Reporting: Survey

Appendix A

Comparing Nutrition Knowledge, Attitude and Behavior among

English-dominant Hispanics, Spanish-dominant Hispanics, and Other Consumers

DRAFT QUESTIONNAIRE

(June 2011)

[RECORD LANGUAGE USED IN THE QUESTIONNAIRE: ENGLISH OR SPANISH]

Form Approved: OMB No. 0910-xxxx

Expiration Date: xx/xx/201x

PUBLIC Disclosure Burden Statement

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:

Department of Health and Human Services
Food and Drug Administration
CFSAN/PRB Comments/HFS-24
5100 Paint Branch Parkway
College Park, MD 20740-3835.

A. knowledge, attitude and behavior toward nutrition and health

A1 [NSS E3]

Think about shopping for food products at the store. On a scale of 1 to 5 where 1 is not important at all and 5 very important, how important to you is each of the factors listed below? [RANDOM ORDER]

1 2 3 4 5 Don’t know (DK)

a. taste

b. price

c. brand

d. healthiness or nutritional qualities

e. convenience

A2 [2004 HDS C1]

How much do you agree or disagree with each of the following statements? [RANDOM ORDER]

Strongly agree Somewhat agree Somewhat disagree Strongly disagree DK

1. If I get the right amount of exercise, I can greatly reduce my chance of getting heart disease.

2. Some people are born to be fat and some thin; there is not much one can do to change this.

3. I generally know which fast food items have more calories and which have fewer calories.

4. To lose weight, one must give up some of his or her favorite foods.

5. There are so many recommendations about healthy ways to eat; it is hard for me to know what to believe.

6. If I eat a healthy diet I can greatly reduce my chance of getting heart disease.

7. If I eat a healthy diet I can greatly reduce my chance of getting cancer.

8. I generally know which menu items in a restaurant have more calories and which have fewer calories.

A3 [2004 HDS B5]

Compared to what you believe is healthy, do you think your diet is too low, too high, or about right in [RANDOM ORDER]

Too low Too high About right DK

1. calories

2. fiber

3. sugar

4. fat

5. cholesterol

6. carbohydrates

A4 [2004 HDS C10]

Have you tried to limit any of the following things in your diet in the past 30 days? [RANDOM ORDER]

Yes No DK

1. calories

2. fat

3. sodium

4. sugar

5. cholesterol

6. carbohydrates

A5 [2004 HDS B1]

The next questions ask about different kinds of fat in foods we eat. Have you ever heard of the following types of fat? [RANDOM ORDER]

Yes No DK

1. trans fat or trans fatty acid

2. saturated fat

3. omega 3 fatty acid

A6 [2004 HDS B2] [[IF ANSWER TO AN ITEM IS YES, ASK A6 FOR THE SAME ITEM; KEEP SAME ORDER AS IN A5]

As far as you know, does [insert fat] raise the risk of heart disease, lower the risk of heart disease, or have no effect on the risk of heart disease, or don’t you know?

Raises the risk of heart disease

lowers the risk of heart disease

has no effect on the risk of heart disease

DK

A7 [2004 HDS C2]

If one wants to lose weight, which is more important, [RANDOM ORDER] eating less fat or eating fewer calories?

Less fat Less calories DK

A8 [2002 HDS N1]

Have you taken a multi-vitamin or multi-mineral supplement in the past 12 months, that is, since (month) 2010? [THESE PRODUCTS ARE THINGS LIKE ONE-A-DAY, MEGA-VITAMIN, CENTRUM A-TO-ZINC, AND OTHER PRODUCTS THAT CONTAIN A VARIETY OF DIFFERENT VITAMINS, MINERALS, AND MAY ALSO CONTAIN OTHER THINGS AS WELL.]

Yes No DK

A9 [2002 HDS N2]

In the past 12 months, have you taken a specialized or single-ingredient vitamin or mineral supplement such as Vitamin C, Vitamin E, iron, or calcium?

Yes No DK

A10 [2002 HDS N3]

Have you taken any kind of herbs, botanicals, or other dietary supplements in the past 12 months, that is, since (month) 2010? These products are things like garlic pills, echinacea, ginkgo, glucosamine, St. John's wort, amino acids, or fish oil.

Yes No DK

A11 [HDS2002 C0] [IF ANY OF A8, A9, A10 = YES]

Before you try a dietary supplement for the first time, do you usually, sometimes, hardly ever, or do you never look for information about the supplement?

Usually sometimes hardly ever never DK

A12 [2002 HDS C1] [IF A11 IS NOT HARDLY EVER OR NEVER]

How much information about a dietary supplement product do you get from each of the following sources? [KEEP a-b AS FIRST TWO ITEMS AND ROTATE items c – h]

A lot of information A little of information No information DK

a. a medical doctor, physician's assistant, registered nurse, or dietitian

b. an alternative medicine practitioner like a nutrition therapist or a herbal therapist

[ALSO INCLUDES: PRACTITIONER/THERAPIST

OF ACUPUNCTURE, BIOFEEDBACK,

CHIROPRACTIC, CHELATION THERAPY,

ENERGY HEALING/REIKI, FOLK MEDICINE,

HEPNOSIS, HERBAL THERAPY, HOMEOPATHY,

MASSAGE, NATUROPATHY, NUTRITION

THERAPY, OSTEOPATHY.]

c. family or friends

d. a sales person at a store

e. newspapers, magazines, books, or medical articles

f. television or radio

g. the Internet

h. product labels

A13 [2002 HDS B1a] [IF ANY OF A8, A9, A10 = YES]

As far as you know, does the government set manufacturing standards for dietary supplements?

Yes No DK

A14 [2002 HDS B1b] [IF ANY OF A8, A9, A10 = YES]

As far as you know, does the government approve dietary supplements before they are marketed to consumers?

Yes No DK

B. health literacy, and use and understanding of food labels and label information

[SHOW THE NUTRITION FACTS LABEL]

B1 [Weiss et al., 2005]

Please look at this label as long as you like. The next six questions will be about this label. If you eat the entire container, how many calories will you eat?

__________ calories

B2 [Weiss et al., 2005]

If you are allowed to eat 60 g of carbohydrates as a snack, how much of this product could you have?

__________

B3 [Weiss et al., 2005]

Suppose your doctor advises to reduce the amount of saturated fat in your diet. You usually have 42 g of saturated fat each day, which includes 1 serving of this product. If you stop eating this product, how many grams of saturated fat would you be consuming each day?

__________ grams

B4 [Weiss et al., 2005]

If you usually eat 2,500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving of product?

__________ percent

B5 [Weiss et al., 2005]

Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings. Is it safe for you to eat this product?

Yes No DK

B6 [Weiss et al., 2005] [IF B5 = NO]

Why is it not safe for you to eat this product?

_______________________

[B7-B12: AT EACH QUESTION, SHOW THE SAME LABEL AS IN B1]

B7 [2005-2006 NHANES DBQ770]

How often do you use the information on the serving size on a food label?

Always most of the time sometimes rarely never DK

B8 [2007-2008 NHANES CBQ685]

How about the information on the percent daily value?

Always most of the time sometimes rarely never DK

B9 [2007-2008 NHANES CBQ695]

Now think about the serving size information on a food label. What does serving size mean to you? Please check all that apply. You can also fill in your answer, if it is not listed. [RANDOM ORDER, EXCEPT ITEM D]

1. the amount of a food that people should eat

2. the amount of a food that people usually eat

3. something that makes it easier to compare foods

4. Other ___________________

B10

Next, look at the label and focus on the “total fat” line. There is a 20% under “% Daily Value.” What does the “20%” mean to you? [RANDOM ORDER, EXCEPT ITEM F]

1. The product has 20% of the minimum amount of total fat that a person should eat in a day

2. 20% of the weight of this product is total fat

3. The product has 20% of maximum amount of total fat that a person should eat in a day

4. A person should get 20% of calories from total fat in a day

5. The product has 20% of the total fat that a person should eat in a day

6. Other _____________________

B11 [NSS E5]

When you buy a food product for the first time, how often do you read the label, like the one you see here, to find out how much it has in things like calories, fat, sodium, or vitamins?

Regularly Occasionally Hardly ever Never DK

B12 [2008 HDS C2]

People tell us they use food labels in many different ways. When you read food labels, either in the store or at home, how often, if at all, do you use the labels in the following ways? [RANDOM ORDER]

Often Sometimes Rarely Never DK

a. To help you decide which brand of a particular food item to buy

b. To figure out how much of the food product you or your family should eat

c. To compare different food items with each other

d. To see if something said in advertising or on the package is actually true

e. To get a general idea of the nutritional content of the food

f. To see how high or low the food is in things like calories, salt, vitamins, or fat

g. To help you in meal planning

h. To see if there is an ingredient that you or someone in your family should avoid

B13 [2008 HDS C10]

Food packages sometimes have statements on the front of the package that describe the amount of certain nutrients in the product, such as “low fat,” “high fiber” or “cholesterol-free.” When it is available, how often do you use this information on certain nutrients when deciding to buy a food product?

Often Sometimes Rarely Never DK

B14 [2008 HDS C11]

About how many of the food labels that use statements like “low fat,” “high fiber” or “cholesterol free” to describe the amount of certain nutrients, do you believe are accurate?

Just about all of them Most of them Only some of them

Almost none of them DK

B15 [1994-96 DHKS]

How much do you agree with each of the following statements? Please select one for each statement. [RANDOM ORDER]

Strongly agree Somewhat agree Somewhat disagree Strongly disagree DK

1. I feel confident that I know how to use food labels to choose a nutritious diet

2. The nutrition information on food labels is hard to interpret

3. Reading food labels takes more time than I can spare

4. I would like to learn more about how to use food labels to choose a nutritious diet

5. Using food labels to choose foods would be better than just relying on my own knowledge about what is in them

B16 [HCHS; Latino Panelists only]

Of Hispanic/Latino and American food, do you usually eat

1. Mainly Hispanic/Latino foods

2. Mostly Hispanic/Latino foods and some American food

3. Equal amounts of both Hispanic/Latino and American foods

4. Mostly American foods and some Hispanic/Latino foods

5. Mainly American foods

B17. [HCHS; ALL respondents]

How often do you or your family usually go out to eat at or bring home ready-to-eat foods from

Less than 1-2 times per week 3-4 times per week 5 or more times per week Never DK

1. Relatives’ or Friends’ homes

2. Fast food restaurants (including Chinese and Latino food)

3. Sit down restaurants (with table service)

4. Buffet restaurants (including Chinese buffet)

5. Pick-up-and-take-home restaurants

6. Grocery stores (hot or cold ready-to-eat food from store)

7. Cafeterias (school or work)

8. Vending machines

9. On-street vendors (including trucks, carts, wagons)

10. Other (for example quick marts and bakeries)

B18 [IF B17b = YES]

Do you remember seeing at fast-food restaurants the numbers of calories for different foods and drinks? This information may be shown behind the cashier.

Yes No DK

B19 [IF B18 = YES]

Have you ever decided on what to order at fast-food restaurants because you saw the numbers of calories for different foods and drinks?

Yes No DK

B20 [IF B17c = YES]

Do you remember seeing at the sit-down restaurant information on how many calories each food or drink has? This information may be shown on the menu or on napkins and placemats.

Yes No DK

B21 [IF B20 = YES]

Have you ever decided on what to order at sit-down restaurants because you saw the numbers of calories for different foods and drinks?

Yes No DK

C. Degree of acculturation

[LATINO PANELISTS ONLY]

C1 [Hamilton, A.S. et al]

In general, what language(s) do you read and speak?

Only Spanish Spanish better than English Both equally

English better than Spanish Only English DK

C2 [Hamilton, A.S. et al]

What language(s) do you usually speak at home?

Only Spanish Spanish better than English Both equally

English better than Spanish Only English DK

C3 [Hamilton, A.S. et al]

In which language(s) do you usually think?

Only Spanish Spanish better than English Both equally

English better than Spanish Only English DK

C4 [Hamilton, A.S. et al]

What language(s) do you usually speak with your friends?

Only Spanish Spanish better than English Both equally

English better than Spanish Only English DK

C5 [HCHS]

Which of the following best describes your Hispanic/Latino heritage? (Check one)

Dominican or Dominican descent

Central American or Central American descent

Cuban or Cuban descent

Mexican or Mexican descent

Puerto - Rican or Puerto Rican descent

South American or South American descent

More than one heritage

Other

DK or Prefer not to answer

D. health status and demographic characteristics

D1 [NSS J1]

Would you say your health in general is …

Excellent Very good Good Fair Poor DK

D2 [NSS J2]

Are these health problems of concern to you? Check all that apply. [RAMDOM ORDER]

1. cancer

2. diabetes

3. heart disease

4. hypertension or high blood pressure

5. high cholesterol

6. obesity or overweight

7. osteoporosis or bone problem

8. stroke

D3 [2004 HDS C35]

Do you consider yourself to be …

Overweight Underweight About the right weight DK

D4 [2004 HDS C36] [IF D3= OVER- OR UNDERWEIGHT]

Are you concerned about your being over/underweight?

Yes No DK

D5 [2004 HDS C37] [IF D4=YES]

Are you very concerned or somewhat concerned about your being over/underweight?

Very concerned somewhat concerned DK

D6 [2004 HDS C38]

Are you taking any action about your weight?

Yes No DK

D7 [2004 HDS D9]

The next two questions may seem a bit personal, but we need this information because our research is about nutrition and health. How tall are you without shoes?

____ feet _____ inches (or _______ cm) Prefer not to answer

D8 [2004 HDS D10]

How much do you weigh without shoes?

_____ pounds (or ______ kg) Prefer not to answer

END OF QUESTIONNAIRE

Sources of questions:

2002, 2004, 2008 HDS - FDA Health and Diet Survey

2007-2008 NHANES. National Health and Nutrition Examination Survey, Flexible Consumer Behavior Module (http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/fcbs_e.pdf)

Hamilton, A.S., et al. “Latinas and Breast Cancer Outcomes: Population-Based Sampling, Ethnic Identity, and Acculturation Assessment.” Cancer Epidemiologic Biomarkers 18,7(2009): 2022-9.

NSS – FDA Nutrition Symbol Study (2010)

Weiss, B.D., et al. “Quick Assessment of Literacy in Primary Care: The Newest Vital Sign.” Annals of Family Medicine 3,6(2005): 514-522.

NHLBI Hispanic Community Health Study/Study of Latinos (HCHS/SOL) http://www.cscc.unc.edu/hchs/public/COM02EXAPersonalInformation08272009.pdf

(Spanish: http://www.cscc.unc.edu/hchs/public/COM02EXAPersonalInformationSpanish08272009.pdf)

http://www.cscc.unc.edu/hchs/public/COM02EXADietaryBehavior08272009.pdf

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