Online Questionnaire
Mixed Foods
- Sandwiches
- Burgers
- Hotdogs/Sausages
- Deli
- Breakfast Sandwiches
- Peanut Butter
- Cheese
- Typical Bread
- Wraps
- End of Section
- Burritos & Tacos
- Burritos
- Tacos
- Haystacks/Taco Salad
- End of Section
- Pizza
- Cheese Only
- Meat Without Vegetables
- Vegetables Only
- Meat & Vegetables
- End of Section
- Asian Food
- Fried Egg Rolls
- Fried Spring Rolls
- Fresh Spring Rolls
- Dumplings/Pot Stickers
- Asian-Style Dumplings/Pot Stickers
- Steamed Or Boiled Dumplings/Pot Stickers
- End of Section
- Cooked mixed Vegetables
- Stir Fried/Sauteed, Steamed Or Boiled
- End of Section
- Noodles & Rice
- Fried Noodles
- Other Rice
- Fried Rice
- End of Section
- Pasta
- Macaroni And Cheese
- Italian-Style Pasta
- Ravioli/Stuffed Pasta
- Lasagna
- End of Section
- Casserole Or Hotdish
- Green Bean
- Mac And Cheese
- Vegan Potato
- Egg & Potato
- Bean & Rice
- Chicken & Rice
- Veggie Enchilada
- Vegetarian Special K
- Cabbage & Veggie Sausage
- Other
- Most Common Other Casserole Or Hotdish
- End of Section
- Egg Dishes
- Omelet
- Egg Dishes With Crust
- Egg Dishes Without Crust
- End of Section
- Chili
- Chili: Intro
- Chili With No Meat/Meat Alternative
- Chili With Meat/Meat Alternative
- End Of Section
- Stews Or Soups
- WITHOUT Noodles Or Pasta
- WITH Noodles Or Pasta
- Typical
- End of Section
- Smoothies
- Fruit-Only
- Fruit-Vegetable
- Vegetable Only
- End of Section
- Miscellaneous
- Savory Pot Pie
- Empanadas Or Pastries
- Lentil Loaf
- Nut Loaf
- Meatloaf
- Cottage Cheese Loaf
- End of Section
=== Individual Foods ===
- Intro
- Meats-Fish
- Unprocessed Meat
- Processed Meats
- Unprocessed Fish
- Processed Fish
- Shellfish/Other Seafood
- End of Section
- Meat Alternatives
- Commercially Produced meat Alternatives
- Whole Food Commercial Meat Alternative Burgers
- Tofu & Soy Products
- Homemade Meat Alternatives
- Vegan Frequency
- End of Section
- Dairy-Non Dairy Products
- Milk
- Cheese
- Cream
- Yogurt
- Ice Cream
- End of Section
- Nuts-Seeds
- Raw/Roasted
- End of Section
- Vegetables
- Intro
- Leafy Greens
- Sprouts
- Cruciferous
- Other
- Allium
- Tubers/Starchy Vegetables
- Herbs & Spices
- Preparation
- End of Section
- Legumes
- Beans, Peas, Lentils
- Typical Preparation
- End of Section
- Fresh Fruit
- Common Fruits
- Tropical Fruits
- Berries
- Stone Fruits
- Citrus
- End of Section
- Cooked Dried Fruits
- Dried Fruit
- Canned/Cooked Fruits
- Typical Preparation
- End of Section
- Beverages & Juices
- Beverages
- Alcoholic Beverages
- Juice
- Fruit/Vegetable Beverage
- Sports/Energy Drinks
- End of Section
- Additions
- To Toast Or Bread
- Sweeteners & Jams
- Salad Dressing
- Condiments
- End of Section
- Cereal
- Cooked
- Granola
- Ready-To-Eat
- End of Section
- Breads & Grains
- Cooked Grains
- Bread
- Bagel Or English Muffin
- Flatbread, Pita, Naan, Paratha, Chapatti
- Tortilla
- Other Bread
- Pancakes Or Waffles
- End of Section
- Snacks
- Desserts/Sweet Snacks
- Savory
- End of Section
=== Eating Habits ===
- Intro
- Eating Context
- Eating Frequency
- Activity While Eating
- Meal Source
- Meal Preparation
- Sustainability
- Sustainability: Food Discarded at Home
- Sustainability: Food Discarded Eating Out
- Sustainability: Single Serving Usage
- Sustainability: Recycling Habits
- Sustainability: Disposable Materials
- Fasting
- Fasting: Habits
- Fasting: Food Consumed
- Fasting: Duration
- Fasting: Frequency
- Fasting: Reasons
- Short Fasting
- Eating Disorders
- Overeating: History
- Overeating: Frequency
- Overeating: Stress
- Overeating: Control
- Overeating: Behavior
- Overeating: Shame
- Overeating: Guilt
- Overeating: Weight Control
- Emotional/stress-related eating
- Night eating: History
- Night eating: Frequency
- End of Section
=== Medical History ===
- Intro
- Cancer History
- Personal Cancer History
- Family Cancer History: Family Members
- Family Cancer History
- No cancer site/year
- Surgeries/Diagnoses
- Surgical History
- Surgical History: Coronary Bypass
- Surgical History: Angioplasty/Stent
- Surgical History: Carotid Arteries
- Cardiovascular System
- Cardiovascular System: Angina Pectoris
- Cardiovascular System: Heart Attack
- Cardiovascular System: High Blood Pressure
- Cardiovascular System: High Cholesterol
- Cardiovascular System: Small Stroke (TIA)
- Cardiovascular System: Congestive Heart Failure
- Cardiovascular System: Atrial Fibrillation
- Respiratory System
- Respiratory System: COPD
- Respiratory System: Asthma
- Digestive System
- Digestive System: GERD
- Digestive System: Ulcerative Colitis/Crohn’s Disease
- Digestive System: Rectal/Colon Polyps
- Endocrine System
- Endocrine System: Diabetes Mellitus (Type I: Juvenile)
- Endocrine system: Diabetes Mellitus (Type II: Adult Onset)
- Endocrine System: Hyperthyroidism
- Endocrine System: Hypothyroidism
- Nervous System
- Nervous System: Parkinson’s Disease
- Nervous System: Diabetic Nerve Disease
- Eyes
- Eyes: Diabetic Eye Disease
- Eyes: Cataract
- Eyes: Macular Degeneration
- Musculoskeletal System
- Musculoskeletal System: Rheumatoid Arthritis
- Musculoskeletal System: Degenerative (Osteo) Arthritis
- Musculoskeletal System: Degenerative Disc, Sciatica/Arthritis of the Back
- Musculoskeletal System: Osteoporosis
- Musculoskeletal System: Lupus
- Genitourinary System
- Genitourinary System: Enlarged Prostate
- Genitourinary System: Kidney Failure
- Medical Test History
- Fractures
- Fracture History: Frequency
- Fracture History: Major Accidents
- Fracture History: Minor Accidents
- Fracture History: Sites of Fractures Due to Minor Accidents
- Fracture History: Hip
- Fracture History: Leg, Above Knee
- Fracture History: Leg, Below Knee
- Fracture History: Ankle
- Fracture History: Upper Arm/Elbow
- Fracture History: Wrist
- Fracture History: Fingers or Toes
- Fracture History: Other
- Fracture History: Underlying Medical Reason
- End of Section
=== Lifestyle Habits ===
- Intro (1 page)
- Physical Activity (9 pages)
- Exercise History
- Health Conditions
- Exercise Program
- Exercise Program: Intensity
- Exercise Program: Duration
- Recreational Activities (9 questions)
- Level of Activity (9 questions)
- Walking Pace (7 questions)
- Daily Stair Count
- Smoking Habits (5 pages)
- Smoking Habits: If Used
- Smoking Habits: What Used (4 booleans)
- Smoking Habits: When Started
- Smoking Habits: When Stopped
- Smoking Habits: Frequency
- Alcohol Habits (4 pages)
- Alcohol Habits: If Used
- Alcohol Habits: When Started
- Alcohol Habits: When Stopped
- Alcohol Habits: Quantity
- Sun Exposure (15 pages)
- Current Sun Exposure: Duration (4 questions)
- Current Sun Exposure: Vacation
- Current Sun Exposure: Vacation Season
- Current Sun Exposure: Vacation Duration
- Current Sun Exposure: Sunscreen Usage
- Current Sun Exposure: What SPF
- Past Sun Exposure: Duration (4 questions)
- Past Sun Exposure: Vacation
- Past Sun Exposure: Vacation Season
- Past Sun Exposure: Vacation Duration
- Past Sun Exposure: Sunscreen Usage
- Past Sun Exposure: What SPF
- Sun Exposure Effects
- Past Residence Locations (8 booleans)
- Present Location
- Free-text with no range checking
- End of Section (1 page)
=== Census Data ===
- Intro (1 page)
- Ethnicity (1 page)
- Racial Origin (1 page, 5 booleans)
- Current Height (1 page)
- Current Weight (1 page)
- Previous Weight (1 page, up to 6 text entries)
- Marital Status (1-2 pages)
- Marital Status
- Single Status (only shows up if divorced/widowed)
- Schooling (1 page)
- Employment Status (1 page, 9 booleans)
- Employment Location (1 page)
- Employment History (1 page)
- No range-checking.
- Primary Occupation (1 page, 2 text entries)
- Personal Yearly Income (1 page, 2 questions)
- Religious Beliefs Age 12-25 (1 page)
- Current Religious Beliefs (1 page)
- Baptism (1 page, 2 questions)
- End of Section