1 Survey

Appendix A

A.2.1.a.2–1

National Children’s Study
Interviewer Instruction Scripts for Completion of Dietary Questionnaires
DIETARY SCRIPT # 1 – P1 OR T1 DIETARY QUESTIONNAIRES COMPLETION
INSTRUCTIONS ARE PROVIDED TO THE MOTHER FOR QUESTIONNAIRES THAT ARE LEFT
WITH HER TO COMPLETE. THE COMPLETED QUESTIONNAIRES WILL BE EITHER PICKED UP
BY THE DATA COLLECTOR OR MAILED BACK BY THE PARTICIPANT. IF A PRE-CONCEPTION
HOME VISIT IS NOT COMPLETED BEFORE PREGNANCY, THESE QUESTIONNAIRES ARE GIVEN
AT THE T1 VISIT.
So that I do not take up more of your time today, I’m going to give you some forms to
complete on your own. The 2 food booklets are called the Food Frequency Questionnaire and
the 3-Day Food Checklist. All of the forms contain instructions on how to complete them, but I
will take some time right now to go over the instructions with you.
A. FOOD FREQUENCY QUESTIONNAIRE SCRIPT
1. This is a Food Frequency Questionnaire. We want to know about the foods you eat. For
all of these questionnaires, you will need to use a black or blue ball-point pen and I have
one for you. [HAND RESPONDENT PEN] Do not use a pencil or felt-tip pen.
2. [USE QUESTIONNAIRE AS GUIDE] On page 2, there are directions for completing this
questionnaire in case you need to refer to them later. First, fill in today’s date, and the
month and year you were born.
3. IF P1 VISIT: Answer all about your usual dietary intake over the past 3 months.
IF T1 VISIT: Answer all questions about your usual dietary intake during 3 months before
you became pregnant.
4. Do the best you can. Estimate if you can’t remember since a guess is better than leaving
a blank.
5. If you mark “Never” or “No” for a question, please follow the arrows to the next
question. [POINT TO AN EXAMPLE OF AN ARROW IN THE BOOKLET]
6. If you need to make a change to your answer, fill in the box containing the wrong
answer completely and put an “X” in the correct box. [POINT TO INSTRUCTIONS]
B. 3-DAY

FOOD CHECKLIST SCRIPT

1. Here’s another form about the food you eat. For this one, we are asking you to record
the food you eat over 3 days. There is one checklist page for each day.
2. We want you to record one weekend day, and two weekdays. So, you will begin on
Thursday/Sunday. [MARK DAYS ON FORM – EITHER THURSDAY, FRIDAY AND
SATURDAY, OR SUNDAY, MONDAY AND TUESDAY]. Let’s look at the booklet. On page
2 you will enter the start date and the day of the week.

Dietary Script # 1

Drafted: 08/29/08

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Appendix A

A.2.1.a.2–2

National Children’s Study
Interviewer Instruction Scripts for Completion of Dietary Questionnaires
3. Now let’s look at the examples on page 1.
4. The food checklist asks about some but not all of the foods you eat. For example, the
dairy section lists “Milk whole”, “Milk skim”, etc. The list does not include all dairy foods
and that’s ok.
5. Record how many different times you eat a food each day, not how many servings you
have each time.
6. Let’s look at the second example on page 1. It says “I ate 2 pieces of cornbread at
lunch.” Only 1 “X” is marked because both pieces were eaten at the same meal.
7. When you eat something that is a mix of foods on the list, make an “X” for each food
included.
8. Let’s look at the third example, lasagna. For this example, you would mark pasta
noodles, beef and tomatoes.
9. At the end of each day make sure you answer question 4 about how many organic foods
you ate.
10. After you complete the booklets, turn through the pages to make sure that you have not
skipped any pages. Also make certain that you have clearly indicated the correct answer
for any changes you have made.

Dietary Script # 1

Drafted: 08/29/08

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