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.
1. What is your AGE?
2. Are you:
Less than 9
9
10
11
15
12
16
13
17
14
18 or older
USE NO. 2 PENCIL ONLY
3. Your
Male
Female
The WRONG way

to mark your
answers!
The RIGHT way

to mark your
answer!
4. Your
Height
Weight
(lbs)
2
3
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?
take per week?
No
3/8 spine
perf
12
35
(Please specify exact brand)
69
10 or more
OW
CK
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
7. How often do you eat food that is fried at home,

like fried chicken?
Other
please specify:
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
Never/less than once per week

13 times per week
7
8
46 times per week

Daily
These questions ask about what you ate and drank over the past year.
DRINKS
3. What is the usual serving
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
(1 can or individual bottle)

1 bottle per week
24 bottles per week
56 bottles per week
1 bottle per day
2 bottles per day
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,
punch, lemonade, Sunny D,

Kool-Aid or other non-carbonated
fruit drinkNOT JUICE (1 glass,
can or individual bottle)
1 bottle per week
24 bottles per week
56 bottles per week
1 bottle per day
2 bottles per day
SERIAL #
page ONE
1
2
3
4
5. Sport drinks (e.g.,
6. Sugar-free or low calorie
Powerade or Gatorade)
or sugar-sweetened
vitamin water
(individual bottle)
energy drinksRed Bull

Sugarfree, Lo-carb
Monster Energy
(individual can/bottle)

1 bottle per week
24 bottles per week
56 bottles per week
1 bottle per day
2 bottles per day
9. Milkshake (1)

1 bottle per week
24 bottles per week
56 bottles per week
1 bottle per day
2 bottles per day
10. Hot tea with caffeine (not
Never/less than
1 per month
13 per month
1 per week
More than 1 per week
herbal) (1 cup)
7. Regular energy
drinksRed Bull, Rock Star
(individual can/bottle)
1 bottle per week
24 bottles per week
56 bottles per week
1 bottle per day
2 bottles per day
11. Decaffeinated
coffee (1 cup)

13 cups per month
12 cups per week
36 cups per week
1 cup per day
2 or more cups per day

13 cups per month
12 cups per week
36 cups per week
1 cup per day
13. Coffee drinks with nonfat 14. Coffee drinks with low-fat 15. Iced coffee with nonfat
milk, e.g., Cappuccino,
Mocha, Latte
17. Watertap and bottled

(1 glass or bottle)
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

13 cups per month
12 cups per week
36 cups per week
1 cup per day
18. Beer (1 glass,
milk, e.g., Coffee

Coolatta, Frappuccino
13 cups per month
12 cups per week
36 cups per week
1 cup per day
19. Wine or wine coolers
bottle or can)
(1 glass)

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

1 glass per week
24 glasses per week
56 glasses per week
1 glass per day
2 glasses per day
page TWO
Jamba Juice or Orange

Julius)
1 glass per week
24 glasses per week
56 glasses per week
1 glass per day
2 glasses per day
12. Coffeenot decaf.

(1 cup)
13 cups per month
12 cups per week
36 cups per week
1 cup per day
16. Iced coffee with low-fat

or whole milk, e.g.,
Coffee Coolatta,
Frappuccino
5
6
7
8
9
10
11
12
13
14
15
16

13 cups per month
12 cups per week
36 cups per week
1 cup per day
20. Liquor, like vodka or rum

(1 drink, 1 shot, 1 bottle)
Include ready to drink
alcoholic beverages like
Hard Lemonade
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
3/8 spine
perf

13 cups per month
12 cups per week
36 cups per week
1 cup per day
or whole milk, e.g.,

Cappuccino, Mocha, Latte
8. Smoothies (e.g., medium
DAIRY FOODS
1. What type of white milk
2. White milk (glass or with
do you usually drink?
6. Light, low calorie or plain
drink (1 packet,
serving/can)
13 times per month
Once per week
24 times per week
More than 4 times per week
3/8 spine
perf
9. Cheese (1 slice)eaten alone or

added to main dish, sandwich,
or quesadillaexclude grilled
cheese
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
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
flavored milk (glass)

Never/less than1 per month
1 glass per week
26 glasses per week
12 glasses per day
More than 2 glasses per day

1 glass per week or less
26 glasses per week
1 glass per day
23 glasses per day
More than 3 glasses per day
Skim/nonfat milk
1% milk
2% milk
Whole milk
Soy milk
Dont know
Dont drink milk
5. High protein shake or
3. Chocolate or other
cereal)
7. Regular yogurt sweetened
yogurte.g., light peach

(46 oz.)not frozen
13 cups per month
1 cup per week
26 cups per week
1 cup per day
More than 1 cup per day
with fruit or other flavoring

e.g., vanilla, strawberry
(46 oz.)not frozen
13 cups per month
1 cup per week
26 cups per week
1 cup per day
More than 1 cup per day
10. Cream cheese (2 Tbs)
(1 serving or can)

13 times per month
Once per week
24 times per week
8. Cottage or ricotta cheese

(1/2 cup)
13 times per month
Once per week
More than once per week
11. What type of cottage cheese, cream

cheese, other cheeses do you usually
use? (Fill in all that apply)

13 times per month
Once per week
26 times per week
Once per day
More than once per day
13. Margarine (1 serving)
4. Instant breakfast drink
3
4
5
1
6
2
7
8
9
10
11
Nonfat
Lowfat
Regular
Dont know
14. Whipped cream (1 serving)
not butter
not fat free

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
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
SERIAL #
page THREE
12
14
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
Leave blank if you dont know.
15
F
16
MAIN DISHES
1. Cheeseburger (1)
13 per month
One per week
24 per week
5. Pizza (2 slices)
9. Chicken nuggets (6)

13 times per month
Once per week
24 times per week
13. Chicken or turkey as

main dish (1 serving)
13 times per month
Once per week
24 times per week
Sloppy Joe (1)

13 per month
One per week
24 per week
6. Tacos (1)
edamame, or other soy

dish (1 serving)
13 per month
One per week
24 per week
7. Burritos (1)

13 per month
One per week
24 per week
10. Beef or Pork hot dogs

13 per month
One per week
24 per week
15. Fish sticks, fish cakes
chicken or turkey, do
you eat the skin?
or fish sandwich
(1 serving)
Yes
No
Sometimes
Dont eat chicken or turkey

13 times per month
Once per week
page FOUR
usually have for

tacos/burritos?
(Fill in all that apply)
1
2
3
4
5
6
7
8
Beef & beans

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

13 per month
One per week
24 per week
14. When you have
8. Which filling do you

13 per month
One per week
24 per week
11. Chicken or Turkey hot
(1) (include corndogs)

13 per month
One per week
24 per week
mixed dish (e.g., stir fry

or soup)
13 times per month
Once per week
24 times per week
16. Dark meat fish as main dish,

e.g., tuna steak, salmon,
sardines, swordfish (1 serving)
13 per month
Once per week
24 per week
3/8 spine
perf

13 times per month
Once per week
24 times per week
4. Veggieburger (1)
3. Tofu, Soyburger, miso,
2. Hamburger or
9
10
11
12
13
14
15
16
17. Other fish as main dish,
18. Shrimp, lobster, scallops 19. Beef, pork or lamb as a
e.g., cod, haddock,

halibut (1 serving)

13 times per month
Once per week

13 per month
Once per week
24 per week
21. Pork, ribs, or ham as
22. Meatballs or meatloaf
main dish (1 serving)

13 times per month
Once per week
24 times per week
3/8 spine
perf

13 times per month
Once per week
29. Bacon (2)

Never/less than once per month
13 times per month
Once per week
24 times per week
as main dish (1 serving)

13 times per month
Once per week
24 times per week

13 times per month
Once per week
24 times per week
23. Noodles/pasta, plain
(1 serving)
24. Lasagna/baked
no sauce (1 serving)

13 times per month
Once per week
24 times per week
with tomato sauce

(1 serving)
13 times per month
Once per week
24 times per week
ziti/ravioli (1 serving)

13 times per month
Once per week
24 times per week
25. Macaroni and cheese or 26. Spaghetti or other pasta 27. Eggse.g., scrambled,
other pasta with cream
sauce (1 serving)
20. Beef (steak, roast) or lamb
mixed dish (e.g., stir fry

or stew)
(1 serving)

13 times per month
Once per week
28. Sausage (beef/pork)
fried, in breakfast
sandwich (1)
13 eggs per month
One egg per week
24 eggs per week
More than 4 eggs per week
(2 oz. or 2 small links)

13 times per month
Once per week
24 times per week
30. Liver (1 serving)
17
18
19
20
21
22
23
24
25
26
27
28
29

Once per month
23 per month
Once per week or more
30
SANDWICHES
1. Peanut butter sandwich (1)
2. Chicken or turkey
or crackers with peanut

butter (1 pack)
sandwich (1)

13 per month
One per week
24 per week
5. Tuna sandwich (1)

13 per month
One per week
24 per week
3. Roast beef
sandwich (1)

13 per month
One per week
24 per week

13 per month
One per week
24 per week
4. Salami, bologna, ham or

other deli meat sandwich (1)
13 per month
One per week
24 per week
6. Grilled cheese sandwich (1)
2
3
4

13 per month
One per week
24 per week
SERIAL #
page FIVE
OTHER FOODS
1. Ketchup
13 times per month
Once per week
24 times per week
5. Low calorie or low fat

salad dressing (12 Tbs.)
13 times per month
Once per week
26 times per week
1 or more times per day
2. Cream (milk) soups
3. Clear soup or broth (with

noodles, rice, vegetables)
1 bowl
or chowder (1 bowl)
13 bowls per month
1 bowl per week
26 bowls per week
1 or more bowls per day
6. Salad dressing (not

low calorie) (12 Tbs.)
13 times per month
Once per week
26 times per week

13 bowls per month
1 bowl per week
26 bowls per week
1 or more bowls per day
7. Salsa (1 serving)
13 times per month
Once per week
26 times per week
4. Mayonnaise (1 Tbs.)
(1 bowl)
3. Oatmeal, include instant

(1 bowl)
13 bowls per month
1 bowl per week
24 bowls per week
57 bowls per week
More than 1 bowl per day
7. English muffins, bagels, or

rolls (1)include breakfast
sandwich
13 per month
1 per week
24 per week
Cheerios
Honey Nut Cheerios
Frosted Mini-Wheats
Frosted Flakes
Cinnamon Toast Crunch
4. Other cooked breakfast

cereale.g., cream of
wheat, grits (1 bowl)
None/less than 1 teaspoon per day

12 teaspoons per day
34 teaspoons per day
5 or more teaspoons per day

13 bowls per month
1 bowl per week
24 bowls per week
57 bowls per week
8. Muffin (1) or cornbread
Other:
Never eat cold breakfast cereal
5. White bread, pita bread,

include toastnot in
sandwiches (1 slice)
1 slice per week or less
24 slices per week
57 slices per week
23 slices per day
9. Croissant (1)
(1 square)
13 per month
1 per week
24 per week
page SIX

13 per month
1 per week
24 per week
5
6
7
8
RK
HB
LC
FL
PB
SK
CC
6. Whole wheat or whole grain
bread, include toastnot in

sandwiches (1 slice)
1 slice per week or less
24 slices per week
57 slices per week
23 slices per day
10. Biscuit (1)

13 per month
1 per week
24 per week
3/8 spine
perf

13 bowls per month
1 bowl per week
24 bowls per week
57 bowls per week
3
4
sugar do you ADD to your

beverages or food each day?
2. Which cold breakfast cereal

do you eat most often (like
Cheerios or Special K)?
8. How many teaspoons of
BREADS CEREALS & GRAINS

1. Cold breakfast cereal
1
28

13 times per month
Once per week
26 times per week
3
4
5
6
7
8
9
10
11. White rice (1 serving)

13 times per month
Once per week
24 times per week
15. French toast (2 slices)

13 times per month
Once per week
24 times per week
12. Brown rice (1 serving)
3/8 spine
perf

13 times per month
1 per week
24 times per week
5. Applesauce (1 serving)
13 per month
1 per week
26 per week
1 or more per day
9. Oranges (1)
13 per month
1 per week
26 per week
1 or more per day
13. Peaches, plums,

apricots (1)
13 per month
1 per week
24 per week
filling e.g., quesadilla

not tacos or burritos (2)
17. Potatoesbaked or boiled (1),
browns (1 serving)
mashed (1 serving)
13
14
15
17
There are no right or wrong answers.
2. Grapes (bunch)
3. Bananas (1)

13 times per month
1 per week
24 times per week
6. Pears (1)

13 per month
1 per week
24 per week
7. Cantaloupe, melon

13 per month
1 per week
26 per week
1 or more per day
(1 wedge)
13 times per month
Once per week
11. Strawberries (1 serving)

13 per month
1 per week
26 per week
1 or more per day
14. Pineapple
11
12
16

13 times per month
Once per week
24 times per week

13 servings per month
1 serving per week
24 servings per week
More than 4 servings per week
10. Grapefruit (1/2)

13 times per month
Once per week
24 times per week

13 per month
1 per week
24 per week
16. French fries, tater tots, hash
FRUITS AND VEGETABLES

1. Raisins (small pack)
13. Corn or flour tortillano 14. Pancakes or waffles (2)

13 times per month
Once per week
24 times per week

13 times per month
Once per week
24 times per week
15. Orange juice
(1 serving)
(1 glass)

13 times per month
Once per week

1 glass per week
26 glasses per week
1 glass per day
More than 1 glass per day
page SEVEN
4. Apples (1)
13 per month
1 per week
26 per week
1 or more per day
8. Watermelon
(1 wedge)
13 times per month
Once per week
12. Blueberries (1 serving)

13 times per month
Once per week
24 times per week
16. Apple juice and other

100% fruit juices (1 glass)
1 glass per week
26 glasses per week
1 glass per day
More than 1 glass per day
1
2
3
4
5
6
14
7
8
9
1
10
2
3
11
12
13
14
15
16
17. Tomatoes (2 slices)

13 per month
1 per week
26 per week
1 or more per day
18. Tomato juice
19. V8 Fusion
(1 small glass)
(1 small glass)

13 per month
1 per week
26 per week
1 or more per day
21. Beans or lentilsinclude 22. Broccoli (1 serving)

baked beans (1 serving)
Once per week or less
26 times per week
Once per day
25. Peas (1 serving)

13 times per month
Once per week
24 times per week
29. Green/red/yellow
peppers (3 slices)
26. Mixed vegetables

(1 serving)

13 times per month
Once per week
24 times per week
37. Cabbage (1 serving)

13 times per month
Once per week

13 times per month
Once per week
24 times per week
27. Spinach, raw as in

salad (1 serving)

13 times per month
Once per week
24 times per week
30. Yams/sweet potatoes

(medium or 1 serving)
13 times per month
Once per week
24 times per week
33. Carrots, raw (1/2 carrot 34. Celery (2 or 3 sticks)

or 24 baby carrots)
23. Cauliflower (1 serving)

13 times per month
Once per week
24 times per week

13 times per month
Once per week
24 times per week
(small serving)
eggplant (1 serving)
13 times per month
Once per week
24 times per week
35. Lettuce/tossed salad

(1 serving)
13 times per month
Once per week
26 times per week
1 or more per day
(small serving)

13 times per month
Once per week

13 times per month
Once per week
24 times per week
24. Corn (1 serving)

13 times per month
Once per week
24 times per week
28. Collard greens/kale/

cooked spinach (1 serving)
13 times per month
Once per week
24 times per week
31. Zucchini, summer squash, 32. Carrots, cooked
39. Pasta salad
38. Potato salad
(1 serving)

13 times per month
Once per week
(1 serving)
13 times per month
Once per week
24 times per week
36. Coleslaw (1 serving)

13 times per month
Once per week
40. Okra (1 serving)

13 times per month
Once per week
SERIAL #
page EIGHT
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
3/8 spine
perf

13 times per month
Once per week
24 times per week

13 times per month
Once per week
24 times per week

13 per month
1 per week
26 per week
1 or more per day
20. Green beans
41. Onion rings, cooked
41
onions, or onion soup

(small serving)
13 times per month
Once per week
SNACK FOODS/DESSERTS
2. Corn chips/Doritos (1 small bag) 3. Popcorn (1 small bag)
1. Potato chips (1 small bag)

13 small bags per month
One small bag per week
26 small bags per week
1 or more small bags per day

One small bag per week
1 or more small bags per day
5. Mixed dried fruit/trail
6. Peanuts (1 small bag)
mix (small bag)
3/8 spine
perf
10. Crackers, e.g., Wheat
(2 squares)
Thins or Ritz, Cheez-Its,

soda crackers, Saltines (1
serving)

13 times per month
14 times per week
13. Snack cakes, like Ring

13 times per month
14 times per week
14. Danish, cinnamon
Dings/Swiss Rolls/Twinkies
(1 package)
13 per month
Once per week
26 per week
1 or more per day
7. Other nuts (1 small bag)

More than 4 small bags per week

13 times per month
1 per week
26 per week
1 or more per day
9. Graham crackers

More than 4 small bags
per week

13 poptarts per month
16 poptarts per week
1 or more poptarts per day
15. Donuts (1) or churros

(1 serving)
rolls, pastry (1)

13 per month
1 per week
24 per week

13 per month
1 per week
26 per week
More than 1 per day
page NINE

1 small bag per week
More than 1 small bag
per week
8. Fruit snacks or fruit rollups

More than 4 small bags per week
11. Poptarts (1)
4. Pretzels (1 small bag)
(1 pack)
13 packs per month
14 packs per week
More than 4 packs per week
12. Cake (1 slice) or cupcake

with frosting (1)
13 slices per month
1 slice per week
More than 1 slice per week
16. Cookies (1)

13 cookies per month
1 cookie per week
26 cookies per week
13 cookies per day
More than 3 cookies per day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17. Brownies (1)
18. Pie or fruit crisp

13 per month
1 per week
24 per week
21. Other candy without
sugar free

13 times per month
Once per week
26 times per week

13 times per month
Once per week
24 times per week
26. Popsicles, ice pops,

13 times per month
Once per week
24 times per week

13 times per month
1 time per week
24 times per week
or M & Ms (1 bar or
packet)
13 per month
1 per week
26 per week
1 or more per day
23. Pudding or pudding

pops, not sugar free
(1 serving)
13 times per month
Once per week
24 times per week
27. Seeds like Sunflower or

Pumpkin (small bag)
fudgesicle (1)
13 per month
1 per week
24 per week
30. High protein bars
(e.g., Clif, Luna,

Glucerna, Powerbar) (1)
19. Chocolate like Hersheys 20. Other candy bars like

13 times per month
1 time per week
24 times per week
Milky Way, Snickers

(1 bar)
13 candy bars per month
1 candy bar per week
26 candy bars per week
1 or more candy bars per day
24. Frozen yogurt or low-fat

ice cream (1 serving)
13 times per month
Once per week
24 times per week
28. Snack bars (e.g.,

Nutrigrain, granola,
Kashi, Planters) (1)
13 times per month
1 time per week
24 times per week
31. Jams, jellies, fluff, syrup
(e.g., Atkins, Zone,

South Beach) (1)
13 times per month
1 time per week
24 times per week
18
19
20
21
22
23
24
25
26
27
28
29
or honey (Tbs.)
30

13 per month
1 per week
24 times per week
More than 1 per day
31
SERIAL #
page TEN
17
3/8 spine
perf
29. Energy bars

13 slices per month
1 slice per week
More than 1 slice per week
22. Jello (1 serving)not
chocolate like Skittles

(1 pack)
25. Ice cream (1 serving)
(1 serving)
page ELEVEN
3/8 spine
perf
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

Use a NO. 2 PENCIL only.

1. What is your AGE?

USE NO. 2 PENCIL ONLY

The WRONG way

The RIGHT way

5. Do you now take vitamins (like Flintstones, Centrum, Centrum Kids)?

(Please specify exact brand)

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

Never/less than once per week

46 times per week

Never/less than once per week

46 times per week

1. Diet soda/pop (1 can or 2. Soda/popnot diet

(1 can or individual bottle)

size of the soda/pop you

4. Sugared iced-tea, fruit drinks,

punch, lemonade, Sunny D,

5. Sport drinks (e.g.,

6. Sugar-free or low calorie

energy drinksRed Bull

Never/less than 1 per month

Never/less than 1 per month

10. Hot tea with caffeine (not

Never/less than 1 per month

Never/less than 1 per month

17. Watertap and bottled

Never/less than 1 per month

18. Beer (1 glass,

milk, e.g., Coffee

19. Wine or wine coolers

Never/less than 1 per month

Never/less than 1 per month

Jamba Juice or Orange

12. Coffeenot decaf.

16. Iced coffee with low-fat

Never/less than 1 per month

20. Liquor, like vodka or rum

Never/less than 1 per month

or whole milk, e.g.,

8. Smoothies (e.g., medium

2. White milk (glass or with

do you usually drink?

6. Light, low calorie or plain

9. Cheese (1 slice)eaten alone or

12. Butter (1 serving)

flavored milk (glass)

Never/less than 1 per month

5. High protein shake or

7. Regular yogurt sweetened

yogurte.g., light peach

with fruit or other flavoring

10. Cream cheese (2 Tbs)

Never/less than 1 per month

8. Cottage or ricotta cheese

11. What type of cottage cheese, cream

Never/less than 1 per month

13. Margarine (1 serving)

4. Instant breakfast drink

14. Whipped cream (1 serving)

not fat free