Experimental Study of Trans Fat Claims on Foods

ATTACHMENT F:

DRAFT QUESTIONNAIRE

INTRODUCTION: Thank you for agreeing to participate in this study of foods and food labels. Today you will be looking at the food label for an everyday food product. We are less concerned about how the label looks, than with what it says. This product is not currently available for sale but it is similar to products you may have seen or purchased.

Your participation is completely voluntary. Your answers are kept strictly confidential

and reported in statistical form only.

START: SHOW FRONT PANEL OF FOOD LABEL [margarine, pound cake or crackers]

Please look at this food label.

1. Does the label say or suggest anything about health benefits associated with

this product?

1……..No [If no, program skips to Q. A3)

2……..YES:

2. What does the label say or suggest about health benefits associated with this

product?

[Pre-codes to be developed in pretests]

Now please CLICK to the next page. Please take a moment to look at the back label for this product.

3. Overall, how important would this product be as part of a healthy diet? On a scale from 1 to 7, where 1 means “Very Important” and 7 means “Not at all Important”

VERY IMPORTANT 1

2

3

NEITHER IMPORTANT NOR 4

UNIMPORTANT

5

6

NOT AT ALL IMPORTANT 7

4. If you were going to eat this product, how healthful a choice would this be?

VERY HEALTHFUL 1

2

3

NEITHER HEALTHFUL NOR 4

UNHEALTHFUL

5

6

NOT AT HEALTHFUL 7

5. On a scale from 1 to 7, where 1 means VERY LIKELY and 7 means VERY

UNLIKELY, how likely is it that eating this product as a regular part of your

diet would…

5a. Raise your risk of having a heart attack?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

5b. Raise your risk of having high blood cholesterol?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

5c. Raise your risk of becoming overweight?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

5d. Raise your risk of having high blood pressure?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

6. Do you consider [this Margarine/Pound Cake]/these Crackers] to be high,

medium or low in …?

[RANDOM START].

NUTRIENT HIGH MEDIUM LOW

1. Calories 1 2 3

2. Total Fat 1 2 3

3. Saturated Fat 1 2 3

4. Trans Fat 1 2 3

5. Cholesterol 1 2 3

f. Sodium 1 2 3

g. Carbohydrates 1 2 3

7. If you were going to buy [this Margarine/Pound Cake] [these Crackers],

how likely would you be to read …?

1. A statement on the front of the package that the product has zero (0)

grams of trans fat?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

b. The Nutrition Facts information about trans fat?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

c. The Nutrition Facts information about calories?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

d. The Nutrition Facts information about saturated fat?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

e. Information on the label about how much trans fat you should eat?

VERY LIKELY 1

2

3

NEITHER LIKELY NOR 4

UNLIKELY

5

6

VERY UNLIKELY 7

8. Have you or has anyone currently living in your household ever

HEALTH CONDITION YES NO DON’T KNOW

1. Had heart disease? 1 2 3

2. Had diabetes? 1 2 3

3. Had high blood pressure? 1 2 3

4. Had a stoke? 1 2 3

5. Been treated for cancer? 1 2 3

6. Been diagnosed as overweight 1 2 3

or obese?

9. In the last two weeks, can you remember an instance where your decision to

buy or use a food product was changed because you read the nutrition label?

Yes 1

No 2

BACKGROUND QUESTIONS FOR STATISTICAL PURPOSES

10. Gender:

Male 1

Female 2

11. What is your date of birth?

______________________
MMDDYYYY

12. What was the last grade or year of school you completed?

a. 8^TH grade or less

b. 9^TH-11^TH grade

c. 12^TH grade/high school graduate/GED

d. Trade or technical training after high school

e. 1-3 years college/associate degree/junior college

f. 4 year college graduate

g. Post graduate