Cognitive interview screener

Health and Diet Survey

0545 Survey Questionnaire

Cognitive interview screener

OMB: 0910-0545

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FDA HEALTH AND DIET SURVEY





Hello, I'm ________________ with (contractor). I am calling on behalf of the United States Food and Drug Administration, the FDA. We’re not selling anything. We’re doing a study about people’s opinions about foods and health. Have I reached you on a landline phone or a cell phone?



[IF LANDLINE]


SCR1. May I speak to the member of your household who is aged 18 or over and has had the most RECENT birthday? Would that be you?


[IF SCR2:1, REINTRODUCE; IF SCR2:2, ASK FOR THE FIRST NAME OF THE ELIGIBLE RESPONDENT FOR CALL-BACK PURPOSE. REINTRODUCE AS NECESSARY.]


SCR2. May I speak with a member of the household who is at least 18 years old and has the most recent birthday?


Yes

No/Not available


(IF NOT AVAILABLE, ASK FOR THE FIRST NAME OF THE ELIGIBLE RESPONDENT FOR CALL-BACK PURPOSE. REINTRODUCE AS NECESSARY.)



[ONLY respondents reached via a cell number]


SCR4. Are you at least 18 years old or under 18?


Yes, 18+ years old

No, under 18


[IF SCR4:1; CONTINUE, OTHERWISE TERMINATE]



FIRST QUESTION SCRIPTED


[ASK SCR0 OF ALL RESPONDENTS]


SCR0. INTERVIEWER DO NOT READ. Is respondent on cell phone or landline?


Landline phone

Cell phone


INTERVIEWER WARNING: YOU HAVE SELECTED [INSERT SCR0 RESPONSE]. IS THIS CORRECT?


YES

NO


[IF NO GO BACK TO SCR0 AND ENTER CORRECT RESPONSE]


SCR3. This call may be monitored for quality control purposes. Your answers to this survey are voluntary and will be kept secure to the extent provided by law. The survey will take about 15 minutes.


[ONLY respondents reached via a landline number]



SCR3a. For personal calls, do you only use a landline phone at your household, or do you also have cell phone service on which I could have reached you?


Landline only

Cell phone also



[SCR5 ON ONLY RESPONDENTS REACHED VIA A CELL NUMBER]


SCR5. For personal calls, do you only use a cell phone, or do you also have regular landline phone at your household on which I could have reached you?


Cell phone only

Landline also



This call may be monitored for quality control purposes. Your answers to this survey are voluntary and will be kept confidential. The survey will take about 15 minutes.



(INTERVIEWER: CODE SEX WITHOUT ASKING)


Male

Female

Not Sure


[ALL RESPONDENTS] GO TO SURVEY.


[RESPONDENTS WILL BE RANDOMLY ASSIGNED TO ANSWER VERION 1 OR VERSION 2 OF THE SURVEY. ALL RESPONDENTS WILL BE ASKED SECTION E (V2 to V13).]


FDA Health and Diet Survey, Version 1


SECTION B. DIET-DISEASE RELATIONSHIPS


D1. First, I am going to read two statements about health and food. As I read each statement, please tell me how much you agree or disagree with it. The first statement is… Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it? …

The next statement is “…”

The next statement is…


(INTERVIEWER: REPEAT RESPONSE OPTIONS WHEN NECESSARY)


Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree


[PROG: D1: RANDOMIZE LIST/RANDOMIZE ITEMS]


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

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


A5. Have you heard anything about heart disease or heart attacks being related to things people eat or drink?


Yes

No

A7. Have you heard anything about cancer being related to things people eat or drink?


Yes

No


DBA700. Now, think about your eating habits. In general, how healthy is your overall diet? Would you say?


Excellent

Very good

Good

Fair, or

Poor


CBQ645. About how many calories do you think a [IF SPEAKING TO A MALE INSERT ‘man’; IF SPEAKING TO A FEMALE INSERT ‘woman’] of your age and physical activity needs to consume a day to maintain your current weight?


(INTERVIEW, READ LIST AS NECESSARY)


Less than 500 calories

500-1000 calories

1001-1500 calories

1501-2000 calories

2001-2500 calories

2501-3000 calories

More than 3000 calories


SECTION C. USE AND UNDERSTANDING OF FOOD LABELS


DBQ750. Think about the Nutrition Facts label on many food products that list the amounts of things like calories, fat, cholesterol, vitamins and minerals in the product. How often do you use the Nutrition Facts label when deciding to buy a food product? Would you say always, most of the time, sometimes, rarely, or never?


(INTERVIEWER: DO NOT READ “DK/NS/RF/ NEVER SEEN THE LABEL”)


Always

Most of the time

Sometimes

Rarely

Never

NEVER SEEN THE LABEL

DK/NS

RF



[PROG: IF DBQ750= Rarely, Never, SKIP TO CBQ698]

[PROG: IF DBQ750=DK/NS/RF OR Never seen the label, SKIP TO J1]



CBQ710. Now think about the types of food products you buy using the Nutrition Facts label. How often do you look for nutrition information on the Nutrition Facts label when you buy each of the following types of foods? Would you say always, most of the time, sometimes, rarely, or never?


[PROG: ALL SKIP TO J1]


[PROG: CBQ710. RANDOMIZE LIST]


(Interviewer – do not read “ I’ve never seen the label” or “I never/don’t buy these products”)


Snacks like chips, popcorn, or pretzels

Breakfast cereals

Salad dressings

Raw meat, poultry, or fish

Processed meat products like hot dogs or bologna

Bread


Always

Most of the time

Sometimes

Rarely

Never

I’ve never seen the label

I never/don’t buy these products

DK/NS

RF



CBQ698. People rarely or never check the Nutrition Facts label for various reasons. Which of the following three reasons is the primary reason that you rarely or never check the Nutrition Facts label when deciding to buy a food product?


I don't have the time

It is difficult to use the label

I don’t feel I need to use the label

DK/NS

RF


[PROG: CBQ698. RANDOMIZE LIST

IF CBQ698= “I don't have the time”, or “DK/NS” OR “RF” SKIP TO J1

IF CBQ698= “It is difficult to use the label” GO TO CBQ698x

IF CBQ698= “I don’t feel I need to use the label” GO TO CBQ698y]



CBQ698x. You said it is difficult for you to use the Nutrition Facts label. Is it:

Because the print on the label is too small,

Because you cannot read English that well, or

Because you don’t know what to look for even if you read the label?

You can choose more than one answer.



[PROG: CBQ698x. RANDOMIZE LIST]



The print is too small

I cannot read English that well

I don’t know what to look for even if I read the label

DK/NS

RF



[ALL SKIP TO J1]



CBQ698y. You said you don’t feel you need to use the Nutrition Facts label. Is it:

Because you usually buy foods that you are used to,

because you buy what you or your family likes,

because you are satisfied with your diet or health, or

because you get product information from other sources

because you don’t think food labels are important to you

You can choose more than one answer.


[PROG: CBQ698y. RANDOMIZE LIST]

I usually buy foods that I'm used to

I buy what I or my family like

I am satisfied with my diet or health

I get product information from sources other than the Nutrition Facts label

I don’t think food labels are important

DK/NS

RF



SECTION D. DIETARY MANAGEMENT


J1. Are you on a reduced-calorie or weight-loss diet?


Yes

No

DK/NS

RF

[PROG: IF J1=NO OR DK/NS OR RF, SKIP TO J3, OTHERWISE CONTINUE TO J2]


J2. Did a doctor or other health professional recommend that you be on a reduced-calorie or weight-loss diet?


Yes

No

DK/NS

RF



J3. There are some food products specially made to have less fat; they’re often labeled “low fat” or “fat free” or something like that. Have you ever seen any of these products or seen them in advertising?


Yes

No

DK/NS

RF

[PROG: IF J3=NO OR DK/NS OR RF, SKIP TO N1, OTHERWISE CONTINUE TO J3a]


J3a. Do you buy “low fat” or “fat free” foods regularly, only sometimes, hardly ever, or do you never buy these products?


Regularly

Only Sometimes

Hardly ever

Never

DK/NS

RF


J4. To the best of your knowledge, does the government set standards about which products are qualified to use statements like “low fat” or “fat free”?


Yes

No

DK/NS

RF


SECTION E. DIETARY SUPPLEMENTS AND ENERGY DRINKS


Now please think about dietary supplements such as vitamins, minerals, herbs, and other supplements that you may take in addition to your regular diet.


(Interviewer note – please PAUSE)


N1. First, have you taken a multi-vitamin or multi-mineral supplement in the past 12 months, that is, since (month, year)?


(INTERVIEWER NOTE: IF NECESSARY, EXPLAIN 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/NS

RF


N2. And 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?


[EXCLUDE: VITAMINS AND MINERALS ADDED TO FOODS OR BEVERAGES—EXAMPLE: VITAMIN-D FORTIFIED MILK AND VITAMIN-C FORTIFIED ORANGE JUICE.

INCLUDE: (1) SINGLE-INGREDIENT PRODUCTS THAT COME WITH AUXILIARY INGREDIENTS--EXAMPLE: A SUPPLEMENT SOLD AS A CALCIUM BUT ALSO INCLUDES MAGNESIUM, COPPER, AND A FEW OTHER THINGS;

(2) PRODUCTS LIKE “CALCIUM-MAGNESIUM-ZINK” WHICH ALSO CONTAINS A FEW OTHER THINGS;

(3) VITAMIN B-COMPLEX;

(4) CALCIUM ANTACID, IF TAKEN FOR THE CALCIUM. IF RESPONDENT IS NOT SURE WHETHER THE PRODUCT(S) HE OR SHE TOOK IS CONSIDERED A VITAMIN OR MINERAL SUPPLEMENT, USE THE CHECKLIST, APPENDIX A, TO HELP HIM OR HER IDENTIFY THE KIND OF SUPPLEMENT.]


(INTERVIEWER NOTE -IF ANSWER IS NOT CLEARLY A SUPPLEMENT AND SOUNDS LIKE IT MAY BE AN INGREDIENT IN FOOD, ASK “IS THAT IN YOUR FOOD OR IS IT TAKEN SEPARATELY AS A SUPPLEMENT?”)


Yes

No

DK/NS

RF


N3. Have you taken any kind of herbs, botanicals, or other supplements that are not vitamins or minerals the past 12 months, that is, since (month, year)? We are talking about things such as garlic pills, echinacea, ginkgo, glucosamine, St. John's wort, amino acids, or fish oil. [INTERVIEWER: PLEASE READ THE EXAMPLES SLOWLY.]

[INCLUDE: SINGLE-INGREDIENT PRODUCTS AND PRODUCTS WITH MORE THAN ONE KIND OF SUPPLEMENT MIXED TOGETHER.


INCLUDE: GINSENG TEA AND OTHER HERBAL TEAS TAKEN MAINLY FOR HEALTH PURPOSES. EXCLUDE: FRESH GARLIC, FRESH GINSENG, GINSENG ROOT, AND HERBS USED TO FLAVOR FOODS IN COOKING SUCH AS GARLIC FOR SPAGHETTI SAUCE OR PEPPERMINT FOR TEA.


EXCLUDE: SUPPLEMENTS THAT ARE NOT TAKEN BY MOUTH, SUCH AS VITAMIN E OR ALOE USED ON SKIN. PRODUCTS MAY BE IN THE FORM OF TABLET, CAPSULE, PILL, EXTRACT, GRANULE, LOZENGE, SYRUP, TEA, TINCTURE, OR IN THEIR NATURAL FORM SUCH AS ROOT AND LEAF. IF RESPONDENT IS NOT SURE WHETHER THE PRODUCT(S) HE OR SHE TOOK IS CONSIDERED A HERBAL SUPPLEMENT, USE THE CHECKLIST, APPENDIX A, TO HELP HIM OR HER IDENTIFY THE KIND OF SUPPLEMENT.]


(INTERVIEWER NOTE -IF ANSWER IS NOT CLEARLY A SUPPLEMENT AND SOUNDS LIKE IT MAY BE AN INGREDIENT IN FOOD, ASK “IS THAT IN YOUR FOOD OR IS IT TAKEN SEPARATELY AS A SUPPLEMENT?”)


Yes

No

DK/NS

RF

[PROG: N3

IF N3=Yes SKIP TO Q16]

IF N3=No and IF (N1 OR N2)=YES, SKIP TO Q1;

IF N1=N2=N3=NO/DK/NS/RF, SKIP TO ER1]

IF N3=DK/NS and IF N1 OR N2=YES, SKIP TO Q1

IF N3=RF and IF N1 OR N2=YES, SKIP TO Q1]





Q1. Before you try a vitamin or mineral 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/NS

RF

[PROG: Q1- ASK Q1 IF N1=yes OR N2=yes

IF Q1= “Never, DK/NS, or RF SKIP TO Q3]


Q2. Do you personally get a lot, a little, or no information about vitamin or mineral supplements from each of the following.


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.]

A medical doctor, physician's assistant, registered nurse, or dietitian

Family or friends

A sales person at a store

Newspapers, magazines, books, or medical articles

Television or radio

The Internet

Product labels


[PROG.: Q2: RANDOMIZE LIST KEEP a AND b TOGETHER AND DON'T CHANGE THEIR ORDER]

(INTERVIEWER - READ LIST)


A lot

A little

No information

DK/NS

RF


Q3. Now, let's talk about the labels on vitamin and mineral products. Do you yourself use these labels to find out …


[PROG: Q3. RANDOMIZE LIST]


What ingredients are in the product

The amounts of specific ingredients in the product

What the product is for

If there are side effects or drug interactions from using the product

If anyone should avoid the product

How different brands of a supplement compare to each other


(INTERVIEWER – DON’T READ “The information is not on the labels/DK/NS/ OR REF

LABELS INCLUDE LABELS ON THE BOTTLES/PACKAGES AND PACKAGE INSERTS.)


Yes

No

The information is not on the labels

DK/NS

RF



R1. I am going to read four statements about vitamin and mineral supplements. Please tell me how strongly you agree or disagree with each statement.


[PROG: R1. RANDOMIZE LIST]


A good reason for me to take vitamin or mineral supplements is to prevent illnesses

A good reason for me to take vitamin or mineral supplements is to treat illnesses.

It is important to educate myself about vitamin and mineral supplements before I try them.

I try to pay attention to possible side effects or drug interactions when I take vitamin or mineral supplements.



Strongly agree

Somewhat Agree

Somewhat Disagree

Strongly disagree

DK/NS

RF


R2. As far as you know, does the government set manufacturing standards for vitamin and mineral supplements?


Yes

No

DK/NS

RF


R3. As far as you know, does the government approve vitamin and mineral supplements before they are marketed to consumers?


Yes

No

DK/NS

RF


[PROG: R3. ALL RESPONSES SKIP TO ER1]


[PROG: Q16. ; ASK Q16 ONLY IF N3=Yes]


Q16. Before you try an herb, botanical, or supplements that are not vitamins or minerals 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/NS

RF


[PROG: If Q16=Never/ DK/NS/or RF SKIP TO Q19]


Q17. Do you personally get a lot, a little, or no information about herb, botanical, or supplements that are not vitamins or minerals from each of the following.


[PROG. Q17: RANDOMIZE LIST KEEP a AND b TOGETHER AND DON'T CHANGE THEIR ORDER]

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.]

A medical doctor, physician's assistant, registered nurse, or dietitian

Family or friends

A sales person at a store

Newspapers, magazines, books, or medical articles

Television or radio

The Internet

Product labels


A lot

A little

No information

DK/NS

RF


Q19. Now, let's talk about the labels on herbs, botanicals, or supplements that are not vitamins or minerals. Do you yourself use these labels to find out


[PROG: Q19. RANDOMIZE LIST]

What ingredients are in the product

The amounts of specific ingredients in the product

What the product is for

If there are side effects or drug interactions from using the product

If anyone should avoid the product

How different brands of a supplement compare to each other


(INTERVIEWER – DON’T READ “The information is not on the labels/DK/NS/ OR REF; LABELS INCLUDE LABELS ON THE BOTTLES/PACKAGES AND PACKAGE INSERTS.)


Yes

No

The information is not on the labels

DK/NS

RF




[PROG: R4. RANDOMIZE LIST]


R4. I am going to read four statements about herbs, botanicals, or supplements that are not vitamins or minerals. Please tell me how strongly you agree or disagree with each statement.


A good reason for me to take herbs, botanicals, or supplements that are not vitamins or minerals is to prevent illnesses.

A good reason for me to take herbs, botanicals, or supplements that are not vitamins or minerals is to treat illnesses.

It is important to educate myself about herbs, botanicals, or supplements that are not vitamins or minerals before I try them.

I try to pay attention to possible side effects or drug interactions when I take herbs, botanicals, or supplements that are not vitamins or minerals


Strongly agree

Somewhat Agree

Somewhat Disagree

Strongly disagree

DK/NS

RF



R5. As far as you know, does the government set manufacturing standards for herbs, botanicals, or supplements that are not vitamins or minerals?


Yes

No

DK/NS

RF


R6. As far as you know, does the government approve herbs, botanicals, or supplements that are not vitamins or minerals before they are marketed to consumers?


Yes

No

DK/NS

RF





ER1. Now, let’s talk about a different topic. Caffeinated beverages are beverages that contain naturally occurring or added caffeine. In the past 30 days, how often did you drink each of the following types of caffeinated beverages?

[ASK FOR AND RECORD PRODUCT NAME(S) AND VERIFY SPELLINGS -- ONLY WHEN “CAFFEINATED ENERGY DRINKS” OR “OTHER TYPES OF CAFFEINATED DRINKS” IS NOT=never/DK/NS/RF IN ER1]


Coffee

Tea

Soda, such as cola

Caffeinated energy drinks

Other types of caffeinated drinks, such as caffeinated waters, smoothies, juices, or shakes


(INTERVIEWER – DON’T READ /DK/NS/ OR REF

CLARIFY IF ANSWER DOES NOT CLEARY INFER CAFFEINATED BEVERAGE - i.e. “FRUIT SMOOTIES”; ASK “ Did you mean Caffeinated smoothie?”)


Never

Less than once a week

Once a week or more but less than once a day

Once a day

More than once a day

DK/NS

RF


[(1) IF D AND/OR E IS NOT=NEVER/DK/NS/RF, LOOP ER1OTHER FOR EACH OPTION , (2) IF D AND E = NEVER, SKIP TO SECTION E/V2.]


ER1_OTHER. You said you drank [INSERT TYPE FROM ER1], what PRODUCT did you drink? (Open Ended)


(INTERVIEWER NOTE: SOME PRODUCTS MAY BE OFF-SPRINGS OF THESE PARENT PRODUCTS, SUCH AS ZERO-CALORIE VARIANTS

DO NOT READ LIST; ACCEPT MULTIPLE MENTIONS)


5-hour Energy

Monster Energy

NOS

Red Bull

Rockstar

X Games Energy

AMP

BAWLS Guarana

Full Throttle

No Fear

Rip It

Spike Shooter

Mio Energy

Crystal Light Energy On-the-Go

Stacker 2 Extra

Cellucor C4 Extreme

Cytomax Sports Energy

VPX Redline

HiBall Sparkling Energy Water

Avitae Water

Water Joe

Naked Juice Energy Smoothie

JetTea Smoothie

Frava Juice

Kickstart Juice

Atkins Mocha Latte Shake

Muscle Monster Coffee Energy Shake

Other [Specify]

DK/NS/CAN’T REMEMBER

REF


ER2. You said that in the past 30 days you drank [READ ONE OR MORE OF “caffeinated energy drinks,” or “other types of caffeinated drinks” PER ANSWERS TO ER1] AND CORRESPONDING FREQUENCY FROM ER1]. Was this more often, less often, or about as often as you drank it a year ago?



Caffeinated energy drinks

Other types of caffeinated drinks, such as caffeinated waters, smoothies, juices, or shakes



(INTERVIEWER – DON’T READ “I did not drink it a year ago” /DK/NS/ OR REF)


More often

Less often

About as often as a year ago

I did not drink it a year ago

DK/NS

RF



ER4. In the past 30 days, have you experienced any effects from caffeinated energy drinks, or other caffeinated beverages such as caffeinated waters, smoothies, juices, or shakes?


Yes

No

DK/NS

RF


[PROG: IF ER4=YES, ASK ER4_OTHER]


ER4_OTHER. ER4. From which type of caffeinated beverages did you have any effect ?


(INTERVIEWER –READ IF NECESSAIRY / WE JUST NEED A GENERAL IDEA ABOUT THE TYPE OF DRINK:

Caffeinated energy drinks

Other caffeinated drinks, such as caffeinated waters, smoothies, juices, or shakes)



[PROG: IF NO, DK/NS, OR RF IN Er4, SKIP TO NEXT SECTION: SECTION E /V2]


ER5. The last time you had such effects, what were they?


(INTERVIEWER – DO NOT READ]

Agitation

Allergic symptoms/reactions (rash, hives, swelling)

Anxiety

Chest pain

Confusion

Diarrhea

Dizziness

Fainting

Headache

Heart problems

Hyper

Increased respiration

Insomnia or other sleep problems

Jittering

Kidney problems

Loss or change of consciousness

Memory problems

Nausea

Nervousness

Restlessness

Ringing in the ears

Seizure or convulsion

Shortness of breath

Improved sports performance

Weight loss/ control

Increased alertness

Relaxation

Improved nutrition/health/mood

Other [specify-RECORD UP TO TWO]

DK/NS

RF

[PROG:

IF ER5 only = “Improved sports performance” / OR

Weight loss/ control” / OR

Increased alertness” / OR

Relaxation” / OR

Improved nutrition/health/mood” / OR

DK/NS” / OR “RF”

SKIP TO V2 in SECTION E]





ER6. Did you do anything about these effects?


Yes

No

DK/NS

RF


[PROG: IF ER6=YES, ASK ER6_OTHER; OTHERWISE, SKIP TO V2 IN SECTION E.]


ER6_OTHER. What did you do about these effects? You can say YES to more than one of the following answers.

[PROG: ER6_OTHER. RANDOMIZE LIST]

(INTERVIEWER - READ LIST)


Stop using the product

Go to see a doctor

Go to an emergency room or other healthcare facility

Admit yourself into a hospital

Treat yourself without seeing a healthcare professional

Take some rest to recover

Report to the manufacturer or the store where you bought the product


Yes
No
DK/NS

RF


ER7. Did you report these effects to …

[PROG: ER7. RANDOMIZE LIST]

(INTERVIEWER - READ LIST)


The Food and Drug Administration or FDA

The Centers for Disease Control and Prevention or CDC

A local or state health department

A poison control center

A doctor

Yes
No

DK

RF



[PROG: ER7. ALL IN ER7 SKIP TO V2 in SECTION E]


FDA Health and Diet Survey, Version 2


SECTION B. DIET-DISEASE RELATIONSHIPS


D1. First, I am going to read two statements about food. As I read each statement, please tell me how much you agree or disagree with it. The first statement is… Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it? …

The next statement is “…”



[PROG: D1: RANDOMIZE LIST/RANDOMIZE ITEMS]



I am confident that I know how to choose healthy foods.

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


(INTERVIEWER: REPEAT RESPONSE OPTIONS WHEN NECESSARY)


Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree


A9. Have you heard anything about high blood pressure being related to things people eat or drink?


Yes

No

DK/NS

RF


A10r. As far as you know, do all adults face the same chance of getting high blood pressure?


Yes

No

DK/NS

RF


A10s. Do adults and children face the same chance of getting high blood pressure?


Yes

No

DK/NS

RF


A10t. Now, let’s talk about how much salt or sodium we eat in our diet. In your opinion, do American adults …..

?

[PROG: A10t. RANDOMIZE LIST, IN LEADING SENTENCE ALSO PLEASE]

[PROG: RANDOMIZE LIST]

eat more salt than they should,

eat as much salt they should, or

eat less salt than they should


A10u. Among the following groups of adults, who should pay special attention to how much salt or sodium they eat?   Please tell me yes or no for each


[PROG: A10u. RANDOMIZE LIST; MP]

(INTERVIEWER –READ LIST SLOWLY)

Those who are 51 years or older

African Americans

Those who have high blood pressure, diabetes, or chronic kidney disease

Those who have cancer

Hispanics

Those who are 50 years or younger


Yes

No

DK/NS

RF



A10v. Some people say that we as a nation should eat less salt or sodium. Whose actions do you think can be most effective in reducing the amount of salt or sodium we eat ….

we the consumer,

food manufacturers and retailers,

the restaurant industry,

or the government?


[PROG: A10v. RANDOMIZE LIST; RECORD ONE ANSWER ONLY]


(INTERVIEWER –READ LIST, DON’T READ “no one”/everyone/all of them equally”/all of the above/DK/NS OR RF)

We the consumer

Food manufacturers and retailers

The restaurant industry

The government

No one

Everyone/all of them equally/all of the above

DK/NS

RF



A10w. Think about the products you see in the supermarket, would you say the amount of salt or sodium in these products are [PROG: A10W. RANDOMIZE “lower” AND “higher”]


Higher

Lower

Or, about the same as five years ago?

DK/NS

RF


SLT1. Now, think about the sources of salt or sodium in your own diet. How much of the salt or sodium you eat comes from each of the following six sources, none, a little, some, or a lot?

[PROG: SLT1 READ AND RANDOMIZE LIST]


The salt I add at the table

The salt added when meals are prepared or cooked at my home

The salt added to packaged or processed foods such as bread, canned soups, chips, sausages

The salt in foods prepared by fast-food or other types of restaurants

The salt that naturally exists in foods


None

A little

Some

A lot

DK/NS

RF


SLT2. How concerned are you about the amount of salt or sodium you eat?

(INTERVIEWER: READ LIST)


Very concerned

Somewhat concerned

Somewhat unconcerned

Not concerned at all

DK/NS

RF

SLT3. If you wanted to eat less salt or sodium, how easy or difficult would it be for you to actually do it?

(INTERVIEWER: READ LIST)


Very easy

Somewhat easy

Somewhat difficult

Very difficult

DK/NS

RF



SLT4. Are you currently watching or reducing your salt or sodium intake?


Yes

No

DK/NS

RF


[PROG: SLT4.if SLT4=NO, DK/NS, OR RF SKIP TO STL6]



SLT5. Has a doctor or other health professional ever advised you to watch or reduce your salt or sodium intake?


Yes

No

DK/NS

RF


SLT6. There are some food products specially made to have less salt or sodium; they’re often labeled “low salt,” “reduced salt,” “low sodium,” “reduced sodium” or something like that. Have you ever seen any of these products in the store or in advertising?



Yes

No

DK/NS

RF


[PROG: SLT6.if SLT6=NO, DK/NS, OR RF SKIP TO STL8]

SLT7. Do you buy “low sodium,” “reduced sodium,” “low salt,” or “reduced salt” foods regularly, only sometimes, hardly ever, or do you never buy these products?


Regularly

Sometimes

Hardly ever

Never

DK/NS

RF


SLT8. I am going to read six statements about reduced or low sodium or salt products. Please tell me how strongly you agree or disagree with each statement.

[PROG: SLT8. RANDOMIZE LIST]


Reduced or low sodium products generally don’t taste as good as regular products

Reduced or low sodium products usually cost more than regular products

Reduced or low sodium products are not always available in the store

Reduced or low sodium products are good for me

I know which products are low in sodium or have reduced amount of sodium

I should eat reduced or low sodium products


Strongly agree

Somewhat Agree

Somewhat Disagree

Strongly disagree

DK/NS

RF


DBA700. Now, think about your eating habits. In general, how healthy is your overall diet? Would you say?

(INTERVIEWER: READ LIST)


Excellent

Very good

Good

Fair, or

Poor

DK/NS

RF



B1. Next, I am going to ask you about three different kinds of fat in foods we eat. As I read each one, please tell me whether you have ever heard of it. [RANDOMIZE LIST]


Trans fat or Trans fatty acid

Saturated fat

Omega 3 fatty acid


Yes

No

DK/NS

RF




B2. You just told me you had heard of [NAME OF FAT FROM B1]. As far as you know, does [NAME OF FAT FROM B1] raise the risk of heart disease, lower the risk of heart disease, or have no effect on the risk of heart disease, or you don’t know?


[PROG: B2.: ASK FOR EACH Yes in B1]


Raise the risk

Lower the risk

Have no effect

DK

NS

RF


SECTION C. USE AND UNDERSTANDING OF FOOD LABELS


E1. I'd like you to think about the labels on many food products that list ingredients and provide nutrition and other information. When you buy a product for the first time, how often do you read this information? Would you say often, sometimes, rarely, or never?


Often

Sometimes

Rarely or

Never

DK/NS

RF


[IF E1=NEVER, SKIP TO E5, IF E1= DK/NS OR RF SKIP TO E10]



E2. People tell us they use food product labels in many different ways. When you look at food labels, either in the store or at home, how often, if at all, do you use the labels in the following ways? Would you say you often, sometimes, rarely or never use the label

[PROG: E2. RANDOMIZE LIST]

[PROG: E2. ALL IN E2 SKIP TO E6]


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

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

To compare different food items with each other

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

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

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

To help you in meal planning

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


Often

Sometimes

Rarely

Never

DK/NS

RF


E5. People have different reasons for not using the nutrition information on the food label. Please say whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with each of the following reasons for not using the food label:


[PROG: E5. RANDOMIZE LIST]

[PROG: E5. ALL IN E5 SKIP TO E10]


I’m just not that interested

The information is hard to understand

It takes too much time

I prefer getting nutrition information from other sources

I don’t need to use the food label since I already know what foods to eat


Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

DK/NS

RF


E6. Now, I would like for you to think about information about serving sizes which is also found on the food label.  Would you say you often, sometimes, rarely or never use serving size information?


Often

Sometimes

Rarely

Never

DK/NS

RF

[IF E6=NEVER, OR IF E6= DK/NS OR RF SKIP TO E10]



E7. What does serving size mean to you? You can choose more than one answer.

[PROG: E7. RANDOMIZE LIST]


The amount of a food that people should eat

The amount of a food that people usually eat

Something that makes it easier to compare foods

[DON”T READ] Other [Specify]

DK/NS

RF

[PROG: E7. ALL RESPONDENTS SKIP TO E10]


E10. Food packages sometimes have statements on the front of the package that describe the product as “low sodium” or “rich in antioxidants.” When it is available, how often do you use this information when deciding to buy a product? Would you say often, sometimes, rarely, or never?


(INTERVIEWER, DON’T READ “I’ve never seen these products”/DK/NS OR RF)


Often

Sometimes

Rarely

Never

I’ve never seen these products

DK/NS

RF


[PROG: E10. IF E10= “I’ve never seen these products”/DK/NS OR RF SKIP TO E20]


E11. About how many of the food labels that use statements like “low sodium” or “rich in antioxidants” do you believe accurately describe the food—just about all of them, most of them, only some of them or almost none of them?


All of them

Most of them

Some of them

None of them

DK/NS

RF


[PROG: ALL GO TO E20]

E20. Some food packages say the product “contains no added sugar” or it has “no sugar added.” When it is available, how often do you use this information when deciding to buy a product? Would you say often, sometimes, rarely, or never?


(INTERVIEWER, DON’T READ “I’ve never seen these products/claims, I don’t know what added sugar is/I”ve never heard of added sugar”/”I’ve never seen these claims”/DK/NS OR RF)


Often

Sometimes

Rarely

Never

I’ve never seen these products/claims, I don’t know what added sugar is/I”ve never heard of added sugar

DK/NS

RF


[PROG: E20. IF E20= “I’ve never seen these products/claims, I don’t know what added sugar is/I”ve never heard of added sugar””/DK/NS OR RF SKIP TO NF1]



E21. About how many of the food labels that use statements like “contains no added sugar” or “no sugar added” do you believe accurately describe the food—just about all of them, most of them, only some of them or almost none of them?


All of them

Most of them

Some of them

None of them

DK/NS

RF


SECTION D. DIETARY MANAGEMENT AND KNOWLEDGE


NF1. Have you tried to limit any of the following things in your diet in the past 30 days? Have you tried to limit the amount of ….. in your diet, yes or no? …. What about ….?

[PROG: NF1. RANDOMIZE LIST]


Saturated fat

Trans fat or trans fatty acid

Calories

Cholesterol

Carbohydrates

Sodium

Sugar


(INTERVIEWER - READ LIST; REPEAT “YES OR NO” WHEN NECESSARY)


Yes

No

DK/NS

RF



NF2. Have you tried to eat enough of any of the following things in your diet in the past 30 days? Have you tried to eat enough of … in your diet, yes or no? …. What about ….? .

[PROG: NF2. RANDOMIZE LIST]


Calcium

Iron

Vitamin A

Vitamin C

Potassium

Fiber

Vitamin D


(INTERVIEWER - READ LIST; REPEAT “YES OR NO” WHEN NECESSARY)


Yes

No

DK/NS

RF


SECTION E. PHONE USE STATUS, HEALTH STATUS, AND DEMOGRAPHICS


[PROG.:V2. ONLY respondents reached via a landline number]


V2. Now, I have a few questions for statistical purposes. Are there any telephone numbers in addition to [the telephone number being called] in your home that you receive calls on? Please exclude cell phone numbers or numbers used only for fax or computer.


Yes

No

DK/NS

RF


[IF V2=YES GO TO V2a

IF V2=( (No, DK/NS, OR RF) AND If SCR3a=”cell also,” )GO TO V4a. OTHERWISE, SKIP TO V3]


[PROG. ASK V2a: ASK V2a. to ONLY respondents reached via a landline number]

V2a. Is this/Are these number(s) for …

Home use

Business and home use

Business use only

DK/NS

RF


[PROG. V4a : ASK IF SCR5=’landline also,’ OR IF V2=’no/dk/ns/rf AND ROUTED TO V4A]


V4a. Of all the telephone calls that you or your household receive, are all or almost all calls received on cell phones, some received on cell phones and some on regular phones, or very few or none received on cell phones?


All or almost all calls received on cell phones

Some received on cell phones and some on regular phones

Very few or none on cell phones

DK/NS

RF


V4b. Thinking just about the landline home phone, not your cell phone, if that telephone rang and someone was home, under normal circumstances, how likely would it be answered? Would you say extremely likely the landline would be answered, very likely, somewhat likely, somewhat unlikely or not at all likely the landline would be answer?


Extremely likely that landline would be answered

Very likely that landline would be answered

Somewhat likely that landline would be answered

Somewhat unlikely that landline would be answered

Very unlikely that landline would be answered

Not at all likely that landline would be answered

DK/NS

RF


V4c. Are there any other persons who use [the telephone number being called] for their personal calls?


Yes

No

DK/NS

RF

V3. How many adults, age 18 and older, including yourself live in your household?


NUMBER: ____________ (RANGE: 1-15)

DK/NS

RF


V5. What is the last grade or year of school that you have completed?


(INTERVIEWER – – READ LIST IF NECESSAIRY)


0-11years

12 years or high school graduate

1-3 years of college

4 years of college or college graduate

Postgraduate/Masters/doctorate/law degree/MD

DK/NS

RF


V6. Are you of Hispanic or Latino origin?


Yes

No

DK/NS

RF


V7. What is your race? Please select one or more categories.

[PROG: V7. READ LIST]


White

Black or African American

Asian

Native Hawaiian or other Pacific Islander

American Indian or Alaskan Native


Yes

No

DK/NS

RF



V8. What year were you born?


19 ________ (RANGE: 19xx-19yy)

DK/NS

RF


[RESPONDENT AGE = 201x – V8.]


The next few questions may seem a bit personal. But we need this information because this survey is about nutrition and health.”


V9. How tall are you without shoes?


(INTERVIEWER WHEN THE RESPONDENT REPORTS FRACTIONS, ROUND UP TO THE NEXT WHOLE NUMBER. FOR EXAMPLE, 3.5 INCHES SHOULD BE CODED AS 4 INCHES. DON’T PROBE.)


( ) feet and ( ) inches

OR

( ) meter(s) and/or ( ) centimeters

DK/NS [ENTER 88 FEET 0 INCH]

RF [ENTER 99 FEET 0 INCH]


V10. How much do you weigh without shoes?


(INTERVIEWER WHEN THE RESPONDENT REPORTS FRACTIONS ROUND UP TO THE NEXT WHOLE NUMBER. FOR EXAMPLE, 122.5 POUNDS SHOULD BE CODED AS 123 POUNDS. DON’T PROBE.)


( ) pounds

OR

( ) kilograms

DK/NS [ENTER 8888 POUNDS]

RF [ENTER 9999 POURNDS]


V11. How do you describe your health? In general, would you say your health is…?

(INTERVIEWER - READ LIST)


Excellent

Very good

Good

Fair, or

Poor

DK/NS

RF


[PROG: VERSION 1 ONLY]

V12a. Have you ever been told by a doctor or other healthcare professional that you have any of the following health conditions? I don’t need to know which condition, just whether you have any of them.

(INTERVIEWER - READ: “high blood pressure, diabetes, high cholesterol, heart disease, obesity, overweight, or cancer.”)


Yes

No

DK/NS

RF


[PROG: VERSION 2 ONLY]

V12b. Have you ever been told by a doctor or other healthcare professional that you have any of the following health conditions: “high blood pressure, diabetes, high cholesterol, heart disease, obesity, overweight, or cancer? I don’t need to know which condition, just whether you have any of them.

(INTERVIEWER - READ.”)


Yes

No

DK/NS

RF


V13. I am going to read you a list of categories of income. Please stop me when I read the category that includes your total household income before taxes for year 201x.


Less than $25,000

From $25,000 to less than $50,000

$50,000 to less than $75,000

$75,000 to less than $100,000

$100,000 or more

DK/NS

RF



Thank you. Those are all the questions I have at this time.

36


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