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A food consumption questionnaire in the form of a draft 3 for the Raine Study. It includes questions about the frequency and types of fruits, vegetables, milk, bread, spreads, sugar, eggs, cheese, and various food groups such as cereals, dairy products, meat & fish, and vegetables. The questionnaire also asks about the consumption of beverages like beer, wine, and spirits.
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Questionnaire about what you usually eat and drink INSTRUCTIONS This questionnaire is about your usual eating habits over the past 12 months. Where possible give only one answer per question for the type of food you eat most often. If you can’t decide which type you have most often, answer for the types you usually eat. Please fill in the date you completed this questionnaire: DAY MTH YEAR
Q1. How many pieces of fresh fruit do you usually eat per day? (Count ½ cup of diced fruit, berries or grapes as one piece)
0 1 2 3 4 5 G220_Fruit_pd G220_ FFQ_DAT
Q6. How many slices of bread do you usually eat per day? (Include all types, fresh or toasted and count one bread roll as 2 slices)
Q7. Which spread do you usually put on bread?
Q 8. On average, how many teaspoons of sugar do you usually use per day? (Include sugar taken with tea and coffee and on breakfast cereal, etc.)
Q 9. On average, how many eggs do you usually eat per week? (Include sugar taken with tea and coffee and on breakfast cereal, etc.)
1^ G220_Bread_pd 2 3 4 5 6 7 G220_Spread_none G220_Spread_Marg G220_Spread_Poly_marg G220_Spread_Mono_marg G220_Spread_Marg_blends G220_Spread_Butter 0^ G220_Sugar_pd 1 2 3 4 0^ G220_Eggs_pw 1 2 3 4
Q 10. On average, how many eggs do you usually eat per week? (Include sugar taken with tea and coffee and on breakfast cereal, etc.)
For each food shown on this page, indicate how much on average you would usually have eaten at main meals during the past 12 months. When answering each question, think of the amount of that food you usually ate, even though you may rarely have eaten the food on its own. If you usually ate more than one helping, fill in the oval for the serving size closest to the total amount you ate. Q11. When you ate potato, did you usually eat:
G220_Cheese_none G220_Cheese_hard G220_Cheese_firm G220_Cheese_soft G220_Cheese_Ricotta G220_cheese_Cream G220_cheese_Lowfat G220_Pot_eat 0
Q14. When you ate meat or vegetable casserole, did you usually eat:
G220_Casserole_eat 0
Q15. Over the past 12 months, on average, how often did you eat the following foods? Please completely fill one oval in every line
N E V E R Less than once 1 to 3 times 1 time 2 times 3 to 4 times 5 to 6 times 1 time 2 times 3 to more times per month per week per day
All Bran (^) G220_bran_All Sultana Bran, FiberPlus, Branflakes (^) G220_bran_Oth Weet Bix, Vita Brits, Weeties (^) G220_Weetbix CronFlakes, Nutrigrain, Special K (^) G220_Cornflakes Porridge (^) G220_Porridge Muesli (^) G220_Muesli Rice (^) G220_Rice Pasta or noodles (include lasagne) (^) G220_Pasta Crackers, crispbreads, dry biscuits (^) G220_biscuits_Dry Sweet biscuits G220_biscuits_Sweet Cakes, sweet pies, tart and other sweet pastries G220_Cakes Meat pies, pasties, quiche and other savory pastries G220_Pastries Pizza (^) G220_Pizza Hamburger with a bun G220_Hamburger Chocolate (^) G220_Chocolate Flavored milk drink (cocoa, Milo, etc.) (^) G220_milk_Flav Nuts (^) G220_Nuts Peanut butter or peanut paste (^) G220_Peanut_butter Corn chips, potato crisps, Twisties, etc. (^) G220_Chips Jam, marmalade, honey or syrups G220_Jam_honey Vegemite, Marmite or Promite (^) G220_Vegemite Cheese G220_Cheese Ice-cream G220_Icecream Yoghurt (^) G220_Yoghurt Beef (^) G220_Beef
N E V E R Less than once 1 to 3 times 1 time 2 times 3 to 4 times 5 to 6 times 1 time 2 times 3 to more times per month per week per day 0 1 2 3 4 5 6 7 8 9
Tomato sauce, tomato paste or dried tomatoes G220_Tom_sauce_paste Fresh or tinned tomatoes (^) G220_Tom_tinned_Fresh Pepper (capsicum) (^) G220_Peppers Lettuce, endive, other salad greens G220_Green_salad Cucumber (^) G220_Cucumber Celery (^) G220_Celery Beetroot (^) G220_Beetroot Carrots (^) G220_Carrots Cabbage or Brussels sprouts (^) G220_Cabbage Cauliflower (^) G220_Cauliflower Broccoli (^) G220_Broccoli Silverbeet or spinach (^) G220_Spinach Peas (^) G220_Peas Green beans (^) G220_beans_Green Bean sprouts or alfalfa sprouts (^) G220_beans_Sprouts Baked beans (^) G220_beans_Baked Soy beans, soy bean curd or tofu (^) G220_beans_Soy Other beans (include chickpeas, lentils, etc.) G220_bean_Oth Pumpkin (^) G220_Pumpkin Onion or leeks (^) G220_Onion Garlic (not garlic tablets) (^) G220_Garlic_fresh Mushroom (^) G220_Mushroom zucchini (^) G220_Zucchini
Q16. Over the last 12 months, how often did you drink beers, wine and/or spirits?
N E V E R less than once a month 1 - 3 days per month 1 day per week 2 days per week 3 days per week 4 days per week 5 days per week 6 days per week every day 0 1 2 3 4 5 6 7 8 9 Beer (low alcohol) G220_Beer_low Beer (full strength) (^) G220_Beer_full Red wine G220_wine_Red White wine (include sparkling wines) G220_wine_White Fortified wines, port, sherry, etc. G220_wine_Fortified Spirits, liqueurs, etc. (^) G220_Spirits When answering the next two questions, please convert the amount you drank into glasses using the examples given below. For spirits, liqueurs, and mixed drinks containing spirits please count each nip (30 ml) as one glass. 1 can or stubby of beer = 2 glasses 1 large bottle beer (750 ml) = 4 glasses 1 bottle wine (750 ml) = 6 glasses 1 bottle of port or sherry (750 ml) = 12 glasses Q17. Over the last 12 months, on days when you were drinking, how many glasses of beers, wine and/or spirits altogether did you usually drink? TOTAL NUMBER OF GLASSES PER DAY 0 1 2 3 4 5 6 7 8 9 10 or more Q18. Over the last 12 months, what was the maximum number of glasses of beers, wine and/or spirits that you drank in 24 hours? MAXIMUM NUMBER OF GLASSES PER 24 HOURS
(^) 19 or more G220_glass_pd G220_Max_glass_pd (^0 12 3 4 5 6 7 8 )