Question Response Type Purpose Source Your Eating Habits Here is a list of common fruits (either fresh, canned, or frozen) you may have eaten over the past 12 months: Apples Pears Bananas Dried fruit (such as prunes, raisins, dried apricots) Peaches, nectarines, or plums Grapes Cantaloupe Other melons (watermelon or honeydew) Strawberries Oranges, tangerines, tangelos Grapefruit Pineapple Other kinds of fruit 1. Over the past 12 months, how often did you eat 2 or more times/day; 1 time/day; fruits? Please consider ALL types of fruits you have eaten, even if 5-­‐6 times/wk; 3-­‐4 times/wk; 2 times/wk; they aren't included on the list. 1 time/wk; 1-­‐6 times / yr; 7-­‐11 times/yr; 2-­‐3 times/mo; 1 time per month Adapted from: Over the past 12 months, how often did you eat ….? [Individual questions asked for each of the fruits in the list above] Status Adapted from NIH/NCI Diet History Questionnaire (DHQ) http://appliedresearch.
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hq-­‐-­‐dhq1.2007.sample 1a. Each time you ate fruit, how much did you usually eat? Consider that a one-­‐cup serving is about the size of a baseball. [Baseball graphic would be off to the side here…] Adapted from: Each time you ate …., how much did you usually eat? [Individual questions asked for each of the fruits in the list above] Adapted from NIH/NCI Diet History Questionnaire (DHQ) http://appliedresearch.
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hq-­‐-­‐dhq1.2007.sample 0, ½, 1, 1 ½, 2, 2 ½, 3, …etc…8+ cups Adapted from: Less than 1/4 cup; 1/4 to 3/4 cup; More than 3/4 cup Here is a list of common vegetables (either fresh, canned, or frozen) you may have eaten over the past 12 months: Cooked greens (such as spinach, turnip, collard, mustard, chard, kale) Raw greens (such as spinach, turnip, collard, mustard, chard, kale) Coleslaw Sauerkraut or cabbage (other than coleslaw) Carrots Question Response Type Purpose Source String beans or green beans Peas Corn Broccoli Cauliflower or Brussels sprouts Mixed vegetables Onions Cooked vegetables Sweet peppers (green, red, or yellow) Tomatoes Lettuce Other kinds of vegetables 2. Over the past 12 months, how often did you eat 2 or more times/day; 1 time/day; Status vegetables? Please consider ALL types of vegetables you have eaten, 5-­‐6 times/wk; 3-­‐4 times/wk; 2 times/wk; even if they aren't included on the list. 1 time/wk; 1-­‐6 times / yr; 7-­‐11 times/yr; 2-­‐3 times/mo; 1 time per month Adapted from: Over the past 12 months, how often did you eat ….? [Individual questions asked for each of the vegetables in the list above] 2a. Each time you ate vegetables, how much did you usually 0, ½, 1, 1 ½, 2, 2 ½, 3, …etc…8+ cups Status eat? Consider that a one-­‐cup serving is about the size of a baseball. [Baseball graphic would be off to the side here…] Adapted from: Adapted from: Each time you ate …., how much did you usually eat? Less than 1/4 cup; [Individual questions asked for each of the vegetables in the list above] 1/4 to 3/4 cup; More than 3/4 cup Skip Pattern: If status < [5 for women, 5 ½ for men] cups, go to 3a. If status >= [5 for women, 5 ½ for men] cups, go to 3b. 3a. Which of the following best describes your plans related to eating I don’t currently have plans to eat at least [5 Readiness to change fruits and vegetables? for women, 5 ½ for men] cups of fruits and vegetables every day I plan to start eating at least [5 for women, 5 ½ for men] cups of fruits and vegetables every day in the next 6 months I plan to start eating at least [5 for women, 5 ½ for men] cups of fruits and vegetables every day in the next 30 days Adapted from: Adapted from: Do you eat at least 5 cups of fruits and vegetables every day? If NO, I don’t currently have plans to begin eating Adapted from NIH/NCI Diet History Questionnaire (DHQ) http://appliedresearch.
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hq-­‐-­‐dhq1.2007.sample Adapted from NIH/NCI Diet History Questionnaire (DHQ) http://appliedresearch.
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hq-­‐-­‐dhq1.2007.sample Adapted from FITShop And WAY to Health Employee Health and Interest Survey (Q21) Question Response Type Purpose Source which of the following best describes your plans for eating fruits and vegetables? [FITShop] more fruits and vegetables every day I PLAN to start eating at least 5 cups of fruits and vegetables every day in the next 6 months I PLAN to start eating at least 5 cups of fruits and vegetables every day in the next 30 days [FITShop] 3b. How long have you been eating at least [5 for women, 5 ½ for Less than 6 months Readiness to change men] cups of fruits and vegetables every day? More than 6 months Adapted from: Adapted from If YES, which of the following best describes you? I have been eating at least 5 cups of fruits and [FITShop] vegetables every day for less than 6 months I have been eating at least 5 cups of fruits and vegetables every day for more than 6 months [FITShop] 4. Here are some common reasons people give to explain why Yes, this reason applies to me / No, this Barriers they do NOT eat at least [5 for women, 5 ½ for men] cups of reason does NOT apply to me fruits and vegetables each day. Please answer “yes” or “no” as to whether each reason applies to you. a) I do not know what types of fruits and vegetables to eat. b) I do not have time to cut up or prepare fruits and vegetables. c) I do not have any friends/coworkers/family members who want to eat fruits and vegetables with me. d) I am not interested in eating fruits and vegetables. e) Eating fruits and vegetables every day costs too much. f) I do not like the taste of most fruits. g) I do not like the taste of most vegetables. h) I don’t have access to fruits and vegetables at my work or near my home. i) Some other reason keeps me from eating at least [5 for women, 5 ½ for men] cups of fruits and vegetables. Please describe: ____________________________ Adapted from: Adapted from: Often, Sometimes, Seldom, Never How often does the following keep you from eating 5 or more fruits and [BEAUTY] vegetables just about every day? a. I do not have time to cut up or prepare fruits and vegetables. b. I can’t get good quality fruits and vegetables where I shop. c. Members of my household do not eat fruits and vegetables. d. Fruits and vegetables cost too much. e. I do not know how to prepare fruits and vegetables. Adapted from FITShop And WAY to Health Employee Health and Interest Survey (Q21) Adapted from Working Well/Working Healthy – Emmons, K., Linnan, L., Shadel, W., Marcus, B., & Abrams, D. (1999). The Working Healthy Project: A worksite health promotion trial targeting physical activity, nutrition, and smoking. Journal of Occupational and Environmental Medicine. 41(7), 545-­‐
555. And BEAUTY -­‐ Linnan, L., *Rose, J., Carlisle, V., Evenson, K., Hooten, EG, *Mangum, A., Ammerman, A., Bangdiwala, K., Hansen, K., Bentley, M., Biddle, A. (2007). The North Carolina BEAUTY and Question Response Type Purpose f. I do not have time to pick out fruits and vegetables when I shop. g. I can’t get fruits and vegetables when I am out. h. People I know are not interested in eating fruits and vegetables. i. I do not like to eat FRUITS. j. I do not like to eat VEGETABLES. k. Fruits and vegetables spoil too quickly. l. Something else influences my decision not to eat fruits and vegetables. (Please write in reason) [BEAUTY] 5.
How confident are you that you can eat at least [5 for women, 5 ½ for men] cups of fruit and vegetables each day? Confidence scale: Not at all confident, Slightly confident, Moderately confident, Very confident, Extremely confident Self-­‐efficacy 6.
To what extent do the following people support you in eating fruits and vegetables? Family/friends Coworkers Extent scale: Not at all, Little extent, Some extent, Great Extent, Significant extent Social support 7.
During the past 30 days, how often did you drink regular soda or pop that contains sugar? Do not include diet soda or 1 time/month or less 2-­‐3 times/month Status Source Health Project: Overview and baseline results. The Community Psychologist. 40(2): 61-­‐
66. And WAY to Health Employee Health and Interest Survey (Q26) Adapted from Emmons, K., Linnan, L., Shadel, W., Marcus, B., & Abrams, D. (1999). The Working Healthy Project: A worksite health promotion trial targeting physical activity, nutrition, and smoking. Journal of Occupational and Environmental Medicine. 41(7), 545-­‐
555 Adapted from Emmons, K., Linnan, L., Shadel, W., Marcus, B., & Abrams, D. (1999). The Working Healthy Project: A worksite health promotion trial targeting physical activity, nutrition, and smoking. Journal of Occupational and Environmental Medicine. 41(7), 545-­‐
555 BRFSS 2013 (adapted response) Question Response Type Purpose Source Status BRFSS 2013 (adapted response) Status BRFSS 2013 (adapted response) diet pop. 8.
9.
1-­‐2 times/week 3-­‐4 times/week 5-­‐6 times/week 1 time/day 2-­‐3 times/day 4-­‐5 times/day 6 or more times/day Adapted from: __ Times per day; __ Times per week; __ Times per month During the past month, how many times per day, week or Never month did you drink 100% PURE fruit juices? Do not include 1 time/month fruit-­‐flavored drinks with added sugar or fruit juice you 2-­‐3 times/month made at home and added sugar to. Only include 100% juice. 1-­‐2 times/week 3-­‐4 times/week 5-­‐6 times/week 1 time/day 2-­‐3 times/day 4-­‐5 times/day 6 or more times/day Don’t know/not sure Adapted from: __ Per day; __ Per week; __ Per month; Never; Don’t know/Not sure During the past 30 days, how often did you drink sugar-­‐
1 time/month or less sweetened fruit drinks (such as Kool-­‐aid and lemonade), 2-­‐3 times/month sweet tea, and sports or energy drinks (such as Gatorade and 1-­‐2 times/week Red Bull)? Do not include 100% fruit juice, diet drinks, or 3-­‐4 times/week artificially sweetened drinks. 5-­‐6 times/week 1 time/day 2-­‐3 times/day 4-­‐5 times/day 6 or more times/day Adapted from: __ Times per day; __ Times per week; __ Times per month Question 10. In a typical week, how many of your own meals come from fast food restaurants, like McDonalds, Taco Bell, or KFC (Kentucky Fried Chicken)? 11. On how many days per week do you usually eat a main meal that is prepared at home? Response Type 1 meal per week; 2 meals per week; 3 meals per week; 4 meals per week; 5 or more meals per week; Do not eat any fast food meals in a typical week; Don’t know/Not sure _____days None Don’t know/Not sure Purpose Source Status NC BRFSS 2009 Status NC BRFSS 2011