Food Frequency Questionnaire

Form Approved:

OMB No. 0923-0046

Exp. Date 02/29/2016

FOOD FREQUENCY QUESTIONNAIRE

Please tell me how often on average you have eaten a serving of each of the following foods during the past 4 weeks. If you usually eat more than a serving at a time, please tell me about how much you eat at a time.

For Interviewer use only:

Read all responses for the first few questions, until the participant understands them. Thereafter, use

responses to prompt as needed. Use the food portion size models if necessary. Remind respondent of 4-week time frame as needed. If respondent has difficulty, go through the responses in the following manner:

Have you eaten any of this food in the past four weeks?

If no, code as “Never” and skip to next question.

If yes, continue:

Would you say you have eaten this food at least weekly in the past four weeks?

If no, code as “1-3 times in the past 4 weeks” and skip to next question.

If yes, continue:

Would you say you have eaten this food at least daily in the past four weeks?

If no, ask: How many times a week have you eaten this in the past four weeks?

If yes, ask: How many times a day have you eaten this in the past four weeks?

Additional prompt: What is your best guess?

Dairy

FFQ_1. An 8-ounce glass of skim or low-fat milk. Not whole milk. Skim or low fat milk.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_2. An 8-ounce glass of whole milk.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Public reporting burden of this collection of information is estimated to average 20 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-XXXX).

Public reporting burden of this collection of information is estimated to average 45 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0046).

FFQ_3. 1 cup of yogurt.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_4. ½ cup of ice cream.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_5. ½ cup of cottage cheese or ricotta cheese.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_6. 1 slice or 1 ounce of some other kind of cheese, like American Cheddar. Please count cheese that

you ate either alone or as part of another dish.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_7. 1 pat (teaspoon) of margarine added to food or bread. Don’t count margarine used in cooking.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_8. 1 pat (teaspoon) of butter added to food or bread. Don’t count butter used in cooking.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Fruits

FFQ_9. 1 fresh apple or pear.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_10. 1 orange, 1 tangerine or ½ grapefruit.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_11. 1 small glass of orange juice or grapefuit juice.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_12. 1 fresh or ½ cup canned peaches, apricots, plums or nectarines.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_13. 1 banana.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_14. ½ cup of papaya or mango.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_15. ½ cup of some other fresh, frozen or canned fruit.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Vegetables

FFQ_16. 1 tomato or 1 small glass of tomato juice.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_17. ½ cup of string beans.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_18. ½ cup of broccoli.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_19. ½ cup of cabbage, cauliflower, or Brussels sprouts.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_20. ½ raw carrot or 2-4 raw carrot sticks.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_21. ½ cup of cooked carrots.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_22. 1 ear of corn or ½ cup frozen or canned corn.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_23. ½ cup of fresh, frozen, or canned peas or lima beans.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_24. ½ cup of sweet potatoes or yams.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_25. ½ cup of cooked spinach, collard greens, kale or mustard greens.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_26. ½ cup of baked or dried beans or lentils.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_27. ½ cup of yellow (winter) squash or pumpkin.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_28. ½ cup of wild spinach or other native (wild) plants.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Meat, Fish, and Eggs

FFQ_29. 1 egg.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_30. 4 to 6 ounces of chicken or turkey, with skin.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_31. 4 to 6 ounces of chicken or turkey, without skin.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_32. 2 slices of bacon.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_33. 1 hot dog or corn dog.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_34. 1 slice of processed meat, like salami or bologna, or a small piece of sausage.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_35. 3 to 4 ounces of liver.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_36. 1 hamburger or Navajo burger.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_37. Beef, pork or lamb (mutton), as a sandwich or in a mixed dish, like a stew or casserole or in lasagna.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_38. 4 to 6 ounces of beef, pork or lamb (mutton), as a main dish, like steak, roast or ham.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_39. 3 to 5 ounces of fish. Remember to count canned fish, like tuna fish.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Sweets, Cereal and Baked Goods

FFQ_40. 1 ounce of chocolate.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_41. 1 ounce of candy without chocolate.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_42. 1 slice of homemade pie.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_43. 1 slice of store-bought pie.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_44. 1 slice of cake.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_45. 1 cookie.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_46. 1 cup of cold breakfast cereal.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_47. 1 cup of hot breakfast cereal.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_48. 1 slice of white bread. Count pita bread.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_49. 1 slice of dark bread. Count wheat pita bread.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_50. 1 tortilla.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Other Foods

FFQ_51. 1 Navajo taco.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_52. 1 serving of frybread.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_53. 1 serving of blue corn mush.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_54. 4 ounces of French fried (or lard-fried) potatoes.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_55. 1 baked or boiled potato or 1 cup mashed potatoes.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_56. 1 cup of plantain, green banana, yucca or ñame.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_57. 1 cup of rice or pasta, like spaghetti or noodles.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_58. 1 small bag or 1 ounce of potato chips or corn chips.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_59. 1 small packet or 1 ounce of nuts.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_60. 1 tablespoon of peanut butter.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_61. 1 tablespoon of oil and vinegar dressing, like Italian.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Beverages

FFQ_62. 1 cup of coffee. Don’t count decaffeinated coffee.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_63. 1 cup of tea. Don’t count herbal or decaffeinated tea.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_64. 1 glass, bottle, or can of beer (or malt liquor).

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_65. 4 ounces of wine (or wine cooler).

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_66. 1 drink or shot of liquor, like whiskey or gin.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_67. 1 glass or can of low-calorie carbonated beverage, like Diet Coke.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_68. 1 glass or can of carbonated beverage with sugar, like Coke or Pepsi.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

FFQ_69. 1 glass of Hawaiian Punch, fruit punch, lemonade or other fruit drink.

( )0 Never

( )1 1-3 times in the past 4 weeks

( )2 1 per week

( )3 2-4 per week

( )4 5- 6 per week

( )5 1 per day

( )6 2-3 per day

( )7 4-5 per day

( )8 6 or more per day

Other Eating Habits

FFQ_70. Are there any other foods that you usually eat at least once per week that I did not mention?

( )0 No

( )1 Yes

If yes, ask and record in the table below.

What foods are these?

For each food, ask:

What is the usual serving size that you eat each time you have that?

If the respondent has difficulty, ask her to point out the size using the food model.

About how many servings per week do you eat of that?

Other foods eaten at least once a week Usual serving size # Servings per week

FFQ_70a. _____________________________________ _______________ ________________

FFQ_70b. _____________________________________ _______________ ________________

FFQ_70c. _____________________________________ _______________ ________________

FFQ_70d. _____________________________________ _______________ ________________

FFQ_70e. _____________________________________ _______________ ________________

FFQ_70f. _____________________________________ _______________ ________________

FFQ_70g. _____________________________________ _______________ ________________

FFQ_70h. _____________________________________ _______________ ________________

FFQ_70i. _____________________________________ _______________ ________________

FFQ_71. In all, about how many teaspoons of sugar do you add to your drinks or food each day?

_____ _____ tsps

FFQ_72. Do you take any prenatal vitamins?

( )0 No → [skip to FFQ_73]

( )1 Yes

FH_73. Do you know the type of pre-natal vitamins you are taking?

( )0 No

( )1 Yes, Specify brand or type_______________________________________________________

FFQ_74. Do you take any other multi-vitamins?

A multivitamin is one pill that contains several different vitamins and minerals, such as One-A-Day or Centrum. [If the respondent cuts you off, prompt: So you take a pill that contains several different vitamins and minerals, like One-A-Day or Centrum, other than prenatal vitamins?]

( )0 No → [skip to FFQ_75]

( )1 Yes

FFQ_74a. If yes, specify type _______________________________________

FFQ_74b. If yes, how often do you take multi-vitamins?

( )0 Never

( )1 Less than once per week

( )2 1 day per week

( )3 2 days per week

( )4 3 days per week

( )5 4 days per week

( )6 5 days per week

( )7 6 days per week

( )8 7 days per week

FFQ_75. Do you take any other vitamin supplements? [For example, calcium or vitamin C]

( )0 No→ [skip to FH_76]

( )1 Yes

FFQ_75a. If yes, specify type _______________________________________

(List all that apply)

FFQ_75b. If yes, how often do you take other vitamin supplements?

( )0 Never

( )1 Less than once per week

( )2 1 day per week

( )3 2 days per week

( )4 3 days per week

( )5 4 days per week

( )6 5 days per week

( )7 6 days per week

( )8 7 days per week

FFQ_76. How much of the visible fat on your beef, pork or lamb do you remove before eating?

( )1 Remove all visible fat

( )2 Remove most of fat

( )3 Remove small part of fat

( )4 Remove none of fat

( )5 Not applicable, do not eat meat

FFQ_77. What kind of fat do you usually use for frying and sautéing at home? Don’t count “Pam”-type sprays.

( )1 Real butter

( )2 Regular margarine

( )3 Reduced-fat margarine

( )4 Vegetable oil (including olive oil)

( )5 Vegetable shortening

( )6 Lard

( )7 Not applicable, do not use fat

( )8 Don’t know/Does not cook

FFQ_78. What kind of fat do you usually use for baking at home?

( )1 Real butter

( )2 Regular margarine

( )3 Reduced-fat margarine

( )4 Vegetable oil (including olive oil)

( )5 Vegetable shortening

( )6 Lard

( )7 Not applicable, do not use fat

( )8 Don’t know/Does not cook

FFQ_79. How often do you eat food that is fried at home? Don’t count food fried using “Pam”-type sprays.

( )0 Never or less than once per week

( )1 1-3 times per week

( )2 4-6 times per week

( )3 once per day

( )4 2 or more times per day

FFQ_80. How often do you eat fried food away from home, such as from a restaurant or fast-food place? Think about foods like french fries, fried chicken, or fried fish.

( )0 Never or less than once per week

( )1 1-3 times per week

( )2 4-6 times per week

( )3 once per day

( )4 2 or more times per day

FFQ_81. When you ate bread over the past four weeks, how often did you eat whole-grain breads, such as whole wheat, whole-grain rye and multi-grain?

( )0 Never or does not eat bread

( )1 Seldom

( )2 Sometimes

( )3 Often

( )4 Almost always

( )8 Does not know

FFQ_82. When you ate breakfast cereal over the past four weeks, how often did you eat brands that were high in fiber? These are cereals such as Cheerios, All Bran, Bran Flakes, Shredded Wheat, Oatmeal and Grapenuts.

( )0 Never or does not eat cereal

( )1 Seldom

( )2 Sometimes

( )3 Often

( )4 Almost always

( )8 Does not know

FFQ_83. When you drank milk as a beverage over the past four weeks, was it usually:

( )0 Does not drink milk

( )1 Whole milk

( )2 2% milk

( )3 1% milk

( )4 Nonfat/skim milk

( )8 Does not know

Women’s Nutritional Questionnaire

(Adapted from Arizona Department of Health Services- Women Infants and Children(WIC))

ENERGY AND NUTRIENTS
1. If you are pregnant, how much weight do you think you should gain during this pregnancy? If you are postpartum, how much weight do you think you need to lose if any?
2. How do you feel about your weight change?	 Too little  Okay  Too much
3. How is your appetite?	 Poor  Fair  Good  Excellent
4. How many meals and snacks do you eat each day?
5. Are there any foods or food groups that you do not think you eat enough of, if yes, what foods?
6. How often do you eat fast food or at a restaurant?
FOOD GROUPS (PLEASE CHECK OR WRITE YOUR ANSWERS TO THE FOLLOWING QUESTIONS)
1. Do you drink milk, if yes, what kind?	 Skim  1%  2%  Whole  Lactaid  Soy Milk  Rice Milk  Other
2. Do you drink water, if yes, how much?
3. What other beverages do you drink each day?
4. Do you eat breads, pasta, and grains, if yes, what kind?	 White  100% Whole Wheat  Bran  Other
5. When selecting and preparing meat, what do you prefer?	 Regular  Lean  Extra Lean  Other  I don’t eat meat
6. What types of fruit and vegetables do you like to eat?
7. What sweets do you eat and how often?
8. What vitamins, minerals or supplements are you taking?	 None  Prenatal Vitamin (Amount Frequency )  Multivitamin (Amount Frequency )  Iron (Amount Frequency )  Minerals (Amount Frequency )  Herbs (Amount Frequency )  Folic Acid (Amount Frequency )  Other

Infant and Toddler (0-23 months) Nutritional Questionnaire

(Adapted from Arizona Department of Health Services- Women Infants and Children(WIC))

PRIMARY FEEDING
1. How would you describe feeding time with your infant/toddler?	Always pleasant Usually pleasant  Sometimes pleasant  Never pleasant
2. How do you know when your infant/toddler is hungry?
3. How do you know when your infant/toddler is full?
4. What types of food does your infant/toddler eat?	Baby cereal  Vegetables  Fruits Meats Desserts  Other
1. How did you know when your infant/toddler was ready to eat solid food?
2. Do you make your own infant/toddler food, if yes, what foods do you prepare?
3. How do you prepare your own infant/toddler food?
4. Does your infant/toddler follow a feeding schedule, if yes, please explain.
5. Is your infant/toddler picky with textures, if yes, please explain.
6. Does your infant/toddler feed himself/herself?
7. Has your infant/toddler started finger foods, if yes, what types of food?
8. If your infant/toddler has not started finger foods, when do you plan on introducing them?
9. What else does your infant/toddler drink other than breast milk or formula?
10. What vitamins, minerals or supplements does your infant/toddler take?	None  Multivitamin (Amount Frequency )  Iron (Amount Frequency )  Minerals (Amount Frequency )  Herbs (Amount Frequency )  Other

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