2012 Youth Adolescent Food Frequency Questionnaire

2012 Youth Adolescent Food Frequency Questionnaire MARKING INSTRUCTIONS
Use a NO. 2 PENCIL only. Do not use ink or ballpoint pen. Darken in the circle completely. Erase cleanly any marks you wish to change. Do not make any stray marks on this form.
The RIGHT way to mark your answer! The WRONG way to mark your answers!
USE NO. 2 PENCIL ONLY
1. What is your AGE?

Less than 9 9 10 11 15 12 16 13 17 14 18 or older
2. Are you:
Male Female
3. Your
Height
0 1 2 3 4 5 6 7 0 1 0 1 2 3 4 5 6 7 8 9
4. Your
Weight (lbs)
0 1 2 3 4 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 A B C D E 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 A 1 2 3 4
I N
F T
5. Do you now take vitamins (like Flintstones, Centrum, Centrum Kids)? Yes a. How many do you b. What specific brand do you usually take?
No
F C O B OW CK
0 1 2 3 4 5 6 7 8
0 1 2 3 4 5 6 7 8 9
0 1 2 3 4 5 6 7 8 9
0 1 2 3 4 5 6 7 8 9
5 a b
take per week?

12 35 69 10 or more
(Please specify exact brand)
3/8 spine perf
6. Do you take any other separate vitamin or mineral pills? (NOT the multivitamin pill listed in question 5b)
Yes No
If yes, do you take any of the following?

Calcium or TUMS Vitamin E Iron Vitamin D Vitamin C Fish Oil Other please specify:
7. How often do you eat food that is fried at home,

like fried chicken?
Never/less than once per week 13 times per week 46 times per week Daily
8. How often do you eat fried food away from home

(like french fries, chicken nuggets)?
Never/less than once per week 13 times per week 46 times per week Daily
7 8
These questions ask about what you ate and drank over the past year.
DRINKS
1. Diet soda/pop (1 can or 2. Soda/popnot diet
individual bottle)
Never/less than 1 per month 13 bottles per month 1 bottle per week 24 bottles per week 56 bottles per week 1 bottle per day 2 bottles per day 3 or more bottles per day
3. What is the usual serving

size of the soda/pop you drink (any type)?
<12 oz. 12 oz. (e.g., can) 1620 (individual bottle) 21+oz. (e.g., Big Gulp) Dont know or dont drink
4. Sugared iced-tea, fruit drinks,
1 2 3 4
(1 can or individual bottle)

punch, lemonade, Sunny D, Kool-Aid or other non-carbonated fruit drinkNOT JUICE (1 glass, can or individual bottle)
SERIAL #
page ONE
5. Sport drinks (e.g.,

Powerade or Gatorade) or sugar-sweetened vitamin water (individual bottle)
6. Sugar-free or low calorie

energy drinksRed Bull Sugarfree, Lo-carb Monster Energy (individual can/bottle)
7. Regular energy
drinksRed Bull, Rock Star (individual can/bottle)
8. Smoothies (e.g., medium

Jamba Juice or Orange Julius)
Never/less than 1 per month 13 glasses per month 1 glass per week 24 glasses per week 56 glasses per week 1 glass per day 2 glasses per day 3 or more glasses per day
5 6 7 8
9. Milkshake (1)
Never/less than 1 per month 13 per month 1 per week More than 1 per week
10. Hot tea with caffeine (not

herbal) (1 cup)
Never/less than 1 per month 13 cups per month 12 cups per week 36 cups per week 1 cup per day 2 or more cups per day
11. Decaffeinated
coffee (1 cup)
12. Coffeenot decaf.

(1 cup)
9 10 11 12
13. Coffee drinks with nonfat 14. Coffee drinks with low-fat 15. Iced coffee with nonfat
milk, e.g., Cappuccino, Mocha, Latte
16. Iced coffee with low-fat

or whole milk, e.g., Coffee Coolatta, Frappuccino
13 14 15
or whole milk, e.g., Cappuccino, Mocha, Latte

milk, e.g., Coffee Coolatta, Frappuccino

3/8 spine perf
16
17. Watertap and bottled

(1 glass or bottle)
18. Beer (1 glass,

bottle or can)
Never/less than 1 per month 13 cans per month 1 can per week 24 cans per week 56 cans per week 1 can per day 2 cans per day 3 or more cans per day
19. Wine or wine coolers

(1 glass)
20. Liquor, like vodka or rum

(1 drink, 1 shot, 1 bottle) Include ready to drink alcoholic beverages like Hard Lemonade
Never/less than 1 per month 13 drinks per month 1 drink per week 24 drinks per week 56 drinks per week 1 drink per day 2 drinks per day 3 or more drinks per day
17 18 19 20
page TWO
DAIRY FOODS
1. What type of white milk
do you usually drink?
Skim/nonfat milk 1% milk 2% milk Whole milk Soy milk Dont know Dont drink milk
2. White milk (glass or with

cereal)
Never/less than 1 per month 1 glass per week or less 26 glasses per week 1 glass per day 23 glasses per day More than 3 glasses per day
3. Chocolate or other
flavored milk (glass)
Never/less than1 per month 13 glasses per month 1 glass per week 26 glasses per week 12 glasses per day More than 2 glasses per day
4. Instant breakfast drink

(1 serving or can)
Never/less than 1 per month 13 times per month Once per week 24 times per week More than 4 times per week
1 2 3 4
5. High protein shake or

drink (1 packet, serving/can)
6. Light, low calorie or plain

yogurte.g., light peach (46 oz.)not frozen
Never/less than 1 per month 13 cups per month 1 cup per week 26 cups per week 1 cup per day More than 1 cup per day
7. Regular yogurt sweetened

with fruit or other flavoring e.g., vanilla, strawberry (46 oz.)not frozen
Never/less than 1 per month 13 cups per month 1 cup per week 26 cups per week 1 cup per day More than 1 cup per day
8. Cottage or ricotta cheese

(1/2 cup)
Never/less than 1 per month 13 times per month Once per week More than once per week
5 1 6 2 7 8
9. Cheese (1 slice)eaten alone or

3/8 spine perf
10. Cream cheese (2 Tbs)

Never/less than 1 per month 13 times per month Once per week 26 times per week Once per day More than once per day
11. What type of cottage cheese, cream

cheese, other cheeses do you usually use? (Fill in all that apply)
Nonfat Lowfat Regular Dont know
9 10 11
added to main dish, sandwich, or quesadillaexclude grilled cheese

Never/less than 1 per month 13 slices per month 1 slice per week 26 slices per week 1 slice per day 23 slices per day More than 3 slices per day
12. Butter (1 serving)

not margarine
Never/less than 1 per month 13 pats per month 1 pat per week 26 pats per week 1 pat per day 24 pats per day More than 4 pats per day
13. Margarine (1 serving)

not butter
Never/less than 1 per month 13 pats per month 1 pat per week 26 pats per week 1 pat per day 24 pats per day More than 4 pats per day
14. Whipped cream (1 serving)

not fat free
Never/less than1 per month 13 servings per month 1 serving per week 26 servings per week 12 servings per day More than 2 servings per day
12 13 14
SERIAL #
page THREE
15. What form of margarine

does your family usually use?
None Stick Tub Squeeze (liquid) Spray Dont know
What specific brand and type of margarine (like Promise Light Spread)?
16. What type of oil does your

family use at home? (Fill in all that apply)
Canola oil Corn oil Olive oil Vegetable oil Safflower oil Dont know
0 1 2 3 4 5 6 7 8 9
0 1 2 3 4 5 6 7 8 9
0 1 2 3 4 5 6 7 8 9
15 F B 16
Leave blank if you dont know.
MAIN DISHES
1. Cheeseburger (1)
Never/less than 1 per month 13 per month One per week 24 per week More than 4 per week
2. Hamburger or
Sloppy Joe (1)
3. Tofu, Soyburger, miso,

edamame, or other soy dish (1 serving)
4. Veggieburger (1)
1 2 3 4
5. Pizza (2 slices)
6. Tacos (1)
7. Burritos (1)
8. Which filling do you

usually have for tacos/burritos? (Fill in all that apply)
Beef & beans Beef Chicken Beans
5 6 7 8
3/8 spine perf
9. Chicken nuggets (6)

10. Beef or Pork hot dogs

(1) (include corndogs)
11. Chicken or Turkey hot

dogs or sausage (1)
12. Chicken or turkey as a

mixed dish (e.g., stir fry or soup)
9 10 11 12
13. Chicken or turkey as

main dish (1 serving)
14. When you have

chicken or turkey, do you eat the skin?
Yes No Sometimes Dont eat chicken or turkey
15. Fish sticks, fish cakes

or fish sandwich (1 serving)
16. Dark meat fish as main dish,

e.g., tuna steak, salmon, sardines, swordfish (1 serving)
Never/less than 1 per month 13 per month Once per week 24 per week More than 4 per week
13 14 15 16
page FOUR
17. Other fish as main dish,

e.g., cod, haddock, halibut (1 serving)
Never/less than 1 per month 13 per month Once per week 24 per week More than 4 per week
18. Shrimp, lobster, scallops 19. Beef, pork or lamb as a

(1 serving)
20. Beef (steak, roast) or lamb

as main dish (1 serving)
17 18 19 20
mixed dish (e.g., stir fry or stew)

21. Pork, ribs, or ham as

main dish (1 serving)
22. Meatballs or meatloaf

(1 serving)
23. Noodles/pasta, plain

no sauce (1 serving)
24. Lasagna/baked
ziti/ravioli (1 serving)
21 22 23 24
25. Macaroni and cheese or 26. Spaghetti or other pasta 27. Eggse.g., scrambled,
other pasta with cream sauce (1 serving)
28. Sausage (beef/pork)

(2 oz. or 2 small links)
Never/less than once per month 13 times per month Once per week 24 times per week More than 4 times per week
25 26 27 28
with tomato sauce (1 serving)

fried, in breakfast sandwich (1)

Never/less than 1 per month 13 eggs per month One egg per week 24 eggs per week More than 4 eggs per week
3/8 spine perf
29. Bacon (2)

Never/less than once per month 13 times per month Once per week 24 times per week More than 4 times per week
30. Liver (1 serving)

Never/less than 1 per month Once per month 23 per month Once per week or more
29 30
SANDWICHES
1. Peanut butter sandwich (1)
or crackers with peanut butter (1 pack)
2. Chicken or turkey
sandwich (1)
3. Roast beef
sandwich (1)
4. Salami, bologna, ham or

other deli meat sandwich (1)
1 2 3 4
5. Tuna sandwich (1)

6. Grilled cheese sandwich (1)

5 6
SERIAL #
page FIVE
OTHER FOODS
1. Ketchup
2. Cream (milk) soups

or chowder (1 bowl)
Never/less than 1 per month 13 bowls per month 1 bowl per week 26 bowls per week 1 or more bowls per day
3. Clear soup or broth (with

noodles, rice, vegetables) 1 bowl
Never/less than 1 per month 13 bowls per month 1 bowl per week 26 bowls per week 1 or more bowls per day
4. Mayonnaise (1 Tbs.)
Never/less than 1 per month 13 times per month Once per week 26 times per week 1 or more times per day
1 28 2 3 4
5. Low calorie or low fat

salad dressing (12 Tbs.)
6. Salad dressing (not

low calorie) (12 Tbs.)
7. Salsa (1 serving)
8. How many teaspoons of

sugar do you ADD to your beverages or food each day?
None/less than 1 teaspoon per day 12 teaspoons per day 34 teaspoons per day 5 or more teaspoons per day
5 6 7 8
BREADS CEREALS & GRAINS

1. Cold breakfast cereal
(1 bowl)
Never/less than 1 per month 13 bowls per month 1 bowl per week 24 bowls per week 57 bowls per week More than 1 bowl per day
RK HB
0 1 2 3 4 5 6 7 8
0 1 2 3 4 5 6 7 8 9
0 1 2 3 4 1 2
2. Which cold breakfast cereal

do you eat most often (like Cheerios or Special K)?
Cheerios Honey Nut Cheerios Frosted Mini-Wheats Frosted Flakes Cinnamon Toast Crunch
LC FL
Other:
L
PB SK CC
3/8 spine perf
5 6 7 8 9
Never eat cold breakfast cereal
3. Oatmeal, include instant

(1 bowl)
4. Other cooked breakfast

cereale.g., cream of wheat, grits (1 bowl)
5. White bread, pita bread,

include toastnot in sandwiches (1 slice)
Never/less than 1 per month 1 slice per week or less 24 slices per week 57 slices per week 23 slices per day More than 3 slices per day
6. Whole wheat or whole grain

Never/less than 1 per month 1 slice per week or less 24 slices per week 57 slices per week 23 slices per day More than 3 slices per day
3 4 5 6
bread, include toastnot in sandwiches (1 slice)
7. English muffins, bagels, or

rolls (1)include breakfast sandwich
Never/less than 1 per month 13 per month 1 per week 24 per week More than 4 per week
8. Muffin (1) or cornbread

(1 square)
9. Croissant (1)
10. Biscuit (1)

7 8 9 10
page SIX
11. White rice (1 serving)

12. Brown rice (1 serving)

13. Corn or flour tortillano 14. Pancakes or waffles (2)

filling e.g., quesadilla not tacos or burritos (2)
Never/less than 1 per month 13 per month 1 per week 24 per week More than 4 per week Never/less than 1 per month 13 times per month Once per week 24 times per week More than 4 times per week
11 12 13 14
15. French toast (2 slices)

16. French fries, tater tots, hash

browns (1 serving)
Never/less than 1 per month 13 servings per month 1 serving per week 24 servings per week More than 4 servings per week
17. Potatoesbaked or boiled (1),

mashed (1 serving)
15 16 17
FRUITS AND VEGETABLES

1. Raisins (small pack)
Never/less than 1 per month 13 times per month 1 per week 24 times per week More than 4 times per week
3/8 spine perf
There are no right or wrong answers.
2. Grapes (bunch)
Never/less than 1 per month 13 times per month 1 per week 24 times per week More than 4 times per week
3. Bananas (1)
4. Apples (1)
Never/less than 1 per month 13 per month 1 per week 26 per week 1 or more per day
1 2 3 4
5. Applesauce (1 serving)
6. Pears (1)
7. Cantaloupe, melon
(1 wedge)
Never/less than once per month 13 times per month Once per week More than once per week
8. Watermelon
(1 wedge)
Never/less than once per month 13 times per month Once per week More than once per week
5 6 14 7 8
9. Oranges (1)
10. Grapefruit (1/2)
11. Strawberries (1 serving)

12. Blueberries (1 serving)

9 1 10 2 3 11 12
13. Peaches, plums,

apricots (1)
14. Pineapple
(1 serving)
15. Orange juice

(1 glass)
Never/less than 1 per month 13 glasses per month 1 glass per week 26 glasses per week 1 glass per day More than 1 glass per day
16. Apple juice and other

100% fruit juices (1 glass)
Never/less than 1 per month 13 glasses per month 1 glass per week 26 glasses per week 1 glass per day More than 1 glass per day
13 14 15 16
page SEVEN
17. Tomatoes (2 slices)

18. Tomato juice

(1 small glass)
19. V8 Fusion
(1 small glass)
20. Green beans

(1 serving)
17 18 19 20
21. Beans or lentilsinclude 22. Broccoli (1 serving)

baked beans (1 serving)
Never/less than 1 per month Once per week or less 26 times per week Once per day Never/less than 1 per month 13 times per month Once per week 24 times per week More than 4 times per week
23. Cauliflower (1 serving)

24. Corn (1 serving)

21 22 23 24
25. Peas (1 serving)

26. Mixed vegetables

(1 serving)
27. Spinach, raw as in

salad (1 serving)
28. Collard greens/kale/

cooked spinach (1 serving)
25 26 27 28
29. Green/red/yellow
peppers (3 slices)
30. Yams/sweet potatoes

(medium or 1 serving)
31. Zucchini, summer squash, 32. Carrots, cooked

eggplant (1 serving)
29 30
(1 serving)
3/8 spine perf
31 32
33. Carrots, raw (1/2 carrot 34. Celery (2 or 3 sticks)

or 24 baby carrots)
Never/less than 1 per month 13 times per month Once per week 24 times per week More than 4 times per week Never/less than 1 per month 13 times per month Once per week 24 times per week More than 4 times per week
35. Lettuce/tossed salad

(1 serving)
Never/less than 1 per month 13 times per month Once per week 26 times per week 1 or more per day
36. Coleslaw (1 serving)

33 34 35 36
37. Cabbage (1 serving)

38. Potato salad

(small serving)
39. Pasta salad

(small serving)
40. Okra (1 serving)

37 38 39 40
SERIAL #
page EIGHT
41. Onion rings, cooked

onions, or onion soup (small serving)
41
SNACK FOODS/DESSERTS
1. Potato chips (1 small bag)
Never/less than 1 per month 13 small bags per month One small bag per week 26 small bags per week 1 or more small bags per day
2. Corn chips/Doritos (1 small bag) 3. Popcorn (1 small bag)

Never/less than 1 per month 13 small bags per month One small bag per week 26 small bags per week 1 or more small bags per day Never/less than 1 per month 13 small bags per month 14 small bags per week More than 4 small bags per week
4. Pretzels (1 small bag)

Never/less than 1 per month 13 small bags per month 1 small bag per week More than 1 small bag per week
1 2 3 4
5. Mixed dried fruit/trail

mix (small bag)
Never/less than 1 per month 13 times per month 1 per week 26 per week 1 or more per day
3/8 spine perf
6. Peanuts (1 small bag)
7. Other nuts (1 small bag)

Never/less than 1 per month 13 small bags per month 14 small bags per week More than 4 small bags per week
8. Fruit snacks or fruit rollups

(1 pack)
Never/less than 1 per month 13 packs per month 14 packs per week More than 4 packs per week
5 6 7 8
Never/less than 1 per month 13 small bags per month 14 small bags per week More than 4 small bags per week
9. Graham crackers
(2 squares)
Never/less than 1 per month 13 times per month 14 times per week More than 4 times per week
10. Crackers, e.g., Wheat

Thins or Ritz, Cheez-Its, soda crackers, Saltines (1 serving)
Never/less than 1 per month 13 times per month 14 times per week More than 4 times per week
11. Poptarts (1)

Never/less than 1 per month 13 poptarts per month 16 poptarts per week 1 or more poptarts per day
12. Cake (1 slice) or cupcake

with frosting (1)
Never/less than 1 per month 13 slices per month 1 slice per week More than 1 slice per week
9 10 11 12
13. Snack cakes, like Ring

Never/less than 1 per month 13 per month Once per week 26 per week 1 or more per day
14. Danish, cinnamon

rolls, pastry (1)
15. Donuts (1) or churros

(1 serving)
Never/less than 1 per month 13 per month 1 per week 26 per week More than 1 per day
16. Cookies (1)

Never/less than 1 per month 13 cookies per month 1 cookie per week 26 cookies per week 13 cookies per day More than 3 cookies per day
13 14 15 16
Dings/Swiss Rolls/Twinkies (1 package)
page NINE
17. Brownies (1)

18. Pie or fruit crisp

(1 serving)
Never/less than 1 per month 13 slices per month 1 slice per week More than 1 slice per week
19. Chocolate like Hersheys 20. Other candy bars like

or M & Ms (1 bar or packet)
17 18 19 20
Milky Way, Snickers (1 bar)

Never/less than 1 per month 13 candy bars per month 1 candy bar per week 26 candy bars per week 1 or more candy bars per day
21. Other candy without

chocolate like Skittles (1 pack)
22. Jello (1 serving)not

sugar free
23. Pudding or pudding

pops, not sugar free (1 serving)
24. Frozen yogurt or low-fat

ice cream (1 serving)
21 22 23 24
25. Ice cream (1 serving)
26. Popsicles, ice pops,

fudgesicle (1)
27. Seeds like Sunflower or

Pumpkin (small bag)
Never/less than 1 per month 13 times per month 1 time per week 24 times per week More than 4 times per week
28. Snack bars (e.g.,

Nutrigrain, granola, Kashi, Planters) (1)
25 26 27 28
3/8 spine perf
29. Energy bars
30. High protein bars

(e.g., Atkins, Zone, South Beach) (1)
31. Jams, jellies, fluff, syrup

or honey (Tbs.)
Never/less than 1 per month 13 per month 1 per week 24 times per week More than 1 per day
29 30 31
(e.g., Clif, Luna, Glucerna, Powerbar) (1)

SERIAL #
page TEN
3/8 spine perf
page ELEVEN
3/8 spine perf
S C A N T R O N
EliteView EM-290520-2:654321
SERIAL #
page TWELVE

2012 Youth Adolescent Food Frequency Questionnaire

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2012 Youth Adolescent Food Frequency Questionnaire MARKING INSTRUCTIONS

USE NO. 2 PENCIL ONLY

1. What is your AGE?

take per week?

(Please specify exact brand)

3/8 spine perf

If yes, do you take any of the following?

7. How often do you eat food that is fried at home,

8. How often do you eat fried food away from home

3. What is the usual serving

4. Sugared iced-tea, fruit drinks,

(1 can or individual bottle)

5. Sport drinks (e.g.,

6. Sugar-free or low calorie

8. Smoothies (e.g., medium

10. Hot tea with caffeine (not

12. Coffeenot decaf.

16. Iced coffee with low-fat

or whole milk, e.g., Cappuccino, Mocha, Latte

milk, e.g., Coffee Coolatta, Frappuccino

3/8 spine perf

17. Watertap and bottled

18. Beer (1 glass,

19. Wine or wine coolers

20. Liquor, like vodka or rum

2. White milk (glass or with

4. Instant breakfast drink

5. High protein shake or

6. Light, low calorie or plain

7. Regular yogurt sweetened

8. Cottage or ricotta cheese

9. Cheese (1 slice)eaten alone or

10. Cream cheese (2 Tbs)

11. What type of cottage cheese, cream

added to main dish, sandwich, or quesadillaexclude grilled cheese

12. Butter (1 serving)

13. Margarine (1 serving)

14. Whipped cream (1 serving)

15. What form of margarine

16. What type of oil does your

Leave blank if you dont know.

3. Tofu, Soyburger, miso,

8. Which filling do you

3/8 spine perf

9. Chicken nuggets (6)

10. Beef or Pork hot dogs

11. Chicken or Turkey hot

12. Chicken or turkey as a

13. Chicken or turkey as

14. When you have

15. Fish sticks, fish cakes

16. Dark meat fish as main dish,

17. Other fish as main dish,

18. Shrimp, lobster, scallops 19. Beef, pork or lamb as a

20. Beef (steak, roast) or lamb

mixed dish (e.g., stir fry or stew)

21. Pork, ribs, or ham as

22. Meatballs or meatloaf

23. Noodles/pasta, plain

28. Sausage (beef/pork)

with tomato sauce (1 serving)

fried, in breakfast sandwich (1)

3/8 spine perf