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Answer each question as best you can. Estimate if you are not sure.
A guess is better than leaving a blank.
Use only a No. 2 pencil.
Be certain to completely blacken in each of the answers.
Erase completely if you make any changes.
Do not make any stray marks on this form.
If you blacken NEVER or NO for a question, please follow any arrows
or instructions that direct you to the next question.
244004 - 1/6
1.
6.
NEVER
NEVER (GO TO QUESTION 7)
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
2.
6a.
NEVER
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
NEVER
7a.
4.
NEVER
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
5.
7.
3.
BAR
1 time per day
23 times per day
45 times per day
6 or more times per day
CODE
LABEL
HERE
10.
NEVER
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
9.
NEVER
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
NEVER
9a.
NEVER
1 time per month or less
23 times per month
12 times per week
34 times per week
56 times per week
9b.
11.
NEVER
9c.
12.
9d.
14a. How often was the cold cereal you ate a whole
grain type (such as shredded wheat, Wheaties,
Cheerios, Raisin Bran or other bran, oat, or
whole wheat cereal)?
YES
NEVER
YES
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
15.
16.
14.
17.
19.
NEVER
2 times per week
34 times per week
56 times per week
1 time per day
2 or more times per day
NEVER
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
20.
23.
NEVER
NO (GO TO QUESTION 24)
21.
YES
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
244004 - 3/6
NEVER
YES
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
26.
NEVER
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
33.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
34.
29.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
35.
30.
31.
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
32.
41.
42.
37.
NEVER
YES
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
38.
NEVER
39.
40.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
45.
NEVER
NEVER
16 times per season
711 times per season
1 time per month
23 times per month
1 time per week
47.
NEVER
2 times per week
34 times per week
56 times per week
1 time per day
2 or more times
per day
48.
How often did you eat lettuce salads (with or without
other vegetables)?
49.
44a. How often were the lettuce salads you ate made
with dark green leaves?
NEVER
44.
10
244004 - 5/6
NEVER
Almost never or never
About 1/4 of the time
About 1/2 of the time
About 3/4 of the time
Almost always or always
55.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
51.
NEVER
52.
56.
57.
53.
54.
58.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
11
62.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
63.
59.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
244004 - 6/6
61.
60.
12
67.
68.
The next questions ask about your intake of breads
other than bagels or English muffins. First, we will ask
about bread you ate as part of sandwiches only. Then
we will ask about all other bread you ate.
65.
69.
70.
NEVER
65a. How often were the breads or rolls that you used
for your sandwiches white bread (including
burger and hot dog rolls)?
66.
71.
66a. How often were the breads or rolls you ate
white bread?
13
75.
76.
77.
74.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
73.
14
72.
82.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
79.
83.
80.
84.
80a. How often was the steak you ate lean steak?
Almost never or never
1/4
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
81.
How often did you eat steak (beef)? (Do not include
steak in sandwiches)
NEVER
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
15
89.
1/4
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
85.
89a. How often was the bacon you ate light, low-fat,
or lean bacon?
90.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
87.
88.
91.
2 times per week
34 times per week
56 times per week
1 time per day
2 or more times per day
NEVER
92.
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
16
86.
97.
93.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
94.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
95.
97c. How often were the soups you ate bean soups?
Almost never or never
About 1/4 of the time
About 1/2 of the time
About 3/4 of the time
Almost always or always
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
96.
17
102.
1/4
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
98.
103.
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
99.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
100.
104.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
101.
NEVER
2 times per week
34 times per week
56 times per week
1 time per day
2 or more times per day
105.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
18
1/4
110a.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
111.
107.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
112.
How often did you eat ice cream, ice cream bars, or
sherbet (including low-fat or fat-free)?
NEVER (GO TO QUESTION 113)
108.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
112a. How often was the ice cream you ate light,
low-fat, or fat-free ice cream or sherbet?
Almost never or never
109.
113.
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
110.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
19
119a. How often was the pie you ate fruit pie (such
as apple, cherry, peach, blueberry, or others)?
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
120.
116.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
117.
121.
122.
118.
NEVER
16 times per year
711 times per year
1 time per month
23 times per month
1 time per week
119.
20
125.
122c. How often were the eggs you ate regular
whole eggs?
122d. How often were the eggs you ate part of egg
salad?
123.
126.
NEVER
Less than 1 time per
month
13 times per month
1 time per week
24 times per week
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
124.
21
131.
132.
Regular powdered
Low-fat or fat-free powdered
Regular liquid
Low-fat or fat-free liquid
NEVER
Less than 1 time per
month
13 times per month
1 time per week
24 times per week
130.
133.
Whole milk
2% milk
1% milk
1/2%
milk
Skim, nonfat, or
Evaporated or condensed (canned) milk
Soy milk
Rice milk
Raw, unpasteurized milk
Other
22
129.
136.
137.
135.
23
139.
How often did you eat foods with oils added or with
oils used in cooking (do not include baked goods or
salads)?
NEVER
138a. How often was the sour cream you ate low-fat
or fat-free?
Olive
Corn
Canola/rapeseed
Other
1/4
of the time
About
About 1/2 of the time
About 3/4 of the time
Almost always or always
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if you would please take a moment to review each page making sure that you:
Did not skip any pages,
Completely blackened-in each answer, and
Completely erased any changes you may have made.
24
HR06
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