Adult Semi-Quantitative

Transcription

1 PURE/Pakistan We are very grateful to you for your participation in this study. All information given by you will be held in strict confidence, and will be used for the purpose of this study only after removing any personal identifying information. Adult Semi-Quantitative INSTRUCTIONS Please answer EACH question by marking an in ONE BO on each line: (unless otherwise instructed) OR By writing number(s) in the spaces provided: 1 8 OR By specifying the answer on the line(s) provided March 26, 2008

2 PURE Page 1 Today s date: year month day starch and cereals? (please check the appropriate box) Starch and Cereal 1. Chapati (without oil) 2. Chapati (with oil) Avg Serving Amount Size >6 (S/M/L) less than /mo /wk /wk /wk /day /day /day /day once/month med roti med roti 3. Chapati Whole Wheat med roti (without oil) 4. Tandoori Naan med 5. Paratha med 6. Sheermaal/ quarter Taftan 7. Puree number 8. Bread slice 9. Rusk number 10. Boiled Rice 11. Biryani/Pulao (with meat) 12. Veg Biryani/ pulao 13. Kitchree 14. Corn flakes 15. Porridge 16. Potatoes Tarkari

3 PURE Page 2 dairy products? (please check the appropriate box) Dairy Avg Serving Amount Size >6 (S/M/L) less than /mo /wk /wk /wk /day /day /day /day once/month 17. Whole milk 18. Low fat milk 19. Fruit yogurt 20. Yogurt/raita 21. Lassi glass 22. Butter/ tsp Margerine 23. Yogurt (green chili paste) 24. Cream When in season, on average, how often have you consumed the following Fruits? (please check the appropriate box) Fruits 25. Bananas medium 26. Watermelon cut 27. Cantaloupe cut 28. Papaya cut 29. Plums number 30. Apricots number 31. Peaches number 32. Apples number

4 PURE Page 3 Centre # Community# Household # # When in season, on average, how often have you consumed the following Fruits? (please check the appropriate box) Fruits con t Avg Serving Amount Size >6 (S/M/L) less than /mo /wk /wk /wk /day /day /day /day once/month 33. Mangoes number 34. Grapes 35. Pomegranate/ number 36. Custard apple number 37. Dates 38. Guava number 39. Bair (berries) number 40. Orange (Keeno, number mosambi, malta, fruiter) 41. Grapefruit number 42. Flasa (berries) 43. Chickoo number 44. Melon cut 45. Persimmon number

5 PURE Page 4 When in season, on average, how often have you consumed the following vegetables? (please check the appropriate box) Vegetables 46. Carrots/Raddish/ Beetroot (raw) 47. Tomato/Cucumber/ Onions (raw) 48. Cauliflower Avg Serving Amount Size less than >6 (S/M/L) once/month /mo /wk /wk /wk /day /day /day /day 49. Cabbage 50. Eggplant 51. Torai/Lokkee (bottle gourd)/kaddu/ Tinda 52. Beetroots 53. Raddish 54. Carrots 55. Turnips 56. DGLV (Spinach/ Mustard/Cholai leaves) 57. Yam 58. Okra 59. Karela (Bitter gourd)cooked 60. String beans/sem (field beans)/guar

6 PURE Page 5 Meat and Poultry? (please check the appropriate box) Meat and Poultry Avg Serving Amount Size less than >6 (S/M/L) once/month /mo /wk /wk /wk /day /day /day /day 61. Mutton/Beef boti Curry 62. Minced Meat 63. Kabab number 64. Kofte number 65. Chicken curry plate 66. Fish Fry/fish piece curry 67. Any curry plate (without meat) 68. Brain plate 69. Katacut plate 70. Paya plate 71. Nihari plate 72. Haleem plate 73. Eggs fried/ number omelette 74. Eggs boiled number 75. Kabab burger, burger chicken burger 76. Liver tbsp

7 PURE Page 6 con t Avg Serving Amount Size >6 (S/M/L) less than /wk /day /day /day /day once/month /mo /wk /wk 77. Chicken Broast/fry quarter 78. Chicken tikka quarter 79. Chowmein or other pasta dishes 80. Pizza slice 81. Seekh Kabab/ skewer Boti(barbecued meat) lentils and legumes 82. Daals (Lentils/ Mung daal/udah/chana,arhar) 83. Lobia (cow pea) 84. Chola (bengal gram whole) 85. Peas Mixed dishes 86. Tomato curry plate 87. Tamarind curry plate 88. Rabbit meat plate curry 89. Pappad plate 90. Mix vegetable plate curry 91. Meat with plate vegetables 92. Lentils meat plate curry 93. Chicken with plate vegetables

8 PURE Page 7 Beverages? (please check the appropriate box) Beverages Avg Serving Amount Size less than >6 (S/M/L) once/month /mo /wk /wk /wk /day /day /day /day 94. Regular Soft bottle drinks 95. Diet Soft drinks bottle 96. Tea 97. Fresh fruit glass juice (apple,orange) 98. Tetra pack small tetra juices pack 99. Sherbet glass Desserts/sweets and Miscellaneous? (please check the appropriate box) Desserts/sweets and miscellaneous 100. Mithai/Halwa piece 101. Kheer/Firni/ Sheer/Custard 102. Zarda 103. Ice Cream serving (Igloo,Polka,Walls) 104. Kulfi/Peshawari glass Ice Cream 105. Biscuits (bakery biscuit or packet) 106. Rabri(dessert) tbsp Dahi baray plate (snack) 108. Cake rusk piece

9 PURE Page 8 Dessert/sweets and Miscellaneous? (please check the appropriate box) Con t Avg Serving Amount Size >6 (S/M/L) less than /wk /day /day /day /day once/month /mo /wk /wk 109. Cakes/brownies slice 110. Cakes with cream/ Pastry slice or pastry 111. Sweets/tofee number 112. Chocolate bar 113. Honey tsp

10 PURE Page 9 Vitamins 114. Do you regularly take vitamin pills? No Yes 115. Do you regularly take mineral pills? No Yes If yes for how many years and how often have you taken? < 1 year 1-3 years 4-6 years > 6 years mostly occasionaly mostly occasionaly mostly occasionaly mostly occasionaly 116. Vitamin A 117. Vitamin D 118. Vitamin E 119. Vitamin B complex 120. Vitamin C 121. Calcium 122. Iron 123. Zinc 124. Multiviamin /Mineral supplement What type of cooking oil is usually used at home and what is the frequency of consumption? Avg Serving less than 1-3/mo 1/wk 2-4/wk 5-6/wk 1/day 2-3/day 4-5/day >6/day 125. Soybean 126. Corn 127. Vegetable 128. Sunflower 129. Canola 130. Cottonseed 131. Olive 1/2 1/2 1/2 1/2 1/2 1/2 1/ Name of Interviewer: (please print) Last Name First Initial Interviewer Code: