DIETARY SCREENER MODULE · DIETARY SCREENER MODULE (DTQ) ... DTQ.010 These questions are about the different kinds of foods {you/SP} ate or drank during

10/6/08 Questionnaire: MEC

DIETARY SCREENER MODULE (DTQ) 2-11 – Household

12-69 – MEC

DTQ.010 These questions are about the different kinds of foods {you/SP} ate or drank during the past month, that is, G/Q/U the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in

restaurants, and anyplace else.

During the past month, how often did {you/SP} eat hot or cold cereals? You can tell me per day, per week or per month.

|___|___|___| ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

NEVER .......................................................... 0 (DTQ.030) REFUSED ..................................................... 777 (DTQ.030) DON'T KNOW ............................................... 999 (DTQ.030)

ENTER UNIT

DAY ............................................................... 1 WEEK............................................................ 2 MONTH ......................................................... 3 REFUSED ..................................................... 7 DON'T KNOW ............................................... 9

CAPI INSTRUCTION: IF RESPONSE > 1 AND UNIT = 1 (DAY), OR IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR IF RESPONSE > 60 AND UNIT = 3 (MONTH), THEN DISPLAY QUESTION DTQ.015.

DTQ.015 You said (DISPLAY NUMBER FROM DTQ.010) times per (DISPLAY UNIT FROM DTQ.010). Is that correct?

YES ............................................................... 1 (CONTINUE) NO ................................................................. 2 (RETURN TO DTQ.010) REFUSED ..................................................... 777 (CONTINUE) DON’T KNOW ............................................... 999 (CONTINUE)

DTQ.020 During the past month, what kinds of cereal did {you/SP} usually eat?

ENTER FIRST FEW LETTERS OF CEREAL NAME TO START THE LOOKUP. SELECT CEREAL FROM LIST. IF CEREAL NOT ON LIST, PRESS BS TO DELETE THE ENTRY AND TYPE ** TO ENTER CEREAL NAME.

CAPI INSTRUCTION: DISPLAY CEREAL LIST. INTERVIEWER SHOULD BE ABLE TO SELECT CEREAL FROM LIST OR PRESS BS TO DELETE ENTRY AND TYPE ** TO ENTER NAME OF CEREAL.

NEW BOX 0

CHECK ITEM DTQ.300: IF THIS IS THE FIRSTENTRY, CONTINUE. OTHERWISE, GO TO DTQ.030.

DTQ.025 IS THERE ANOTHER CEREAL SP USUALLY EATS?

OR ASK IF NECESSARY (Is there another cereal {you/SP} usually eat(s)?)

YES ...............................................................NO .................................................................

1 2

(RETURN TO DTQ.020) (DTQ.030)

DTQ.030 G/Q/U

(During the past month), how often did {you/SP} have milk {either to drink or on cereal}? Do not include soy milk or small amounts of milk in coffee or tea. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTION: INCLUDE: SKIM, NO-FAT, LOW-FAT, WHOLE MILK, BUTTERMILK, AND LACTOSE-FREE MILK. ALSO INCLUDE CHOCOLATE OR OTHER FLAVORED MILKS. DO NOT INCLUDE: CREAM.



ENTER UNIT

DAY ...............................................................WEEK............................................................MONTH .........................................................REFUSED .....................................................DON'T KNOW ...............................................

1 2 3 7 9

CAPI INSTRUCTION: IF DTQ.010 >= 1, DISPLAY PHRASE {“either to drink or on cereal”}.

CAPI INSTRUCTION: IF RESPONSE > 2 AND UNIT = 1 (DAY), ELIMINATEQUESTIONNAIRE SECTION (SPs 2-11 YEARS OLD) IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR IF RESPONSE > 60 AND UNIT = 3 (MONTH), THEN DISPLAY QUESTION DTQ.035.

>2 AND UNIT = 1 FOR HOUSEHOLD



2

DTQ.040 During the past month, how often did {you/SP} drink regular soda or pop that contains sugar? Do not G/Q/U include diet soda. You can tell me per day, per week or per month. INTERVIEWER INSTRUCTION: INCLUDE: MANZANITA AND PEÑAFIEL SODAS. DO NOT INCLUDE: DIET OR SUGAR-FREE FRUIT DRINKS. DO NOT INCLUDE JUICES OR TEA IN

CANS.


NEVER .......................................................... 0 (DTQ.050) REFUSED ..................................................... 777 (DTQ.050) DON'T KNOW ............................................... 999 (DTQ.050) ENTER UNIT


CAPI INSTRUCTION: IF RESPONSE > 2 AND UNIT = 1 (DAY), OR IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR IF RESPONSE > 60 AND UNIT = 3 (MONTH), THEN DISPLAY QUESTION DTQ.045. DTQ.045 You said (DISPLAY NUMBER FROM DTQ.040) times per (DISPLAY UNIT FROM DTQ.040). Is that

correct?


3

DTQ.050 (During the past month), how often did {you/SP} drink 100% pure fruit juice such as orange, mango, apple, G/Q/U grape and pineapple juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at

home and added sugar to. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTION: INCLUDE: ONLY 100% PURE JUICES. DO NOT INCLUDE: FRUIT-FLAVORED DRINKS WITH ADDED SUGAR, LIKE CRANBERRY COCKTAIL, HI-C, LEMONADE, KOOL-AID, GATORADE, TAMPICO, AND SUNNY DELIGHT.


NEVER .......................................................... 0 (BOX 1) REFUSED ..................................................... 777 (BOX 1) DON'T KNOW ............................................... 999 (BOX 1)

ENTER UNIT


CAPI INSTRUCTION: IF RESPONSE > 1 AND UNIT = 1 (DAY), ELIMINATE > 1 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRES (SPs 2-11 YEARS OLD) IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR IF RESPONSE > 60 AND UNIT = 3 (MONTH), THEN DISPLAY QUESTION DTQ.055.



NEW BOX 1

CHECK ITEM DTQ.305: IF SP AGE 2-11 YEARS OLD, SKIP TO DTQ.070. OTHERWISE, CONTINUE.

4

DTQ.060 (During the past month), how often did {you/SP} drink coffee or tea that had sugar or honey added to it? G/Q/U Include coffee and tea you sweetened yourself and presweetened tea and coffee drinks such as Arizona

Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea. (You can tell me per day, per week or per month.)



ENTER UNIT





5

DTQ.070 (During the past month), how often did {you/SP} drink sweetened fruit drinks, sports or energy drinks, such G/Q/U as Kool-aid, lemonade, Hi-C, cranberry drink, Gatorade, Red Bull or Vitamin Water? Include fruit juices you

made at home and added sugar to. Do not include diet drinks or artificially sweetened drinks. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTION: INCLUDE: DRINKS WITH ADDED SUGAR, TAMPICO, SUNNY DELIGHT, AND TWISTER. DO NOT INCLUDE: 100% FRUIT JUICES OR SODA, YOGURT DRINKS, CARBONATED WATER OR FRUIT-FLAVORED TEAS.



ENTER UNIT


CAPI INSTRUCTION: IF RESPONSE > 1 AND UNIT = 1 (DAY), ELIMINATE > 1 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRES (SPs 2-11 YEARS OLD) IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR IF RESPONSE > 60 AND UNIT = 3 (MONTH), THEN DISPLAY QUESTION DTQ.075.



6

DTQ.080 (During the past month), how often did {you/SP} eat fruit? Include fresh, frozen or canned fruit. Do not G/Q/U include juices. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: DRIED FRUITS.



ENTER UNIT





7

DTQ.090 (During the past month), how often did {you/SP} eat a green leafy or lettuce salad, with or without other G/Q/U vegetables? (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: SPINACH SALADS.



ENTER UNIT





8

DTQ.100 (During the past month), how often did {you/SP} eat any kind of fried potatoes, including french fries, home G/Q/U fries, or hash brown potatoes? (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: POTATO CHIPS.



ENTER UNIT





9

DTQ.110 (During the past month), how often did {you/SP} eat any other kind of potatoes, such as baked, boiled, G/Q/U mashed potatoes, sweet potatoes, or potato salad? (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: ALL TYPES OF POTATOES EXCEPT FRIED. INCLUDE POTATOES AU GRATIN, SCALLOPED POTATOES.



ENTER UNIT





10

DTQ.120 (During the past month), how often did {you/SP} eat refried beans, baked beans, beans in soup, pork and G/Q/U beans or any other type of cooked dried beans? Do not include green beans. (You can tell me per day, per

week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: SOYBEANS, KIDNEY, PINTO, GARBANZO, LENTILS, BLACK, BLACK-EYED PEAS, COW PEAS, AND LIMA BEANS.



ENTER UNIT





11

DTQ.210 (During the past month), how often did {you/SP} eat brown rice or other cooked whole grains, such as G/Q/U bulgur, cracked wheat, or millet? Do not include white rice. (You can tell me per day, per week or per

month.)

HELP SCREEN: Brown rice is a type of whole grain. It is brown in color and takes longer to cook than white rice. It contains almost all of the rice grain and is not as processed as white rice. Compared to white rice it also contains more fiber and more of some vitamins and minerals that are lost during the processing of rice.



ENTER UNIT





12

DTQ.130 (During the past month), not including what you just told me about (lettuce salads, potatoes, cooked dried G/Q/U beans), how often did {you/SP} eat other vegetables? (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: DO NOT INCLUDE: RICE EXAMPLES OF OTHER VEGETABLES INCLUDE: TOMATOES, GREEN BEANS, CARROTS, CORN, CABBAGE, BEAN SPROUTS, COLLARD GREENS, AND BROCCOLI. INCLUDE ANY FORM OF THE VEGETABLE (RAW, COOKED, CANNED, OR FROZEN).



ENTER UNIT





13

DTQ.150 (During the past month), how often did {you/SP} have Mexican-type salsa made with tomato? (You can tell G/Q/U me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: ALL TOMATO-BASED SALSAS.



ENTER UNIT





14

DTQ.140 During the past month, how often did {you/SP} eat pizza? Include frozen pizza, fast food pizza, and G/Q/U homemade pizza. You can tell me per day, per week or per month.



ENTER UNIT





15

DTQ.160 (During the past month), how often did {you/SP} have tomato sauces such as with spaghetti or noodles or G/Q/U mixed into foods such as lasagna? {Please do not count tomato sauce on pizza.} (You can tell me per day,

per week or per month.)



ENTER UNIT


CAPI INSTRUCTION: IF DTQ.140 >= 1, DISPLAY “Please do not count tomato sauce on pizza.”




16

DTQ.190 (During the past month), how often did {you/SP} eat any kind of cheese? Include cheese as a snack, G/Q/U cheese on burgers, sandwiches, and cheese in foods such as lasagna, quesadillas, or casseroles. {Please

do not count cheese on pizza.} (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: MACARONI AND CHEESE, ENCHILADAS. DO NOT INCLUDE: CREAM CHEESE OR CHEESES MADE FROM NON-DAIRY FOODS, SUCH AS SOY OR RICE, OR CHEESE ON PIZZA.



ENTER UNIT


CAPI INSTRUCTION: IF DTQ.140 >= 1, DISPLAY “Please do not count cheese on pizza.”




17

DTQ.170 Please look at this card, during the past month, how often did {you/SP} eat red meat, such as beef, pork, G/Q/U ham, or sausage? Do not include chicken, turkey or seafood. (You can tell me per day, per week or per

month.)

HAND CARD DTQ1



ENTER UNIT





18

DTQ.180 Please look at this card, (during the past month), how often did {you/SP} eat processed meat, such as G/Q/U bacon, lunch meats, or hot dogs? (You can tell me per day, per week or per month.)

HAND CARD DTQ2

INTERVIEWER INSTRUCTIONS: INCLUDE: PROCESSED POULTRY AND RED MEAT. DO NOT INCLUDE: CANNED TUNA FISH OR CHICKEN NUGGETS.

HELP SCREEN: PROCESSED MEAT: Meats (usually red meats, but not always) preserved by smoking, curing, or salting, or by the addition of preservatives. Examples include: ham, bacon, pastrami, salami, sausages, bratwursts, frankfurters, hot dogs, or spam.



ENTER UNIT





19

DTQ.200 (During the past month), how often did {you/SP} eat whole grain bread including toast, rolls and in G/Q/U sandwiches? Whole grain breads include whole wheat, rye, oatmeal and pumpernickel. Do not include

white bread. (You can tell me per day, per week or per month.)

HAND CARD DTQ3

INTERVIEWER INSTRUCTIONS: INCLUDE: CRACKED WHEAT, MULTI-GRAIN, BRAN BREADS, WHOLE GRAIN WHITE BREAD.



ENTER UNIT





20

DTQ.220 During the past month, how often did {you/SP} eat chocolate or any other types of candy? Do not include G/Q/U sugar-free candy. You can tell me per day, per week or per month.



ENTER UNIT





21

DTQ.230 (During the past month), how often did {you/SP} eat doughnuts, sweet rolls, Danish, muffins, (pan dulce) or G/Q/U pop-tarts? Do not include sugar-free items. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS. DO NOT INCLUDE: PANCAKES, WAFFLES, FRENCH TOAST, CAKE, ICE CREAM AND OTHER FROZEN DESSERTS OR CANDY.



ENTER UNIT





22

DTQ.240 (During the past month), how often did {you/SP} eat cookies, cake, pie or brownies? Do not include G/Q/U sugar-free kinds. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS, TWINKIES AND HOSTESS CUPCAKES. DO NOT INCLUDE: ICE CREAM AND OTHER FROZEN DESSERTS OR CANDY.



ENTER UNIT





23

DTQ.250 (During the past month), how often did {you/SP} eat ice cream or other frozen desserts? Do not include G/Q/U sugar-free kinds. (You can tell me per day, per week or per month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT KINDS. ALSO INCLUDE FROZEN YOGURT AND SHERBET. DO NOT INCLUDE: NON-DAIRY FROZEN DESSERTS, SUCH AS SORBET, SNO-CONES.



ENTER UNIT





24

DTQ.260 (During the past month), how often did {you/SP} eat popcorn? (You can tell me per day, per week or per G/Q/U month.)

INTERVIEWER INSTRUCTIONS: INCLUDE: LOW-FAT POPCORN.


NEVER .......................................................... 0 (END OF SECTION) REFUSED ..................................................... 777 (END OF SECTION) DON'T KNOW ............................................... 999 (END OF SECTION)

ENTER UNIT




YES ............................................................... 1 (END OF SECTION) NO ................................................................. 2 (RETURN TO DTQ.260) REFUSED ..................................................... 777 (END OF SECTION) DON’T KNOW ............................................... 999 (END OF SECTION)

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Documents

DIETARY SCREENER MODULE · DIETARY SCREENER MODULE (DTQ) ... DTQ.010 These questions are about the different kinds of foods {you/SP} ate or drank during