Attachment 3j Flexible Consumer Behavior Survey (FCBS) Phone Follow-Up
Form Approved
OMB No. 0920-0950
Exp. Date XX/XX/20XX
CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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, SD-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0950).
Assurance of Confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice or an establishment will be used only for statistical purposes. NCHS staff, contractors and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA every NCHS employee, contractor and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.
Flexible Consumer Behavior Survey Module - FCBS
Target Group: SPs 1 year +
BOX 1
CHECK ITEM CBQ.500:
YARGET AGE 1-150
IF SP IS AGE 1-15 THEN PROXY WILL ANSWER THE QUESTIONS.
Section A. Hand Card Information
CBQ.502 Do you have the green hand card booklet? {It is in the same bag as the food measuring guides {you used for your/we used for SP’s} dietary phone interview. I’ll wait while you locate it.
Do you have it?}
Yes 1 (CBQ.506)
No, 2
REFUSED 7
DON'T KNOW 9
CBQ.503 Let’s go ahead with the interview anyway. Do you have a cereal box, can or package of food with a food label on the back or the side that you can use for this interview? I’ll wait while you locate it.
Yes 1
No 2
REFUSED 7
DON'T KNOW 9
Section B. Use of calorie labeling on menus
CBQ.506 I am going to ask you about eating foods and beverages from different places. The types of places are listed on hand card 1 in your booklet. Please turn to hand card 1. We will start with foods or beverages from fast food or pizza places, then I’ll go down the list and ask you about each of the other places.} For the first few questions, please answer yes or no.
In the past 12 months, did you buy food from fast food or pizza places?
CAPI INSTRUCTION:
If CBQ.502=”2”, “7”, OR “9”, REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
“Ok, let’s go ahead with the interview. I am going to ask you about eating foods and beverages from different places. The types of places include: fast food or pizza places; restaurants with waiter or waitress service; all-you-can-eat buffets; places that sells mostly beverages, such as a coffee shop or juice bar; movie theatres, sports arenas, or other places of recreation; grocery stores; and convenience stores. We will start with foods or beverages from fast food or pizza places, then I’ll ask you about each of the other places.”
Yes 1
No 2 [CBQ.551]
REFUSED 7
DON'T KNOW 9
CBQ.536 At the last fast food or pizza place you bought foods or beverages, did you notice any calorie information on the menu?
YES 1
NO 2 (CBQ.551)
REFUSED 7 (CBQ.551)
DON'T KNOW 9 (CBQ.551)
CBQ.541 Did you use the information in deciding what to buy?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.551 In the past 12 months, did you eat in or get take-out from a restaurant with waiter or waitress service?
Yes 1
No 2 [CBQ.830]
REFUSED 7
DON'T KNOW 9
CBQ.581 The last time you ate or got take-out from a restaurant with a waiter or waitress, did you notice any calorie information on the menu?
YES 1
NO 2 (CBQ.830)
REFUSED 7 (CBQ.830)
DON'T KNOW 9 (CBQ.830)
CBQ.586 Did you use the information in deciding what to order?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.830 In the past 12 months, did you eat at an all-you-can-eat buffet style restaurant?
Yes 1
No 2 [CBQ.845]
REFUSED 7
DON'T KNOW 9
CBQ.835 The last time you ate at an all-you-can-eat buffet style restaurant, did you notice any calorie information on the menu?
YES 1
NO 2 (CBQ.845)
REFUSED 7 (CBQ.845)
DON'T KNOW 9 (CBQ.845)
CBQ.840 Did you use the information in deciding what to eat?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.845 In the past 12 months, did you buy any foods or beverages at a place that sells mostly beverages such as a coffee shop or juice bar?
Yes 1
No 2 [CBQ.860]
REFUSED 7
DON'T KNOW 9
CBQ.850 The last time you bought foods or beverages at a place that sells mostly beverages, did you notice any calorie information on the menu?
YES 1
NO 2 (CBQ.860)
REFUSED 7 (CBQ.860)
DON'T KNOW 9 (CBQ.860)
CBQ.855 Did you use the information in deciding what to order?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ860 In the past 12 months, did you buy any foods or beverages at movie theaters, sports arenas, or other places of recreation?
Yes 1
No 2 [CBQ.875]
REFUSED 7
DON'T KNOW 9
CBQ.865 The last time you bought foods or beverages at a movie theater, sports arena, or other place of recreation, did you notice any calorie information on the menu?
YES 1
NO 2 (CBQ.875)
REFUSED 7 (CBQ.875)
DON'T KNOW 9 (CBQ.875)
CBQ.870 Did you use the information in deciding what to order?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.875 In the past 12 months, did you buy prepared foods such as salads, soups, chicken, sandwiches and cooked vegetables from grocery store salad bars and deli counters?
Yes 1
No 2 [CBQ.890]
REFUSED 7
DON'T KNOW 9
CBQ.880 The last time you bought prepared foods at a grocery store, did you notice any calorie information about these foods?
YES 1
NO 2 (CBQ.890)
REFUSED 7 (CBQ.890)
DON'T KNOW 9 (CBQ.890)
CBQ.885 Did you use the information in deciding what to buy?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.890 In the past 12 months, did you buy prepared foods at convenience stores including gas stations or corner stores?
Yes 1
No 2 [Box 2]
REFUSED 7
DON'T KNOW 9
CBQ.895 The last time you bought prepared foods at a convenience store, including a gas station or corner store, did you notice any calorie information about these foods?
YES 1
NO 2 (Box 2)
REFUSED 7 ( Box 2)
DON'T KNOW 9 ( Box 2)
CBQ.900 Did you use the information in deciding what to buy?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
BOX 2
CHECK ITEM CBQ.615: CBQ.645 ONLY APPLY TO RESPODENT WHO IS A SP.
IF RESPONDENT IS A SP, CONTINUE. OTHERWISE, GO TO CBQ.700. |
Section C. Calories knowledge
CBQ.645 {Please turn to hand card 2.}
About how many calories do you think a {man/woman} of your age and physical activity needs to consume a day to maintain your current weight?
[HAND CARD #2]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
A. Less than 500 calories 1
B. 500-1000 calories 2
C. 1001-1500 calories 3
D. 1501-2000 calories 4
E. 2001-2500 calories 5
F. 2501-3000 calories 6
G. More than 3000 calories 7
REFUSED 77
DON'T KNOW 99
Section D. Food label
CBQ.700 {Now turn the page to use hand card 3.}
Many food packages contain an expiration date such as “use by” or “sell by”. How often do you use the expiration date when deciding to buy a food product?
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARD #3]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
DBQ.780 Some food packages contain health claims about the benefits of nutrients or foods {like the examples on hand card 4}. How often do you use this kind of health claim when deciding to buy a food product?
{Using hand card 5,} would you say always, most of the time, sometimes, rarely, or never?
[HAND CARDS #4 & #5]
CAPI INSTRUCTIONS:
IF CBQ.502=2, 7, or 9, REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
‘For example, "Diets low in sodium may reduce the risk of high blood pressure”, or “Adequate calcium throughout life may reduce the risk of osteoporosis” ’, Do NOT display “Using hand card 5”, in the third sentence.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
DBQ.750 {Please turn to hand card 6. For the next question you’ll use hand card 7 to respond, but first please look at hand card 6 which shows an example of the food label.
How often do you use the Nutrition Facts panel on a food label, such as the part colored in yellow on the sample food label on hand card 6, when deciding to buy a food product?}
{Looking at hand card 7,} would you say always, most of the time, sometimes, rarely, or never?
[HAND CARDS #6 & #7]
CAPI INSTRUCTIONS:
IF CBQ.502=1, DISPLAY DBQ.750 AS SHOWN ABOVE.
ELSE IF CBQ.503=1, REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
“Next, we have some questions about food labels. On your (cereal box, can, food package, etc.) please look for the food label that is usually on the back or the side of the package. A food label has two parts, a Nutrition Facts panel and a list of ingredients. The "Nutrition Facts panel" of a food label lists the amount of calories, fat, fiber, carbohydrates and some other nutritional information.
How often do you use the Nutrition Facts panel when deciding to buy a food product?”
Do NOT display “Looking at hand card 7”, in the fourth sentence.
ELSE IF CBQ.503=2, 7, OR 9, REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
“Next, we have some questions about food labels. A food label usually is on the back or the side of the food package. It has two parts, a Nutrition Facts panel and a list of ingredients. The "Nutrition Facts panel" of a food label lists the amount of calories, fat, fiber, carbohydrates and some other nutritional information.
How often do you use the Nutrition Facts panel when deciding to buy a food product?”
Do NOT display “Looking at hand card 7”, in the fourth sentence.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
DBQ.760 {Please turn to hand card 8. Again, for the next question, you’ll use hand card 9 to respond, but first look at hand card 8.}
How often do you use the list of ingredients on a food label, {such as the part colored in pink on hand card 8,} when deciding to buy a food product?
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARD #8 & #9]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
DBQ.770 {Please turn your hand card to the next page.} How about the information on the serving size? [HAND CARD #10]
How often do you use information on the serving size on a food label, {such as the part colored in green on hand card 10,} when deciding to buy a food product?
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARD #10 & #11]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.905 {Please turn to hand cards 12 and 13.} How about the information on the number of servings in the package?
[How often do you use information on the number of servings in the package on a food label, {such as the part colored in purple on hand card 12,} when deciding to buy a food product?]
[Would you say always, most of the time, sometimes, rarely, or never?]
[HAND CARDS #12 & #13]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.910 {Please turn to hand cards 14 and 15.} How about the information contained in the footnote?
[How often do you use information contained in the footnote on a food label, {such as the part colored in orange on hand card 14,} when deciding to buy a food product?]
[Would you say always, most of the time, sometimes, rarely, or never?]
[HAND CARDS #14 & #15]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.685 {Please turn to {hand cards 16 and 17.} How about the information on the percent daily value?
[How often do you use information on the percent daily value on a food label, {such as the part colored in blue on hand card 16,} when deciding to buy a food product?]
[Would you say always, most of the time, sometimes, rarely, or never?]
[HAND CARD #16 & #17]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5 (CBQ.925)
NEVER SEEN 6 (CBQ.925)
REFUSED 7 (CBQ.925)
DON'T KNOW 9 (CBQ.925)
CBQ.915 {For the next question you’ll use {hand card 19/hand card 21} to respond, but first please look at {hand card 18/hand card 20.}
Which one do you use more often when deciding to buy a food product - information on the food label about Percent Daily Value, {such as the part colored in blue on {hand card 18/hand card 20},} or about the amount of nutrients such as the value in grams or milligrams noted next to each nutrient {such as the part highlighted in yellow}?
{Looking at {hand card 19/hand card 21},} would you say you use…
[HAND CARDS #18 & #19]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
CAPI INSTRUCTION: IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 1 AND “[HAND CARDS #18 & #19]”. IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 2 AND ”[HAND CARDS #20 & #21]”.
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #1
Only percent daily value; 1
Percent daily value more often; 2
Both percent daily value and the
amount of nutrients about the same; 3
The amount of nutrients more often; or 4
Only the amount of nutrients 5
DO NOT USE EITHER 6
REFUSED 7
DON'T KNOW 9
[HAND CARDS #20 & #21]
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #2
Only the amount of nutrients; 5
The amount of nutrients more often; 4
Both the amount of nutrients and percent daily value
about the same; 3
Percent daily value more often; or 2
Only percent daily value 1
DO NOT USE EITHER 6
REFUSED 7
DON'T KNOW 9
BOX NEW
CHECK ITEM CBQ.920: IF CBQ.502 = 1, CONTINUE. OTHERWISE, GO TO CBQ.930.
|
CBQ.925 Now turn to {hand cards 22 and 23/hand cards 24 and 25}. The label of the product shows 5% Daily Value for Vitamin A in a serving of the product. What does the 5% Daily Value mean to you?
[HAND CARDS #22 & #23]
CAPI INSTRUCTION: IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 1 AND “[HAND CARDS #22 & #23]”. IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 2 AND “[HAND CARDS #24 & #25]”.
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #1
5 percent of the calories in one serving of the product come from
Vitamin A 1
One serving of the product contains 5 percent
Vitamin A by weight 2
One serving of the product supplies 5 percent of the
Vitamin A you should have in a day 3
REFUSED 7
DON'T KNOW 9
[HAND CARDS #24 & #25]
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #2
One serving of the product supplies 5 percent of the
Vitamin A you should have in a day 3
One serving of the product contains 5 percent
Vitamin A by weight 2
5 percent of the calories in one serving of the product come from
Vitamin A 1
REFUSED 7
DON'T KNOW 9
CBQ.930 {Look at hand cards 26 and 27.} How often do you use the calorie information on a food label, {such as the part colored in green,} when deciding to buy a food product?
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARD #26 and 27]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.935 {Please turn your hand cards to the next page.} How about information on sugars?
[How often do you use information on sugars on a food label, {such as the part colored in pink on hand card 28,} when deciding to buy a food product?]
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARD #28 & 29]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.New1 {Please turn your hand cards to the next page.} How about information on added sugars?
[How often do you use information on sugars on a food label, {such as the part colored in yellow on hand card 30,} when deciding to buy a food product?]
Would you say always, most of the time, sometimes, rarely, or never?
HAND CARD #30 & 31
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.945 {Now turn to hand cards 32 and 33.} How about information on sodium?
[How often do you use information on sodium on a food label, {such as the part colored in blue on hand card 32,} when deciding to buy a food product?]
[Would you say always, most of the time, sometimes, rarely, or never?]
[HAND CARD #32 & #33]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
CBQ.950 {Please turn to the next hand card page.} Some food packages contain two column labels. {For example, the one shown in hand card 34}. The first column has nutrient information for one serving of the food, and the second column contains information for the entire package.
On packages containing two column labels, how often do you use the second column with information per container when deciding to buy a food product?
Would you say always, most of the time, sometimes, rarely, or never?
[HAND CARDS #34 & #35]
CAPI INSTRUCTION: Do NOT display the text in braces if CBQ.502=”2”.
ALWAYS 1
MOST OF THE TIME 2
SOMETIMES 3
RARELY 4
NEVER 5
NEVER SEEN 6
REFUSED 7
DON'T KNOW 9
BOX 5 New
CHECK ITEM CBQ.708: IF (DBQ.750 = 1-3) OR (DBQ.760 = 1-3) OR (DBQ.770 = 1-3) OR (DBQ.780 = 1-3), OR (CBQ.905 = 1-3), OR (CBQ.910 = 1-3), OR (CBQ.685 = 1-3), OR (CBQ.930 = 1-3), OR (CBQ.935 = 1-3), OR (CBQ.945 = 1-3), OR (CBQ.950 = 1-3), CONTINUE; ELSE IF (DBQ.750 = 6-9) AND (DBQ.760 = 6-9) AND (DBQ.770 = 6-9) AND (DBQ.780 = 6-9), AND (CBQ.905 = 6-9), AND (CBQ.910 = 6-9), AND (CBQ.685 = 6-9), AND CBQ.930 = 6-9), AND (CBQ.935 = 6-9), AND (CBQ.945 = 6-9), AND (CBQ.950 = 6-9), GO TO CBQ.695; OTHERWISE, GO TO CBQ.698.
|
CBQ.738 {What is the reason or reasons that you check the food label when deciding to buy a food product? There are some examples on {hand card 36/hand card 37}. You may give more than one answer.}
[HAND CARD #36]
CAPI INSTRUCTIONS:
IF CBQ.502=1, DISPLAY CBQ.738 AS SHOWN ABOVE.
ELSE IF CBQ.502=2, 7, OR 9 –
1. REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
“For this next question you may give more than one answer. What is the reason or reasons that you check the food label when deciding to buy a food product? I will read you some examples.”
DISPLAY ALL THE RESPONSE CATEGORIES IN LOWER CASE
CODE ALL THAT APPLY.
CAPI INSTRUCTION: IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 1 AND “[HAND CARD #36]”. IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 2 AND “[HAND CARD #37]”.
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #1
TO WATCH MY WEIGHT AND/OR LOSE WEIGHT 1
A FAMILY MEMBER IS TRYING TO WATCH THEIR WEIGHT AND/OR LOSE WEIGHT 2
TO WATCH FOR DIABETES, HIGH TRIGLYCERIDES, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE OR OTHER HEALTH CONDITIONS 3
A FAMILY MEMBER HAS A HEALTH CONDITION
(FOR EXAMPLE, DIABETES, HIGH TRIGLYCERIDES, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, ETC) 4
I AM ALLERGIC TO CERTAIN FOOD(S) 5
A FAMILY MEMBER HAS FOOD ALLERGIES 6
TO AVOID CERTAIN INGREDIENTS
(SUCH AS MSG, HIGH FRUCTOSE CORN SYRUP, COLOR DYES, ARTIFICIAL PRESERVATIVES, OR HYDROGENATED OILS, ETC) 7
TO INCREASE CERTAIN NUTRIENTS IN MY/FAMILY’S DIET
(SUCH AS FIBER, CALCIUM, ETC) 8
TO COMPARE WHICH BRAND/FOOD IS BETTER/HEALTHIER 9
TO MAKE BETTER/HEALTHIER CHOICES FOR ME AND MY FAMILY 10
TO WATCH FOR CALORIE CONTENT OR NUTRIENTS (SUCH AS SODIUM, TRANS FAT, SUGAR, CARBOHYDRATES, OR PROTEIN, ETC) 11
OTHER SPECIFY________________ 91
REFUSED 77
DON’T KNOW 99
[HAND CARD #37]
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #2
TO COMPARE WHICH BRAND/FOOD IS BETTER/HEALTHIER 9
TO MAKE BETTER/HEALTHIER CHOICES FOR ME AND MY FAMILY 10
TO AVOID CERTAIN INGREDIENTS
(SUCH AS MSG, HIGH FRUCTOSE CORN SYRUP, COLOR DYES, ARTIFICIAL PRESERVATIVES, OR HYDROGENATED OILS, ETC) 7
A FAMILY MEMBER HAS A HEALTH CONDITION
(FOR EXAMPLE, DIABETES, HIGH TRIGLYCERIDES, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, ETC) 4
I AM ALLERGIC TO CERTAIN FOOD(S) 5
A FAMILY MEMBER HAS FOOD ALLERGIES 6
TO WATCH FOR DIABETES, HIGH TRIGLYCERIDES, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE OR OTHER HEALTH CONDITIONS 3
TO INCREASE CERTAIN NUTRIENTS IN MY/FAMILY’S DIET
(SUCH AS FIBER, CALCIUM, ETC) 8
TO WATCH MY WEIGHT AND/OR LOSE WEIGHT 1
A FAMILY MEMBER IS TRYING TO WATCH THEIR WEIGHT AND/OR LOSE WEIGHT 2
TO WATCH FOR CALORIE CONTENT OR NUTIENTS (SUCH AS SODIUM, TRANS FAT, SUGAR, CARBOHYDRATES, OR PROTEIN, ETC) 11
OTHER SPECIFY________________ 91
REFUSED 77
DON’T KNOW 99
BOX 5A.
CHECK ITEM CBQ.751:
GO TO CBQ.695. |
CBQ.698 {What is the reason or reasons that you rarely or never check the food label when deciding to buy a food product? There are some examples on {hand card 38/hand card 39}. You may give more than one answer.}
[HAND CARD #38]
CAPI INSTRUCTIONS:
IF CBQ.502=1, DISPLAY CBQ.698 AS SHOWN ABOVE.
ELSE IF CBQ.502=2, 7, OR 9 –
1. REPLACE TEXT IN THE BRACES WITH THE FOLLOWING:
“For this next question you may give more than one answer. What is the reason or reasons that you rarely or never check the food label when deciding to buy a food product? I will read you some examples.”
DISPLAY ALL THE RESPONSE CATEGORIES IN LOWER CASE
CODE ALL THAT APPLY.
CAPI INSTRUCTION: IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 1 AND “[HAND CARD #38]”. IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 2 AND “[HAND CARD #39]”.
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #1
I DON'T HAVE THE TIME 1
THE PRINT IS TOO SMALL FOR ME TO READ 2
I’M SATISFIED WITH MY HEALTH SO THERE IS NO NEED FOR ME TO CHECK 3
I HAVE A GOOD DIET SO THERE IS NO NEED TO CHECK LABELS 4
I USUALLY BUY FOODS THAT I'M USED TO, SO I DON’T FEEL THAT I NEED TO CHECK LABELS 5
I BUY WHAT I OR MY FAMILY LIKE, I DON’T CARE ABOUT THE LABELS 6
I DON’T THINK THE FOOD LABELS ARE IMPORTANT TO ME 7
I WON’T KNOW WHAT TO LOOK FOR EVEN IF I READ THE LABELS 8
I CAN’T READ ENGLISH THAT WELL 9
OTHER SPECIFY________________ 91
REFUSED 77
DON’T KNOW 99
[HAND CARD #39]
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #2
I DON'T HAVE THE TIME1
I WON’T KNOW WHAT TO LOOK FOR EVEN IF I READ THE LABELS 8
I’M SATISFIED WITH MY HEALTH SO THERE IS NO NEED FOR ME TO CHECK 3
I CAN’T READ ENGLISH THAT WELL 9
I HAVE A GOOD DIET SO THERE IS NO NEED TO CHECK LABELS 4
I BUY WHAT I OR MY FAMILY LIKE, I DON’T CARE ABOUT THE LABELS 6
I DON’T THINK THE FOOD LABELS ARE IMPORTANT TO ME 7
THE PRINT IS TOO SMALL FOR ME TO READ 2
I USUALLY BUY FOODS THAT I'M USED TO, SO I DON’T FEEL THAT I NEED TO CHECK LABELS 5
OTHER SPECIFY________________ 91
REFUSED 77
DON’T KNOW 99
CBQ.695 {Now turn to {hand cards 40 and 41/hand cards 42 and 43}.} Again, for this next question you may give more than one answer.
Now think about the “serving size” on a food label. What does serving size mean to you? Serving size is…
CODE ALL THAT APPLY
[HAND CARD #40 & #41]
CAPI INSTRUCTION:
Do NOT display the text in braces if CBQ.502=”2”.
IF (DBQ.750 = 6-9) AND (DBQ.760 = 6-9) AND (DBQ.770 = 6-9) AND (DBQ.780 = 6-9), AND (CBQ.905 = 6-9), AND (CBQ.910 = 6-9), AND (CBQ.685 = 6-9), AND CBQ.930 = 6-9), AND (CBQ.935 = 6-9), AND (CBQ.945 = 6-9), AND (CBQ.950 = 6-9), Do NOT display the word “Again,” in the introduction sentence.
CAPI INSTRUCTION: IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 1 AND “[HAND CARDS #40 & #41]”. IF HOUSEHOLD ID EQUAL TO XXX, DISPLAY RANDOMIZED ORDER VERSION 2 AND “[HAND CARDS #42 & #43]”.
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #1
The amount of this food that people should eat 1
The amount of this food that people usually eat 2
Something that makes it easier to compare foods 3
REFUSED 7
DON'T KNOW 9
[HAND CARDS #42 & #43]
CAPI INSTRUCTION: RANDOMIZED ORDER VERSION #2
The amount of this food that people usually eat 2
The amount of this food that people should eat 1
Something that makes it easier to compare foods 3
REFUSED 7
DON'T KNOW 9
Section E. Respondent information
BOX 6.
CHECK ITEM CBQ.750:
CBQ.755, DBQ.930-DBQ.945, CBQ.760-CBQ.770 ONLY APPLY TO NON-SP PROXY.
IF RESPONDENT IS A SP, GO TO CBQ.785. OTHERWISE, CONTINUE. |
CBQ.755 What is your relation with {SP}?
Mother of SP 1
Father of SP 2
Grandparent of SP 3
Child care provider, Caretaker 4
Other Relative 5
Friend, Non Relative 6
REFUSED 7
DON'T KNOW 9
DBQ.930 Are you the person who does most of the planning or preparing of meals in your family?
INTERVIEWER INSTRUCTION: IF SP ANSWERS “SOMETIMES” OR “50/50”, ENTER YES
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
DBQ.935 Do you share in the planning or preparing of meals with someone else?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
DBQ.940 Are you the person who does most of the shopping for food in your family?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
DBQ.945 Do you share in the shopping for food with someone else?
YES 1
NO 2
REFUSED 7
DON'T KNOW 9
CBQ.760 How old are you?
|___|___| Years
Enter AGE
REFUSED 77
DON'T KNOW 99
CBQ.765 Which of the following best describe your highest education level?
Less than high school 1
High school diploma (including GED), or 2
More than high school 3
REFUSED 7
DON'T KNOW 9
CBQ.770 WHAT IS THE GENDER OF THE RESPONDENT?
[Interviewer Instruction: this is a question for the interviewer to complete by selecting the appropriate option. No need to read the question to the SP]
MALE 1
FEMALE 2
CBQ.785 THE INTERVIEW WAS COMPLETED IN:
INTERVIEWER INSTRUCTION:
This is a question for the interviewer to complete by selecting the appropriate option. Do not read the question to the SP.
ENGLISH 1
SPANISH 2
ENGLISH AND SPANISH 3
OTHER 4
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Frenk, Steven M. (CDC/OPHSS/NCHS) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |