SEARCH Food Frequency Questionnaire

SEARCH for Diabetes in Youth Study

Att 4b.16_Food Frequency Feb 2014

SEARCH Food Frequency Questionnaire

OMB: 0920-0904

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Form Approved 
OMB No. 0920‐0904 
Exp. Date 11/30/2014 
 

 
    
         Food Questionnaire

 

 
This questionnaire was developed by Block Dietary Data System (© BDDS, Berkely CA, 510-704-8514) and modified by the University of South
Carolina, Arnold School of Public Health, Center for Research in Nutrition and Health Disparities.
Permission for use must be obtained from both organizations.
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 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D‐74, Atlanta, Georgia 
30333; ATTN: PRA (0920‐0904). 

 
SEARCH 3 Cohort Study ‐ Food Questionnaire revised 1‐03‐12 

This survey is about all the food you ate over the past week. This includes food eaten
anywhere like at home, school, a friend’s house, and in restaurants. There are no right or
wrong answers. Think about all the foods you ate over the past week and not just what you
think you should be eating.
Please, answer the questions by filling the bubbles using a sharp pencil. Do not use a pen.
Answer each question as best you can. If you are unsure, estimate what you ate. A guess is
better than leaving a blank. Be sure to fill in the bubbles completely. If you make a mistake,
just erase the mistake and fill in the correct bubble.
It is best to work on this in a quiet place without taking too many breaks.
If you complete this form at home, you should plan to do it as soon as you get it. If you
complete it before your study visit, please bring the form along to your study visit. If you take
it with you after your study visit, please have it returned within one week (return by
___/____/____). You should use the envelope provided to return your questionnaire.

Page 2

Please answer the next few questions before we ask you about specific foods:
Last week, about how many times each day did
you eat? (including meals & snacks)

O

O

O

O

O

O

O

0

1

2

3

4-5

6-7

8-10

Last week, about how many times did you eat school
lunch or breakfast?

O

O

O

O

O

O

O

0

1

2

3

4-5

6-7

8-10

Last week, about how many times did you eat out,
including fast food or pizza? (Not including school lunch
or breakfast)

O

O

O

O

O

O

O

0

1

2

3

4-5

6-7

8-10

Now you will go through a list of foods. This form is used by people all over the country so there might be foods listed that you never eat.
Don’t worry if you have never heard of some of these foods. Feel free to call ____________________________ if you have any questions
about foods listed or how to fill out this form.
 For each of the questions, think about whether or not you ate that food.
 Think about all the meals and snacks you had in the last week. These could be foods from anywhere-home, school, vending
machines, the mall, or a restaurant.
 You might never eat that food and that is okay. If you did not eat it, fill in the bubble next to “No”.
 If you did eat it, think about how often you ate that food over the last week.
o Fill in the bubble under the number of days you ate that food last week.
o Think about the amount of that food you ate each time. Mark the usual amount that you ate when you ate that food last
week. Use the pictures at the end of this booklet to help you estimate the amount of food you ate.
Here is an example of how to fill out the form. If you ate corn chips two days and tortilla chips one day last week and the amount you ate
looked like what is in the picture of the medium bowl, your answer would look like this:

Page 3 

First, you will tell us about the breakfast foods you ate last week. Please include times other than breakfast when you eat these foods.

Page 4 

Next you will tell us about the fruits that you ate last week.

Page 5 

Now you will tell us about meats and other main dishes that you ate last week.  Remember to include foods that you ate at home, summer camp, school, work, 
vending machines, and restaurants.   

 
Page 6 

Page 7 

Now you will tell us about soups, breads, and cheeses that you ate last week. Remember to include foods that you ate at home, at summer camp, school, work,
vending machines and restaurants.

Page 8 

Now you will tell us about the vegetables that you ate last week.  Remember to include foods that you ate at home, summer camp, school, work, from 
vending machines, or restaurants.   

VEGETABLES 
Type of Food 
Last week, did you eat any 
green salad? 

Yes  
or  
No 

               How many days last week? 
1 
2 
3‐4 
5‐6 
If Yes 
Day  Days 
Days 
Days 
 

    Yes 
    No 

How many 
days? 

 

 

 

 

 

Every 
Day 

 

Usual amount eaten in one day? 
See picture
Which bowl? 

 
S 

 
M 

 
L

 

 
 

Did you have green beans, or 
string beans? 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any baked beans, 
chili with beans, kidney beans, 
pork & beans or any other kind 
of beans? (not including refried 
beans) 
Did you eat refried beans (as a 
side dish)? 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate?  
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any corn, corn on 
the cob, or chicos? 

    Yes  How many 
    No  days? 

 

 

 

 

 

See picture
Which plate 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Last week, did you eat any 
tomatoes? (Don’t include 
tomato sauce) 

    Yes  How many 
    No  days? 

 

 

 

 

 

How many?
 
A little 

 
1/2 

 
1 

 
2

 

 
 

Did you eat any greens, 
including spinach, mustard 
greens, or turnip greens, or 
collards? 
Did you eat any broccoli?  

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 
 
 

 
Page 9 

 
L

 

 

VEGETABLES (Continued) 
Type of Food 
Did you eat any cauliflower, 
cabbage, Brussels sprouts, or 
kimchee? 

Yes  
or  
No 

               How many days last week? 
1 
Day 

If Yes 

    Yes  How many 
    No  days? 

 

2 
Days 
 

3‐4 
Days 
 

 

 

5‐6 
Days 

Every 
Day 

 

 

Usual amount eaten in one day? 
See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any coleslaw? 

    Yes  How many 
    No  days? 

 

 

 

 

See pictures
Which plate? 
How much? 

 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any carrots, either 
raw or cooked? 

    Yes  How many 
    No  days? 

 

 

 

 

See pictures
Which plate? 
How much? 

 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any other 
vegetables, like peas, squash, 
peppers, or okra? 

    Yes  How many 
    No  days? 

 

 

 

 

See pictures
Which plate? 
How much? 

 

 
VS 

 
S 

 
M 

 
L

 

 
 

When you eat cooked 
vegetables, about how often 
are these fried vegetables? 

 

Did you eat any sweet 
potatoes, or sweet potato pie? 

    Yes  How many 
    No  days? 

 
         Seldom or never            Sometimes          Almost always 
 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you eat any French fries, 
fried potatoes, Tater Tots, or 
hush puppies? 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

Did you have any other kind of 
potatoes, like baked, boiled, or 
mashed? 

    Yes  How many 
    No  days? 

 

 

 

 

 

See pictures
Which plate? 
How much? 

 
VS 

 
S 

 
M 
 
 

 
Page 10 

 
L

 

 

VEGETABLES (Continued) 
Type of Food 
Did you eat any steamed rice, 
brown rice, or Musubi? 
 Did you eat any fried rice? 

Yes  
or  
No 

               How many days last week? 
1 
Day 

If Yes 

    Yes  How many 
    No  days? 
    Yes  How many 
    No  days? 

 

2 
Days 
 

 

3‐4 
Days 
 

 

 

 

 

5‐6 
Days 

Every 
Day 

 

 

 

 

Usual amount eaten in one day? 
See pictures 
Which plate? 
How much? 
See pictures 
Which plate? 
How much? 

 
VS 

 
S 

 
M 

 
L

 

 
 

 
VS 

 
S 

 
M 

 
L

 

 
 

 

Now you will tell us about the condiments that you used on or with foods that you ate last week. 

CONDIMENTS 
 

Yes  
or  
No 

               How many days last week? 
1 
Day 

If Yes 

2 
Days 

3‐4 
Days 

 

 

5‐6 
Days 

Every 
Day 

 

Did you eat any gravy, like on 
mashed potatoes or on rice? 

    Yes  How many 
    No  days? 

 

 

 

 

 

 

Did you have any Ketchup, 
salsa, or barbecue sauce? 

    Yes  How many 
    No  days? 

 

 

 

 

 

 

Did you use ranch dressing or 
other salad dressing, either on 
salads or on any other food? 

    Yes  How many 
    No  days? 

 

 

 

 

 

 

Do you use any margarine or butter, like on bread, pancakes, on potatoes, or vegetables?
         Seldom or never                Sometimes                 Almost always or always                
Do you add fatback, bacon, ham hocks, lard, or vegetable oil to your vegetables, beans, or bread? 
         Seldom or never                 Sometimes                 Almost always or always                 Don’t know 
 

Page 11 

 

 

 

 

 

 

Now you will tell us about snacks and sweets that you ate last week. Remember to include foods that you ate at home, summer camp,
school, work, vending machines, and restaurants.

Page 12 

Page 13 

Now you will tell us about beverages you drank last week. Remember to include foods that you ate at home, summer camp, school,
work, vending machines, and restaurants.

Page 14 

 

BEVERAGES (Continued) 
Type of Food 
Did you drink any liquid meals 
like Slimfast? 

Yes  
or  
No 

               How many days last week? 
1 
2 
3‐4 
5‐6 
If Yes 
Day  Days 
Days 
Days 

    Yes  How many 
    No  days? 

 

 

 

 

 

 

Every 
Day 

 

Usual amount eaten in one day? 
How many 
bottles or cans in 
1 day?  

 
    1 

 
2 

 
3‐4 

 
5+

 

 
 

Last week, did you drink any 
sodas like coke, Sprite, etc.? 
(Don’t count diet soda) 

    Yes  How many 
    No  days? 

 

Did you drink diet soda or 
unsweetened mineral water? 

    Yes  How many 
    No  days? 

 

Did you drink any Kool‐Aid or 
Gatorade? 

    Yes  How many 
    No  days? 

 

Did you drink any Sunny 
Delight, Hi‐C, Hawaiian Punch, 
or Ocean Spray? 

    Yes  How many 
    No  days? 

 

Did you drink any real orange 
juice?  (Don’t count orange 
sodas) 
Did you drink any other real 
fruit juices like apple juice or 
grape juice? (Remember juice 
boxes) 
Did you drink any sweet tea or 
coffee with sugar? 

    Yes  How many 
    No  days? 

 

    Yes  How many 
    No  days? 

 

    Yes  How many 
    No  days? 

 

 

 

 

 

 
 

 

 

 

 

 
 

 

 

 

 

 
 

 

 

 

 

 

How many 
glasses in 1 day?  

 
    1 

 
2 

 
3 

 
4 

How many 
glasses in 1 day?  

 
    1 

 
2 

 
3 

 
4 

 
    1 

 
2 

 
3 

 
4 

 
    1 

 
2 

 
3 

 
4 

 
    1 

 
2 

 
3 

 
4 

 
    1 

 
2 

 
3 

 
4 

 
    1 

 
2 

 
3 

 
4 

How many 
glasses in 1 day?  
How many 
glasses or juice 
boxes in 1 day?  
How many 
glasses in 1 day?  

 
How many 
glasses in 1 day?  

 

 

 

 
Page 15 

 

How many cups 
in 1 day?  

We might have missed some of the foods that you often eat.  Please write down any other food that you ate 5 or more days last week.  
Examples of these foods include Spam Musubi, Chinese dumpling, spring rolls or egg rolls, plate lunch, bento, loco moco, frugal, game like 
venision or rabbit, shellfish, red chile con carne, posole, sushi, or anything else that you ate every day or almost every day last week.   
 
1.    _______________________________________ 
 
5‐6 days   
Every day 
 
2.    _______________________________________ 
 
5‐6 days   
Every day 
 
3.    _______________________________________ 
 
5‐6 days   
Every day 
 

Last week did you take any vitamin pills, such as one‐a‐
day, vitamin C, or any other? 

 

Yes 

 

No 

Last week, did you take any herbal supplements like 
ginseng, echinachea, or any other? 

 

Yes 

 

No 

Last week, did you use any protein supplements like 
protein powder, creatine, or glutamine? 

 

Yes 

 

No 

How often do you eat food that is sold as a special     
“low‐fat” food, such as low‐fat chips, low‐fat ice cream, 
low‐fat cookies, low‐fat lunch meats, or low‐fat salad 
dressing?  

 

 

Seldom or never 

 

Sometimes 

 

Almost always or always 

 

Don’t know 

Yes 

 

Last week, did you eat any cold cereal? 
 
           IF YES  

 

 
Page 16 

 

 

No 

 
Please write down the name of the cereal you eat most often. 
 
_______________________________________________________ 
 

 

 
 

 

 

Where did you spend most of your time during the weekdays last week? 

   In school  

   On vacation 

 

 

 

 

   At camp 

   Other (specify) 

 

 
 

 
 

 
 

 
 

   At work 
 

 
 

 
 
 

Was what you ate last week fairly typical for you, for what you were doing last week?  

   Yes 

 

 

            If NO 
 
 
 

   Would you say you ate: 

 
 

 

 
 

     A lot more 
   A little more 
  A little less 
   A lot less 
 
 
 
   What made last week different from most other weeks? 

 
 

 
 
 

 
 
 

 
 
 

     Sick 
   Trying a new diet 
   Other (specify) 
 
 
 
 
 
___________________________________________________________________ 

 
 
 

 
 
 

 

___________________________________________________________________ 

 

 

   No 

 

   
 

Is there anything else that you would like us to know about the foods that you eat? 

   Yes 

 

 

 

 

 

 

   No 

          If YES         ____________________________________________________________________________________ 
                             ____________________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

THANK YOU VERY MUCH FOR FILLING OUT THIS QUESTIONNAIRE! 
 
Page 17 

 
 
 
 
 
 
                                    

 
Page 18 


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