/Palestine 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 X in ONE BOX on each line: (unless otherwise instructed) X OR By writing number(s) in the spaces provided: 1 8 OR By specifying the answer on the line(s) provided Version 1.2 June 12, 2012
Page 1 dairy foods? (please check the appropriate box) Dairy Foods 1. Milk 2. Milk (whole) (low fat) 1 cup 1 cup 3. Cheese (white) 1/2 square 4. Cheese (yellow) 1 slice 5. Yogurt (regular) 1 cup 6. Labeneh 1 tsp. 7. Ice cream 1 cup 8. Laban up 1 cup vegetables? (please check the appropriate box) Vegetables 9. Fresh tomatoes 1 medium 10. Fresh cucumber 1 medium 11. Vegetable salad 1 spatula 12. Tabooleh 1 spatula 13. Fried Zucchini, 1 medium Eggplant or Cauliflower 14. Arugala 1 spatula 15. Pickles 1 medium (Any vegetable)
Page 2 fruits? (please check the appropriate box) Fruits 16. Apple 1 medium 17. Strawberry 5 strawberries 18. Bananas 1 medium 19. Dried fruit (figs, 1 medium dates, raisins etc..) 20. Oranges 1 medium 21. Cherries 5 cherries 22. Grape 7 grapes 23. Guava 1 medium 24. Olives 5 olives 25. Fig (fresh) 1 medium 26. Apricots 1 medium 27. Plum 1 medium 28. Peaches 1 medium 29. Pear 1 medium 30. Watermelon 2 medium pieces 31. Other melon 5 pieces 32. Tangerine 1 medium 33. Cactus 1 medium 34. Pomegranate 1 medium
Page 3 mixed dishes? (please check the appropriate box) Mixed dishes 35. Vegetable soup 1 cup 36. Chicken soup 1 cup 37. Lentil soup 1 cup 38. Baked chicken 1 cup 39. Stuffed chicken 1 spatula 40. Musakan 1 whole taboon bread 41. Green beans 1 spatula (any type) 42. Upside down 1 cup 43. Stuffed eggplant 1 piece or zucchini or grape leaves or cabbage 44. Leafy vegetables 1 spatula (cooked) ie. spinach 45. Okra (cooked) 1 spatula 46. Cauliflower yogurt 1 spatula 47. Mujadara 1 spatula
Page 4 meat, eggs etc.? (please check the appropriate box) Meat, Eggs 48. Eggs 1 egg 49. Chicken 90-120g (without skin) 50. Chicken 90-120g (with skin) 51. Meat as a side 90-120g dish 52. Meat as a main 90-120g dish 53. Kafta (ground 1 medium meat) 54. Fried fish 1 medium 55. Grilled fish 1 medium 56. Lamb organs 1 cup (sometime stuffed with rice) 57. Chicken organs 1 medium
Page 5 es and snacks? (please check the appropriate box) Sandwiches and snacks 58. Lamb kababs 1 medium 59. Falafel 1 medium 60. Zaatar manakeesh 1 lage 61. Meat manakeesh 1 large 62. Kubbeh (fried) 1 medium 63. Hummus 1 medium 64. Pizza 1 piece 65. Olive oil 1 tbs 66. Zatar 1 tbs 67. Shawarma meat 1 medium 68. Shawarma 1 medium chicken 69. Cheese 1 large manakeesh 70. Meat (arayes) 1 large 71. Cold cuts 1 medium
Page 6 breads, cereals and starches? (please check the appropriate box) Breads, cereals Starches 72. Breakfast 1 bowl cereal 73. Any white bread 1 medium 74. Any whole wheat 1 medium bread 75. White rice 1 spatula (cooked) 76. Other grains 1 spatula (whole or not) 77. Pasta, spaghetti 1 spatula 78. French fries 5 fries 79. Potatoes 1 medium (baked/boiled) 80. Biscuits/crackers 1 medium
Page 7 beverages? (please check the appropriate box) Beverages 81. Coffee no sugar 1 cup 82. Coffee with sugar 1 cup 83. Coke, Pepsi (regular) 84. Low calorie soft drink 85. Tea (no sugar) 1 can 1 can 1 cup 86. Tea (with sugar) 1 cup 87. Fruit juice 1 cup 88. Juice (bottled) 1 cup 89. Energy drink 1 can
Page 8 sweet baked goods? (please check the appropriate box) Sweet baked goods 91. Arabic sweets (baklava) 1 medium 92. Knafeh 1/2 Owieh 93. Hareesh 1 slice 94. Cake 1 slice 95. Hallaweh 1 Tbs. 96. Chocolate 1 medium piece 97. Honey, jam 1 Tbs. seeds? (please check the appropriate box) Seeds 98. Almond 1/4 cup 99. Cashews 1/4 cup 100. Turmus 1/4 cup 101. Peanuts 1/4 cup 102. Seeds(sunflower, watermelon, 1/4 cup pumpkin) 103. Pistachios 1/4 cup 104. Mixed nuts 1/4 cup 105. How often do you eat meals at a fast food/non-fast food restaurant?
Page 9 What type of cooking oil is usually used at home and what is the frequency of consumption? 106 Corn 107. Sunflower 108. Canola 109. Olive 110. Curd 1/2 cup 1/2 cup 1/2 cup 1/2 cup 1/2 cup Vitamins 111. Do you regularly take vitamin pills? No Yes 112. Do you regularly take mineral pills? No Yes If yes for how many years and how often have you taken? 113. Vitamin A 114. Vitamin D 115. Vitamin E 116. Vitamin B complex 117. Vitamin C 118. Calcium < 1 year 1-3 years 4-6 years > 6 years mostly occasionaly mostly occasionaly mostly occasionaly mostly occasionaly 119. Iron 120. Zinc 121. Multiviamin /Mineral supplement 122. Name of Interviewer: (please print) Last Name First Initial Interviewer Code: