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Protocol - Dietary Intake

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Description:

The Dietary Screener Questionnaire (DSQ) is a 30-item questionnaire from the National Health and Nutrition Examination Survey (NHANES) 2009-2010 series. The interview includes items about frequency of intake of various food items (per month, daily, etc.).

Protocol:

SP = Survey Participant

1. These questions are about the different kinds of foods {you/SP} ate or drank during the past month, that is, 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

[ ] 0 NEVER(Q2)

[ ] 777 REFUSED (Q2)

[ ] 999 DON’T KNOW (Q2)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 2.

2. You said (DISPLAY NUMBER FROM Q1) times per (DISPLAY UNIT FROM Q1). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q1)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

4. IS THERE ANOTHER CEREAL SP USUALLY EATS?

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

[ ] 1 YES(RETURN TO Q3)

[ ] 2 NO (Q5)

5. (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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q7)

[ ] 777 REFUSED (Q7

[ ] 999 DON’T KNOW (Q7)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

CAPI INSTRUCTION:

IF Q1 >= 1, DISPLAY PHRASE {"either to drink or on cereal"}.

CAPI INSTRUCTION:

IF RESPONSE > 2 AND UNIT = 1 (DAY), ELIMINATE >2 AND UNIT = 1 FOR HOUSEHOLD QUESTIONNAIRE SECTION (SPs 2-11 YEARS OLD)

IF RESPONSE > 14 AND UNIT = 2 (WEEK), OR

IF RESPONSE > 60 AND UNIT = 3 (MONTH),

THEN DISPLAY QUESTION Q6.

6. You said (DISPLAY NUMBER FROM Q5) times per (DISPLAY UNIT FROM Q5). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q5)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

7. During the past month, how often did {you/SP} drink regular soda or pop that contains sugar? Do not 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.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q9)

[ ] 777 REFUSED (Q9)

[ ] 999 DON’T KNOW (Q9)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q8.

8. You said (DISPLAY NUMBER FROM Q7) times per (DISPLAY UNIT FROM Q7). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q7)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

9. (During the past month), how often did {you/SP} drink 100% pure fruit juice such as orange, mango, apple, 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.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(BOX 1)

[ ] 777 REFUSED (BOX 1)

[ ] 999 DON’T KNOW (BOX 1)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q10.

10. You said (DISPLAY NUMBER FROM Q9) times per (DISPLAY UNIT FROM Q9). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q9)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

BOX 1

IF SP AGE 2-11 YEARS OLD, SKIP TO Q13.

OTHERWISE, CONTINUE.

11. (During the past month), how often did {you/SP} drink coffee or tea that had sugar or honey added to it? 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q13)

[ ] 777 REFUSED (Q1)

[ ] 999 DON’T KNOW (Q13)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q12.

12. You said (DISPLAY NUMBER FROM Q11) times per (DISPLAY UNIT FROM Q11). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q11)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

13. (During the past month), how often did {you/SP} drink sweetened fruit drinks, sports or energy drinks, such 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q15)

[ ] 777 REFUSED (Q15)

[ ] 999 DON’T KNOW (Q15)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q14.

14. You said (DISPLAY NUMBER FROM Q13) times per (DISPLAY UNIT FROM Q13). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q13)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

INTERVIEWER INSTRUCTIONS:

DO NOT INCLUDE: DRIED FRUITS.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q17)

[ ] 777 REFUSED (Q17)

[ ] 999 DON’T KNOW (Q17)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q16.

16. You said (DISPLAY NUMBER FROM Q15) times per (DISPLAY UNIT FROM Q15). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q15)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

INTERVIEWER INSTRUCTIONS:

INCLUDE: SPINACH SALADS.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q19)

[ ] 777 REFUSED (Q19)

[ ] 999 DON’T KNOW (Q19)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q18.

18. You said (DISPLAY NUMBER FROM Q17) times per (DISPLAY UNIT FROM Q17). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q17)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

INTERVIEWER INSTRUCTIONS:

DO NOT INCLUDE: POTATO CHIPS.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q21)

[ ] 777 REFUSED (Q21)

[ ] 999 DON’T KNOW (Q21)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q20.

20. You said (DISPLAY NUMBER FROM Q19) times per (DISPLAY UNIT FROM Q19). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q19)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

21. (During the past month), how often did {you/SP} eat any other kind of potatoes, such as baked, boiled, 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q23)

[ ] 777 REFUSED (Q23)

[ ] 999 DON’T KNOW (Q23)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q22.

22. You said (DISPLAY NUMBER FROM Q21) times per (DISPLAY UNIT FROM Q21). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q21)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

23. (During the past month), how often did {you/SP} eat refried beans, baked beans, beans in soup, pork and 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q25)

[ ] 777 REFUSED (Q25)

[ ] 999 DON’T KNOW (Q25)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q24.

24. You said (DISPLAY NUMBER FROM Q23) times per (DISPLAY UNIT FROM Q23). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q23)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

25. (During the past month), how often did {you/SP} eat brown rice or other cooked whole grains, such as 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q27)

[ ] 777 REFUSED (Q27)

[ ] 999 DON’T KNOW (Q27)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q26.

26. You said (DISPLAY NUMBER FROM Q25) times per (DISPLAY UNIT FROM Q25). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q25)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

27. (During the past month), not including what you just told me about (lettuce salads, potatoes, cooked dried 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q29)

[ ] 777 REFUSED (Q29)

[ ] 999 DON’T KNOW (Q29)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q28.

28. You said (DISPLAY NUMBER FROM Q27) times per (DISPLAY UNIT FROM Q27). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q27)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

INTERVIEWER INSTRUCTIONS:

INCLUDE: ALL TOMATO-BASED SALSAS.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q31)

[ ] 777 REFUSED (Q31)

[ ] 999 DON’T KNOW (Q31)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q30.

30. You said (DISPLAY NUMBER FROM Q29) times per (DISPLAY UNIT FROM Q29). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q29)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q33)

[ ] 777 REFUSED (Q33)

[ ] 999 DON’T KNOW (Q33)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q32.

32. You said (DISPLAY NUMBER FROM Q31) times per (DISPLAY UNIT FROM Q31). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q31)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

33. (During the past month), how often did {you/SP} have tomato sauces such as with spaghetti or noodles or 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q35)

[ ] 777 REFUSED (Q35)

[ ] 999 DON’T KNOW (Q35)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

CAPI INSTRUCTION:

IF Q31 >= 1, DISPLAY "Please do not count tomato sauce on pizza."

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 Q34.

34. You said (DISPLAY NUMBER FROM Q33) times per (DISPLAY UNIT FROM Q33). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q33)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

35. (During the past month), how often did {you/SP} eat any kind of cheese? Include cheese as a snack, 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q37)

[ ] 777 REFUSED (Q37)

[ ] 999 DON’T KNOW (Q37)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

CAPI INSTRUCTION:

IF Q31 >= 1, DISPLAY "Please do not count cheese on pizza."

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 Q36.

36. You said (DISPLAY NUMBER FROM Q35) times per (DISPLAY UNIT FROM Q35). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q35)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

37. During the past month, how often did {you/SP} eat red meat, such as beef, pork, ham, or sausage? Do not include chicken, turkey or seafood. (You can tell me per day, per week or per month.)

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q39)

[ ] 777 REFUSED (Q39)

[ ] 999 DON’T KNOW (Q39)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q38.

38. You said (DISPLAY NUMBER FROM Q37) times per (DISPLAY UNIT FROM Q37). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q37)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

39. (During the past month), how often did {you/SP} eat processed meat, such as bacon, lunch meats, or hot dogs? (You can tell me per day, per week or per month.)

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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q41)

[ ] 777 REFUSED (Q41)

[ ] 999 DON’T KNOW (Q41)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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.185.

40. You said (DISPLAY NUMBER FROM Q39) times per (DISPLAY UNIT FROM Q39). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q39)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

41. (During the past month), how often did {you/SP} eat whole grain bread including toast, rolls and in 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.)

INTERVIEWER INSTRUCTIONS:

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

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q43)

[ ] 777 REFUSED (Q43)

[ ] 999 DON’T KNOW (Q43)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q42DTQ.205.

42. You said (DISPLAY NUMBER FROM Q41) times per (DISPLAY UNIT FROM Q41). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q41)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q45)

[ ] 777 REFUSED (Q45)

[ ] 999 DON’T KNOW (Q45)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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.225.

44. You said (DISPLAY NUMBER FROM Q43) times per (DISPLAY UNIT FROM Q43). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q43)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

45. (During the past month), how often did {you/SP} eat doughnuts, sweet rolls, Danish, muffins, (pan dulce) or 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 CREAMAND OTHER FROZEN DESSERTS OR CANDY.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(DTQ.240)

[ ] 777 REFUSED (DTQ.240)

[ ] 999 DON’T KNOW (DTQ.240)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q46.

46. You said (DISPLAY NUMBER FROM Q45) times per (DISPLAY UNIT FROM Q45). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q45)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

47. (During the past month), how often did {you/SP} eat cookies, cake, pie or brownies? Do not include 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q49)

[ ] 777 REFUSED (Q49)

[ ] 999 DON’T KNOW (Q39)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q48.

48. You said (DISPLAY NUMBER FROM Q47) times per (DISPLAY UNIT FROM Q47). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q48)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

49. (During the past month), how often did {you/SP} eat ice cream or other frozen desserts? Do not include 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 QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(Q51)

[ ] 777 REFUSED (Q51)

[ ] 999 DON’T KNOW (Q51)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q50.

50. You said (DISPLAY NUMBER FROM Q49) times per (DISPLAY UNIT FROM Q49). Is that correct?

[ ] 1 YES(CONTINUE)

[ ] 2 NO (RETURN TO Q49)

[ ] 777 REFUSED (CONTINUE)

[ ] 999 DON’T KNOW (CONTINUE)

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

INTERVIEWER INSTRUCTIONS:

INCLUDE: LOW-FAT POPCORN.

|___|___|___|

ENTER QUANTITY IN DAYS, WEEKS, OR MONTHS

[ ] 0 NEVER(END OF SECTION)

[ ] 777 REFUSED (END OF SECTION)

[ ] 999 DON’T KNOW (END OF SECTION)

ENTER UNIT

[ ] 1 DAY

[ ] 2 WEEK

[ ] 3 MONTH

[ ] 7 REFUSED

[ ] 9 DON’T KNOW

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 Q52.

52. You said (DISPLAY NUMBER FROM Q51) times per (DISPLAY UNIT FROM Q51). Is that correct?

[ ] 1 YES(END OF SECTION)

[ ] 2 NO (RETURN TO Q51)

[ ] 777 REFUSED (END OF SECTION)

[ ] 999 DON’T KNOW (END OF SECTION)

Protocol Name from Source:

National Health and Nutrition Examination Survey Questionnaire - Dietary Screener Questionnaire

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy

Participants:

Adults and Children - All ages

Specific Instructions:

A SAS program and associated data files (ZIP, 41KB) are available that process the DSQ data from the self-administered questionnaire.

The Web-based version of the DSQ is available for public use. DSQ*Web takes advantage of the features of automated and electronic questionnaires-respondents follow automated skip patterns, are queried to complete all questions before proceeding to the next, navigate within the instrument to correct or modify responses, and can log in at any time to complete the questionnaire, starting where they left off. DSQ*Web provides efficiency with respect to data quality because the possibility of missing or inconsistent responses is eliminated. DSQ*Web was modeled after DHQ*Web, a system that has been operating since 2005.

To request a study in the web-based dietary screener questionnaire, users may submit a request form. A SAS program and associated data files (ZIP, 58KB) are available that process the DSQ data from the self-administered questionnaire for the Web.

The Working Group suggests that the analysis and interpretation take into account the specific age range. For younger children, parent report is used, for mid-age children, parent-assisted report is used.

Selection Rationale

In observational studies, dieting is a robust predictor of weight change. Because diets may be focused on changing diet composition rather than caloric restriction, a measure of dietary intake is important. This screener provides a shorter alternative to obtaining total dietary intake and is an alternative when obtaining total dietary intake is not necessary. The NHANES dietary intake questionnaire is broadly validated in this large-scale study.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Obesity Dietary Screener Questionnaire Assessment Score 4994174 CDE Browser
Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2009-2010). National Health and Nutrition Examination Survey Questionnaire (NHANES). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention Question numbers: DTQ.010-DTQ.265.

General References

None

Protocol ID:

231201

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
Research Domain Information
Measure Name:

Dietary Intake

Release Date:

November 30, 2015

Definition

Questions asking respondents about foods they consumed or drank during the past month (30 days).

Purpose

The purpose of this measure is to assess the nutritional intake of adults and children.

Keywords

Diet, food intake, eating behaviors, nutrition, nutrient intake, foods and beverages, NHANES, National Health and Nutrition Examination Survey Questionnaire