often was cheese or cheese sauce addedto your potatoes, EITHER IN COOKING OR ATTHE TABLE?55a. Each time you ate baked, boiled, ormashed potatoes, how much did youusually eat?Almost never or never (GO TO QUESTION 56)About ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always1 small potato or less than ½ cup1 medium potato or ½ to 1 cup1 large potato or more than 1 cup55h. Each time cheese or cheese sauce wasadded to your potatoes, how much wasusually added?55b. How often was sour cream (including lowfat) added to your potatoes, EITHER INCOOKING OR AT THE TABLE?Less than 1 tablespoon1 to 3 tablespoonsMore than 3 tablespoonsAlmost never or never (GO TO QUESTION 55d)About ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always56. How often did you eat salsa?55c. Each time sour cream was added to yourpotatoes, how much was usually added?NEVER (GO TO QUESTION 57)1 time in past month2–3 times in past month1 time per week2 times per weekLess than 1 tablespoon1 to 3 tablespoonsMore than 3 tablespoons55d. How often was margarine (including low-fat)added to your potatoes, EITHER IN COOKINGOR AT THE TABLE?56a. Each time you ate salsa, how much did youusually eat?Less than 1 tablespoon1 to 5 tablespoonsMore than 5 tablespoonsAlmost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always57. How often did you eat catsup?55e. How often was butter (including low-fat) addedto your potatoes, EITHER IN COOKING OR ATTHE TABLE?Almost never or neverAbout ¼ of the timeAbout ½ of the timeAbout ¾ of the timeAlmost always or always55f.NEVER (GO TO QUESTION 58)1 time in past month2–3 times in past month1 time per week2 times per week3–4 times per week5–6 times per week1 time per day2 or more times per day57a. Each time you ate catsup,
2–3 times in past 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 1a. Each time you drank carrot juice, how much did you usually drink? Less than ½ cup (4 ounces) ½ to 1¼ cups (4 to 10 ounces) More than 1¼ cups (10 ounces) 2.
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2 Questionnaire survey Survey research Rossi, P. H., et al. (2013). [4] 3 Questionnaire design A split questionnaire survey design Raghunathan, T. E., et al. (1995). [5] 4 Questionnaire design Designing a questionnaire Ballinger, C., et al. (1998). [6] 5 Questionnaire design Questionnaire design: the good, the bad and the pitfalls.
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