Diet Questionnaire Administration and Q by Q

Mechanics
Use # 2 pencil To ensure that the scanner reads correctly, the questionnaire must be completed using a #2 pencil. A hard pencil may produce too light a mark, and may be scanned as missing. Comments or notes should not be written on the questionnaire, as they may confuse the scanner. Comments must be on a separate page.

No other marks on the questionnair e Bubble completely One bubble per answer No staples

Fill in the answer bubbles completely. Do not simply make a checkmark or an 'X' over the bubble. Never mark two bubbles for the same answer -- both will be lost as an error. Staples would have to be removed, and if inadvertently not removed would damage the scanner. Marks left by staples can interfere with the scanner reading of tracking marks, booklet number marks or page number marks, and necessitate someone copying over the entire questionnaire. Do not insert any extra pages or papers with notes on them into the booklet, or attach yellow stickies. If not noticed prior to scanning, they might interfere with the scanning. Do not fold the questionnaire. Holes might interfere with the scanning process.

No extra pages

No folds No 3-hole punch

General Instructions Introducin g the Food Questionna ire Introduce the questionnaire, with a phrase such as the following: "Now I'd like to ask you some questions about the foods you usually eat." Do not use phrases that include the word "diet", as some respondents may think we mean "dieting", rather than simply their usual food habits. Do not spend too much time at this initial introduction.

Read questions as written

The words are not optional. Do not paraphrase. Do not omit any words. For example, "in season" is an essential part of the prompt for the foods in which it is used. Some foods that may be unfamiliar to you are being marketed nationally; do not omit them. If the respondent interrupts you with an answer before you have finished the entire question, continue on reading the question; there may be foods at the end of the list that the respondent didn't realize were to be included. If respondent asks a question for clarification, and you know the answer because it is in this manual, you may give him or her the answer; it is not necessary to reread the entire question. For example, in the general question "How often do you use fat or oil, to fry ,stir fry....?": If respondent asks, "Does that include butter I put on bread?" you may answer "No, just fat you may use to fry, stir-fry...", without rereading the whole question. Read the introduction to the food list, on page 2. "The next section is about your usual eating habits in the past year or so. This includes al meals or snacks, at home or in a restaurant or carry-out. There are two kinds of questions to answer for each food. 1. HOW OFTEN, on average, did you eat the food during the past year?" After the last sentence you should point to the questionnaire, and prompt, "is it >Never= , >A few times per year= , >Once per month= , >2-3 times per month= , >Once per week= , >2 times per week= , >3-4 times per week= , >5-6 times per week= , or Every day= ." Continuing with the introduction, read the next section: "How much did you usually eat of the food? * Sometimes we ask how many you eat, such as 1 egg, 2 eggs, etc., ON THE DAYS YOU EAT IT. * Sometimes we ask "how much" as A, B, C, or D. LOOK AT THE ENCLOSED PICTURES." At this point, you should hand them the page of portion size pictures, and continue with the introduction: "For each food, pick the picture (bowls or plates) that looks the most like the serving size you usually eat." The respondent can use either the plates or the bowls to choose her serving size, but generally, she should refer to the bowl pictures for foods that are usually eaten in bowls (breakfast cereal, soups...), and the plate pictures for foods that are usually eaten on plates. Note that there is no >A= bowl. Finally, if you refer to the portions as A, B, C, or D, it will encourage the respondent to refer to them that way, thus speeding up the process.

Respondent questions

Introducing the Food List

Foods not on the food list

The food list represents the most important nutrient sources in most people's diets. It does not and is not intended to include all possible foods that people ever eat. Thus, it is likely that some foods that a person eats will not be on the list. Do not attempt to force unmentioned foods into categories by guessing at their similarity.

Instructions About the Frequency Part of the Food Questions 2

Importanc e of frequency Frequency categories

Although portion size improves the accuracy of the nutrient estimates, the interviewer should be aware that frequency of consumption is much more important than exact portion size in determining long-term usual intake. Note the frequency categories at the top of the columns. Be careful to mark the right column, since being off by a column can make a big difference in the nutrient estimate. Although you will ask the question in an open-ended way ("How often do you eat..."), encourage the respondent to give her answers in terms of one of the predefined categories. Respondents easily get the idea, and will quickly learn to give answers in the categories shown. The categories are not the same all the way through the questionnaire -- the categories on the final page of the questionnaire go up to "2+ times per day". When you get to this section, make the respondent aware of this change. You might say something like "for the foods on the final page of the questionnaire you can answer as much as "2 or more times per day".

Should I read all the response categories ?

In this Food Questionnaire, the answers are all in categories, such as "Less than once per week", "1-2 per week", ... "4+ per day". In most cases it is not necessary to read the response categories every time, although you may do so if the respondent is hesitating or unclear. Instead, you will first show the respondent an example of the type of categories you will be using to record her answers. Then, you will simply ask the question in an open-ended way, wait for a response (such as "5 times a week"), and record it in the appropriate category. It is not necessary to say "How often do you eat ...." for every food. You can repeat the introductory phrase from time to time, but most often you should just read the next food, without the "How often...." This will make the interview go a little faster, be less boring, and perhaps encourage the respondent to pick up the pace. Similarly, avoid repetitively saying "(name of food). How often do you eat that?" It is okay to say that occasionally to vary 3

Wording of the frequency questions

the wording and pace, but not for every food. Do not, however, just say "Do you eat ..."; this unnecessarily lengthens the interview, because then if the respondent says 'yes' you still have to ask the "How often" question. 2+ per day categories Remember to remind the respondent of the different categories when you come to the frequency pages in which 2+/day and higher are possible answers: If the respondent says "Every day", at least the first time he/she does that you should probe, "Would that be once a day or 2+ times a day?" You don't need to do that probe every time, if it appears that the respondent understands that "2+ times a day" is one of the possibilities. There is a potential confusion between how often and how many, particularly for the fruits. Make sure to keep them separate for the respondent. For example, when you ask 'bananas', some respondents may say "I eat two a week"; this could lead to double-counting if you marked '2/wk', then asked 'how many' and she said '2'. So if respondent is answering fruits as "I eat two a week", explain that you will ask "How many each time" in a subsequent question; right now, you want her to tell you 'how often' per week, meaning "how many days", not how many bananas per week. Always get the frequency ("How often") before asking about portion size ("How much" or "How many"). While the respondent is thinking about her answer to "How often", do not interrupt with any mention of portion size. Do not point to the portion size pictures until after you know her answer to "How often". Seasonalit y A few foods say specifically in season. The respondent should give the frequency with which that food is consumed, just in the few-month period when it is in season. All other foods require an estimate of average year-round frequency of consumption. If the respondent eats some of these year-round items more in one season than another, the reported frequency should still be a rough average over the whole year. For example, if respondent says "I eat apples 3-4 times a week now that they're in season", you should say something like, "Please try to estimate how often that would average out to over the whole year." 4

How often vs. How many

If the respondent is unable to do the conversion herself, then the interviewer may use the following chart to estimate for her. Average use in season Every day 5-6 times per week 3-4 time per week 2 times per week Once per week 2-3 times per month Once per month A few times per year Never Buying in bulk Conversion Average year round use Twice per week Once per week 2-3 times per month 2-3 times per month Once per month A few times per year A few times per year Never Never

Shift 3 columns to the left Shift 3 columns to the left Shift 3 columns to the left Shift 2 columns to the left Shift 2 columns to the left Shift 2 columns to the left Shift 1 column to the left Shift 1 column to the left No change

Some respondents will say something like "I buy a gallon and then drink it until I'm done with it", and then doesn't drink it so frequently for the subsequent time period. Again, you should ask her to try to average her intake over the whole year. Something like, "Please estimate how many glasses per day or per week you think you drink, on average over the whole year."

Items with more than one food

For example, "Fresh apples or pears". Do not try to get separate estimates of either frequency or portion size for the two foods. Just ask the respondent to answer their frequency for that group of foods. And don't worry about the two foods having different sizes; just ask the respondent to pick the portion size picture that best approximates how much he/she usually eats of that group of foods. If the respondent answers with a range that does not fit exactly into one of the available categories, ask the respondent to choose which of the available categories is closer to how often she uses that item. For example, if she answers "four or five times a week", you would then say, "Would it be closer to "3-4 times per week" or "5-6 times per week"? Use the "Never" column for any foods either literally never eaten, or eaten by the respondent less than once per year. They will be counted as zero. Apply common sense. "Less than once a year" or "3-4 times in my life": code it as "Never" without further probing. "A couple of times a month": code as "2-3 per month" without further probing. If respondent answers "Rarely" or "Hardly ever", ask "Would that be less than once per year?"; if respondent indicates 'yes', code as "Never".

Frequency answers that overlap the response categories "Never" frequency Frequency answers with different wording

Instructions about the Portion Size Part of the Food Questions Portion size is EASY in this interview You don't worry about converting to half cups, ounces, etc. You just mark the bubble corresponding the respondent's portion size choice: "A" = 1st bubble "B" = 2nd bubble "C" = 3rd bubble 6

"D" = 4th bubble Wording of the portion size questions It is not necessary to make a full sentence out of the portion size section each time. I.e., do not say, for every food, "When you have ..., about how much/many do you have each time?" For the "how manys'", just say "How many teaspoons", etc. For the "How much"s, you can say "How much each time?" and point to the pictures; or, after a while, just say "A, B, C or D?"; or you can say "Which bowl?" If the respondent says that his/her usual portion is larger than the largest model (which corresponds to the fourth bubble), record the answer as the fourth bubble. Although portion size will definitely improve the accuracy of the answers, you should not permit the respondent to spend undue time on the portion size answers. This section should move along quite quickly, with a breezy "How many" or "A, B, C or D?" The portion size part of the beverages section is designed to capture both the number of glasses, bottles, cans, etc. that the respondent usually drinks, on the days she drinks the beverage, and about the size of the beverage that the respondent drinks. These portion sizes are provided as clarification for you, the interviewer, so that you will be able to answer questions if the respondent asks. The interviewer does not need to offer the respondent this information, but if she asks, you may respond to questions, using the information provided here.

"XXL" How important is portion size? Note on Beverage "portion sizes"

Correct wording for asking the portion size questions Each food has a correct wording for asking the portion size question ("how many", "how much" etc), and a recommended portion size model to use. The correct wording is given in the column just preceding the portion size bubbles. The cue about the correct wording is in the words underneath the portion size bubbles.

SUMMARY OF HOW TO ASK PORTION SIZE

How many questions

Ask "How many each time" or sometimes just "How many". Use the unit that is the name of the food (e.g., >bananas= ) or that is shown in the "Portion Size" column (e.g.,'slices', 'teaspoons', 'bowls'). Code response according to respondent= s answer ("1", "2", "3", etc). For example, examine "Bananas": ask portion size in an openended way, as "How many, each time?" You then record the answer in the appropriate bubble, "1/2", "1", "2". If the number reported is larger than shown for any of the bubbles, use the fourth bubble. Occasionally, "How many" is awkward; so for "Cantaloupe", it would be "Do you eat 1/8, 1/4 or 1/2 a cantaloupe each time?" Acceptable phraseology: "How many bananas, each time?" "How many, each time?" "How many, on the days you eat them?"

How much questions

Ask "How much each time, A, B, C or D?", or just "A, B, C or D?", or "Which picture, A, B, C or D?" Code A-B-C-D as 1st bubble, 2nd bubble, 3rd bubble, 4th bubble, without any kind of conversion, calculation or interpretation. For example, examine "Canned fruit like applesauce, fruit cocktail, or dried fruit like raisins": In the "How Much" section, you see "A,B,C,D". For these foods, indicate the portion size pictures and ask the respondent to choose the picture closest to her usual portion. Again, the respondent may use either the plates or the bowls to give his/her answer. Acceptable phraseology: "How much each time? A, B, C or D?" "Which of these pictures is closest to your usual portion?" "Which picture is closest to the amount you usually eat" Eventually, you could say simply "A, B, C or D?"

Q by Q (question by question) Responden t ID Number Today= s date The ID number must always be filled in. This is the only way it will be possible to connect the nutrient estimates with the right individual. The date the questionnaire is completed

Sex Breast feeding Age

Sex should not be omitted. The analysis program will use it to evaluate reasonableness of nutrient estimates. This is not used by the nutrient analysis program, but may be useful as a categorical variable. Age must always be filled in, and bubbled in. The analysis program uses it to evaluate reasonableness of nutrient estimates. This is not used in the nutrient analysis calculations. However, if printed output is requested, it is reported in the printed output, and advice on desirable weight may be generated. The bubbles should be filled in, not just written in at the top. This is not used in the nutrient analysis calculations. However, if printed output is requested, it is reported in the printed output, and advice on desirable weight may be generated. The bubbles should be filled in, not just written in at the top. Note that the first bubble is for height in feet, and the second bubble is for inches. In case of 1/2 inch", round down. This item will not be entered into the database. They are not scanned by the scanner.

Weight

Height

Name

Introducin g the Main Food List

Read the introduction to the food list, on page 2. "The next section is about your usual eating habits in the past year or so. This includes al meals or snacks, at home or in a restaurant or carry-out. There are two kinds of questions to answer for each food. 1. HOW OFTEN, on average, did you eat the food during the past year?" After the last sentence you should point to the questionnaire, and prompt, "is it > Never= , > A few times per year= , > Once per month= , > 2-3 times per month= , > Once per week= , > 2 times per week= , > 3-4 times per week= , > 5-6 times per week= , or Every day= ." Continuing with the introduction, read the next section: "How much did you usually eat of the food? * Sometimes we ask how many you eat, such as 1 egg, 2 eggs, etc., ON THE DAYS YOU EAT IT. * Sometimes we ask "how much" as A, B, C, or D. LOOK AT THE PICTURES." At this point, you should hand them the page of portion size pictures, and continue with the introduction: "For each food, pick the picture (bowls or plates) that looks the most like the serving size you usually eat." The respondent can use either the plates or the bowls to choose her serving size, but generally, she should refer to the bowl pictures for foods that are usually eaten in bowls (breakfast cereal, soups...), and the plate pictures for foods that are usually eaten on plates. Note that there is no > A= bowl. Finally, if you refer to the portions as A, B, C, or D, it will encourage the respondent to refer to them that way, thus speeding up the process. The time frame that it covers is "the past year or so". This is deliberately a little vague, because it is not expected that anyone could remember exactly what they ate during exactly the past year. The idea is just to get a usual pattern -- their current diet at this point in their life. Some people raise the objection, "Oh, I can't even remember what I ate yesterday; how could anyone answer what they ate in the past year?" If respondents have this concern, it's important to make clear to them that the idea is not to remember, but to think about their usual pattern of frequency. For example, they don't have to remember how many times they had eggs in the past year. Instead, what they can tell you with reasonable accuracy is, "Oh, I have eggs about twice a week." For some items, people may indicate that they have changed their habits in the past 10

year. In that case, ask "Do you expect that this is a lasting change?" If the new habit appears to be lasting and stable, she should report on the new pattern rather than the former pattern. In all the examples given below for foods, you should not probe for information about any of the clarifications discussed here. These are provided as clarification for you, the interviewer, so that you will be able to answer questions if the respondent asks. Read the questions exactly as written. Do not re-word, or leave things out. But you may respond to questions, using the information provided here. Summary questions Servings of Vegetable s and Fruit These questions are used by the program to compare and if necessary adjust some of the food list responses. Servings of vegetables, fruit: This doesn't mean 'how many different kinds'. It doesn't refer to 'seconds': for that, they would mark a > D= in the main food list. Here, we mean how many times it shows up on your plate during the day. So green beans with lunch and squash with dinner would be 2/day; green beans with lunch and green beans with dinner would be 2/day; nothing with lunch and both squash and green beans with dinner would be 2/day. Salad and potatoes are excluded from these questions simply to clarify which foods we are asking about. Acceptable answers to respondent questions: Q: "Do you mean different kinds of vegetables (fruits, cereals)?" A: "No, just how often you eat vegetables of any kind." Q: "Should I count second helpings as two servings?" A: "No, this is just how often you eat vegetables of any kind." Q: "Give me an example of how to count them up." A: "If you usually have some fruit with breakfast and some fruit for a snack, that would be twice a day." Q: "What if I have a big salad with lots of stuff in it?" A: The key is whether it would be enough of any one vegetable that they would include it in their main food list answer. For example, suppose their salad sometimes 11

includes as much as 1/2 cup of broccoli; in the main food list, they would/should think of all times they have broccoli, including the quite substantial portion they have in big salads, and include that in their "Broccoli" answer. Therefore, if their salad contains a large enough amount of a vegetable to have been counted as a serving on the main food list, it should be so counted here. Cold cereal Frequency with which respondent eats any cold cereal. This question will be used to adjust the frequencies of the specific cereal questions on page 4 of the questionnaire. Frequency of fat or oil in cooking: Note that fat or oil use is in fry, stirfry or simmer; does not include fat used in baking. Also does not include oil used on salad, and does not include butter/margarine used on bread. Ask this question only if respondent's answer to the previous question on fat or oil was "once per week" or more often. Put some emphasis on "kinds" of fat, so the respondent understand that you are asking a different question. Do not read "Mark only one or two." Do not read the response categories. Leave it open-ended, and then fill in the appropriate box to fit the subject's answer. If respondent names only one, mark only one without further probing. If she names two, mark two. If she names more than two kinds of fats/oils, ask her which two she uses most often. If she states, in answer to this question, "I do not use it", go back and clarify her answer to the previous question, which was "How often do you use fat or oil to fry...?" Safflower oil or peanut oil can be marked under "Corn oil, vegetable oil". "Crisco" refers to Crisco shortening. If subject specifies Crisco oil, mark it under "vegetable oil". Sesame oil: If respondent reports "sesame oil", ask if she uses it in large quantities such as 1-2 tablespoons; if so, code as vegetable oil. If she only uses a few drops for flavoring, do not code as oil at all.

Fat or oil in cooking

"What kinds of fat...."

During past year, ... vitamins? (If yes) what...? Multiple vitamins

If "No, not regularly" (at least once a week), they may skip to the diet instructions in the middle of the page.

There are two different multiple vitamin types. "Regular once-a-day, Centrum or Thera" is one type, "Stress Tabs or B-Complex" is a second type. They should not mark two or more types unless they in fact do take two or more different 12

types of multiple vitamins. What is a "Regular once-a-day..."? Multiple vitamins typically contain all of the vitamins (A, B1, B2, C, D, E and others) and often contain minerals (iron, zinc, calcium and others). One-a-Day, Theragran, Centrum, Centrum Silver, and any local brand (e.g., Safeway Multivits) counts here. The key characteristic is that it contains many different vitamins; it is thought to be a sort of all-round supplement, covering all the bases at least at a basic level. The fact that it does contain A, C and E does not make it an "Antioxidant combination", if it contains other things besides those vitamins. What is a "Stress tab or B-Complex type"? These will have "stress", or "B-Complex", or "High-B" in the name. They all have B vitamins at levels substantially higher than the RDA. Single Vitamins In general, these are supplements where each pill contains only the one vitamin or mineral. Thus, it is important to note that we are asking here about single supplements, that are not part of multiple vitamins. An exception: Occasionally a pill may contain just two minerals, such as calcium & zinc. Since we don't have a place for "multiple minerals", it is okay for respondent to record the frequency of consumption under both "calcium" and "zinc" separately. For Vitamin A, it is important to note that this is "not betacarotene". Many respondents have learned that vitamin A and beta-carotene are in some way related. However, the Vitamin A line is asking specifically about preformed vitamin A, also known as retinol. If they take vitamin A as beta-carotene, they should mark their frequency only under the beta-carotene line. Contain minerals? Vitamin C or E, What milligrams This need only be filled in if respondent takes multiple vitamins. (If respondent doesn= t know, the program will assume with minerals, since that is 80% of the market.) This need only be filled in if respondent takes vitamin C or E as single supplements (not part of multiple vitamins). These are the commonly available pill sizes. Note that this 13

refers to the total milligrams in the day, on the days respondent takes it. It is not milligrams in a pill, or milligrams in each dose. These are not included in the nutrient analysis. However, the results returned to the researcher do indicate whether the supplement was reported as having been taken at least once a month.

Botanical supplemen ts

Q by Q -- Beverages Tomato or V8 juice Real 100% Orange juice or grapefruit juice When you drink orange juice... Other real fruit juices, ... Kool-Aid, Hi-C or other drinks with added vitamin C Drinks with some juice in them, like Sunny Delight Instant breakfast... Include any meal supplement or replacement, such as Boost or Ensure; any dieting milkshake, such as Sego or 14 Any tomato juice, including Clamato, etc. Canned, bottled, frozen or fresh. Do not include fruit drinks, or any drink that is not 100% orange or grapefruit juice. (Sunny Delight is not 100% juice.)

The program will use the answer to this question to choose the type of orange juice to use for the frequency of orange juice reported above. Canned, bottled, frozen or fresh. Other 100% real fruit juices (not 'drinks') could be included here, such as lemonade. Include any drinks, whether real fruit juice or not, if they contain added vitamin C. Most forms of Kool-Aid do now contain added vitamin C. Include Sunny Delight here.

Ensure Glasses of milk...

Slim-Fast; or Instant Breakfast milkshakes like Carnation. This applies to glasses of milk, not to milk added to coffee or cereal. Be careful that respondents do not double-count the milk they may have added to their Carnation Instant Breakfast. The program will use the answer here to choose the kind of milk to apply to the frequency of glasses of milk reported in the previous item. This answer applies to glasses of milk, not to milk added to coffee or cereal. If they drink more than one type of milk, ask them to choose the one they drink most often. Any soft drink that is not artificially sweetened. Includes cola, ginger ale, pepper types, orange or grape soda, etc., or sugar-sweetened bottled water. If the respondent buys large bottles of soft drink (such as the standard 64 oz. bottle) and then drinks it in cups or glasses, then the interviewer may suggest that the respondent choose from the ABCD cup models. The interviewer should code an "A" in the "<1 can/bot", a "B" in the "<1 can/bot", a "C" in the "12 oz can/bot", and a "D" in the " 16 oz can/bot". Bottles, glasses, cans, or draft, all varieties. If respondent drinks nonalcoholic beer, do not include it in this response, but include it in the open-ended section at the end of the questionnaire. Portion size asks what size can or bottle they usually drink. The program will use the answer to this question to choose the type of beer to use for the frequency of beer reported above. All forms, including champagne, spritzers. If respondent drinks nonalcoholic wine, do not include it in this response, but include it in the open-ended section at the end of the questionnaire. Include all forms, including whisky, scotch, gin, etc. Note that "How many glasses or drinks" is reported in the "how often" section. In the portion size section, respondent should report the amount of alcohol (number of shots) used in each glass. Note here that portion size is not asked -- a standard portion size will be assumed. Include caffeinated or decaffeinated, brewed or instant. 15

When you drink...

Regular soft drinks...

Beer

What kind of beer? Wine...

Liquor...

Coffee...

Tea... What do you usually add to coffee? What do you usually add to tea? Do you usually add sugar or honey to coffee Do you usually add sugar or honey to tea

Any form of regular tea or iced tea. Exclude herbal teas. Choose the type that is usually added to coffee. If the respondent uses more than one type, have her pick the one she uses most often. Choose the type that is usually added to tea. If the respondent uses more than one type, have her pick the one she uses most often. Refers to only real sugar or honey, not sugar substitutes. Fill in the Yes/No question. If > Yes= , also fill in the number of teaspoons.

Refers to only real sugar or honey, not sugar substitutes. Fill in the Yes/No question. If > Yes= , also fill in the number of teaspoons.

Q by Q -- Fruits In this section, the number of times per month or week refers to number of days per month or week. For example, the respondent eats bananas on about two days a week. Then, the portion size section provides the location where the respondent can tell you how many pieces of that fruit she eats, on the days she eats them. Seasonality: Among the fruits, some of the items refer to food intake "in season", and the other items refer to intake "year round". If any of these "year-round" foods are eaten more in one season than another, ask respondent for her best estimate of a year-round average. "Raw peaches..." are "in season". It is essential to read the "in season", and respondent should report the frequency with which that fruit is eaten when it is in season (refer to the "seasonality" section above for a detailed discussion). Do not probe for length of season. Jams and jellies should not be counted as servings of fruit. Fruit in yogurt does not count as servings of fruit. Raw peaches, apricots, nectarines, in season Any type. Report frequency only for the few months when they are "in season". The frequency section gets at "how often", not how many peaches per week. Get number of days first; then in portion size get "How many" each time. If she seems to be answering peaches per week, clarify and first get 'how often', then under portion size get 'how many each time'. Be careful, for this item and all other items that come in units, that you do not double-count or triple16

count: that is, be careful that she doesn't say "2 a week", (which you would record in the "2/wk" column), and then say '2' for how many each time. That would calculate out as four peaches a week instead of two. Cantaloupe , in season The focus here is on cantaloupe. Other melons should be counted only if they are deep orange like cantaloupe. Do not include honeydew or other non-orange melons. Report frequency only for the few months when they are "in season". Fresh only. Report frequency only for the few months when they are "in season". Any other fresh fruit. Report frequency only for the few months when they are "in season".

Strawberrie s, in season Any other fruit in season, like grapes... in season Bananas Apples or pears

All kinds, all sizes. All kinds, all sizes; includes pears, or Asian pears. Discourage respondents from trying to do math, adding up separately their apples and their pears. An intuitive average is fine. All kinds, all sizes; includes tangerines, tangelos, mandarin oranges. (Orange juice is a later item.) If respondent only uses oranges to make juice, tell her to wait and count that as orange juice. If she sometimes eats them as oranges and sometimes as juice, just get frequency of 'as oranges' in the fruit section, and then later get the 'as juice' in the juice section. All kinds, all sizes. Frequency is average year-round frequency of consumption.

Oranges or tangerines

Grapefruit Canned fruit like applesauce , fruit cocktail, or dried fruit like raisins

Q by Q -- Breakfast items, dairy Eggs, including Include real eggs when eaten as eggs, including scrambled, boiled, fried, or on sandwiches. Also, include deviled, or egg 17

egg biscuits or Egg McMuffins (not egg substitute s) Bacon Breakfast sausage, including sausage biscuits Pancakes, waffles, French toast, Pop Tarts Breakfast bars, granola bars, power bars Cooked cereals like oatmeal, cream of wheat or grits High-fiber cereals like All Bran, Raisin Bran, or Fruit -nFiber

salad or quiche(which is mainly egg). Do not count eggs used in cooking, such as in cakes, custards, etc. Do not count Egg Beaters, egg substitutes, or if only egg whites are eaten. The main point is the cholesterol, so if they scramble, for example, one egg yolk and two egg whites, just count the number of yolks. See caution under "Bananas" above, about care in recording the answers to the "How often" and "How many" questions. Includes when eaten at any time, including BLT sandwiches, not just with breakfast. This includes breakfast-type items, but not sandwich-type cold-cuts, not main-meal items like Italian or Polish sausage, and not hot-dog type sausages like German hot dogs. Turkey sausage may be included here. With or without butter or syrup. Syrup will be added automatically.

These do not have to be eaten for breakfast.

This refers to all cooked cereals, including cream of wheat, cream of rice, and less common types like kasha, as well as those mentioned.

This item may include any higher-fiber cereals, including the very-high-fiber cereals like All-Bran and the moderately high-fiber cereals like "Fruit-n-Fiber". Any cereal with the words "bran" or "fiber" in their titles may be included here. Note that the cereals should be counted even if they are eaten as a snack rather than a breakfast cereal, and regardless of whether they are eaten with milk.

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Which high- fiber cereal... Product 19, Just Right or Total Any other cold cereal,... Milk or milk substitute s on cereal

The program will use the answer to this question to choose the type of high-fiber cereal to use for the frequency of the cereal reported above. This item includes only these three cereals. These cereals contain 100% of the RDA (Recommended Dietary Allowance) for several nutrients. This item refers to all other cold cereals, like corn flakes, rice krispies, Special K, or Frosted Flakes, etc. Ask about milk on cereal only if cereal is eaten. Ask the question just like any other, "how often do you use...", if the respondent eats cereal; do not just assume that the frequency will be the same as the frequency of cereal. (Some people eat cereal plain, as a snack.) Frequency: For most people, this will be the number of days per week or month that they eat any kind of cereal with milk. Some respondents may say "every time". Do not code this as 'every day'. Rather, look back at her cereal frequencies and remind her of how often she said she eats cereal; then ask her, "So, about how often do you use milk on cereal, per week?"

Yogurt, frozen yogurt Cheese, sliced cheese, or cheese spread, including on sandwiche s When you eat cheese, ...

Include all varieties, with or without fruit, regular or low-fat, sweetened or artificially sweetened. Do not code the fruit in yogurt separately as fruit. Include all types, regular or low-fat, hard cheese or soft cheese, natural or processed, including cream cheese. This refers specifically to cheese eaten as cheese. It should not include cheese eaten in lasagna, pizza, etc. Those foods will come later. For the nutrient calculations, a regular or lowfat item on the database will be selected for the calculations, depending on the respondent= s answer to the following question on use of regular or low-fat items. "Cheese" here refers specifically to cheese by itself, not as part of pizza, lasagna, etc. The program will use the answer to this question to choose the fat content of the cheese whose frequency was reported above.

Q by Q -- Vegetables 19

When starting the vegetable page, be sure to read the introductory sentence at the top, so that they know to include frozen, canned, etc. All vegetables consumed, whether fresh, frozen, canned or in stir-fry, should be included here if the amount equals at least the >A= size portion picture. Vegetable soups and vegetable or vegetable-beef stew are separate items, and the vegetables from those items should not be reported separately under the particular vegetable. Small "incidental" amounts that may be included in salads or mixed dishes should not be reported separately under the particular vegetable, unless the amount is equal to at least a half cup. Most of the vegetables must be answered in terms of the portion size pictures; do not let them answer in ounces. Broccoli Includes cooked or raw. Includes items from salads only if the amount comes to at least the size of a half cup, and then only the frequency that this vegetable itself is actually eaten, not just the frequency that salad may be eaten. Includes cooked or raw. Include items from salads only if the amount comes to at least the size of a half cup, and then only the frequency that this vegetable itself is actually eaten, not just the frequency that salad may be eaten. Also includes carrots eaten in mixed dishes such as soup or stew, as those items are captured elsewhere. Fresh, frozen or canned. As with year-round fruits, ask the respondent to estimate a year-round average, if eaten more in season. Remember that people may eat corn on the cob when it is in season, but eat canned or frozen corn during the rest of the year. One ear of corn equals approximately a "B" or medium serving. Green beans refers to canned, frozen, fresh, or in salad bars, but not to dried-type peas like black-eye peas, split peas. Green peas (canned, frozen, fresh, or in salad bars) may also be counted in this category. Includes cooked or raw. Spinach salad should be recorded here, not under salad. This refers specifically to the dark-green, strong-flavored greens. Beet greens, for example, may be counted here. However, lighter-green leafy vegetables such as celery tops should not be counted here. Include home or restaurant fries, and "home fries".

Carrots, or mixed vegetables or stews containing carrots Corn

Green beans

Spinach Mustard greens, turnip greens, collards French fries, fried potatoes, hash browns

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White potatoes not fried... Sweet potatoes, yams Cole slaw, cabbage Green salad

Include all forms of potatoes except fried. Do not include potatoes eaten in soups or stews, as those are captured elsewhere. All types. Do not include the sweet potatoes eaten in pies; that question is asked later. Includes raw or cooked cabbage, including Chinese cabbage, and cole slaw whether homemade or from a restaurant. Includes all kinds of green salad that include some lettuce, whether mostly of iceberg lettuce or of other types of lettuce, and regardless of whether other vegetables are sometimes eaten in it. Spinach salad should be recorded under "spinach", and should not be double-counted here. Includes tomatoes eaten in alone or in salad Does not include tomato sauces, which are captured under 'spaghetti', etc. Does not include the tomatoes in tomato or vegetable soups, which are captured under that item. The portion size refers to 1/4, 1/2... of a medium tomato. All types, creamy or not, including oil & vinegar. Program will assign a regular or low-fat type depending on respondent's answer to the "How often low-fat" question that follows. The program will use the answer to this question to choose the fat content of the salad dressing whose frequency was reported above. Includes any vegetable not already mentioned.

Raw tomatoes

Salad dressing

Is your salad dressing... Any other vegetable. .. Refried beans or bean burritos Chili with beans Baked beans, black-eyed

Burritos which have both meat and beans should be recorded here.

With or without meat. This includes all dried-type beans, regardless of whether they're mentioned here or not, such as navy beans, red beans, etc. Do not include pea or bean soups; these are 21

peas... Vegetable stew Vegetable soup... Split pea, bean or lentil soups Any other soup... Spaghetti.. . with tomato sauce Cheese dishes without tomato sauce...

asked later Any type of vegetable stew, canned or home-made. Any type of vegetable soup that has a lot of carrots, or has a tomato base. Any type of pea, bean or lentil soups may be counted here.

This is the catch-all for all other forms of soup, whether creamed or not. This item should include only those pasta dishes that are eaten with tomato sauce. It can include mixed pasta items such as raviolis. The defining characteristic is the tomato sauce. When asking this question, emphasize the words "with tomato sauce". This item should not include any pasta dishes that are eaten with tomato sauce. Therefore, you must be careful to correctly say "without tomato sauce", not "with". This includes only dishes that commonly have a fair amount of cheese, such as macaroni and cheese, certain Mexican dishes that have a lot of cheese, Welsh rarebit, etc. Incidental sprinkle cheese often used on spaghetti does not make it count as a cheese dish. Cheese sandwiches should be counted in the earlier 'cheese' item, where number of slices can be indicated. All forms, all sizes, all toppings.

Pizza...

Q by Q -- Meats and main dishes Hamburge rs, cheesebur gers, meat loaf... Tacos, burritos, enchiladas All sizes, at home or in a restaurant. Does not include the ground beef used in spaghetti, lasagna or pizza. Only hamburgers, etc. made with beef are to be included here. Turkey burger should not be coded here, but should be included under "chicken or turkey, roasted or broiled". Includes beef burritos, tacos, enchiladas, tamales, or other similar dishes, whether with meat or chicken. Bean burritos should be included in the previous section, under "refried 22

... Beef steaks, roasts, pot roasts... How do you like your beef cooked Pork... When you eat meat... Veal, lamb, or deer meat Ribs, spareribs Liver... Gizzard, pork neckbones , chitlins, pigs feet, etc. Mixed dishes with beef or pork... Mixed dishes with chicken... Fried chicken... Chicken or

beans or bean burritos". Fresh, in frozen dinners, or on sandwiches. Do not include beef eaten as ground beef.

This is not used by the nutrient analysis program, but may be a useful variable.

Do not include pork-based lunch meats. The program will use the answer to this question to choose the fat content of the meats whose frequency was reported above. This item includes these three types of meat, or any other > game= meat (not foul). Any type, any size All forms. This item includes the listed foods as well as any other organ meats.

Include any mixed dish with beef, pork, veal or lamb. Do not double-count beef stew reported earlier for the vegetable stew item. Mixed dishes with chicken is a later item. Includes any mixed dish with chicken.

All parts of a chicken are included (wings, thighs, breast, etc.) provided they are fried. Include McNuggets, etc. Include turkey burgers here, but not chicken/turkey eaten 23

turkey not fried... When you eat chicken... Oysters Other shellfish... Tuna...

as part of a mixed dish. The program will use the answer to this question to choose the fat content of the chicken whose frequency was reported above. Any form, plain or in stew or soup. All forms, including clams, mussels, squid, oysters. All forms of tuna, light meat or dark, in oil or in water, straight or in a casserole. Portion size, however, refers to the amount of tuna, and should not include any noodles, etc., eaten with it. Home-fried or restaurant, fast food. All types of fish. All other fish, after excluding fried, tuna or shellfish. All forms, including chicken/turkey. The program will use the answer to this question to choose the fat content of the hot dogs and dinner sausage whose frequency was reported above. Lunch meats, all types. Ham refers to slices as for sandwiches; ham eaten as a roast or as the entree for a main meal should be reported under "pork". Do not include small amounts eaten on pizza, etc. The program will use the answer to this question to choose the fat content of the lunch meats whose frequency was reported above. This item includes all other pasta dishes that do not contain substantial tomato sauce or substantial cheese. This could include, for example, pasta with white clam sauce (not red), or pesto sauce. Refers to "fresh" tofu such as is normally served in Chinese restaurants, or bought in the refrigerator section of supermarkets. Includes all consumption, whether at home or in a restaurant. Count "vegetarian hot dogs" under the next item, "meat substitutes made from soy". Includes only regular tofu, not including fermented or dry, spiced, or 24

Fried fish... Other fish, not fried Hot dogs... Are your hot dogs ... Bologna...

Are your lunch meats ... Noodles, macaroni, Pasta salad Tofu, bean curd

koritofu. Meat substitute s, such as ... This includes all dishes made with a soy-based meat substitute, such as veggie-burgers made from soy, or tofu hot dogs. This is not just veggieburgers, but veggieburgers made from soy.

Q by Q --Snacks Snacks, like potato chips... Are these snacks... These should be reported here even if respondent reports eating only low-salt or low-fat varieties. Exclude items here only if respondent eats only air-popped popcorn. The program will use the answer to this question to choose the fat content of the snacks whose frequency was reported above. This question should be answered based on the type of salty snack he or she eats most often. Any nuts, including walnuts, etc., or seeds such as sunflower. Saltines, or any other crackers This is intended to capture full-fat types of doughnuts and pastries. If they eat a low-fat kind of pastry such as Entenmann= s coffee cake, they should report it in the next item. All kinds of cakes or coffee cakes, home-made or packaged, including snack cakes. The program will use the answer to this question to choose the fat content of the cakes/pastries whose frequency was reported above. If respondent usually eats low-fat cakes (such as Entenmann= s) but eats regular-fat varieties of other foods in the item above, this question should be answered based on the food he or she eats most often. All kinds, all sizes. Since cookies can vary widely in size, the portion size is best recorded in terms of the wood blocks. They may push them into shapes to help them estimate. The program will use the answer to this question to choose the fat content of the cookies whose frequency was 25

Peanuts, other nuts and seeds Crackers Doughnuts , Danish pastry Cakes, sweet rolls... Are they...

Cookies

Are your cookies...

reported above. Ice cream... Is your ice cream... All forms including ice cream bars, fast-food milkshakes, etc. The program will use the answer to this question to choose the fat content of the ice cream whose frequency was reported above. Again, this question should be answered based on the type of ice cream he or she eats most often. Include pies or puddings made with pumpkin or sweet potato. However, do not double-count the frequency of sweet potato reported in an earlier item. All forms, fruit-filled or not. Include fast-food pies. Only chocolate-covered or chocolate-based candy and candy bars should be included here. The point is the chocolate, not just any candy. Any sugar-based non-chocolate candy.

Pumpkin pie... Any other pies... Chocolate candy, candy bars Other candy...

Q by Q --Breads, etc Point out the different frequency categories to the respondent. For foods on this page, a response of "every day" always needs to be probed to determine whether the food is eaten once a day or more often. Then, it is important to phrase the serving size question as "How many each time". For example, if the respondent answers that she eats bread twice a day, the portion size should refer to how many slices she eats on each of those times. Suppose she eats bread "twice a day", and has two slices each time; you would record "2+ per day" as her frequency, and "2" as her portion size. (If she is more comfortable telling you she eats four slices per day, it is okay to record "every day" and then "4". But it is important to be careful that you do not accidentally record "2+ per day" for frequency and "4" for portion, as that would give her eight slices per day rather than four.) If the respondent eats bread "twice per day", but has a different portion size each time, she may have difficulty coding her consumption correctly. The easiest way to handle may be for you to convert her frequency of consumption to "every day", and then code the portion size as the total number of pieces consumed each day. For example, if the respondent eats two slices of bread for lunch and one slice of bread for dinner, you may code this as "Every day", and "3 slices". 26

Biscuits or muffins...

Biscuits include homemade or from fast food places such as Kentucky Fried Chicken, McDonalds. Muffins include kinds such as bran muffins, blueberry muffins, etc., but do not include English muffins, which should be included under 'Rolls,...', below. All types, all sizes. Note that these items come as two halves. Therefore, if they only eat 1/2 a bagel, etc., the portion size should be marked as "1/2". Only a whole bagel, English muffin, hamburger bun, etc., should be marked as "1". Includes whole wheat, rye, pumpernickel, or other dark breads. In reporting portion size, the response is in "slices". Include bread eaten in sandwiches. White, French, Italian, etc., all forms. In reporting portion size, the response is in "slices". Include bread eaten in sandwiches. Includes cornbread, corn muffins, hush puppies. Includes flour and corn tortillas. Portion size is in number of tortillas each time. This includes not only rice eaten by itself, but also as fried rice, Rice-a-roni, beans-n-rice, rice pudding, etc. All forms, on bread or added to vegetables at the table. A "pat" is about one teaspoonful.

Rolls, Hamburge r buns, English muffins, bagels Dark bread... White bread... Cornbread. .. Tortillas Rice, or dishes ... Margarine on bread or potatoes... Butter on bread or potatoes... Gravy Peanut butter Mayonnais e,

All forms, on bread or added to vegetables at the table. A "pat" is about one teaspoonful. Include meat gravies or packaged varieties. Other nut butters may also be included in this item. All types 27

sandwich spreads Catsup, salsa... Mustard, soy sauce... All kinds of tomato-based condiments. Any other type of sauce, not already captured above.

Concluding Questions The last questions are not used by the nutrient calculations. However, they are important aids in understanding the results, and their presence on the same file will often aid in interpretation. Self-assessed health status: This simple question has been shown in numerous studies to be a powerful predictor of subsequent morbidity and mortality. It appears to be even more powerful a predictor than such objective measures as medical conditions, or physician examination. Repeated weight loss: In addition to being individually implicated in cardiovascular disease, this behavior alters metabolism and thus the relationship between energy intake and resulting body weight. Smoking: Current smoking is not only a risk factor for most health conditions, but it reduces plasma levels of many nutrients, and alters the relationship between intake and tissue level. Thus, even validation studies are poorly interpretable without this question. Language spoken: This may provide clues to the respondent= s ability to self-administer this or other questionnaires. In addition, if unusual nutrient estimates are observed, this may serve to indicate that the food list on the questionnaire was not quite appropriate for this respondent= s ethnicity. Ethnicity: Similar rationale as for language.

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