Date of Interview/Examination/Bioassay (MM/DD/YYYY):

Transcription

1 PhenX Measure: Dietary Intake (#231200) PhenX Protocol: Dietary Intake (#231201) Date of Interview/Examination/Bioassay (MM/DD/YYYY): SP = Survey Participant 1. These questions are about the different kinds of foods {you/sp} ate or drank during the past month, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else. During the past month, how often did {you/sp} eat hot or cold cereals? You can tell me per day, per week or per month. NEVER... 0 (Q2) 77 (Q2) 99 (Q2) DAY... 1

2 THEN DISPLAY QUESTION You said (DISPLAY NUMBER FROM Q1) times per (DISPLAY UNIT FROM Q1). Is that correct? NO... 2 (RETURN TO Q1) 77 (CONTINUE) 3. During the past month, what kinds of cereal did {you/sp} usually eat? 4. IS THERE ANOTHER CEREAL SP USUALLY EATS? OR ASK IF NECESSARY (Is there another cereal {you/sp} usually eat(s)?) YES... 1 (RETURN TO Q3) NO... 2 (Q5) 5. (During the past month), how often did {you/sp} have milk {either to drink or on cereal}? Do not include soy milk or small amounts of milk in coffee or tea. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTION: INCLUDE: SKIM, NO-FAT, LOW-FAT, WHOLE MILK, BUTTERMILK, AND LACTOSE-FREE MILK. ALSO INCLUDE CHOCOLATE OR OTHER FLAVORED MILKS. DO NOT INCLUDE: CREAM.

3 NEVER... 0 (Q7) 77 (Q7 99 (Q7) DAY... 1 IF Q1 >= 1, DISPLAY PHRASE { either to drink or on cereal }. IF RESPONSE > 2 AND UNIT = 1 (DAY), ELIMINATE >2 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRE SECTION (SPs 2-11 YEARS OLD) THEN DISPLAY QUESTION Q6. 6. You said (DISPLAY NUMBER FROM Q5) times per (DISPLAY UNIT FROM Q5). Is that correct? NO... 2 (RETURN TO Q5)

4 77 (CONTINUE) 7. During the past month, how often did {you/sp} drink regular soda or pop that contains sugar? Do not include diet soda. You can tell me per day, per week or per month. INTERVIEWER INSTRUCTION: INCLUDE: MANZANITA AND PEÑAFIEL SODAS. DO NOT INCLUDE: DIET OR SUGAR-FREE FRUIT DRINKS. DO NOT INCLUDE JUICES OR TEA IN CANS. NEVER... 0 (Q9) 77 (Q9) 99 (Q9) DAY... 1 IF RESPONSE > 2 AND UNIT = 1 (DAY), OR

5 THEN DISPLAY QUESTION Q8. 8. You said (DISPLAY NUMBER FROM Q7) times per (DISPLAY UNIT FROM Q7). Is that correct? NO... 2 (RETURN TO Q7) 77 (CONTINUE) 9. (During the past month), how often did {you/sp} drink 100% pure fruit juice such as orange, mango, apple, grape and pineapple juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTION: INCLUDE: ONLY 100% PURE JUICES. DO NOT INCLUDE: FRUIT-FLAVORED DRINKS WITH ADDED SUGAR, LIKE CRANBERRY COCKTAIL, HI-C, LEMONADE, KOOL-AID, GATORADE, TAMPICO, AND SUNNY DELIGHT. NEVER... 0 (BOX 1) 77 (BOX 1) 99 (BOX 1)

6 DAY... 1 IF RESPONSE > 1 AND UNIT = 1 (DAY), ELIMINATE > 1 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRES (SPs 2-11 YEARS OLD) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q9) times per (DISPLAY UNIT FROM Q9). Is that correct? NO... 2 (RETURN TO Q9) 77 (CONTINUE) BOX 1 IF SP AGE 2-11 YEARS OLD, SKIP TO Q13. OTHERWISE, CONTINUE. 11. (During the past month), how often did {you/sp} drink coffee or tea that had sugar or honey added to it? Include coffee and tea you sweetened yourself and presweetened tea and coffee drinks such as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea. (You can tell me per day, per week or per month.)

7 NEVER... 0 (Q13) 77 (Q1) 99 (Q13) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q11) times per (DISPLAY UNIT FROM Q11). Is that correct? NO... 2 (RETURN TO Q11) 77 (CONTINUE)

8 13. (During the past month), how often did {you/sp} drink sweetened fruit drinks, sports or energy drinks, such as Kool-aid, lemonade, Hi-C, cranberry drink, Gatorade, Red Bull or Vitamin Water? Include fruit juices you made at home and added sugar to. Do not include diet drinks or artificially sweetened drinks. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTION: INCLUDE: DRINKS WITH ADDED SUGAR, TAMPICO, SUNNY DELIGHT, AND TWISTER. DO NOT INCLUDE: 100% FRUIT JUICES OR SODA, YOGURT DRINKS, CARBONATED WATER OR FRUIT-FLAVORED TEAS. NEVER... 0 (Q15) 77 (Q15) 99 (Q15) DAY... 1 IF RESPONSE > 1 AND UNIT = 1 (DAY), ELIMINATE > 1 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRES (SPs 2-11 YEARS OLD)

9 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q13) times per (DISPLAY UNIT FROM Q13). Is that correct? NO... 2 (RETURN TO Q13) 77 (CONTINUE) 15. (During the past month), how often did {you/sp} eat fruit? Include fresh, frozen or canned fruit. Do not include juices. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: DRIED FRUITS. NEVER... 0 (Q17) 77 (Q17) 99 (Q17)

10 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q15) times per (DISPLAY UNIT FROM Q15). Is that correct? NO... 2 (RETURN TO Q15) 77 (CONTINUE) 17. (During the past month), how often did {you/sp} eat a green leafy or lettuce salad, with or without other vegetables? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: SPINACH SALADS. NEVER... 0 (Q19) 77 (Q19) 99 (Q19)

11 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q17) times per (DISPLAY UNIT FROM Q17). Is that correct? NO... 2 (RETURN TO Q17) 77 (CONTINUE) 19. (During the past month), how often did {you/sp} eat any kind of fried potatoes, including french fries, home fries, or hash brown potatoes? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: POTATO CHIPS.

12 NEVER... 0 (Q21) 77 (Q21) 99 (Q21) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q19) times per (DISPLAY UNIT FROM Q19). Is that correct? NO... 2 (RETURN TO Q19) 77 (CONTINUE)

13 21. (During the past month), how often did {you/sp} eat any other kind of potatoes, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: ALL TYPES OF POTATOES EXCEPT FRIED. INCLUDE POTATOES AU GRATIN, SCALLOPED POTATOES. NEVER... 0 (Q23) 77 (Q23) 99 (Q23) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q21) times per (DISPLAY UNIT FROM Q21). Is that correct?

14 NO... 2 (RETURN TO Q21) 77 (CONTINUE) 23. (During the past month), how often did {you/sp} eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried beans? Do not include green beans. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: SOYBEANS, KIDNEY, PINTO, GARBANZO, LENTILS, BLACK, BLACK-EYED PEAS, COW PEAS, AND LIMA BEANS. NEVER... 0 (Q25) 77 (Q25) 99 (Q25)

15 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q23) times per (DISPLAY UNIT FROM Q23). Is that correct? NO... 2 (RETURN TO Q23) 77 (CONTINUE) 25. (During the past month), how often did {you/sp} eat brown rice or other cooked whole grains, such as bulgur, cracked wheat, or millet? Do not include white rice. (You can tell me per day, per week or per month.) HELP SCREEN: Brown rice is a type of whole grain. It is brown in color and takes longer to cook than white rice. It contains almost all of the rice grain and is not as processed as white rice. Compared to white rice it also contains more fiber and more of some vitamins and minerals that are lost during the processing of rice. NEVER... 0 (Q27) 77 (Q27) 99 (Q27)

16 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q25) times per (DISPLAY UNIT FROM Q25). Is that correct? NO... 2 (RETURN TO Q25) 77 (CONTINUE) 27. (During the past month), not including what you just told me about (lettuce salads, potatoes, cooked dried beans), how often did {you/sp} eat other vegetables? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: RICE EXAMPLES OF OTHER VEGETABLES INCLUDE: TOMATOES, GREEN BEANS, CARROTS, CORN, CABBAGE, BEAN SPROUTS, COLLARD GREENS, AND BROCCOLI. INCLUDE ANY FORM OF THE VEGETABLE (RAW, COOKED, CANNED, OR FROZEN).

17 NEVER... 0 (Q29) 77 (Q29) 99 (Q29) IF RESPONSE > 2 AND UNIT = 1 (DAY), OR THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q27) times per (DISPLAY UNIT FROM Q27). Is that correct? NO... 2 (RETURN TO Q27) 77 (CONTINUE) 29. (During the past month), how often did {you/sp} have Mexican-type salsa made with tomato? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS:

18 INCLUDE: ALL TOMATO-BASED SALSAS. NEVER... 0 (Q31) 77 (Q31) 99 (Q31) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q29) times per (DISPLAY UNIT FROM Q29). Is that correct? NO... 2 (RETURN TO Q29) 77 (CONTINUE)

19 31. During the past month, how often did {you/sp} eat pizza? Include frozen pizza, fast food pizza, and homemade pizza. You can tell me per day, per week or per month. NEVER... 0 (Q33) 77 (Q33) 99 (Q33) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q31) times per (DISPLAY UNIT FROM Q31). Is that correct?

20 NO... 2 (RETURN TO Q31) 77 (CONTINUE) 33. (During the past month), how often did {you/sp} have tomato sauces such as with spaghetti or noodles or mixed into foods such as lasagna? {Please do not count tomato sauce on pizza.} (You can tell me per day, per week or per month.) NEVER... 0 (Q35) 77 (Q35) 99 (Q35) IF Q31 >= 1, DISPLAY Please do not count tomato sauce on pizza.

21 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q33) times per (DISPLAY UNIT FROM Q33). Is that correct? NO... 2 (RETURN TO Q33) 77 (CONTINUE) 35. (During the past month), how often did {you/sp} eat any kind of cheese? Include cheese as a snack, cheese on burgers, sandwiches, and cheese in foods such as lasagna, quesadillas, or casseroles. {Please do not count cheese on pizza.} (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: MACARONI AND CHEESE, ENCHILADAS. DO NOT INCLUDE: CREAM CHEESE OR CHEESES MADE FROM NON- DAIRY FOODS, SUCH AS SOY OR RICE, OR CHEESE ON PIZZA. NEVER... 0 (Q37) 77 (Q37) 99 (Q37)

22 IF Q31 >= 1, DISPLAY Please do not count cheese on pizza. THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q35) times per (DISPLAY UNIT FROM Q35). Is that correct? NO... 2 (RETURN TO Q35) 77 (CONTINUE) 37. During the past month, how often did {you/sp} eat red meat, such as beef, pork, ham, or sausage? Do not include chicken, turkey or seafood. (You can tell me per day, per week or per month.) NEVER... 0 (Q39)

23 77 (Q39) 99 (Q39) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q37) times per (DISPLAY UNIT FROM Q37). Is that correct? NO... 2 (RETURN TO Q37) 77 (CONTINUE) 39. (During the past month), how often did {you/sp} eat processed meat, such as bacon, lunch meats, or hot dogs? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: PROCESSED POULTRY AND RED MEAT.

24 DO NOT INCLUDE: CANNED TUNA FISH OR CHICKEN NUGGETS. HELP SCREEN: PROCESSED MEAT: Meats (usually red meats, but not always) preserved by smoking, curing, or salting, or by the addition of preservatives. Examples include: ham, bacon, pastrami, salami, sausages, bratwursts, frankfurters, hot dogs, or spam. NEVER... 0 (Q41) 77 (Q41) 99 (Q41) DAY... 1 THEN DISPLAY QUESTION DTQ.185.

25 40. You said (DISPLAY NUMBER FROM Q39) times per (DISPLAY UNIT FROM Q39). Is that correct? NO... 2 (RETURN TO Q39) 77 (CONTINUE) 41. (During the past month), how often did {you/sp} eat whole grain bread including toast, rolls and in sandwiches? Whole grain breads include whole wheat, rye, oatmeal and pumpernickel. Do not include white bread. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: CRACKED WHEAT, MULTI-GRAIN, BRAN BREADS, WHOLE GRAIN WHITE BREAD. NEVER... 0 (Q43) 77 (Q43) 99 (Q43)

26 THEN DISPLAY QUESTION Q42DTQ You said (DISPLAY NUMBER FROM Q41) times per (DISPLAY UNIT FROM Q41). Is that correct? NO... 2 (RETURN TO Q41) 77 (CONTINUE) 43. During the past month, how often did {you/sp} eat chocolate or any other types of candy? Do not include sugar-free candy. You can tell me per day, per week or per month. NEVER... 0 (Q45) 77 (Q45) 99 (Q45)

27 THEN DISPLAY QUESTION DTQ You said (DISPLAY NUMBER FROM Q43) times per (DISPLAY UNIT FROM Q43). Is that correct? NO... 2 (RETURN TO Q43) 77 (CONTINUE) 45. (During the past month), how often did {you/sp} eat doughnuts, sweet rolls, Danish, muffins, (pan dulce) or pop-tarts? Do not include sugar-free items. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS. DO NOT INCLUDE: PANCAKES, WAFFLES, FRENCH TOAST, CAKE, ICE CREAMAND OTHER FROZEN DESSERTS OR CANDY. NEVER... 0 (DTQ.240) 77 (DTQ.240) 99 (DTQ.240)

28 THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q45) times per (DISPLAY UNIT FROM Q45). Is that correct? NO... 2 (RETURN TO Q45) 77 (CONTINUE) 47. (During the past month), how often did {you/sp} eat cookies, cake, pie or brownies? Do not include sugar-free kinds. (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS, TWINKIES AND HOSTESS CUPCAKES. DO NOT INCLUDE: ICE CREAM AND OTHER FROZEN DESSERTS OR CANDY.

29 NEVER... 0 (Q49) 77 (Q49) 99 (Q39) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q47) times per (DISPLAY UNIT FROM Q47). Is that correct? NO... 2 (RETURN TO Q48) 77 (CONTINUE) 49. (During the past month), how often did {you/sp} eat ice cream or other frozen desserts? Do not include sugar-free kinds. (You can tell me per day, per week or per month.)

30 INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS. ALSO INCLUDE FROZEN YOGURT AND SHERBET. DO NOT INCLUDE: NON-DAIRY FROZEN DESSERTS, SUCH AS SORBET, SNO-CONES. NEVER... 0 (Q51) 77 (Q51) 99 (Q51) THEN DISPLAY QUESTION Q You said (DISPLAY NUMBER FROM Q49) times per (DISPLAY UNIT FROM Q49). Is that correct?

31 NO... 2 (RETURN TO Q49) 77 (CONTINUE) 51. (During the past month), how often did {you/sp} eat popcorn? (You can tell me per day, per week or per month.) INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT POPCORN. NEVER... 0 (END OF SECTION) 77 (END OF SECTION) 99 (END OF SECTION) THEN DISPLAY QUESTION Q52.

32 52. You said (DISPLAY NUMBER FROM Q51) times per (DISPLAY UNIT FROM Q51). Is that correct? YES... 1 (END OF SECTION) NO... 2 (RETURN TO Q51) 77 (END OF SECTION) DON T KNOW (END OF SECTION)