DIETARY BOOKLET FOR TEENAGERS

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Theresa Singleton
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1 Study ID Number DIETARY BOOKLET FOR TEENAGERS / / Date of birth M 1 F 2 Please circle

2 YOUR EATING HABITS and We would like you to fill out this booklet to show your usual eating pattern over the past year. We want to know how often you eat each of these foods and how much you eat. We realize your food intake may vary so give us the best overall picture you can. How Much Use the following codes to write your answers in the space next to each food. Beside each food there is a "standard serve" size. If you usually eat more or less than this amount for a particular food, (and lots of people often do) please write it in the line. See examples. How Often If you NEVER have a food... write N If you RARELY have a food (less than once a month)... write R If you usually eat a food About once a MONTH... write 1M About twice a MONTH... write 2M About three times a MONTH... write 3M About once a WEEK... write 1W About twice a WEEK... write 2W About three times a WEEK... write 3W and so on...(4w, 5W, 6W) About once a DAY... write 1D About twice a DAY... write 2D and so on... (3D, 4D, 5D, 6D)

3 HERE ARE SOME EXAMPLES PLEASE READ CAREFULLY STANDARD HOW SERVE OFTEN (HOW MUCH) Ice Cream 2 Scoops...1D... 4 scoops, only in Summer Beef stew/curry 1 cup...2w... 1 ½ cups Glass of water 1 medium glass...3d... Plus 600ml bottle on sports days 2W The person above has, on average :- - Two standard serves of ice cream once a day only in Summer. - One and a half serves of beef stew/curry twice a week. - Three medium glasses of water per day but an additional 600ml bottle twice a week. Pleas make sure you fill in all gaps. 1

4 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? CEREALS HOW OFTEN (How much) Porridge/Oatmeal 1 cup (cooked)... Muesli 1/2 cup... Other breakfast cereal 1 cup... Plain bran (raw) 1 tablespoon... Wheatgerm 1 tablespoon... Bread roll 1 roll... (NOT hamburger buns) Fried rice 1 cup (cooked)... Boiled rice 1 cup (cooked)... Instant noodles (Maggi etc.) 1 cup (cooked)... Other pasta 1 cup (cooked)... (spaghetti, macaroni etc.) Q-1 How many slices of bread do you usually eat? Remember the bread in toast and sandwiches. If bread is not eaten at all, write 'none'. slices/day OR slices/week... Q-2 What type of bread do you usually eat? (Circle the number beside one answer) 1 Wholemeal or mixed grain 2 White 3 About half the time wholemeal and half white 4 Other breads (e.g. rye, Hi-Fibe) (please specify type)... 5 I do not eat bread Q-3 Do you eat low-salt types of bread? (Circle one answer) ALL or MOST OF THE TIME OCCASIONALLY RARELY/NEVER 2 40

5 Q-4 Which of the following do you usually spread on bread or crackers? (Circle one answer) 1 Butter 2 Polyunsaturated margarine : please name. 3 Table or cooking margarine; please name.. 4 Reduced-fat margarine (e.g. Era, Becel Light) please name.. 5 Dripping/Lard 6 I do not use anything 7 I do not eat bread or crackers 8 Something else : please name.... Q-5 For whatever spread you have, is it usually the regular variety or reduced salt?. (Circle one answer) 1 Usually has the regular variety 2 Usually has the reduced-salt variety Q-6 What types of breakfast cereals do you most commonly eat? Please name : Q-7 If you eat muesli (NOT muesli bars) is it : (Circle one answer). 1 Home made muesli 2 Pre-packaged muesli 3 Don t eat muesli Q-8 How many cups of milk do you usually add to breakfast cereal, porridge or muesli? (Circle the number closest to the amount you have) 1 None 2 About a half a cup 3 About one cup 4 About one and a half cups 5 About two cups or more (please state how much...). Q-9 What type of milk do you usually add to cereals, porridge or muesli? (e.g. whole milk, Hi-Lo, Lite, skim, powdered skim, Shape, Farmers Best, goat's milk, condensed/evaporated milk etc.)? Type of milk added :.... Q-10 How many teaspoons of sugar or honey do you usually add to cereal, porridge or muesli. (Note : 1 level dessertspoon = 2 level teaspoons) Write the number of level teaspoons you have here :.... Q-11 Do you add salt to porridge? (Circle one number) 1 Yes 2 No 3 I don't eat porridge. 51 3

6 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? CEREAL FOODS HOW OFTEN (How much) Crumpet or Muffin 1... Croissant 1... Fruit Loaf/Currant bread 1 slice... Sweet bun/doughnut 1... Crispbread/Cracker 2... Salted biscuits 3... Plain sweet biscuits 2... Fancy biscuits (eg choc-coated) 2... Cake 1 small cake or... 1 slice large cake Milk pudding (eg rice, sago) 1/2 cup... Steamed sponge - suet 1/4 small pudding

7 ABOUT HOW OFTEN DO YOU USUALLY HAVE THESE DRINKS? BEVERAGES HOW OFTEN (How much) Sustagen (made with powder) 1 cup... Sustagen Gold small carton... (300 ml) Carton of other flavoured milk small carton... (eg chocolate, strawberry etc) (300 ml) Cocoa 1 cup... Drinking Chocolate/Milo/ 1 cup... Quik etc. Akta-Vite 1 cup... Glass of milk (as such) 1 glass... Milk shake/thick shake regular size... Tea 1 cup... Herbal tea 1 cup... Instant coffee 1 cup... Ground coffee (eg filter/drip) 1 cup... Decaffeinated coffee 1 cup... Coffee substitute (eg Caro) 1 cup EOL 5

8 Q-1 Do you have milk : (Circle one for each) in tea? YES NO DO NOT DRINK TEA. in coffee? YES NO DO NOT DRINK COFFEE. in coffee substitute (Caro)? YES NO DO NOT DRINK COFFEE SUBSTITUTE. Q-2 Do you have cocoa/chocolate/milo/akta-vite with : (Circle one number) 1 Mostly milk? 2 Mostly water? 3 About half and half? 4 I do not drink these drinks.. Q-3 What type of milk do you usually add to tea/coffee/cocoa/chocolate etc? (Please state the type of milk used eg whole milk, Lite, Hi-Lo, skim, powdered skim, Shape, Farmers Best, goats milk, condensed milk, evaporated milk etc.) Type of milk added.... Q-4 How many teaspoons of sugar/honey do you usually have in each cup of : (Circle one number for each drink) Tea? Coffee? Coffee substitute? Cocoa? Milo/Quik/Chocolate?

9 ABOUT HOW OFTEN DO YOU USUALLY HAVE THESE DRINKS? BEVERAGES HOW OFTEN (How much) Glass of cordial medium glass... Glass of cola (eg Coca Cola) medium glass... (If cans or bottles please state) Glass of fizzy drink medium glass... Includes mineral water with juice (If cans or bottles please state) Glass of low-calorie fizzy drink medium glass... (If cans or bottles please state) Fruit drink (eg Fruit Box) 250 ml carton... Pure fruit juice medium glass... Vegetable juice small glass... Water (bottled or tap) medium glass... Mineral Water medium glass

10 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? DAIRY PRODUCTS and EGGS HOW OFTEN (How much) Cheese 30 grams... (1 slice) Low-fat cottage cheese 100 gm... (1/2 carton) Cream 1 tablespoon... Yoghurt 200 gm... (1 carton) Icecream (from a tub) 2 scoops SUMMER... WINTER... Icecream desserts 1 serving SUMMER... (eg Symphony, Vienetta) WINTER... Icecream (on a stick/cone) 1 icecream SUMMER... WINTER... Vitari 1 cone SUMMER... WINTER... Ice block/icy Pole 1 SUMMER... WINTER... Custard 1/2 cup... Fried egg 1 egg... Boiled egg 1 egg... Omelette/Scrambled eggs 2 eggs

11 Q-1 When you eat cheese, do you have the reduced-salt varieties (Circle one number) 1 Always or nearly always 2 Sometimes 3 Rarely or never 4 I do not eat cheese Q-2 When you eat cheese, do you have the reduced-fat varieties (Circle one number) 1 Always or nearly always 2 Sometimes 3 Rarely or never 4 I do not eat cheese Q-3 When you eat yoghurt which type is it? (Circle one number) 1 Plain (eg not fat-reduced) 2 Plain, low fat 3 Fruit flavoured (not fat-reduced) 4 Fruit flavoured, low-fat 5 Frozen yoghurt 6 I do not eat yoghurt Q-4 When you eat ice-cream, diet-ice or similar is it usually? (Circle one number) 1 Low calorie 2 Regular ice-cream 3 Other (please state...) 9 100

12 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? MEATS HOW OFTEN (How much) Steak (whole piece) 1 medium (100g)... (approximately size of fillet) Pork chop 1 medium chop... Lamb chop 2 chops... (loin chop size) Roast pork/pork fillet 2 slices... Roast beef/veal 2 slices... Roast lamb 2 slices... Sausages 2 thick or 3 thin... Rissole, meat patty 1 rissole/patty... Frankfurters/Saveloys 2 thick or 3 thin... Bacon 2 rashers... Ham 3 thin or... 2 thick slices Luncheon meat/fritz/ 3 slices... Devon/Polony etc. (1 cm thick if small nob) Continental Sausage 3 slices... (salami/mettwurst etc) Pate/liver paste 1 tablespoon... Liver 1/2 liver (150 gm)... Kidney 2 kidneys... Brains 1/2 cup... Pureed meat dishes 1/2 cup... (canned/bottled) EOL

13 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? MIXED DISHES HOW OFTEN (How much) Hamburger WITH bun 1 medium... Pizza (frozen) 1 mini or... 1/4 large Pizza (homemade or take-away) 1/2 small or... 1/4 large Sausage roll 1 large or... 2 small Meat pie 1 individual... Meat pie 1 individual or... (homemade) 1 slice of large pie Pastie 1 individual... Crumbed veal (schnitzel) 1 large piece... Stew/casserole/curry/goulash 1 cup... (with meat or chicken) Stew/casserole/curry/goulash 1 cup... (without meat or chicken) Chinese meat and veg dish 1 cup... Quiche or other savoury pastry 1 individual OR... 1 slice of large pie Mince meat dishes 1 piece (8x8x4cm)... (eg Shepherds' pie) Spicy mince added to 1/2 cup mince... pastas (eg spag. sauce) Mince meat (not included above) 1 cup

14 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? CHICKEN, FISH AND SEAFOOD HOW OFTEN (How much) Roast/Barbecue chicken 2 slices of breast or... 1 drumstick or 2 wings Boiled chicken as above... Crumbed, fried chicken 4 small pieces... Chicken nuggets 6 nuggets... Fish fried 1 piece or 6 nuggets... (PLEASE STATE WHAT TYPE OF FISH) Fish without batter 1 piece... (STEAMED, GRILLED/BOILED) (PLEASE STATE WHAT TYPE OF FISH) Canned fish (tuna, salmon etc) 1/3 cup... Fish Fingers 3-4 fingers... Seafood (prawns, crab, lobster etc) 1/2 cup... Mornay dishes 1 cup... Q-1 If you eat the following meats, how are they usually cooked? (Circle one for each food) Steak FRIED GRILLED/BAKED MICROWAVED DON'T EAT Chops FRIED GRILLED/BAKED MICROWAVED DON'T EAT Sausages FRIED GRILLED/BAKED MICROWAVED DON'T EAT Bacon FRIED GRILLED/BAKED MICROWAVED DON'T EAT Q-2 When you eat meat with fat on it, do you eat : (Circle one number) 1 All of the fat 2 Most of the fat 3 About half of the fat 4 Little or none of the fat 5 I do not eat meat 85EOL 12

15 Q-3 Do you have the skin removed from your chicken? (Circle one number) 1 Always or nearly always 2 Sometimes (about half the time or less) 3 Rarely (less than a quarter of the time) 4 Never 5 I do not eat chicken Q-4 If you eat fried fish, in which of the following is it usually coated? (Circle one number) 1 Batter 2 Breadcrumbs 3 Flour 4 Other coating; please name... 5 Fried without coating Q-5 If you eat fresh fish, what variety is it usually?

16 The following list of foods contains some vegetables that may be eaten much more frequently at some times of the year than others (eg in the warmer or cooler weather). Please fill in how often each food is eaten in BOTH the warmer months of the year (SUMMER) and the cooler months (WINTER). For example :- If you usually have : and: A standard serve of peas about twice a week during the warmer months of the year and about every day during the cooler months : Two medium potatoes (roasted) a week throughout the year : You would write : Summer Winter Green peas 1 cup...2w d... Potato - roasted 1 medium...1w w... two potatoes ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? HOW OFTEN SEASONAL VEGETABLES Summer Winter (How much) Potato mashed 1/3 cup (with milk) Potato boiled (not mashed) 1 medium Potato - roasted 1 medium French fries/hot chips/ chips Potato wedges 10 wedges Potato Gems/ about Pommes Noisettes Carrots (fresh/frozen) 1/3 cup Turnip/Swede (fresh/frozen) 1/3 cup Broad beans (fresh/frozen) 1/2 cup Green beans (fresh/frozen) 1/3 cup EOL 14

17 HOW OFTEN SEASONAL VEGETABLES(continued) Summer Winter (How much) Green peas (fresh/frozen) 1/3 cup Cabbage 1/3 cup Brussels sprouts (fresh/frozen) Silver beet/spinach 1/3 cup (fresh/frozen) Broccoli (fresh/frozen) 1/3 cup Cauliflower (fresh/frozen) 1/2 cup Pumpkin 1/3 cup Sweetcorn (fresh/frozen) 1 small cob Zucchini (courgettes) 1 medium sized Onion - fried 1/4 cup Onion (raw, baked, boiled) 1 medium (fresh/frozen) Tomato - fresh 1 medium Tomato - grilled/fried 1/2 medium Lettuce 2 small leaves Cucumber 3 slices (each cm thick) Celery (fresh/frozen) 1 x 15cm stick Capsicum (Green pepper) 2 strips (each (fresh/frozen) 0.5 cm thick) Mushrooms - fresh 6-7 small ones Sprouted bean shoots 1/3 cup Fried mixed vegetables 1/2 cup (eg stir fried) Not already counted for above EOL

18 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? CANNED and DRIED VEGETABLES HOW OFTEN (How much) Potato - canned 2-3 small... Potato - packet (powdered) 1/3 cup (cooked)... Carrots - canned 1/3 cup... Beetroot - canned 2 slices... Green beans - canned 1/3 cup... Haricot, Lima beans - canned 1/3 cup... Baked beans in tomato sauce 1/3 cup... Green peas - canned 1/3 cup... Lentils - dried/canned 1/3 cup... Sweetcorn - canned 1/3 cup... (including creamed corn) Mushrooms - canned 6-7 small ones... Canned tomatoes 1/3 cup... Pureed vegetables 1/3 cup... (canned/bottled) SALADS and OTHER VEGETABLES Potato salad 1/3 cup... Zucchini salad 1/3 cup... Coleslaw 1/2 cup... Olives 3 medium... Gherkins/Pickled onions 3 pieces EOL

19 Q-1 About how many serves of vegetables do you usually eat? serves/day OR serves/week... Q-2 When you use canned vegetables, are they reduced-salt varieties? (Circle one number) 1 Always or nearly always 2 Sometimes 3 Never or rarely 4 Only for some vegetables (please state which...). Q-3 Is salt added to the cooking water when boiling the following foods? ( Circle one for each food) Vegetables USUALLY SOMETIMES NEVER. Pasta and rice USUALLY SOMETIMES NEVER. Q-4 If salt is added to the cooking water when boiling foods, is the water : (Circle one number) 1 Lightly salted 2 Medium salted 3 Heavily salted 4 Salting is highly varied 5 Salt is not added to cooking water. Q-5 How often do you add salt to your meals after they are cooked? (Circle one number) 1 Rarely or never 2 Sometimes 3 Always or nearly always. Q-6 When you add salt at the table to your meals, how much is usually added? (Circle one) 1 A light sprinkle 2 A medium sprinkle 3 A heavy sprinkle 4 Salting is highly varied 5 Salt is not added at the table. Q-7 When you eat vegetables which of the following methods is the one most commonly used to cook them? (Circle one number) 1 Boiled in a little water 2 Boiled in a lot of water 3 Steamed 4 Cooked in a pressure cooker 5 Microwaved. 6 Stir-fried 17 15

20 Q-7 1 Vegetable oils (olive, sunflower etc.) 4 Dripping/lard/meat juices 2 Cooking or table margarine 5 Polyunsaturated margarine 3 Butter 6 Nothing From the list above write which type of fat/oil is most commonly used : (a) When roasting/frying meats/fish.... (b) When roasting/frying vegetables.... (c) On vegetables when served (eg butter on peas).... Q-8 Is butter or margarine added to your potatoes when they are mashed? (Circle one number) 1 Yes, always 2 Yes, occasionally 3 Never. ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? FRUIT HOW OFTEN (How much) Orange, Mandarin, Grapefruit 1 medium... Apple, Pear - fresh/baked 1 medium... Banana 1 medium... Fresh fruit salad 1 cup... Dried fruit (apple/apricot etc) 4-5 pieces... Raisins, sultanas or currants 1/3 cup... Fruit in syrup or stewed 1/2 cup... (including fruit salads) Fruit canned in water (low-cal) 1/2 cup... (including fruit salads) Fruit pie or pastry or fritters 1 small pie or... 1 slice large 46 18

21 The fruits listed below are sometimes only available for a short time during the year. Therefore we only want you to record how often you have them when they are IN SEASON. HOW OFTEN DO YOU EAT THESE FOODS WHEN THEY ARE IN SEASON? SEASONAL FRUIT HOW OFTEN (How much) Berries - fresh/frozen 3/4 cup... Melon (not watermelon) 1 large slice... Peach - fresh 1 medium... Plum - fresh 1 plum... Nectarine - fresh 1 medium... Apricot - fresh 1 apricot... Grapes - fresh about Pineapple - fresh 1 slice... Avocado 1/2 a medium... Please list here, along with your standard serve size, any other fruit that you eat (eg mango; pureed, canned/bottled fruits) SERVE HOW OTHER FRUIT SIZE OFTEN Q-1 About how many serves of fruit do you usually eat? serves/day OR serves/week EOL

22 HOW OFTEN DO YOU USUALLY EAT THESE FOODS? NUTS and SNACKS HOW OFTEN (How much) Potato crisps, Twisties etc 1 small bag or pieces Peanuts (fresh) 9-10 nuts... Nuts - salted & cooked 9-10 nuts... Other unsalted nuts 5-6 nuts... (fresh walnuts/almonds etc) SOUPS Canned soup (eaten as such) 1 cup WINTER... SUMMER... Packet soup (eaten as such) 1 cup WINTER... SUMMER... Homemade soup (eaten as such) 1 cup WINTER... SUMMER... Write an example of the type of soup you most often eat (eg canned tomato; homemade pea and ham)

23 ABOUT HOW OFTEN DO YOU USUALLY EAT THESE FOODS? CONFECTIONERY, JAMS AND SAUCES HOW OFTEN (How much) Chocolate 1 small bar... (50 grams) Chocolate covered bar 1 bar... (eg Mars/Bounty) Individually wrapped 4-5 lollies... lollies, eg toffees Packet lollies 1 small packet... (eg Lifesavers/Polos) Muesli bar/health bar 1 bar... Honey, jam, marmalade 1 tablespoon... Vegemite, marmite etc 1/2 teaspoon... Thick sauces (tomato/hp etc) 1 tablespoon... Polyunsaturated Mayonnaise/ 1 tablespoon... Salad cream Regular Mayonnaise/ 1 tablespoon... Salad cream Low calorie salad dressings 1 tablespoon... Polyunsaturated salad dressings 1 tablespoon

24 If you have any other foods or drinks that we have not mentioned at least once a month (for example types of whole grains, seeds, sports drinks, popcorn, spring rolls, ethnic foods, rollups, peanut butter, nutella etc), please write them down here and tell us how often you have them, using the same response scale as before FOODS AND DRINKS I EAT THAT HAVE NOT BEEN MENTIONED : Name of Food My usual How often serve size is it eaten? VITAMIN AND MINERAL SUPPLEMENTS If you take any vitamins or minerals, or any other dietary supplements, such as fibre tablets, lecithin, kelp, yeast etc, please fill in the table below. (Check the label on the box or bottle if you are unsure of some of the answers). BRAND NAME OF PRODUCT SIZE OF DOSE NUMBER OF DOSES (eg Nyal) (eg vitamin C pill) (eg 250 mg) (eg 2 per day) HAVE YOU CHANGED YOUR DIET IN PAST 2-3 MONTHS? YES NO IF SO, WHAT ARE THESE CHANGES? ARE YOU ON A SPECIAL DIET? YES NO IF SO, PLEASE DESCRIBE WHAT IT IS

25 THANK YOU VERY MUCH FOR YOUR PARTICIPATION IN THIS STUDY REMEMBER PLEASE RETURN THIS QUESTIONNAIRE AT THE TIME OF YOUR ASSESSMENT SO WE CAN GO OVER IT WITH YOU OR RETURN BY POST Date of completion: / / Completed by: (please tick appropriate box) Teenager only... Teenager with parent/caregiver assistance... Parent/caregiver only... We would welcome any comments you may have regarding this questionnaire below Would you be available to participate in further studies of diet and nutrition? Yes No 23

This packet provides information for your individual nutrition report as well as a food questionnaire.

FOOD QUESTIONNAIRE This packet provides information for your individual nutrition report as well as a food questionnaire. First: Middle: Last: Company: Gender: Male Female Identification Number: Date of