| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | ABS Question | ABS Response | Skip pattern | ||
| At restaurant | Eating at restaurant frequency | About how often do you get food and drink for yourself or others from each of the following places? Include breakfast, lunch, dinner, and snacks. Include eat-in, take-out, and delivery. Fast food restaurants such as McDonald's, Taco Bell, or Subway Fast casual restaurants such as Panera, Blaze Pizza, and Qdoba (Chipotle) Coffee shops or bakeries such as Starbucks or Dunkin Donuts Sit down, full service restaurants with waiter or waitress such as Chili's, or Applebee's Cafeterias Food stands or food trucks Gas stations and/or convenience stores Grocery store hot food bar or food that you order from a menu board such as pizza slices and sandwiches Grocery store deli foods such as luncheon meats and cheeses, salads, and ready to eat and prepared foods Meal kits that are delivered to your house such as from Blue Apron, Hello Fresh, Plated, or Sun Basket |
Once a day or more frequently 3 to 6 times a week Once or twice a week 1 to 3 times per month Less than once a month Just tried it once or twice Never |
Ask all | ||
| At restaurant | Eating at restaurant | In general, when ordering food and drink at a restaurant, how often do you try to make healthier choices? | Always Often Sometimes Never Never eat at restaurants |
Ask all | ||
| At restaurant | Menu labeling | In general, when you order at any restaurant, how often do you see calorie information listed on menus or menu boards? |
Always Often Sometimes Never Never eat at restaurants |
Ask all | ||
| Menu labeling | Do you ever use the calorie information on menus or menu boards to decide what to order? | Yes No |
If yes to seeing calorie info | |||
| At restaurant | Menu labeling | How did you use the calorie information when deciding what to order? Check all that apply. | Version 1 Order something with fewer calories Order something with more calories Order fewer items Order more items Order smaller sized items (e.g. small vs. large) Order larger sized items Share the meal with someone else Save part of the meal for later |
If yes to using calorie info | ||
| Menu labeling | How did you use the calorie information when deciding what to order? Check all that apply. | Version 2 Avoid ordering high-calorie menu items Avoid ordering something that would leave you hungry Decide on a smaller portion size Decide on a larger portion size Order fewer items Order more items |
If yes to using calorie info | |||
| At restaurant | Health inspection scores | Have you ever seen health inspection scores or grades posted at restaurants? The inspection score or grade is a score (0% - 100%) or an overall grade (A, B, or C) a restaurant receives after being inspected by local health departments. | Yes No |
Ask all | ||
| At restaurant | Health inspection scores | Have you ever changed your mind about eating at a restaurant because of the health inspection score or grade? | Yes No |
If yes to the previous question | ||
| At restaurant | Consumer advisory | Restaurant menus or menu boards sometimes have statements that describe the risk of consuming certain raw or undercooked foods like the one shown here. "Consuming raw or undercooked meats, poultry, seafood shellfish, or eggs may increase your risk of foodborne illness." Have you seen this kind of statement on a menu or menu board? | Yes No |
Ask all | ||
| At restaurant | Consumer advisory | How helpful is the statement when you are deciding what to order? | 1 -- Not at all helpful 2 -- Slightly helpful 3 -- Somewhat helpful 4 -- Very helpful 5 -- Extremely helpful Don't know |
If yes to the previous question | ||
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | REVISED RDD RESPONSE | ABS RESPONSES | Skip pattern |
| Diet Knowledge | Knowledge of food bacteria | How common do you think it is for people in the US to get food poisoning because of food being contaminated with germs? |
How common do you think it is for people in the US to get food poisoning because of food being contaminated with germs? | Very common Somewhat common Not very common Don't know Refused |
Very common Somewhat common Not very common |
Ask all |
| Diet Knowledge | Food safety - risk of foods in general | How common do you think it is for people in the United States to get food poisoning because of the way food is prepared in their home? Would you say that it is… | How common do you think it is for people in the United States to get food poisoning because of the way food is prepared in their home? | Very common Somewhat common Not very common Don’t know Refused |
Very common Somewhat common Not very common |
Ask all |
| Diet Knowledge | Food safety - risk of foods in general | How about food prepared at restaurants? How common do you think it is for people in the United States to get food poisoning because of the way food is prepared at restaurants? Would you say that it is… | How common do you think it is for people in the United States to get food poisoning because of the way food is prepared at restaurants? | Very common Somewhat common Not very common Don’t know Refused |
Very common Somewhat common Not very common |
Ask all |
| Diet Knowledge | Who is at risk for foodborne illness | Do you think certain types of people such as pregnant women, the elderly, or young children have a higher risk, lower risk, or the same risk of getting food poisoning as everyone else? |
Do you think certain types of people such as pregnant women, the elderly, or young children have a higher risk, lower risk, or the same risk of getting food poisoning as everyone else? |
Higher risk Lower risk Same risk as everyone else Don't know Refused |
Higher risk Lower risk Same risk as everyone else Don't know |
Ask all |
| Diet Knowledge | Food safety risk of personal behavior | Now, I’m going to read a list of some ways that food may be handled. For each, please tell me how likely it is that you would get sick if you ate food that was handled that way. Please use any number between 1 and 5, where 1 is “not at all likely” and 5 is “very likely.” (IF RESPONDENT SAYS THEY DON’T PREPARE THE FOOD, ASK THEM FOR THEIR OPINION. | How likely are you to get sick if you ate food that was handled in each of the following ways? (THIS WILL BE A MATRIX WITH THE ITEMS BELOW) NEED HELP WITH SCALES MATCHING. | 1 - Not at all likely 2 - 2 3 - 3 4 - 4 5 - Very likely Don’t know Refused |
1 - Not at all likely 2 3 4 5 - Very likely |
Ask all |
| Diet Knowledge | Food safety risk of personal behavior | If you forget to wash your hands before you begin cooking, how likely are you to get sick? Where 1 is “not at all likely” and 5 is “very likely.” (IF NECESSARY: Where 1 is not at all likely and 5 is very likely. ) | If you forget to wash your hands before you begin cooking. | Ask all | ||
| Diet Knowledge | Food safety risk of personal behavior | If vegetables you will eat raw happen to touch raw meat or chicken, how likely are you to get sick? (IF NECESSARY: Where 1 is not at all likely and 5 is very likely.) | If you eat raw vegetables that touched raw meat or chicken. | Ask all | ||
| Diet Knowledge | Food safety risk of personal behavior | If you eat meat or chicken that is not thoroughly cooked, how likely are you to get sick? (IF NECESSARY: Where 1 is not at all likely and 5 is very likely.) (Version 1) If you eat meat or chicken that is not cooked the recommended temperature, how likely are you to get sick?(IF NECESSARY: Where 1 is not at all likely and 5 is very likely.) (Version 2) |
If you eat meat or chicken that is not thoroughly cooked (Version 1) If you eat meat or chicken that is not cooked to the recommended temperature.(Version 2) |
Ask all | ||
| Diet Knowledge | Food safety risk of personal behavior | If you eat a meat or chicken that was left at room temperature for more than 2 hours. (IF NECESSARY: Where 1 is not at all likely and 5 is very likely. ) | If you eat meat or chicken that was left at room temperature for more than 2 hours. | Ask all | ||
| Diet Knowledge | Knowledge of food bacteria | Have you ever heard of Salmonella (sal - mon - ELL - la) as a problem in food? (NOTE: IF THE RESPONDENT HAS HEARD OF SALMONELLA, BUT NOT AS A PROBLEM IN FOOD, CODE AS “NO”) | Which of the following have your heard of as a problem in food? (Check all that apply) Salmonella Listeria Campylobacter Norovirus E. coli Vibrio |
Check all that apply | Ask all | |
| Diet Knowledge | Knowledge of food bacteria | [Have you ever heard of] Listeria (lis - TEER - ee - ah) as a problem in food? (NOTE: IF THE RESPONDENT HAS HEARD OF LISTERIA, BUT NOT AS A PROBLEM IN FOOD, CODE AS “NO”) | See above | Ask all | ||
| Diet Knowledge | Knowledge of food bacteria | [Have you ever heard of] Campylobacter (KAM - pee - low - BACK - ter) as a problem in food? (NOTE: IF THE RESPONDENT HAS HEARD OF CAMPYLOBACTER, BUT NOT AS A PROBLEM IN FOOD, CODE AS “NO”) | See above | Ask all | ||
| Diet Knowledge | Knowledge of food viruses | Have you ever heard of Norovirus as a problem in food? (NOTE: IF THE RESPONDENT HAS HEARD OF CAMPYLOBACTER, BUT NOT AS A PROBLEM IN FOOD, CODE AS “NO”) |
See above | Ask all | ||
| Diet Knowledge | Knowledge of food bacteria | [Have you ever heard of ] E. coli as a problem in food? [NOTE: IF THE RESPONDENT HAS HEARD OF E.COLI, BUT NOT AS A PROBLEM IN FOOD, CODE AS “NO”] |
See above | Ask all | ||
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD Response | ABS Response | Skip pattern |
| Eat- risky foods | Raw food consumption | In the past 12 months which of the following raw foods did you eat? Raw clams? Raw oysters? Steak tartare or raw ground beef such as raw hack, raw kibbeh, or tiger meat? Sushi with raw fish, ceviche, or other raw fish? Raw alfalfa sprouts, bean sprouts, or other spouts? Raw chicken or other raw poultry Raw pork |
In the past 12 months which of the following raw foods did you eat? (Check all that apply) |
Yes No Don't know Refused |
Raw clams Raw oysters Steak tartare or raw ground beef such as raw hack, raw kibbeh, or tiger meat Sushi with raw fish, ceviche, or other raw fish Raw alfalfa sprouts, bean sprouts, or other spouts Raw chicken or other raw poultry Raw pork None of the above |
Ask all |
| Eat- risky foods | Raw food consumption | In the past 12 months, have you eaten eggs with runny yolks, soft scrambled eggs, or soft meringue? | In the past 12 months, have you eaten eggs with runny yolks, soft scrambled eggs, or soft meringue? | Yes No Don't know Refused |
Yes No |
Ask all |
| Eat- risky foods | Raw food consumption | In the past 12 months, did you eat any foods that contain raw eggs? We are talking about things like raw homemade cookie dough or raw homemade frosting that has raw egg in it where you eat the food . [IF NECESSARY: We mean foods that contain raw egg when you eat them, not foods made with a raw egg that is cooked before eaten.] |
In the past 12 months, did you eat any foods that contain raw eggs? Please include any things like raw homemade cookie dough or raw homemade frosting that has raw egg in it when you eat it. | Yes No Don't know Refused |
Yes No |
Ask all |
| Eat-risky foods | Raw food consumption | In the past 12 months have you ever tasted or eaten something with uncooked flour in it, such as raw cookie dough or cake batter ? | In the past 12 months have you ever tasted or eaten something with uncooked flour in it, such as raw cookie dough or cake batter ? | Yes No Don't know Refused |
Yes No |
Ask all |
| Eat- risky foods | Raw food perceptions | How likely do you think it is that the following foods contain germs or other microorganisms that could make you sick? Please use a 1 to 5 scale where 1 is “not at all likely” and 5 is “very likely.” Raw chicken Raw beef Raw shellfish Raw fish, like ceviche or sushi |
How likely do you think it is that the following foods contain germs that could make you sick? (MATRIX) Raw chicken Raw beef Raw shellfish Raw fish, like ceviche or sushi |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know Refused |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know |
Ask all |
| How likely do you think it is that the following foods contain germs or other microorganisms that could make you sick? Please use a 1 to 5 scale where 1 is “not at all likely” and 5 is “very likely.” Raw eggs Uncooked flour Raw homemade cookie dough |
How likely do you think it is that the following foods contain germs that could make you sick? (MATRIX) Raw eggs Uncooked flour Raw homemade cookie dough |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know Refused |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know |
|||
| How likely do you think it is that the following foods contain germs that could make you sick? Please use a 1 to 5 scale where 1 is “not at all likely” and 5 is “very likely.” Bagged, pre-cut lettuce or packaged, pre-cut salads Fresh, raw vegetables Uncooked frozen packaged vegetables such as packaged frozen spinach or peas Fresh, raw fruit Fresh, raw fruit that you buy at the store already cut and peeled |
How likely do you think it is that the following foods contain germs that could make you sick? (MATRIX) Bagged, pre-cut lettuce or packaged, pre-cut salads Fresh whole heads of lettuce Fresh, raw vegetables Uncooked frozen packaged vegetables such as packaged frozen spinach or peas Fresh, raw fruit Fresh, raw fruit that you buy at the store already cut and peeled Frozen fruit |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know Refused |
1 (Not at all likely) 2 3 4 5 (Very likely) Don't know |
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| Eat- risky foods | Raw food perceptions -- sprouts | Have you heard or read about any possible health problems related to eating “raw” sprouts, such as alfalfa or bean sprouts? | Have you heard or read about any possible health problems related to eating “raw” sprouts, such as alfalfa or bean sprouts? | Yes No Don't know Refused |
Yes No Don't know |
Ask all |
| Eat-risky foods | Raw food perceptions -- sprouts | Have you heard or read about any possible health benefits related to eating "raw" sprouts, such as alfalfa or bean sprouts | Have you heard or read about any possible health benefits related to eating "raw" sprouts, such as alfalfa or bean sprouts | Yes No Don't know Refused |
Yes No Don't know |
Ask all |
| Some cheese is made from milk that is not pasteurized. It is sometimes called "raw milk" cheese or "unpasteurized cheese." Have you heard or read about any possible health problems related to eating "raw milk" cheese? | Yes No Don't know |
Ask all | ||||
| Eat - risky foods | Raw cheese | In the past 12 months have you eaten any cheese that was made from milk that was not pasteurized? This type of cheese is sometimes called "raw milk" cheese. | In the past 12 months have you eaten any cheese that was made from milk that was not pasteurized? This type of cheese is sometimes called "raw milk" cheese. | Yes No [Do not eat any cheese (include those with cheese allergies)] [Do not eat any milk (include those with milk allergies)] [Do not eat either milk or cheese] Don't know Refused |
Yes No |
All |
| Eat - risky foods | Raw milk | In the past 12 months, did you drink any raw milk or milk that was not pasteurized? This type of milk is often sold off-the-farm or door-to-door. (n = 4,099) [Asked of all except those that said they did not drink any milk.] |
In the past 12 months, did you drink any raw milk or milk that was not pasteurized? This type of milk is often sold off-the-farm or door-to-door. |
Yes No Don't know Refused |
Yes No |
All |
| Eat - risky foods | Raw milk | How often do you drink raw milk? Would you say… |
How often do you drink raw milk? |
Less than once a year A few times a year Once a month A few times a month Once a week Two to three times per week Daily [Don't know] [Refused] |
Less than once a year A few times a year Once a month A few times a month Once a week Two to three times per week Daily |
[Asked of those who said they drank raw milk in the past 12 months.] |
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | Revised RDD | Revised ABS | RDD Response | ABS Response | Skip pattern |
| Food allergies | Food allergy experience | Now, I’d like to ask if you have any current food allergies, or do you suspect you have a food allergy? (IF NEEDED: Do not count allergies you used to have but outgrew or were desensitized to). (MARK YES IF RESPONDENT THINKS HE/SHE HAS A FOOD ALLERGY. IT IS NOT NECESSARY TO HAVE BEEN DIAGNOSED BY A DOCTOR. DO NOT COUNT ALLERGIES THAT OTHER HOUSEHOLD MEMBERS HAVE.) | Do you have any current food allergies or do you suspect you have a food allergy? | Yes No or not aware of Someone in household died from food allergy (not read outload) Don't know Refused |
Yes No |
Ask all |
| Food allergies | Food allergy experience | Has a medical doctor diagnosed your condition as a food allergy? | Has a medical doctor diagnosed your condition as a food allergy? | Yes No Don't know Refused |
Yes No |
If yes to above |
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD Response | ABS Response | Skip pattern |
| Diet Knowledge and Practice |
Awareness of diet-health relationship | I am going to read four statements about health and food. As I read each statement, please tell me how much you disagree or agree with it: 1. " If I eat a healthy diet I can reduce my chance of getting heart disease." Do you strongly disagree, somewhat disagree, somewhat agree, or strongly agree with it? 2. "If I eat a healthy diet I can reduce my chance of getting cancer." Do you strongly disagree, somewhat disagree, somewhat agree, or strongly agree with it? 3. "I am confident that I know how to choose healthy foods." Do you strongly disagree, somewhat disagree, somewhat agree, or strongly agree with it? 4. "Eating a healthy diet is important for my long-term health." Do you strongly disagree, somewhat disagree, somewhat agree, or strongly agree with it? |
How strongly do you disagree or agree with each of the following statements? (MATRIX) 1. " If I eat a healthy diet I can reduce my chance of getting heart disease." 2. "If I eat a healthy diet I can reduce my chance of getting cancer." 3. "I am confident that I know how to choose healthy foods." 4. "Eating a healthy diet is important for my long-term health." |
Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don't know Refuse |
Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don't know |
All |
| Diet Knowledge and Practice |
Awareness of diet-health relationship | In general, how healthy is your overall diet? Would you say… | In general, how healthy is your overall diet? | excellent, very good, good, fair, or poor? Refused Don't know |
excellent, very good, good, fair, or poor? |
All |
| Diet Knowledge and Practice |
Vegetable consumption | During the past 7 days, how many times did you eat vegetables? Count all raw, cooked, canned, and frozen vegetables. Do not count French fries or fried potatoes or other deep fried vegetables. Include vegetables you ate at all mealtimes and for snacks. | During the past 7 days, how many times did you eat vegetables? Count all raw, cooked, canned, and frozen vegetables. Do not count French fries or fried potatoes or other deep fried vegetables. Include vegetables you ate at all mealtimes and for snacks. | 3 or more times per day 1 - 2 times per day 4 - 6 times in the past 7 days 1 - 3 times in the past 7 days I did not eat vegetables during the past 7 days Don't know Refused |
3 or more times per day 1 - 2 times per day 4 - 6 times in the past 7 days 1 - 3 times in the past 7 days I did not eat vegetables during the past 7 days Don't know |
All |
| Diet Knowledge and Practice |
Sweet consumption | During the past 7 days, how many times did you eat “sweets” such as soda, cake, cookies, pastries, donuts, muffins, chocolate, candies or ice cream? Do not count diet soda or items made with artificial sweeteners. |
During the past 7 days, how many times did you eat “sweets” such as soda, cake, cookies, pastries, donuts, muffins, chocolate, candies or ice cream? Do not count diet soda or items made with artificial sweeteners. |
3 or more times per day 1 - 2 times per day 4 - 6 times in the past 7 days 1 - 3 times in the past 7 days I did not eat sweets in the past 7 days Don't know Refused |
3 or more times per day 1 - 2 times per day 4 - 6 times in the past 7 days 1 - 3 times in the past 7 days I did not eat sweets in the past 7 days Don't know |
All |
| Diet Knowledge and Practice |
Diet with focus on calorie | Are you on a weight loss diet? | Are you on a weight loss diet? | Yes No Don't know Refused |
Yes No |
Ask all |
| Diet Knowledge and Practice |
Diet with focus on calorie | On a scale of 1 to 5, where one is not at all confident and 5 is very confident, how confident are you that you know how many calories you should eat each day? | How confident are you that you know how many calories you should eat each day? | 1 -- not at all confident 2 3 4 5 -- Extremely confident Don't know Refused |
1 -- Not at all confident 2 - Slightly confident 3 -- Somewhat confident 4 -- Very confident 5 -- Extremely confident |
Ask all |
| Diet Knowledge and Practice |
Diet with focus on calorie | On a scale of 1 to 5, where one is not at all confident and 5 is very confident, how confident are you that you know how many calories are in the foods you eat? | How confident are you that you know how many calories are in the foods you eat? | 1 -- not at all confident 2 3 4 5 -- Extremely confident Don't know Refused |
1 -- Not at all confident 2 - Slightly confident 3 -- Somewhat confident 4 -- Very confident 5 -- Extremely confident Don't know |
|
| Diet Knowledge and Practice |
Diet with focus on calorie | About how many calories do you think a person of your age, gender, and physical activity needs to consume a day to maintain your current weight? | About how many calories do you think a person of your age, gender, and physical activity needs to consume a day to maintain your current weight? | Number Don't know Refused Less than 500 calories 500-1000 calories 1001-1500 calories 1501-2000 calories 2001-2500 calories 2501-3000 calories More than 3000 calories [DK] [RF] |
Number Don't know Less than 500 calories 500-1000 calories 1001-1500 calories 1501-2000 calories 2001-2500 calories 2501-3000 calories More than 3000 calories [DK] [RF] |
Ask all |
| Diet Knowledge and Practice Covariates |
Diet with focus on calorie | Do you think your diet is too low, too high, or about right in calories? | Do you think your diet is too low, too high, or about right in calories? | Too low Too high About right Don't know Refused |
Too low Too high About right Don't know |
Ask all |
| Diet Knowledge and Practice Covariates |
Diet with focus on calorie | Do you try to keep track, on a daily basis, of the amount of calories you eat? | Do you try to keep track, on a daily basis, of the amount of calories you eat? | Yes No Don't know Refused |
Yes No |
Ask all |
| Diet Knowledge and Practice |
Fat | Have you ever heard of the following types of fat? Trans fat or trans fatty acids Saturated fat Omega -3 fatty acids Unsaturated fat Monounsaturated fat Polyunsaturated fat |
Which of the following types of fats have you heard of? (Check all that apply) |
Yes No Don't know Refused |
Trans fat or trans fatty acids Saturated fat Omega -3 fatty acids Unsaturated fat Monounsaturated fat Polyunsaturated fat Have not heard of any of these. |
Ask all |
| Diet Knowledge and Practice |
Fat | Which of the following do you consider to be "good fat"? (Check all that apply.) |
Trans fat or trans fatty acids Saturated fat Omega -3 fatty acids Unsaturated fat Monounsaturated fat Polyunsaturated fat None of the above Don't know |
Ask all? | ||
| Diet knowledge and Practice | Fat | Which of the following foods contain high amounts of "good fats"? (Check all that apply.) |
Salmon Nuts Avocados Olive oil Red meat Whole milk None of the above Don't know |
Ask all | ||
| Diet Knowledge and Practice |
Sugar | Do you think your diet is too low, too high, or about right in sugar? | Do you think your diet is too low, too high, or about right in sugar? | Too low Too high About right Don't know Refused |
Too low Too high About right Don't know |
Ask all |
| Diet Knowledge and Practice |
Sugar | Are you currently trying to reduce your sugar intake? | Yes No |
Ask all | ||
| Diet knowledge and Practice | Fiber | Do you think your diet is too low, too high, or about right in fiber? | Do you think your diet is too low, too high, or about right in fiber? | Too low Too high About right Don't know Refused |
Too low Too high About right Don't know |
Ask all |
| Diet knowledge and Practice | Fiber | Are you currently watching your diet to make sure you get enough fiber? | Yes No |
Ask all | ||
| Diet Knowledge | Dietary fiber & whole grain | Which of the following foods contain high amounts of fiber? (Check all that apply.) | Beans Whole apples Fresh vegetables Nuts Chicken Milk Fruit juice None of the above Don't know |
Ask all | ||
| Diet Knowledge | Salt & sodium | Do you think your diet is too low, too high, or about right in salt or sodium? | Do you think your diet is too low, too high, or about right in salt or sodium? | Too low Too high About right Don't know Refused |
Too low Too high About right Don't know |
Ask all |
| Diet Knowledge | Salt & sodium | Are you currently watching or reducing your salt or sodium intake? | Are you currently watching or reducing your salt or sodium intake? | Yes No Don't know Refused |
Yes No |
Ask all |
| Diet Knowledge | Salt & sodium | Why did you decide to watch or reduce your salt or sodium intake? • A doctor or other health professional advised me to • Talking with family members or friends • Hearing or seeing something in the news about salt or sodium Other • Don’t know |
Why did you decide to watch or reduce your salt or sodium intake?? (Check all that apply.) • A doctor or other health professional advised me to • Talking with family members or friends • Hearing or seeing something in the news about salt or sodium * Other |
Yes No Don't know Refused |
If yes to previous question | |
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD Response | ABS Response | Skip pattern |
| Shopping | How much of your household's food shopping do you do? | How much of your household's food shopping do you do? | All of the food shopping Most of it About half of it Only a little of it None of it Don’t know Refused |
All of the food shopping Most of it About half of it Only a little of it None of it Don’t know |
All | |
| Shopping | About how often do you, or someone in your household, buy food or shop for food from each of the following places? (Include both in-person and online purchases.) Traditional grocery stores (Supermarkets such as Safeway, Giant, Kroger, Wegmans, Harris Teeter, Stop and Shop, and Food Lion) Big box stores/Supercenters (e.g. Walmart, Target, Kmart) Warehouse club stores (such as Sam’s Club, Costco) Limited assortment stores (such as Save-A-Lot, Aldi, Grocery Outlet, Trader Joe’s) Dollar store Drug stores Military commissary Natural/organic grocery stores (Whole Foods, Mom’s Organic) Convenience stores Farmer’s market Ethnic or international grocery store (for example, HMart, Asian grocery stores, Hispanic grocery stores) Specialty stores (e.g. butcher, cheese shop, bakery) Online only store such as Amazon |
3 ore more times per week Once or twice a week 1 to 3 times per month Less than once a month Just tried it once or twice Never Don't know |
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| Shopping | About how often do you or someone else in your household shop for food/groceries online that are delivered to you? (Do not include food from restaurants or weekly farm deliveries) | 3 ore more times per week Once or twice a week 1 to 3 times per month Less than once a month Just tried it once or twice Never Don't know |
||||
| Look at Labels | New NFL | Think about the Nutrition Facts label on many food products that list the amounts of things like calories, fat, vitamins and minerals in the product. In the past year, have you heard anything about changes to the Nutrition Facts label? | Yes No Don't know |
All | ||
| Look at Labels | NFL - general | When buying a food product for the first time, how often do you use the Nutrition Facts label? Would you say always, most of the time, sometimes, rarely, or never use the Nutrition Facts label? | When buying a food product for the first time, how often do you use the Nutrition Facts label? | Always Most of the time Sometimes Rarely Never Never seen the label Don't know Refused |
Always Most of the time Sometimes Rarely Never Never seen the label |
Ask all |
| Look at Labels | NFL - general | People may use the Nutrition Facts label in different ways,. When you look at Nutrition Facts labels, either in the store or at home, how often, if at all, do you use the labels in the following ways? Would you say you often, sometimes, rarely or never use the label [READ AND ROTATE LIST]? a. To help you decide which brand of a particular food item to buy b. To figure out how much of the food product you or your family should eat c. To compare different food items with each other d. To see if something said in advertising or on the package is actually true e. To get a general idea of the nutritional content of the food f. To see how high or low the food is in things like calories, salt, vitamins, or fat g. To help you in meal planning |
When you look at Nutrition Facts labels, either in the store or at home, how often, if at all, do you use the labels in the following ways? (MATRIX) a. To help you decide which brand of a particular food item to buy b. To figure out how much of the food product you or your family should eat c. To compare different food items with each other d. To see if something said in advertising or on the package is actually true e. To get a general idea of the nutritional content of the food f. To see how high or low the food is in things like calories, salt, vitamins, or fat g. To help you in meal planning |
Often Sometimes Rarely Never Don't know Refused |
Often Sometimes Rarely Never |
SKIP those that never use the label or have never seen the label. |
| Look at Labels | NFL - general | How much do you disagree or agree with the following statements? Would you say that you strongly disagree, somewhat disagree, somewhat agree, or strongly agree? a. I am interested in the Nutrition Facts label. b. The information on the Nutrition Facts label is easy to understand. c. When I use the Nutrition Facts label, I make better choices. d. The information on the Nutrition Facts label is believable. e. The information on the Nutrition Facts label is useful to me. |
How much do you disagree or agree with the following statements? a. I am interested in the Nutrition Facts label. b. The information on the Nutrition Facts label is easy to understand. c. When I use the Nutrition Facts label, I make better choices. d. The information on the Nutrition Facts label is believable. e. The information on the Nutrition Facts label is useful to me. |
Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don't know Refuse |
Strongly disagree Somewhat disagree Neither agree not disagree Somewhat agree Strongly agree Don't know |
Ask of all |
| Look at Labels | NFL - general & New NFL |
Which of the following do you usually look for when looking at a Nutrition Facts label? (Check all that apply) Serving size Number of servings Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrate Dietary fiber Total Sugars Added Sugars Protein Vitamins and minerals None of the above |
Check all that apply | Ask all | ||
| Look at Labels | NFL - general | What does serving size mean to you? You can choose more than one answer. [RANDOMIZE ITEMS: ACCEPTABLE MULTIPLE ANSWERS.] | What does serving size mean to you? (Check all that apply.) | The amount of a food that people should eat The amount of a food that people usually eat Something that makes it easier to compare foods Other Don't know Refused |
The amount of a food that people should eat The amount of a food that people usually eat Something that makes it easier to compare foods Other Don't know |
Ask all |
| Look at Labels | %DV | When you look at the Nutrition Facts label on a food product, which information do you use, the gram or milligram amounts, the percent Daily Value amounts, or both? | When you look at the Nutrition Facts label, which of the following do you look at? | The gram or milligram amounts The percent daily value amounts Both Neither Don't know Refused |
The gram or milligram amounts The percent daily value amounts Both Neither Don't know |
Ask all |
| Look at Labels | NFL - general | The Nutrition Facts label (below) shows that the product contains 5% Daily Value for Total Fat in a serving of the product. What does the 5% Daily Value mean to you? | 5 percent of the calories in one serving of the product come from Total Fat. One serving of the product contains 5 percent Total Fat by weight. One serving of the product contains 5 percent of the Total Fat that an average person should eat in an entire day. Don’t know |
Ask all | ||
| Look at Labels | NFL - general | The Nutrition Facts label (below) shows that one serving of the food contains 25% of your Daily Value (DV) of Sodium. Based on the information, would you consider a serving of this product to have a low, medium, or high amount of Sodium? | Low Medium High Don’t know |
Ask all | ||
| Look at Labels | NFL-ingredient list | When buying a food product for the first time, how often do you check the list of ingredients for an ingredient that you or someone in your family should avoid?” | When buying a food product for the first time, how often do you check the list of ingredients for an ingredient that you or someone in your family should avoid?” | Often Sometimes Rarely Never Don't know Refused |
Often Sometimes Rarely Never |
|
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD Response | ABS Response | Skip pattern |
| Look at Food Packages |
Label claims - general |
Which of the following, if you saw on the front of a food package, would make you more likely to purchase that product? (Check all that apply.) | Low sugar Low sodium No artificial ingredients No artificial colors No added sugar Whole grain High fiber No preservatives No antibiotics Natural Non-GMO Low calorie Low fat Low saturated fat No HFCS (high fructose corn syrup) Organic Healthy Gluten-free No additives Sustainably raised |
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| Look at Food Packages |
Food additives | On a scale of 1 to 5 where 1 not at all concerned and 5 being very concerned, how concerned are you about each of the following? (MATRIX) Artificial colors in food Artificial ingredients in food Preservatives in food Bacteria in food Antibiotics in food Pesticides in food |
Not at all concerned Slightly concerned Somewhat concerned Very concerned Extremely concerned |
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| Look at Food Packages |
Organic vs. non- | As you may know, some fruits and vegetables are produced by organic methods. Using a 5-point scale, how well informed would you say you are about organically grown fruits and vegetables, if one means you are not at all informed about organically grown fruits and vegetables and five means you are very well informed? | How well informed would you say you are about organic fruits and vegetables? | 1 -- not at all informed 2 3 4 5 -- Very well informed Don't know Refused |
1 -- not at all informed 2 -- Slightly informed 3 -- Somewhat informed 4 -- Moderately informed 5 -- Very well informed |
|
| Look at Food Packages |
Organic vs. non- | When available, how often do you buy organically grown fruits or vegetables? | When available, how often do you buy organically grown fruits or vegetables? | All of the time Most Some Never Don't know Refused |
All of the time Most Some Never Don't know |
|
| Look at Food Packages |
Organic vs. non- | Do you think that organically grown fruits and vegetables are more likely or less likely to have harmful germs than those grown without using organic methods, or are they the same? | Do you think organically grown fruit and vegetables are more or less likely to have harmful germs than other fruits and vegetables? | More likely Less likely About the same Don't know Refused |
More likely Less likely About the same Don't know |
|
| Look at Food Packages |
Organic vs. non- | Do you think that organically grown fruits and vegetables are more likely or less likely to cause long term health problems than those grown without using organic methods, or are they the same? | Do you think organically grown fruit and vegetables are more or less likely to cause long-term health problems than other fruits and vegetables? | More likely Less likely About the same Don't know Refused |
More likely Less likely About the same Don't know Refused |
|
| Look at Food Packages |
Organic vs. non- | How about the environment? Do you think that organically grown fruits and vegetables are better or worse for the environment, or are they the same as those grown without using organic methods? | Do you think organically grown fruit and vegetables are better or worse for the environment than other fruits and vegetables? | Better Worse About the same Don't know Refused |
Better for the environment Worse for the environment About the same Don't know |
|
| Look at Food Packages |
Organic vs. non- | How about nutrition? Do you think that organically grown fruits and vegetables are more nutritious or less nutritious than those grown without using organic methods, or are they the same? | Do you think organically grown fruit and vegetables are more or less nutritious than other fruits and vegetables? | More nutritious Less nutritious About the same Don't know Refused |
More nutritious Less nutritious About the same Don't know |
|
| Look at Food Packages |
GE foods | Some food products are being developed with the help of scientific techniques, such as genetic engineering. Sometimes these new foods are called “genetically modified” foods, "GMO", or "bioengineered foods." How much do you know about bout genetically engineered foods? | Some food products are being developed with the help of scientific techniques, such as genetic engineering. Sometimes these new foods are called “genetically modified” foods, "GMO", or "bioengineered foods." How much do you know about bout genetically engineered foods? | Nothing Very little Some A lot Don’t know Refused |
Nothing Very little Some A lot Don’t know |
|
| Look at Food Packages |
GE foods | Do you think that genetically engineered foods are more likely or less likely to have harmful germs than foods produced without genetic engineering, or are they the same? (IF RESPONDENT ASKS WHETHER YOU ARE TALKING ABOUT GENETICALLY MODIFIED ORGANISMS OR FOODS, THE ANSWER IS YES.) |
Do you think genetically engineered foods are more or less likely to have harmful germs than other foods? | More likely Less likely About the same Don't know Refused |
More likely Less likely About the same Don't know |
|
| Look at Food Packages |
GE foods | Do you think that genetically engineered foods are more likely or less likely to cause long term health problems than foods produced without genetic engineering, or are they the same? (IF RESPONDENT ASKS WHETHER YOU ARE TALKING ABOUT GENETICALLY MODIFIED ORGANISMS OR FOODS, THE ANSWER IS YES.) | Do you think genetically engineered foods are more or less likely to cause long-term health problems than other foods? | More likely Less likely About the same Don't know Refused |
More likely Less likely About the same Don't know |
|
| Look at Food Packages |
GE foods | How about the environment? Do you think that genetically engineered foods are better or worse for the environment, or are they the same as foods produced without genetic engineering? | Do you think genetically engineered foods are better or worse for the environment than other foods? | Better Worse About the same Don't know Refused |
Better for the environment Worse for the environment About the same Don't know |
|
| Look at Food Packages |
GE foods | How about the nutrition? Do you think that genetically engineered foods are more nutritious or less nutritious than foods produced without genetic engineering, or are they the same? | Do you think genetically engineered foods are more or less nutritious than other foods? | More nutritious Less nutritious About the same Don't know Refused |
More nutritious Less nutritious About the same Don't know |
|
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD response | ABS response | Skip pattern |
| Preparing -- Raw foods | Frozen vegetables | Now, I would like to ask you about store bought, packaged frozen vegetables such as frozen spinach, peas, and corn. How often do you look at the cooking instructions for packaged frozen vegetables? Would you say...? | How often do you look at the cooking instructions for store bought, packaged frozen vegetables such as frozen spinach, peas, and corn? | Every time I make them Sometimes Just the first time I make them Never Never prepare Don't know Refused |
Every time I make them Sometimes Just the first time I make them Never Never prepare store bought packaged frozen vegetables Don't know |
All |
| Preparing -- Raw foods | Frozen vegetables | Do you ever prepare and eat any of the following store bought, packaged frozen vegetables without first cooking or heating them? For example by adding them to a salad, dip, or smoothie. (MATRIX) Frozen spinach Frozen corn Frozen peas Frozen carrots Frozen broccoli Frozen kale Frozen asparagus Frozen cauliflower Frozen mixed vegetables Other frozen vegetables -- Specify |
Yes No I never prepare this food. |
All | ||
| Preparing -- Raw foods | Frozen other | Have you ever eaten store bought, packaged frozen waffles or pancakes without first heating them? | Yes No I never prepare this food. |
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| Preparing -- Raw foods | Fruit and vegetable washing | Do you ever buy bagged, pre-cut lettuce marked “prewashed” or “ready to eat”? | All | |||
| Preparing -- Raw foods | Fruit and vegetable washing | Do you usually wash or rinse bagged, pre-cut lettuce that is marked “prewashed” or “ready to eat” or do you eat it as is from the bag? | Do you usually wash or rinse bagged, pre-cut lettuce that is marked “prewashed” or “ready to eat” or do you eat it as is from the bag? | Wash or rinse Eat as is without washing It depends (I.e. product type, how it looks, how it smells) Don't know Refused |
Wash or rinse Eat as is without washing It depends (I.e. product type, how it looks, how it smells) Don't eat bagged, pre-cut lettuce Don't know |
Of those who buy bagged lettuce for RDD, ABS all |
| Preparing -- Raw foods | Fruit and vegetable washing | Do you ever buy whole avocados? | Yes No Don't know Refused |
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| Preparing -- Raw foods | Fruit and vegetable washing | Do you usually wash or rinse avocados before you prepare or eat them? | Do you usually wash or rinse avocados before you prepare or eat them? | Yes No Don't know Refused |
Yes No I never prepare this food. |
Of those who buy avocados for RDD, ABS all |
| Preparing -- Raw foods | Fruit and vegetable washing | Do you ever buy whole cantaloupe? | Yes No Don't know Refused |
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| Preparing -- Raw foods | Fruit and vegetable washing | Do you usually wash or rinse cantaloupe before you prepare or eat them? | Do you usually wash or rinse cantaloupe before you prepare or eat them? | Yes No Don't know Refused |
Yes No I never prepare this food. |
Of those who buy whole cantaloupe RDD, ABS all |
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
||||||
| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD response | ABS response | Skip pattern |
| Preparing-food handling | resources | Where you live, do you have a refrigerator and either a stove or microwave? | Where you live, do you have a refrigerator and either a stove or microwave? | Yes No Don't know Refused |
Yes No |
All |
| Preparing-food handling | Cooking experience | Version 1. How often do you prepare the main meal in your household? Do you prepare the main meal…? Version 2. When eating food cooked at home, how often are you the one who cooks or prepares the food? (FoodNet modified) |
Version 1. How often do you prepare the main meal in your household? Version 2. When eating food cooked at home, how often are you the one who cooks or prepares the food? (Food Net modified) |
All or nearly all of the time Only some of the time Never Don't know Refused |
All or nearly all of the time Only some of the time Never |
All |
| Preparing-food handling | Follow recipes | How strongly do you disagree or agree with the following statements? Would you say that you strongly disagree, somewhat disagree, somewhat agree, or strongly agree? I often cook new recipes I have many cookbook I often look up recipes online I usually cook new recipes by instinct I consider myself a creative cook I use a wide variety of spices I am a good cook Others view me as a good cook I am a relatively better cook than my friends |
How strongly do you disagree or agree with the following statements? I often cook new recipes I have many cookbooks I often look up recipes online I usually rely on recipes when preparing something new I consider myself a creative cook I use a wide variety of spices I am a good cook Others view me as a good cook I am a relatively better cook than my friends |
Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don't know Refused |
Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don't know |
All |
| Preparing-food handling | Follow recipes | Have you ever seen information about using a food thermometer included in recipes? | Have you ever seen information about using a food thermometer included in recipes? | Yes No Don't know Refused |
Yes No |
All |
| Follow recipes | Have you ever seen information about hand washing included in recipes? | Have you ever seen information about hand washing included in recipes? | Yes No Don't know Refused |
Yes No |
All | |
| Preparing-food handling | Hand washing | Before you begin preparing food, how often do you wash your hands with soap? | Before you begin preparing food, how often do you wash your hands with soap? | All of the time Most of the time Some of the time Rarely Don't know Refused |
All of the time Most of the time Some of the time Rarely |
All |
| Preparing-food handling | Hand washing | After you have cracked open raw eggs, do you usually continue cooking, or do you first rinse your hands with water, or wipe them, or wash them with soap?[IF NECESSARY TO CLARIFY “CONTINUE COOKING”: You touch anything besides the eggs such as cookware, bottles of seasoning or other ingredients.] | After you have cracked open raw eggs, what do you usually do? |
Continue cooking Rinse or wipe hands Wash with soap [Never handle raw eggs] Don't know Refused |
Continue cooking Rinse or wipe hands Wash hands with soap Never handle raw eggs |
All |
| Preparing-food handling | Prepare meat or chicken | When you cook food at home, do you ever prepare meals where you begin with raw meat or chicken? | When you cook food at home, do you ever prepare meals where you begin with raw meat or chicken? | Yes No Don't know Refused |
Yes No |
All or just those who cook the main meal at least some of the time |
| Preparing-food handling | Hand washing | After handling raw meat or chicken, do you usually continue cooking, or do you first rinse your hands with water, or wipe them, or wash them with soap? IF NECESSARY TO CLARIFY “CONTINUE COOKING”: You touch anything besides the meat such as cookware, bottles of seasoning or other ingredients.] |
After handling raw meat or chicken, what do you usually do? | Continue cooking Rinse or wipe hands Wash with soap [Never handle raw meat or chicken] Don't know Refused |
Continue cooking Rinse or wipe hands Wash with soap Never handle raw meat or chicken Don't know Refused |
Asked of those who prepare raw meat or chicken. |
| Preparing-food handling | Cutting board | After you have used a cutting board or other surface for cutting raw meat or chicken, do you use it as it is for other food to be eaten raw for the same meal, or do you first rinse it, or wipe it, or wash it with soap? | After cutting raw meat or chicken, what do you do with the cutting board or surface? [Mark all that apply.] | Use as it is Rinse or Wipe it Wash with soap [Wash with bleach/disinfectant] [Use a different board] [Don't cut raw meat or poultry] [Put in the dishwasher] [Bleach/Disinfectant and soap] [Bleach/Disinfectant and dishwasher] [Disposable board] [Flip board] [Hand wash with soap then put in dishwasher] [Other] [Don't know] [Refused] Use as it is Rinse or Wipe it Wash with soap [Wash with bleach/disinfectant] [Use a different board] [Don't cut raw meat or poultry] [Put in the dishwasher] [Bleach/Disinfectant and soap] [Bleach/Disinfectant and dishwasher] [Disposable board] [Flip board] [Hand wash with soap then put in dishwasher] [Other] [Don't know] [Refused] |
Continue using it Rinse or Wipe it Wash it with soap Wash with bleach Put in dishwasher Don't cut raw meat or poultry Don't know |
Asked of those who prepare raw meat or chicken. |
| Preparing-food handling | Thawing raw meat | How often do you use the following methods to thaw frozen raw meat or chicken? Put in the refrigerator to thaw Thaw on the counter or table Thaw in microwave Thaw in container of water. Cook raw meat or chicken from frozen without thawing. |
How often do you use the following methods to thaw frozen raw meat or chicken? Put in the refrigerator to thaw Thaw on the counter or table Thaw in microwave Thaw in container of water. Cook raw meat or chicken from frozen without thawing. |
Always Often Sometimes Never Don’t ever thaw raw meat or chicken Don't know Refused |
Always Often Sometimes Never Don’t ever thaw raw meat or chicken Don't know Refused |
Ask of those who thaw raw meat or chicken. |
| Preparing-food handling | Washing chicken pieces | Would you say that you always, sometimes, or never wash or rinse raw chicken pieces before cooking them? [IF NEEDED: We are talking about chicken breasts, thighs, legs, and wings.] |
How often do you wash or rinse raw chicken pieces before cooking them? |
Always Often Sometimes Never Don't cook raw chicken pieces Don't know Refused |
Always Often Sometimes Never Don't cook raw chicken pieces Don't know |
Ask of those who prepare raw meat or chicken. |
| Preparing-food handling | Washing whole chicken | What about when you prepare a whole chicken or whole turkey, do you always, sometimes or never wash or rinse whole chicken or turkeys before cooking? |
How often do you wash whole chickens or turkeys before cooking them? | Always Often Sometimes Never Don't cook whole chickens or turkeys Don't know Refused |
Always Often Sometimes Never Don't cook raw chicken pieces Don't know |
Ask of those who prepare raw meat or chicken. |
| Preparing-food handling | Hamburgers | In your home, how are beef hamburgers usually served? | In your home, how are beef hamburgers usually served? | Rare Medium rare Medium Medium - well Well done Hamburgers are never served Don't know Refused |
Rare Medium rare Medium Medium - well Well done Hamburgers are never served Don't know |
Ask all. -- may need to move location of question to another tab (Eat -- Preference for Risky food) or another location on this tab |
| Preparing-food handling | Hamburgers | When you say beef hamburgers are usually served [INSERT medium, medium rare, or medium well DEPENDING ON PREVIOUS ANSWER] do you mean they are brown all the way through or that they still have some pink in the middle? | When you say beef hamburgers are usually served "medium," how would you describe the color? | Brown all the way through Still have pink in the middle Don't know Refused |
Brown all the way through Still have pink in the middle Don't know |
Ask those who serve hamburgers medium. |
| Preparing-food handling | Storing food | If you cook a large pot of soup, stew, or other food with meat or chicken and want to save it for the next day, when do you put the food in the refrigerator? Would it be…? | If you cook a large pot of soup, stew, or other food with meat or chicken and want to save it for the next day, when do you put the food in the refrigerator? | Immediately After first cooling it at room temperature After first cooling it in cold water [Do not cook such foods] [Would not refrigerate it] [Don't know] [Refused] |
Immediately After first cooling it at room temperature After first cooling it in cold water Do not cook such foods Would not refrigerate it Don't know |
Ask all |
| Preparing-food handling | Storing food | For about how long would you let it cool at room temperature? | For about how long would you let it cool at room temperature? | [Less than two hours] [Two hours or more/about two hours] [Don't know] [Refused] |
Less than two hours Two hours or more Don't know |
Asked of those who let it cool at room temperature |
| Preparing-food handling | Grilling | Have you grilled meat, chicken, or fish outside in the past year? | Have you grilled meat, chicken, or fish outside in the past year? | Yes No Don't know Refused |
Yes No |
Ask those who prepare the main meal at least some of the time |
| Preparing-food handling | Grilling | After the food is cooked, what do you usually use to carry it from the grill to the place where it will be eaten? Do you use…? | After the food is cooked, what do you usually use to carry it from the grill to the place where it will be eaten? Do you use…? | The same plate or pan you used to carry the food to the grill A different plate or pan Serve directly from the grill to individual plates Don't know Refused |
The same plate or pan you used to carry the food to the grill A different plate or pan Serve directly from the grill to individual plates Don't know |
Asked of those who grill |
| Preparing-food handling | Grilling | Do you use the plate or pan as it is, or do you first wipe it, or rinse it, or wash it with soap? | Do you use the plate or pan as it is, or do you first wipe it, or rinse it, or wash it with soap? | Use as it is Rinse or Wipe it Wash with soap Don't know Refused |
Use as it is Rinse or Wipe it Wash with soap Don't know |
Asked of those who grill |
| Preparing-food handling | Prepare raw fish | Do you ever prepare meals where you begin with raw fish or shellfish? | Do you ever prepare meals where you begin with raw fish or shellfish? | Yes No Don't know Refused |
Yes No |
Asked of those who prepare main meal |
| Preparing-food handling | Hand washing | After handling raw fish, do you usually continue cooking, or do you first rinse your hands with water, or wipe them, or wash them with soap? [IF NECESSARY TO CLARIFY “CONTINUE COOKING”: You touch anything besides the fish such as cookware, bottles of seasoning or other ingredients.] | After handling raw fish, what do you usually do? | Continue cooking Rinse or wipe hands Wash with soap Never handle raw fish Don't know Refused |
Asked of those who prepare raw fish or shellfish. | |
| Preparing-food handling | Cutting board | After cutting raw fish or shellfish, what do you do with the cutting board or surface? [IF NECESSARY: Do you use it as it is for cutting food to be eaten raw for the same meal, or do you first rinse it, wipe it or wash it with soap?] | After cutting raw fish or shellfish, what do you do with the cutting board or surface? [Mark all that apply.] | Continue using it Rinse or Wipe it Wash it with soap Wash with bleach Put in dishwasher Don't cut raw meat or poultry Don't know |
Asked of those who prepare raw fish/shellfish | |
| Preparing-food handling | Storing food | If you cooks a large pot of soup, stew, or other food with fish or shellfish and want to save it for the next day, when do you put the food in the refrigerator? Would it be…? | If you cook a large pot of soup, stew, or other food with fish or shellfish and want to save it for the next day, when do you put the food in the refrigerator? | Immediately After first cooling it at room temperature After first cooling it in cold water [Do not cook such foods] [Would not refrigerate it] [Don't know] [Refused] |
Immediately After first cooling it at room temperature After first cooling it in cold water Do not cook such foods Would not refrigerate it Don't know |
Asked of those who prepare fish or shellfish With modification can ask all |
| Preparing-food handling | Storing food | For about how long would you let it cool at room temperature? | For about how long would you let it cool at room temperature? | [Less than two hours] [Two hours or more/about two hours] [Don't know] [Refused] |
Less than two hours Two hours or more Don't know |
Asked of those who let it cool at room temperature |
| Preparing-food handling | Thermometer | Do you have a food thermometer, such as a meat thermometer? | Do you have a food thermometer, such as a meat thermometer? | Yes No Don't know Refused |
Yes No Don't know |
Ask all. |
| Preparing-food handling | Thermometer | Thinking of your usual habits over the past year, when you prepare the following foods, how often do you use a food thermometer? For beef, lamb, or pork roasts - how often do you use a thermometer when you cook roasts? Would you say… | Over the past 12 months, how often do you use a food thermometer to test for doneness when you prepare the following foods? Beef, lamb, or pork roasts Whole chickens or turkeys Chicken parts such as breasts or legs Baked egg dishes such as quiche, custard, or bread pudding Hamburgers Frozen foods such as meals, entrees, burritos, and sandwiches |
Always Often Sometimes Never [Never cook the food] Don't know Refused |
Always use a food thermometer Often use a food thermometer Sometimes use a food thermometer Never use a food thermometer Did not cook the food in the past 12 months Don't know |
Asked of those who have a food thermometer and who prepare raw meat/poultry For ABS, just ask all who have a food thermometer. |
| Preparing-food handling | Thermometer | How about whole chickens or turkeys - how often do you use a thermometer when you cook whole chickens or turkeys? Would you say… | Always Often Sometimes Never [Never cook the food] Don't know Refused |
Asked of those who have a food thermometer and who prepare raw meat/poultry For ABS, just ask all who have a food thermometer. |
||
| Preparing-food handling | Thermometer | How about chicken parts, such as breasts or legs - how often do you use a thermometer when you cook chicken parts? Would you say… | Always Often Sometimes Never [Never cook the food] Don't know Refused |
Asked of those who have a food thermometer and who prepare raw meat/poultry For ABS, just ask all who have a food thermometer. |
||
| Preparing-food handling | Thermometer | How about baked egg dishes such as quiche, custard, or bread pudding - how often do you use a thermometer when you cook baked egg dishes? | Always Often Sometimes Never [Never cook the food] Don't know Refused |
Asked of those who have a food thermometer and who prepare the main meal all or some of the time. For ABS, just ask all who have a food thermometer. |
||
| Preparing-food handling | Thermometer | How about hamburgers - how often do you use a thermometer when you cook or grill hamburgers? [ NOTE: Turkey burgers are included if the respondent volunteers but do not probe for turkey burgers. Do not include veggie burgers.] | Always Often Sometimes Never Never cook the food Don't know Refused |
Asked of those who have a food thermometer and prepare raw meat/poultry. For ABS, just ask all who have a food thermometer. |
||
| Pets in kitchen | Do you have any pets in your household? | Do you have any pets in your household? | Yes No Don't know Refused |
Yes No Don't know |
||
| Pets in kitchen | What type of pets you have? (Accept multiples) | Which of the following pets do you have? (Select all that apply) | Dog Cat Bird Rabbit Reptile - snake, turtle, lizard, frog Fish Hamster or other small rodent Other pet Don't know Refused |
Dog Cat Bird Rabbit Reptile - snake, turtle, lizard, frog Fish Hamster or other small rodent Other pet Don't know Refused |
Of those who have pets | |
| Pets in kitchen | When you are preparing food, do your pets ever come in the kitchen? | When you are preparing food, do your pets ever come in the kitchen? | Yes No Don't know Refused |
Yes No Don't know |
Of those who have pets (other than fish) | |
| Pets in kitchen | Do(es) your pet(s) ever get on the kitchen counter? | Do(es) your pet(s) ever get on the kitchen counter? | Yes No Don't know Refused |
Yes No Don't know |
Of those who have pets (other than fish) | |
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD response | ABS Response | Skip pattern |
| Demographics | LANDLINE PARTICIPANTS: Now I have a couple of questions for statistical purposes: For personal calls, do you only use a landline phone at your household, or do you also have a cell phone on which I could have reached you? LANDLINE PARTICIPANTS: Are there any other phone numbers at your home, in addition to this phone number, that you receive phone calls? Please exclude any cell phones and also exclude any phone numbers used only for fax machines or computers. CELL PHONE PARTICIPANTS: For personal calls, do you only use a cell phone, or do you have a landline phone at your household on which I could have reached you? |
Do you have a landline telephone in your home that is used to make and receive calls? Do you or anyone in your household have a cell phone that is used to make and receive calls? |
Landline only Cell phone also phone Don't know Refused Yes No Don't know Refused Cell phone only Landline also Don't know Refused |
Yes No Yes No |
||
| Demographics | What is the zip code where you live? | What is the zip code where you live? | Enter number | Enter number | All | |
| Demographics | How many total people, including yourself, live in your household? | How many total people, including yourself, live in your household? | Enter number | Enter number | All | |
| Demographics | How many of these people [in your household] are children five years and younger? | How many of the people in your household are children five years and younger? | Enter number | Enter number | All | |
| Demographics | How many of these people [in your household] are children between 6 and 17 years? | How many of the people in your household are children between 6 and 17 years? | Enter number | Enter number | All | |
| Demographics | Are you the parent or primary caregiver to any of the children in your household? | Are you the parent or primary caregiver to any of the children in your household? | Yes No Don't know Refused |
Yes No |
Those with children in household | |
| Demographics | How many of these people [in your household] are adults age 18-59 years? | How many of these people in your household are adults age 18-59 years? | Enter number | Enter number | All | |
| Demographics | How many of these people [in your household] are adults 60 years of age or older? | How many of these people in your household are adults 60 years of age or older? | Enter number | Enter number | All | |
| Demographics | How do you describe yourself? Would you say that you are male, female, transgender, or do you not identify as male, female, or transgender? | How do you describe yourself? (Check one) | Male Female Transgender Something else Don't know Refused |
Male Female Transgender Something else Don't know |
All | |
| Demographics | What year were you born in? | What year were you born in? | Enter number | Enter number | All | |
| Demographics | Which of the following best describes your house, apartment, or mobile home? Is it owned by you or someone in this household with a mortgage or loan? Include home equity loans. Is it owned by you or someone in this household free and clear (without a mortgage or loan)? Is it rented? Is it occupied without payment of rent? |
Is this house, apartment, or mobile home – Mark (X) ONE box. Owned by you or someone in this household with a mortgage or loan? Include home equity loans. Owned by you or someone in this household free and clear (without a mortgage or loan)? Rented? Occupied without payment of rent? |
Select response | See question | ||
| Demographics | Is anyone in your household pregnant? | Is anyone in your household pregnant? | Yes No Don't know |
All | ||
| Demographics | Are you pregnant or is it someone else? | Are you pregnant? | I'm pregnant Someone else Someone else and me |
If yes to 15. | ||
| Demographics | Are you Hispanic or Latino? | Are you Hispanic or Latino? | Yes No Don't know Refused |
Yes No |
All | |
| Demographics | Do you usually speak English, Spanish, or some other language at home? | Do you usually speak English, Spanish, or some other language at home? | English Spanish Other language Multiple languages Don't know Refused |
English Spanish Other language Multiple languages Don't know |
All | |
| Demographics | What is your race? Please select one or more. Are you…[Multiple responses are allowed.] |
What is your race? Please select one or more. | White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Don't know Refused |
White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Don't know |
All | |
| Demographics | What is the last grade or year of school that you have completed? | What is the last grade or year of school that you have completed? | Less than high school degree High school graduate or GED (12 years) 1 - 3 years college/some college (13-15 years) College graduate -- Bachelors' degree or equivalent (16 years) Postgraduate, master's degree, doctorate, law degree, other professional degree Don't know Refused |
Less than high school degree High school graduate or GED (12 years) 1 - 3 years college/some college (13-15 years) College graduate -- Bachelors' degree or equivalent (16 years) Postgraduate, master's degree, doctorate, law degree, other professional degree |
All | |
| Demographics | Is your annual household income from all sources… (A household consists of all people who occupy a particular housing unit as their usual residence, or who live there at the time of the interview and have no usual residence elsewhere.) |
Is your annual household income from all sources… (A household consists of all people who occupy a particular housing unit as their usual residence, or who live there at the time of the interview and have no usual residence elsewhere.) |
Less than $25,000 Less than $20,000 Less than $15,000 Less than $10,000 Less than $35,000 Less than $50,000 Less than $75,000 Less than $150,000 |
Less than $10,000 $10,000 to $14,999 $15,000 to $19,999 $20,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $149,999 More than $150,000 |
All | |
| Demographics | We appreciate your taking the time to participate in our study. Those are all of the questions I have. Is there anything you’d like to add?” | We appreciate your taking the time to participate in our study. Is there anything you’d like to add?” | All | |||
| OMB Control No. 0910-0345 | Expiration Date: xx/xx/xxxx | |||||
| Food Safety, Health, and Diet Survey | ||||||
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0345. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov. |
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| Level 1 Topic | Level 2 Topics | RDD | ABS | RDD Response | ABS Response | Skip pattern |
| Covariates | Food service worker | Have you worked for any of the following in the past five years? Food manufacturing plant Farm Restaurant Catering Grocery store Public Health Organization Health care provider State or local food agency |
Have you worked for any of the following in the past five years? (Check all that apply.) Food manufacturing plant Farm Restaurant Catering Grocery store Public Health Organization Health care provider State or local food agency |
Yes No Don't know Refused |
||
| Covariates | ServSafe | Do you have or have you ever had a ServSafe or other similar safe food handling certification? | Do you have or have you ever had a ServSafe or other similar safe food handling certification? | Yes No Don't know |
||
| Covariates | Internet | Do you use the internet or email, at least occasionally? | Do you use the internet or email, at least occasionally? | Yes No Don't know Refused |
Yes No |
|
| Covariates | Internet | Do you access the internet on a cellphone, tablet or other mobile handheld device, at least occasionally? | Do you access the internet on a cellphone, tablet or other mobile handheld device, at least occasionally? | Yes No Don't know Refused |
Yes No Don't know |
|
| Covariates | Health Status | Would you say your health in general is . . | Would you say your health in general is . . | Excellent Very good Good Fair Poor Don't know Refused |
Excellent Very good Good Fair Poor Don't know |
modified to match NHANES |
| Covariates | Foodborne illness experience | In the past year, did you get sick from eating spoiled or unsafe food? Don't include allergies to food. (Version 1) In the past year, did you have any foodborne illness or food poisoning? (Version 2) |
In the past year, did you get sick from eating spoiled or unsafe food? Don't include allergies to food. (Version 1) In the past year, did you have any foodborne illness or food poisoning? (Version 2) |
Yes No Don't know Refused |
Yes No Don't know |
|
| Covariates | Health Status | Have you ever been told by a doctor or other healthcare professional that you have any of the following health conditions? I don’t need to know which condition, just whether you have any of them. [READ: “high blood pressure, diabetes, high cholesterol, heart disease, obesity, overweight, or cancer.] | Have you ever been told by a doctor or other healthcare professional that you have high blood pressure, diabetes, high cholesterol, heart disease, or cancer? | Yes No Don't know Refused |
Yes No Don't know |
|
| Covariates | Health Status | Have you ever been told by a doctor or other healthcare professional that you are overweight or obese? | Yes No Don't know |
|||
| Covariates | Health Status | How tall are you without shoes? | How tall are you without shoes? | Enter height in ft, inch Enter height in m, cm Refused Don't know |
Enter height in ft, inch Enter height in m, cm Don't know |
modified to match NHANES |
| Covariates | Health Status | How much do you weigh without clothes or shoes? | How much do you weigh without clothes or shoes? | Enter weight in lbs. Enter weight in kg Refused Don't know |
Enter weight in lbs. Enter weight in kg Don't know |
modified to match NHANES |
| Covariates | Calories | About how many calories does a medium size apple have? | About how many calories does a medium size apple have? Please give us your best guess without consulting others. | |||
| Covariates | SNAP | In the past 12 months has anyone living in your household received SNAP/food stamp benefits? | In the past 12 months has anyone living in your household received SNAP/food stamp benefits? | Yes No Don't know Refused |
Yes No Don't know |
All |
| Covariates | SNAP30days | In the past 30 days has anyone living in your household received SNAP/Food stamp benefits? | In the past 30 days has anyone living in your household received SNAP/Food stamp benefits? | Yes No Don't know Refused |
Yes No Don't know |
Of those who were on SNAP in the last 12 months |
| Covariates | WIC | In the past 12 months has anyone living in your household received food through the WIC (Women Infant Children) program? | In the past 12 months has anyone living in your household received food through the WIC (Women Infant Children) program? | Yes No Don't know Refused |
Yes No Don't know |
If female 18-55, or if family includes females 12-55 or children 0-5: |
| Covariates | School lunch | In the past 12 months have any children in the family received free or reduced-cost lunches at school? | In the past 12 months have any children in the family received free or reduced-cost lunches at school? | Yes No Don't know Refused |
Yes No Don't know |
If family includes children 7-17. |
| Covariates | Exercise | About how many days per week do you engage in moderate or vigorous physical activity (such as brisk walking, jogging, biking, aerobics, or yard work)? | About how many days per week do you engage in moderate or vigorous physical activity (such as brisk walking, jogging, biking, aerobics, or yard work)? | 1 2 3 4 5 6 7 Don't know Refused |
1 2 3 4 5 6 7 |
Ask all |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |